CA2162969A1

CA2162969A1 - Drug-loaded elastic membrane and method for delivery

Info

Publication number: CA2162969A1
Application number: CA002162969A
Authority: CA
Inventors: Michael S. Williams
Original assignee: Individual
Current assignee: Abbott Cardiovascular Systems Inc
Priority date: 1994-11-16
Filing date: 1995-11-15
Publication date: 1996-05-17
Also published as: EP0712615B1; JPH08317993A; AU3783395A; DE69529598T2; DE69529598D1; EP0712615A1; US5707385A

Abstract

An expandable sheath is provided for delivering a therapeutic drug in a body lumen which comprises an expandable membrane with a therapeutic drug incorporated therein. The expandable membrane is in a cylindrical configuration and mounted on the balloon portion of a catheter for intraluminal drug delivery into a patient's vascular system. The expandable membrane may also be mounted on an intravascular stent, both of which are implanted within the patient's vascular system. The therapeutic drug then diffuses into the vascular system at a controlled rate to match a specific clinical need.

Description

2~629~ `

DRUG-LOADED ELASTIC MEMBRANE
AND METHOD FOR DELIVERY

BACKGROUND OF THE INVENTION

Field of the Invention This invention relates generally to the treatment of cardiovascular diseases resulting from such conditions restenosis, acute thrombosis, intimal hyperplasia and sub-acute thrombosis. More particularly, the invention relates to an expandable membrane which contains a therapeutic drug intended to be released into a body lumen for treating disease or ln~ury.

Description of Related Art Coronary devices to treat undesirable cardiovascular conditions have, experienced unprecedented growth throughout the 1980's and 1990's such that coronary angioplasty now is commonplace for treatment of atherosclerotic vascular disease.
- 15 In a typical percutaneous transluminal coronary angioplasty (PTCA) procedure, a guiding catheter having a pre-formed distal tip is percutaneously introduced into the cardiovascular system through the brachial or femoral arteries and is advanced therethrough until the distal tip is in the ostium of the desired coronary artery. A guidewire and a dilatation catheter having an inflatable balloon on the distal end thereof, are introduced through the guiding catheter with the guidewire slidably-disposed within an inner lumen of the dilatation catheter. The guidewire first is advanced out of the distal end of the guiding catheter and is maneuvered into the coronary vasculature of the patient in which the lesion to be dilated is located, and then is advanced beyond the lesion. Thereafter, the dilatation catheter is advanced over the guidewire until the dilatation balloon is located across the target lesion.
Once in position across the lesion, the balloon of the dilatation catheter is filled with radiopaque liquid at a relatively high pressure (e.g., greater than about 4X05X10sNT/M2 (atmospheres)), and is inflated to a pre-determined size so as to radially compress the atherosclerotic plaque of the lesion 216296!~

against the inside of the arterial wall and to thereby dilate the lumen of the artery. The balloon then is deflated so that the dilatation catheter can be removed and blood flow can resume through the dilated artery.
By way of example, further details of the angioplasty procedure and the devices used in such procedures can be found in U.S. Patent 4,323,071 (Simpson-Robert); U.S. Patent No.
4,439,185 (Lindquist); U.S. Patent No. 4,516,972 (Samson); U.S.
Patent No. 4,538,622 (Samson et al.); U.S. Patent No. 4,554,929 ~0 (Samson et al.); U.S. Patent No. 4,616,652 (Simpson); U.S.
Patent No. 4,638,805 (Powell); and U.S. Patent No. 4,748,982 (Horzewski et al.).
A common problem that sometimes occurs after an angioplasty procedure is the appearance of restenosis at or near the site of the original stenosis in the blood vessel for which treatment was rendered. This problem can require a secondary angioplasty procedure or a bypass surgery. Numerous - approaches developed during the late 1980's to treat restenosis of the coronary arteries in an attempt to decrease the incidence of acute complications and the chronic restenosis rate. For example, in the prior art are found mechanical approaches such as atherectomy, stents, laser angioplasty, and the application of pharmacologic agents. Of the mechanical approaches described, only the stents have been most promising to prevent restenosis and to prevent elastic recoil of the vascular wall.
With regard to expandable stents that are delivered with expandable catheters, such as balloon catheters, the stents are positioned over the balloon portion of the catheter and are expanded from a reduced diameter to an enlarged diameter, greater than or equal to the diameter of the arterial wall, by inflating the balloon from within the stent. Stents of ~his- type can be expanded to an enlarged diameter by deforming the stent and expanding it into engagement with the vascular wall. It is common for stents of this type to experience endothelial growth over and around the stent.
Examples of such expandable catheters and stents are disclosed in U.S. Patent No. 5,102,417 (Palmaz), U.S. Patent No.
5,123,917 (Lee), and U.S. Patent No. 5,133,732 (Wiktor).
Unfortunately, the stents that currently are being implanted are reported to be affected by a fairly high restenosis rate, in the range of seven to forty percent.
With this relatively high restenosis rate, there has developed a need for some means of reducing the restenosis rate when using a stent, and to limit recurrent stenosis even when a stent is not used. The present invention fulfills this need.

SUMMARY OF THE INVENTION

The present invention is directed to an expandable membrane for use in delivering a therapeutic drug in a body lumen. One of the primary advantages of the invention is to provide local delivery of a therapeutic drug to eliminate the need for systemic delivery of pharmaceuticals which may have - undesirable side effects. Local delivery of a drug can be accomplished using a drug-loaded expandable membrane carried by a perfusion-type catheter system (non-implantableJ, or by loading the membrane on a stent for implanting in a vessel.
The drug release from the expandable membrane can be controlled to suit a particular clinical need or a specific condition such as restenosis or acute thrombosis.
The expandable sheath of the present invention comprises an expandable membrane in the form of a tubular or cylindrical member having a cavity for carrying a drug or which carries the drug in a matrix form. A therapeutic drug is loaded in the expandable membrane so that it can diffuse outwardly into the vessel wall once the expandable membrane is delivered to the site where a PTCA procedure has occurred. The expandable membrane is mounted on the distal end of a catheter, and, more specifically, on an expandable portion, e.g., a balloon, by sliding or stretching the expandable membrane around the expandable portion of the catheter.
In one embodiment, the membrane may be in the form of a flat sheet with a first and second edge which edges overlap 21~2969 and are attached to each other so as to form a sleeve around the expandable portion of the catheter. In an alternative embodiment, the membrane is in the form of a seamless tube carried by the catheter. The catheter then is delivered intraluminally to the area at which the diseased or injured area is presented, and the expandable portion of the catheter is expanded such that it also expands the expandable membrane.
Once expanded, the therapeutic dxug diffuses into the vessel wall for treating the injured or diseased area. Thereafter, the expandable portion of the catheter is deflated, and the catheter and expandable membrane are withdrawn from the vasculature.
In another embodiment of the invention, the expandable membrane has a first layer and a second layer which are affixed to each other by sealing the edges of each layer.
A cavity or reservoir is formed between the two layers for containing a therapeutic drug. Prior to attaching the two layers, the first elastic layer is stretched and drilled with a plurality of micro-holes or apertures through which the therapeutic drug can pass. Thereafter, the first layer and second layer are affixed to each other as described, and a therapeutic drug is injected into the cavity between the two layers through any of the plurality of apertures. When the expandable membrane is in its relaxed condition, the plurality of apertures close tightly so that no therapeutic drug can pass therethrough. The expandable membrane then is rolled onto the balloon portion of the catheter to form a cylindrical configuration and is delivered intraluminally as described above. The flat sheet is rolled into a cylinder and the edges are joined by means such as by welding or adhesive, etc. The balloon portion of the catheter is expanded, thereby expanding the expandable membrane and forcing the therapeutic drug through the plurality of apertures and into contact with the vessel wall at the site of the injured or diseased area. After the therapeutic drug has been delivered, the balloon portion of the catheter is deflated, and the catheter and expandable membrane are withdrawn from the vasculature. Instead of 21 ~2~ 9 forming the expandable membrane from flat sheets, this embodiment also may be achieved with two tubular members, one within the other, to form a cavity between the layers. The ends are sealed and micro-holes are drilled by laser into the outer layer to allow the therapeutic drug to pass therethrough.
The tubular members also may have a drug incorporated in the polymer material in the form of a matrix which allows the drug to diffuse into the vessel wall over time.
In another embodiment of the invention, the expandable membrane is in the form of a flat sheet and having a thickness in the range of 0.05-0.5 millimeters (0.002-0.020 inch). A plurality of micro-pockets or pores are drilled into the outer surface of the expandable membrane, but are not drilled all the way through that surface so as to form a hole.
The micro-pockets are drilled while the membrane is in its stretched position. Thereafter, a therapeutic drug is loaded into the various micro-pockets and the membrane is relaxed so that the pockets close with the therapeutic drug inside. The elastic membrane then can be rolled into a cylindrical form and mounted on a catheter for delivery to the diseased or injured area. When the expandable membrane is expanded by the balloon portion of the catheter, the micro-pockets open and the therapeutic drug is delivered to the diseased or injured area.
After the therapeutic drug has been delivered, the balloon portion of the catheter is deflated and the catheter and expandable membrane are withdrawn from the patient.
In yet another embodiment of the invention, an intravascular stent is mounted on the balloon portion of a catheter so that it may be implanted in a conventional manner within the vasculature. An expandable membrane, having a therapeutic drug contained therein in the form of a matrix, is mounted on the outer surface of the stent, and the catheter, the stent, and the expandable membrane are delivered intraluminally to the injured or diseased area. As the balloon is expanded, the balloon forces the stent radially outward, along with the expandable membrane, and the expandable membrane thus is forced into contact with the vessel wall. The balloon 2~62~9 portion of the catheter then is deflated, and the catheter and balloon are withdrawn from the vasculature, leaving the intravascular stent and expandable membrane implanted at the injured or diseased area. Thereafter, the therapeutic drug will diffuse from the matrix into the vessel wall in an effort to reduce the incidence of restenosis.
In both the reservoir or matrix form of drug delivery, the therapeutic drug may be retained in various structures including microspheres, sheets, tubes, etc.
The expandable membrane of the present invention may be deployed in a body lumen through a variety of devices, which include but which are not limited to, balloon catheters and specialized devices that can deliver a stent within a body lumen. These and other advantages of the invention will become more apparent from the following detailed description thereof when taken in conjunction with the accompanying exemplary drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGURE 1 is a top view of the expandable membrane of the invention, prior to rolling the membrane into a cylindrical configuration; ~ ;

FIG. 2A is a perspective view of the expandable membrane of FIG. 1 in its rolled up condition, with its first edge attached to the second edge in an overlapping relationship;

FIG. 2B is a perspective view depicting the elastic membrane, in a hollow tubular form that is seamless;

FIG. 3 depicts a partial, cross-sectional elevational view of a rapid-exchange catheter system, having a stent mounted on a balloon with the expandable membrane mounted over the stent;

21~29~9 FIG. 4A is a partial cross-sectional view depicting an over-the-wire catheter system, having a stent mounted on the balloon portion of the catheter and an expandable membrane mounted over the stent;

FIG. 4B is a partial cross-sectional view of a per~usion-type catheter system, having a stent mounted on the balloon portion of the catheter and an expandable membrane over the stent;

FIG. 5 is an elevational view depicting the rapid exchange catheter system of FIG. 3, wherein the stent mounted on the balloon portion of the catheter has a specific configuration and the expandable membrane is mounted over the stent;

FIG. 5A is a cross-sectional view taken along line 5A-5A depicting the expandable membrane over the stent and balloon portion of the catheter;

FIG. 6 is a partial, cross-sectional view of the catheter delivery system and stent with the expandable membrane mounted on the stent being delivered transluminally within the vasculature of the patient;

FIG. 7 is a partial, cross-sectional view of the balloon portion of the catheter expanding the stent and the expandable membrane within the vasculature of the patient;

FIG. 8 is a partial, cross-sectional view of an 2 5 intravascular stent and an expandable membrane implanted against the vessel wall of a patient;

FIG. 8A is a cross-sectional view taken along line 8A-8A depicting the expandable membrane and stent expanded and in contact with the vessel wall;

~ l~2969 FIG. 9 is a perspective view of the expandable membrane, wherein the first layer and the second layer are spaced apart prior to affixing the edges to each other;

FIG. 10 is the expandable membrane of FIG. 9, wherein the first layer and the second layer have been joined, and the plurality of holes are closed because the membrane is in its relaxed condition;

FIG. 11 is a perspective view of the expandable membrane of FIG. 10 in its rolled-up condition and in an unexpanded state, with the plurality of micro-holes tightly closed to thereby contain the drug within the drug-filled reservolr;

FIG. llA is a perspective view of an expandable membrane, having an inner tube and an outer tube with a drug receiving cavity between the two tubes;

FIG. 12 is a perspective view of an expandable membrane having a plurality of micro-pockets, for receiving a therapeutic drug; and FIG. 13 is a perspective view of the expandable membrane of FIG. 12 in its rolled-up condition and in a cylindrical form, with the micro-pockets tightly closed and in an unexpanded condition.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

During PTCA procedures it is common to use a dilatation catheter to expand a diseased area to open the lumen of a patient so as to allow blood to flow freely. In spite of the beneficial aspects of the PTCA procedure and its widespread and accepted use, it has several drawbacks, including restenosis and, possibly, acute thrombosis. Recurrent stenosis ~1629~9 has been estimated to occur in seventeen to fifty percent of patients even when the initial PTCA procedure has been successful. Restenosis is a complex and not fully understood biological response to the injury of a vessel. It results in chronic hyperplasia of the neointima. Intimal hyperplasia is activated by growth factors which are released in response to an injury to the vessel. Acute thrombosis also can be a result of vascular injury, and treatment of it requires systemic antithrombotic drugs and possibly thrombolytics as well. Such therapy can increase bleeding at the catheter insertion site and may result in a longer hospital stay. Another result of vessel injury is acute closure. It occurs in three to five percent of the patients who have received treatment by PTCA, and is caused by any one or all of three events; namely, thrombosis, vessel dissection, or elastic recoil.
Several procedures have been developed to combat restenosis and acute closure, one of which is the delivery and implanting of an intravascular stent. Stents are in the developmental stage at this point and are being used in clinical trials throughout the United States and are regularly implanted in patients in Europe and other countries.
Generally, st.ents can take on numerous forms, however, a stent typically comprises a cylindrical hollow tube that holds open the vascular wall at an area which previously has been dilated by dilatation catheter. The use of a stent does not always reduce restenosis and can aggravate the site of treatment by causing acute thrombosis, subacute thrombosis and intimal hyperplasia. In order to address the complications arising from PTCA procedures and the deployment of intravascular stents, the present invention for delivering therapeutic drugs was developed.
In one embodiment of the invention, and referring to FIGS. 1 and 2A, an elastic membrane 5 is depicted wherein it has a first edge 6 and a second edge 7. In FIG. 2A, elastic membrane 5 has been rolled into a cylindrical form with first edge 6 and second edge 7 attached in an overlapping relationship as depicted at point 8. It may be desirable to '~1,6~g9 join first edge 6 and second edge 7 in an abutting relationship (not shown), rather than in an overlapping relationship, in order to reduce the overall profile of the finished membrane 5.
In another preferred embodiment, and as is depicted in FIG. 2B, an elastic membrane 5 is shown with a first end 1 and a second end 2. This embodiment substantially is a hollow cylinder. It further has an inner surface 3 and an outer surface 4, and is generally of a unitary nature. That is, it is formed from a continuous material and has no seams or overlapping edges. Various means are described below in which a therapeutic agent is incorporated within the elastic membrane 5 so that it may be delivered into a the vascular system of a patient, for the purpose of diffusing the therapeutic agent at a controlled rate.
The membrane 5 may be formed of any suitable material that is elastic and resilient. Preferably the material is one that has a high degree of non-linearity (i.e., is plastically deformable) for a wide range of stress and strain values (i.e., a material that has very low residual stress). In the preferred embodiment, however, any elastic material my be used.
Commercially available tubing may be used such as the tubing manufactured under the tradename "C-FLEX" by Concept Polymer Technologies of Largo, Florida.
In addition, the expandable material should have good "tear strength" to prevent fracturing or splitting when it is expanded and stretched. Other suitable properties for expandable membrane 5 include a low modulus of elasticity, high toughness, a high percentage of elongation (at least three hundred percent), and a minimal residual of stress after expansion. Several preferred materials for the expandable membrane 5 are ethylene vinyl acetate (EVA) and biospan. Other suitable materials for the expandable membrane 5 include latexesj urethanes, polysiloxanes, and modified styrene-ethylene/butylene-styrene block copolymers (SEBS), and the associated families, as well as elastomeric bioabsorbable materials from the linear aliphatic polyester group.

In keeping with the invention, a therapeutic drug is combined with the expandable membrane 5, for the purposes of diffusing the drug into the vessel wall of the patient. For this purpose, any therapeutic drug for use in the body can be combined with the expandable membrane for treatment. For example, therapeutic drugs for treating an injured or diseased area in a vessel and for combination with the expandable membrane can include anti-platelets, anti-thrombins, and anti-proliferatives. Examples of anti-platelets and anti-thrombins include sodium heparin, LMW heparin, hirudin, hirulog, argatroban, forskolin, vapiprost, prostacyclin, dextran, D-phe-pro-arg-chloromethylketone (synthetic antithrombin), dipyridamole, glycoprotein IIb/IIIa platelet membrane receptor antibody, recombinant hirudin, thrombin inhibitor (from the company Biogen) and 7E-3B (an anti-platelet drug from the company Centocor). Examples of anti-proliferatives include angiopeptin (somatostatin analogue from the French company - Ibsen), angiotensin-converting enzyme inhibitors (Captopril (from the Squibb Corporation), Cilazapril (from the Hoffman-LaRoche Corporation) and Lisinopril (from the Merck Company)), calcium channel blockers (Nifedipine), colchicine, fibroblast growth factor (FGF) antagonists, fish oil (omega 3-fatty acid), low molecular weight heparin (from the co~panies Wyeth and Glycomed), histamine antagonists, lovastatin (inhibitor of HMG-CoA reductase, a cholesterol-lowering drug from the Merck Company), methotrexate, monoclonal antibodies (to PDGF
receptors, etc.), nitroprusside, phosphodiesterase inhibitors, prostacyclin analogues, prostaglandin inhibitor (from the Glaxo Corporation), seramin (PDGF antagonist), serotonin blockers, steroids, thioprotease inhibitors, triazolopyrimidine (PDGF
antagonist from a Japanese company). While the foregoing therapeutic agents have been used to prevent or treat restenosis and thrombosis, they are provided by way of example and are not meant to be limiting, as other therapeutic drugs may be developed which are equally applicable for use with the present invention.

~1~2g69 In keeping with the invention, the therapeutic drug can be combined with the expandable membrane 5 by one of several methods. The therapeutic drug can be loaded into the expandable membrane by known methods such as melt processing, solvent casting, injection molding, extrusion, coating or by diffusion/absorption techniques. Other methods of incor-porating a drug into a polymeric material are well known and include heating processes. Such processes must be monitored carefully and controlled at temperatures that are low enough to prevent degrading the drug. It is important that the therapeutic drug be able to diffuse out of the expandable membrane 5 and into the ascular system of the patient at a controlled rate, upon delivery of he expandable membrane to the injured or diseased area. Thus, the rate of diffusion is controlled to suit the circumstances and can range from a very rapid diffusion rate to a long term diffusion rate.
In general, the expandable membrane 5 can be delivered within the vascular system of a patient by any catheter system, such as commonly known dilatation catheters having balloon portions at the distal tips thereof. There are a wide range of catheter systems available, three of which are depicted in FIGS. 3, 4A and 4B. In FIG. 3 a rapid-exchange catheter system is depicted; in FIG. 4A an over-the-wire system is depicted, and in FIG. 4B a perfusion catheter is depicted.
For purposes of the present invention, any of these systems would suffice, and numerous other catheter systems would be appropriate, including dilatation catheters. Typical dilatation catheter and perfusion balloon catheter systems can be found in U.S. Patent Nos. 4,323,071; 4,516,972; 5,061,273;
5,137,513; 5,195,971. An advantage to using a perfusion balloon catheter system is that the balloon can remain inflated for ionger periods of time as it allows blood flow to continue in the vessel while the balloon is inflated.
While the expandable membrane 5 can be mounted directly onto the balloon portion of a catheter for intraluminal delivery, the preferred embodiment involves deploying the expandable membrane 5 in the vascular system of ~ ~29~

a patient by use of an intravascular stent. Thus, FIGS. 4A, 4B, 5 and 5A illustrate a stent delivery system which embodies features of the invention for implanting the expandable membrane 5.
Referring to FIG. 3, the rapid-exchange delivery system includes a delivery sheath 10 which has an outer lumen 11 and an intravascular catheter 12 disposed within the outer lumen 11. The intravascular catheter has an elongated catheter body 13 and a balloon 14 on the distal portion of the catheter body. A manipulating device 15 is provided on the distal end of the delivery system which is employed to affect relative axial or longitudinal movement between the delivery sheath 10 and the intravascular catheter 12. An expandable stent 16, which is to be delivered and implanted within a body lumen of a patient, is mounted on the exterior of the balloon 14. The stent disclosed in U.S. Serial No. 08/164,986, which is commonly assigned to Advanced Cardiovascular Syustems, Inc., is suitable for use with the present invention. Such stents are expandable and deform beyond their elastic limit to hold open the vessel wall in which they are implanted.
The delivery sheath 10 has a distal port 17 in its distal end which is in fluid communication with the outer lumen 11 and a proximal port 18 disposed proximally to the distal port. The distal portion of delivery sheath 10 tapers down in a spherical-like manner so that the cross-sectional area is somewhat less in the distal region than the cross-sectional area of the rest of the delivery sheath. A slit 19 extends from the proximal port 18 to a location just proximal to the distal port 17.
The intravascular catheter 12 has a distal port 20 and a proximal port 21 which are in fluid communication with a first inner lumen 22 extending within the distal portion of the catheter 12 and being adapted to slidably receive a guidewire therein. A slit 23 extends from the proximal port 21 to a location 24 proximal to the proximal end of balloon 14. The proximal end of the guidewire-receiving first inner lumen 22 is provided with a ramp 25 to guide the proximal end of a ~1~2~g guidewire 26 out of the proximal port 21 of an intravascular catheter 12 when the catheter is mounted onto the guidewire, as will be discussed hereinafter. A second, much longer inner lumen 27 is provided within the catheter body 13 to direct inflation fluid from the proximal end of the catheter body to the interior of balloon 14.
Proximal to the proximal port 21 in the catheter body 13 is a stiffening member 28 which is disposed in the third inner lumen 29 provided within the catheter body 13. As shown in the drawings, the third inner lumen 29 and the first inner lumen 22 may be the same lumen with a plug 30 separating the two lumens. The ramp 25 is on the distal side of the plug 30.
In a typical stent deployment, the expandable membrane 5 is loaded onto the stent 16 so that it covers the 15 stent without overlapping the ends of the stent. The expandable membrane and intravascular stent will be implanted in the vascular system of a patient to treat the diseased and injured area and to allow sufficient blood flow through the vessel. Thus, as depicted in FIGS . 5 - 8 ( including FIGS . 5A and 20 8A), the intravascular stent 16 and the expandable membrane 5 are implanted in the vascular system of the patient.
- Typically, in these situations there usually will be a guidewire 26 (or other guiding member) which extends across the damaged section of the artery such as shown in FIG. 6. The 25 proximal end of the guidewire 26, which extends out of the patient during the entire procedure, is inserted through the distal port 20 in the distal end of the catheter 12 and advanced proximally through the first inner lumen 22 until the proximal end of the guidewire impacts the ramp 25 and is 30 thereby directed through the proximal port 21.
The intravascular catheter 12 preferably is positioned within the outer lumen 11 of the delivery sheath 10 so that at least a significant portion of the proximal port 18 in the sheath is in alignment with the proximal port 21 of the 35 intravascular catheter. In this manner, proximal advancement of the guidewire 26 through the inner lumen 22 also will direct the proximal end of the guidewire out the proximal port 18 in ~1~2~9 the delivery sheath. The proximal end of the guidewire 26 then may be manually held to maintain the position of the guidewire within the vasculature of the patient, while the stent delivery system is advanced over the guidewire and through the vascular system. The advancement of the stent delivery system with the expandable membrane 5 mounted thereon continues until the distal ends of the catheter and sheath extend adjacent to or across the injured or diseased area. Next, the manipulator 15 on the proximal end of the delivery system is actuated to move sheath 10 proximally with respect to the catheter 12 and to thereby expose the stent 16 and the expandable member 5 which are mounted on balloon 14. Thereafter, inflation fluid is directed under substantial pressure through the inflation lumen 27 in the catheter body 13 to the interior of the balloon 14, thereby expanding the balloon and simultaneously expanding the stent 16 and the expandable member 5 against the vessel wall as shown in FIG. 7. After the balloon 14 is deflated, the - delivery systems, both the sheath 10 and the catheter 12, are removed from the patient along with the guidewire 26, leaving the expanded the stent 16 pressing against the expandable member 5, which is in contact with the vessel wall as is shown in FIGS. 8 and 8A.
The therapeutic drug contained within the expandable membrane 5 then can diffuse directly into the vessel wall at the area of the injured or diseased vessel to provide treatment.
In another embodiment of the invention, as depicted in FIG. 4A, an over-the-wire catheter system is employed to carry the stent 16 and the expandable membrane 5 within the patient's vasculature to the damaged area. A guidewire 26 is employed to cross a damaged area and locate the position within the patient so that the intravascular catheter can reach the diseased or injured area. As is typical in over-the-wire catheter systems, the intravascular catheter has an outer member 77 and an inner member 78 which are coaxially aligned.
The inner member 78 has an inner lumen 79 which carries the guidewire 26. The guidewire can move freely within the inner ~162969 lumen 79 in an axial direct.ion. The intravascular catheter is slidably-disposed within the sheath 10 in the inner lumen 11.
The port 17 at the distal end of the sheath 10 provides an opening through which the catheter can extend.
s The method of deploying the expandable membrane 5 is similar to that which is described for the rapid exchange system explained above and as is depicted in FIGS. 3, 5-8, and 5A and 8A. Generally, a guidewire 26 is positioned at a location just past the injured or diseased area and the catheter system is threaded over the guidewire 26 so that the balloon 14, along with the stent 16 and the expandable membrane 5 are positioned at the injured or diseased area. Thereafter, the balloon 14 is expanded radially outwardly to thereby expand the stent 16 and the expandable membrane 5. The expandable membrane 5 is sandwiched between the vasculature of the patient and the stent 16. The balloon 14 then is deflated and the catheter system is withdrawn from the vasculature of the patient leaving the stent 16 and the expandable membrane 5 securely implanted in the injured or diseased area. The therapeutic drugs within the expandable membrane 5 then diffuse into the vessel wall of the patient to treat the injured or diseased area.
The expandable membrane 5 also~can be delivered intraluminally by loading it onto a perfusion-type dilatation catheter of the type disclosed in U.S. Patent No. 5,195,971 (Sirhan) and as depicted in FIG. 4B. One advantage in using a perfusion catheter is that blood continues to flow on both sides of the balloon while it is inflated thereby allowing longer balloon inflation times. Thus, as shown in FIG. 4B, the expandable membrane 5 may be loaded directly onto the balloon 41, or onto a stent that is carried by the balloon. The balloon 41 is mounted on a tubular extension 40 which is carried by the perfusion catheter. The proximal end of the balloon 41 is attached to the distal section 42 of the catheter. The perfusion catheter has an inflation lumen 43 and a guidewire lumen 44. The inflation lumen 43 will carry inflation fluid to expand the balloon 41 and the expandable ~296~

membrane 5. The guidewire lumen 44 will receive a guidewire (not shown) similar to that which is depicted in FIG. 4A. In order to permit blood to flow continuously while the balloon 41 is expanded, a plurality of perfusion ports are incorporated into the catheter. Thus, proximal perfusion ports 46 and distal perfusion ports 47 permit blood to flow through the guicewire lumen 44 while the balloon 41 and the expandable membrane 5 are in their expanded condition. Intraluminal delivery and implanting are similar to that which is described for the over-the-wire catheter of FIG. 4A. By using a perfusion-type catheter system, the expandable membrane 5 does not have to be implanted because it can be delivered and expanded into contact with the vessel wall for long periods of time without adverse effects to the patient. When the drug has diffused, the perfusion balloon is deflated and the elastic membrane 5 elastically contracts along with the deflated balloon. The entire catheter system and the elastic membrane 5 are then removed from the patient.
In another embodiment of the invention, as depicted in FIGS. 9 and 10, the expandable membrane 5 has a first layer 80 and second layer 81 spaced apart. The first layer 80 and second layer 81 are then joined along their edges to form a fluid-tight seal 82 along all of their edges. Both the first layer 80 and second layer 81 can be formed from any of the expandable and elastic materials described above with respect to the elastic membrane depicted in FIG. 1.
Before joining the first layer 80 to the second layer 81, a plurality of apertures 84 (holes) are formed in the first layer 80 by known methods, such as using a laser or other means for making micro-holes in an elastic membrane. Holes 84 are formed in a first layer 80 while it is in stretched condition so that when the first layer 80 is in a relaxed condition the holes will close to form a fluid-tight seal.
Once the first layer 80 and second layer 81 have been joined together, the layers are stretched and a therapeutic drug is injected through any of the holes 84 to fill a cavity 83 which has been formed between the two joined layers. After 2~62g6~

the therapeutic drug is injected into the cavity 83, the expandable membrane is relaxed and the holes 84 close so that the therapeutic drug is contained within the structure. The expandable membrane 5 as depicted in FIG. 11 now is ready to be rolled into a cylindrical configuration. It also may be desirable to roll the membrane so that the edges abut rather than overlap so that in order to reduce the profile of the cylindrical shape.
Delivery of the expandable membrane 5 of FIG. 11 is similar to that which is described for the expandable membrane of FIGS. 1, 2A and 2B. Again referring to the expandable membrane of FIG. 11, it can be mounted on a stent which is mounted on the balloon portion of the catheter. Thereafter, the catheter, along with the expandable membrane and stent, is delivered intraluminally as described above. Unlike the prior description relating to the expandable membrane of FIGS. 2A and 2B, expanding the expandable membrane 5 of FIG. 11 will force - the therapeutic drug through the holes 84 when the expandable membrane is expanded by the balloon 14 and the stent 16 upon which the membrane is mounted. Thus, as the expandable membrane 5 gets larger, the holes 84 begin to open allowing the diffusion of the therapeutic drug into the vessel wall of the patient. As the balloon expands the stent 16 expands, radially outwardly and it increases the pressure on the expandable membrane 5 and causes yet more of the therapeutic drug to diffuse outwardly into the vessel wall of the patient. The expandable membrane 5 then is sandwiched between the vessel wall and the stent 16 when the balloon 14 is fully expanded and the stent is implanted against the vessel wall. Thus, the therapeutic drug is injected at the injured or diseased area to provide maximum treatment at the specific site. The invention eliminates systemic levels of drugs which may well result in negative (undesirable) side effects such as bleeding complications and toxicity. The polymer sleeve also may be loaded in matrix format to allow for sustained release of the same or a different drug.

~b~

In another embodiment of the invention, as depicted in FIG. llA, a pair of seamless cylindrical tubes, concentrically aligned, form the expandable membrane 5. An inner tubular member 100 is surrounded by an outer tubular member 101 and the ends 102,103 are sealed by any known method such as welding or by adhesives. A reservoir 104 is formed between the inner and outer tubular members 100,101 for receiving a therapeutic drug. A plurality of micro-holes 105 is formed in the outer tubular member 101 by a laser or other known method. While the expandable membrane 5 is in a stretched condition, the therapeutic drug is injected into the reservoir 104 through the micro-holes 105, and thereafter the expandable membrane 5 is relaxed, thereby closing the micro-holes 105 and trapping the therapeutic drug in the reservoir 104. The expandable membrane 5 of FIG. llA then can be loaded onto a stent 16 and implanted against a vessel wall in the same manner as previously described for FIG. 11. Once the expandable membrane 5 is expanded, the therapeutic drug is injected through the micro-holes 105 directly into the vessel wall.
It should be understood that with all of the - embodiments described herein, the expandable membrane 5 also can carry one or more therapeutic drugs in a matrix format.
For example, again referring to FIG. llA, inner and outer tubular members 100,101 each may be loaded with one or more therapeutic drugs in a matrix form. When the expandable membrane 5 is implanted as described above, the therapeutic drug(s) contained in the matrix will release into the vessel wall at a predetermined rate. The therapeutic drug in the reservoir 104, however, will be injected into the vessel wall rapidly as previously described. Thus, by providing a combination of drugs within the reservoir 104 and in matrix form in the inner and outer tubular members 100,101, drugs are continuously administered at a specific site over a long period of time. For example, the inner tubular member 100 can be loaded with a sustained-released antithrombotic drug since the inner tubular member is in direct contact with the blood flow.

~1629~9 The outer tubular member 101, which is pressed against the vessel wall, can be loaded with a sustained-release antiproliferative drug. Depending on the drug and the polymer used, in excess of forty percent by weight of a drug can be loaded into the tubular members lOO,lol.
In another embodiment of the invention, as depicted at FIGS. 12 and 13, the expandable membrane 5 is substantially thicker than previously described, and on the order of the 0.25-1.3 millimeters (0.010-0.050 inch). In this embodiment, an elastic sheet 90 contains a plurality of micro-pockets 91 which have a depth of several millimeters, but which do not extend entirely through the sheet 90. Thus, the micro-pockets 91 each have a bottom 92 and are hollow for receiving a therapeutic drug. The micro-pockets 91 can be formed by laser drilling or conventional drilling while the expandable membrane is in a stretched condition, as depicted in FIG. 12.
Thereafter, the expandable membrane 5 is relaxed and the micro-pockets 91 close tightly thereby containing the therapeutic drug therein. As depicted in FIG. 13, the sheet 90 is rolled into a cylindrical form so that it may be delivered intraluminally in the same manner as the expandable membrane depicted in FIGS. 9-11. In the preferred form, the micro-pockets 91 are filled with a therapeutic drug in the form of micro-spheres as described herein. The micro-pockets 91 (FIG.
13) may be covered with a thin film that will act as a rate-limiting membrane (not shown). Such rate-limiting membranes are well known and can be of the perfusion membrane type, or can be a hydrophilic coating that dissolves quickly upon exposure to the vessel of the patient. Commonly known hydrophilic coatings include hydrogel, glucose, acetate, agar and starch. Until expandable membrane 5 is expanded, the therapeutic drug in the micro-pockets 91 is sealed in by the rate-limiting membrane. Upon expansion of the membrane 5, the drug diffuses from the micro-pockets 91 through the rate-limiting membrane at a predetermined rate. The rate-limiting membrane can be laminated to the sheet 90 as herein described.

216~969 The expandable membrane 5 depicted in FIG. 12 need not be formed solely from a flat sheet but also can be formed from a seamless tubular member similar to that shown in FIG.
2B. In this embodiment as well as with FIGS. 12-13, a therapeutic drug can be in the form of a matrix combined with the polymer comprising the expandable membrane 5. By loading the drug into matrix form, the time during which the drug diffuses into the vessel wall can be controlled to allow for various stages of disease treatment and recovery. Further, multiple drugs in the matrix can be diffused at rates that coordinate with the particular injury or disease to provide optimal treatment. The matrix can be dispersed in the expandable membrane 5 by known methods including solvent casting, coating, absorption or melt processing.
The membrane 5 as described herein also can be made from bioabsorbable materials which will completely absorb into the vascular system of the patient over time. The membrane 5 - can be made from members or co-members of the linear aliphatic polyester family, polyurethanes, and composites.
The dimensions of the intravascular catheter described herein generally will follow the dimensions of intravascular catheters used in angioplasty procedures in the same arterial location. Typically, the length of a catheter for use in the coronary arteries is about 150 centimeters, the outer diameter of the catheter shaft is about 0.89 millimeters (0.035 inch), the length of the balloon is typically about 2 centimeters, and the inflated diameter is approximately 1 to about 8 millimeters.
The materials of construction may be selected from those used in conventional balloon angioplasty catheters. The delivery sheath enerally will be slightly shorter than the intravascular catheter, e.g., by about the length of the manipulating device 15, with an inner diameter large enough to accommodate the intravascular catheter and to allow the catheter free longitudinal movement therein. The sheath and the catheter shaft can be made of conventional polyethylene tubing, or any other suitable material.

~1629~9 While the present invention has been described herein in terms of delivering an expandable membrane and intravascular stent to a desired location within a vascular system of a patient, the delivery system can be employed to deliver S expandable membranes and/or stents to locations within other body lumens, such as peripheral arteries and vessels, the urethra, or the fallopian tubes, so that the stents can be expanded to maintain the patency of these body lumens. Other areas in which an expandable membrane might be implanted on the iliac arteries, the aorta, or virtually any other body lumen.
Various changes and improvements also may be made to the invention without departing from the scope and spirit thereof.

Claims

1. An expandable sheath for delivering a therapeutic drug in a body lumen, comprising:
an expandable membrane in the form of a cylindrical member and having a first end and a second end;
a therapeutic drug combined with said expandable membrane;
means for intraluminally delivering and expanding said expandable membrane in the body lumen so that said therapeutic drug can be eluted at a specific site in the body lumen.

2. The expandable sheath of claim 1, wherein said expandable membrane is made from materials taken from the group of materials consisting of the linear aliphatic polyester family, polyurethanes, latexes, urethanes, polysiloxanes, ethylene vinyl acetate, and modified styrene-ethylene/butylene-styrene block copolymers (SEBS).

3. The expandable sheath of claim 1, wherein said therapeutic drug combined with said expandable membrane is taken from the group of drugs consisting of antiplatelets, antithrombins, and antiproliferatives.

4. The expandable sheath of claim 3, wherein said therapeutic drug is combined with said expandable membrane in a matrix by any process of solvent casting, coating, melt processing, or absorption.

5. The expandable sheath of claim 1, wherein said means for intraluminally delivering said expandable membrane is a catheter system having a proximal end and a distal end, the catheter further having a balloon portion at said distal end with said expandable membrane affixed to said balloon portion.

6. The expandable sheath of claim 5, wherein said catheter system includes a perfusion balloon to permit fluids to flow on both sides of said perfusion balloon when said perfusion balloon is fully expanded.

7. The expandable sheath of claim 1, wherein said means for intraluminally delivering said expandable membrane is a catheter having a proximal end and a distal end, the catheter further having a balloon portion at said distal end, an intravascular stent is mounted on said balloon, said expandable membrane is attached to said stent to form a cylinder around said stent.

8. The expandable sheath of claim 1, wherein said cylindrival member is seamless.

9. The expandable sheath of claim 1, wherein said expandable membrane further comprises a first layer and a second layer, said first layer and said second layer are bonded together along their edges to form a reservoir between the two layers.

10. The expandable sheath of claim 9, wherein a plurality of apertures are provided in said first layer.

11. The expandable sheath of claim 10, wherein said apertures are formed in said first layer by a laser when said expandable membrane is in a stretched condition.

12. The expandable sheath of claim 11, wherein said therapeutic drug is loaded into said reservoir through said apertures when said membrane is in said stretched condition.

13. The expandable sheath of claim 12, wherein said expandable membrane retains said therapeutic drug within said reservoir when said membrane is in a relaxed condition.

14. The expandable sheath of claim 13, wherein said membrane is rolled into a cylinder so that said first edge and said second edge overlap and are attached to each other.

15. The expandable sheath of claim 13, wherein said membrane is rolled into a cylinder so that said first edge and said second edge abut and are attached to each other.

16. The expandable sheath of claim 14, wherein said expandable membrane is attached to a balloon portion of a catheter for intravascular transport and delivery to a specific site in the body lumen.

17. The expandable sheath of claim 16, wherein said balloon portion of said catheter expands, thereby expanding said expandable membrane and forcing said therapeutic drug in said reservoir to diffuse through said apertures and into the lumen wall.

18. The expandable sheath of claim 9, wherein said first layer has an outer surface loaded with a sustained release therapeutic drug so that when said outer surface contacts the body lumen said drug will diffuse into the body lumen at a predetermined rate.

19. The expandable sheath of claim 18, wherein said sustained release therapeutic drug is an antiproliferative drug.

20. The expandable sheath of claim 9, wherein said second layer has an inner surface in contact with blood flow, said inner surface loaded with a sustained release antithrombotic drug for diffusing into the blood at a predetermined rate.

21. The expandable sheath of claim 1, wherein said expandable membrane is bioabsorbable.

22. An expandable sheath for delivering a therapeutic drug in a body lumen, comprising:
an expandable membrane having a first layer and a second layer, said first layer and said second layer affixed to each other along their edges to form a drug-containing reservoir between the two layers;
a plurality of apertures on said first layer through which a therapeutic drug can diffuse from within said drug-containing reservoir, said plurality of apertures remaining open when said first layer is in a stretched condition and said apertures tightly closing when said first layer is in a relaxed condition.

23. The expandable sheath of claim 22, wherein said therapeutic drug within said drug-containing reservoir is taken from the group consisting of antiplatelets, antithrombins, and antiproliferatives.

24. The expandable sheath of claim 22, further compromising a catheter having a proximal end and a distal end, the catheter further having an expandable balloon portion at its distal end and an intravascular stent mounted thereon, said expandable membrane is affixed to said stent by rolling said expandable membrane to form a cylinder around said intravascular stent.

25. The expandable sheath of claim 24, wherein said expandable balloon is expanded from a first diameter to a second enlarged diameter thereby expanding said stent and said expandable membrane so that said stent and said expandable membrane are implanted in the body lumen.

26. The expandable sheath of claim 25, wherein said plurality of apertures on said first layer open when said expandable membrane is expanded by said expandable balloon and intravascular stent, so that as said plurality of apertures open the therapeutic drug will diffuse from within said drug-containing reservoir to said body lumen.

27. The expandable sheath of claim 22, wherein said first layer has an outer surface loaded with a sustained release therapeutic drug so that when said outer surface contacts the body lumen said drug will diffuse into the body lumen at a predetermined rate.

28. The expandable sheath of claim 27, wherein said sustained release therapeutic drug is an antiproliferative drug.

29. The expandable sheath of claim 22, wherein said second layer has an inner surface in contact with blood flow, said inner surface loaded with a sustained release antithrombotic drug for diffusing into the blood at a predetermined rate.

30. An expandable sheath for delivering a therapeutic drug in a body lumen, comprising:
an expandable membrane in the form of a cylindrical member having a first end and a second end and a lumen therethrough;
a therapeutic drug combined with said expandable membrane;
a catheter system for intraluminally delivering and expanding said expandable membrane in the body lumen, said catheter system having a distal end and a proximal end and a balloon portion at said distal end; and means for loading said expandable membrane on said balloon portion on said catheter system so that when said balloon portion is inflated said balloon portion will expand radially outwardly thereby expanding said expandable membrane into contact with said body lumen so that said therapeutic drug can be eluted at a specific site in the body lumen.

31. The expandable sheath of claim 30, wherein said balloon portion of said catheter is a perfusion balloon permitting blood flow on either side of said perfusion balloon when said perfusion balloon is fully expanded.

32. The expandable sheath of claim 30, wherein said expandable membrane has a low modulus of elasticity and can expand to at least 300% of its initial size.

33. An expandable sheath for delivering a therapeutic drug in a body lumen, comprising:
an expandable membrane in the form of a cylindrical member and having an inner surface and an outer surface;
a plurality of micro-pockets disbursed upon said outer surface but not penetrating through to said inner surface;
a therapeutic drug for loading into said micro-pockets; and means for intraluminally delivering and expanding said expandable membrane in the body lumen so that said therapeutic drug can be eluted at a specific site in the body lumen.

34. The expandable sheath of claim 33, wherein said plurality of micro-pockets are covered by a rate limiting membrane so that as expandable membrane is expanded, said therapeutic drug diffuses from said micro-pockets and through said rate limiting membrane at a predetermined rate.