US20100324554A1 - Aortic Valve Repair - Google Patents

Aortic Valve Repair Download PDF

Info

Publication number
US20100324554A1
US20100324554A1 US12/870,270 US87027010A US2010324554A1 US 20100324554 A1 US20100324554 A1 US 20100324554A1 US 87027010 A US87027010 A US 87027010A US 2010324554 A1 US2010324554 A1 US 2010324554A1
Authority
US
United States
Prior art keywords
catheter
treatment
treatment catheter
valve
site
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US12/870,270
Inventor
Hanson Gifford
Mark E. Deem
Stephen Boyd
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Twelve Inc
Original Assignee
Foundry LLC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Foundry LLC filed Critical Foundry LLC
Priority to US12/870,270 priority Critical patent/US20100324554A1/en
Publication of US20100324554A1 publication Critical patent/US20100324554A1/en
Priority to US13/692,613 priority patent/US9414852B2/en
Assigned to FOUNDRY NEWCO XII, INC. reassignment FOUNDRY NEWCO XII, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: FOUNDRY, LLC
Assigned to TWELVE, INC. reassignment TWELVE, INC. CHANGE OF NAME (SEE DOCUMENT FOR DETAILS). Assignors: FOUNDRY NEWCO XII, INC.
Priority to US15/212,797 priority patent/US10350004B2/en
Priority to US16/511,947 priority patent/US11272982B2/en
Abandoned legal-status Critical Current

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14Probes or electrodes therefor
    • A61B18/1492Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements 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
    • A61B17/22004Implements 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 using mechanical vibrations, e.g. ultrasonic shock waves
    • A61B17/22012Implements 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 using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements 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
    • A61B17/22004Implements 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 using mechanical vibrations, e.g. ultrasonic shock waves
    • A61B17/22012Implements 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 using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement
    • A61B17/2202Implements 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 using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement the ultrasound transducer being inside patient's body at the distal end of the catheter
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements 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
    • A61B17/221Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B17/3205Excision instruments
    • A61B17/3207Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320758Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with a rotating cutting instrument, e.g. motor driven
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/02Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/24Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2442Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
    • A61F2/2445Annuloplasty rings in direct contact with the valve annulus
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/01Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02Holding devices, e.g. on the body
    • A61M25/04Holding devices, e.g. on the body in the body, e.g. expansible
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N7/00Ultrasound therapy
    • A61N7/02Localised ultrasound hyperthermia
    • A61N7/022Localised ultrasound hyperthermia intracavitary
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements 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
    • A61B2017/22038Implements 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 with a guide wire
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements 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
    • A61B2017/22051Implements 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 with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A61B2017/22061Implements 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 with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation for spreading elements apart
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements 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
    • A61B2017/22051Implements 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 with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A61B2017/22065Functions of balloons
    • A61B2017/22069Immobilising; Stabilising
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements 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
    • A61B2017/22079Implements 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 with suction of debris
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements 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
    • A61B2017/22098Decalcification of valves
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements 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
    • A61B17/221Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A61B2017/2215Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having an open distal end
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00005Cooling or heating of the probe or tissue immediately surrounding the probe
    • A61B2018/00011Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053Mechanical features of the instrument of device
    • A61B2018/00214Expandable means emitting energy, e.g. by elements carried thereon
    • A61B2018/0022Balloons
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/02Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques
    • A61B2018/0231Characteristics of handpieces or probes
    • A61B2018/0262Characteristics of handpieces or probes using a circulating cryogenic fluid
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/12Diagnosis using ultrasonic, sonic or infrasonic waves in body cavities or body tracts, e.g. by using catheters
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/10Balloon catheters
    • A61M2025/1043Balloon catheters with special features or adapted for special applications
    • A61M2025/105Balloon catheters with special features or adapted for special applications having a balloon suitable for drug delivery, e.g. by using holes for delivery, drug coating or membranes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N7/00Ultrasound therapy
    • A61N2007/0039Ultrasound therapy using microbubbles

Definitions

  • Aortic valve stenosis is a common cardiac disease resulting in approximately 65 , 000 aortic valve replacement surgeries in the United States annually.
  • Aortic valve stenosis can occur via several etiologies including rheumatic disease, congenital and degenerative calcific stenosis. In developing countries, rheumatic fever results in thickening and progressive immobility of the valve tissues. Calcific disease accounts for almost all of the cases of aortic stenosis in the United States and in developed countries where rheumatic disease is rare.
  • calcific material such as nodular calcific deposits may be superimposed on an underlying fibrotic aortic valve leaflet or calcific deposits may be diffusely distributed throughout the body (spongiosa) of the aortic valve leaflets.
  • calcific deposits may be diffusely distributed throughout the body (spongiosa) of the aortic valve leaflets.
  • distribution and type of deposits may differ depending on valve geometry (bicuspid, tricuspid), the deposits generally contribute to leaflet immobility, thickening and other pathologies that lead to degenerative valve function. The presence and progression of this disease leads to a decreased functional area of the valve and dramatically reduced cardiac output.
  • valve cross-sectional area devices and techniques have suffered from only a modest ability to increase valve cross-sectional area, however. For instance, many studies showed that a pre-dilatation area of about 0.6 cm 2 could be opened to only between about 0.9 to about 1.0 cm 2 . It would be desirable to open such a stenosis to an area closer to about 1.2 to about 1.5 cm 2 . In addition to opening the cross-sectional area, it may be desirable to treat the leaflets and surrounding annulus to remove calcific deposits that stiffen the valve, impair flow dynamics, and otherwise degenerate valve function. Toward this end, other techniques such as direct surgical ultrasonic debridement of calcium deposits have had some success, but required an open surgical incision, thereby increasing the risk to the patient.
  • balloon dilatation offered patients a viable, less invasive alternative, it fell into disfavor in the early to mid 1990s primarily as a result of rapid restenosis of the valve post treatment. At six months, reports of restenosis rates were commonly in excess of 70-80%.
  • balloon valvuloplasty is primarily reserved for palliative care in elderly patients who are not candidates for surgical replacement due to comorbid conditions.
  • anti-calcification drugs including ACE inhibitors, statins, and angiotensins, specifically angiotensin II, as detailed in United States Patent Application Publication 2004/0057955, the disclosure of which is expressly incorporated herein by reference.
  • the present invention provides various devices and methods that create more effective treatments for aortic stenosis and prevent or reduce the incidence and/or severity of aortic restenosis.
  • the present inventions provides methods and devices for decalcification or debridement of aortic stenosis, either as a stand alone therapy or in conjunction with conventional techniques, such as traditional valvuloplasty, stenting, valve repair, and percutaneous or surgical valve replacement.
  • the present invention relates to the repair of aortic and other cardiac valves, and more particularly devices and methods for calcium removal and anti-restenosis systems for achieving such repair.
  • the invention can take a number of different forms, including apparatus, acute interventions performed at the time of the aortic repair or valvuloplasty, or temporary or permanent implant, and the like.
  • the methods and devices of the reduce or remove calcifications on or around the valve through application or removal of energy to disrupt the calcifications.
  • the present invention may apply ultrasound energy, RF energy, a mechanical energy, or the like, to the valve to remove the calcification from the valve.
  • it may be desirable to instead remove energy (e.g. cryogenically cooling) from the calcification to enhance the removal of the calcification from the valve.
  • it will be desirable to create an embolic containment region over a localized calcific site on or near the cardiac valve. Such containment may be achieved by creating a structure about the localized site and/or by actively aspirating embolic particles from the site as they are created. Suitable structures include filters, baskets, balloons, housings and the like.
  • treatment catheters are provided to deliver a working element to the vicinity of the diseased valve.
  • Working element can include an ultrasonic element, or any other delivery mechanism or element that is capable of disrupting, e.g., breaking up or obliterating calcific deposits in and around the cardiac valve.
  • Such devices may be steerable or otherwise positionable to allow the user to direct the distal end of the catheter grossly for initial placement through the patient's arteries to the valve, and then precisely adjust placement prior to and/or during treatment.
  • the present invention provides a treatment catheter that comprises a mechanical element that can disrupt, e.g., mechanically break up, obliterate, and remove the calcific deposits in and around the aortic valve.
  • a mechanical element that can disrupt, e.g., mechanically break up, obliterate, and remove the calcific deposits in and around the aortic valve.
  • the catheter comprising the mechanical element may be steerable or otherwise articulable to allow the user to direct the distal end of the catheter grossly for initial placement, and then fine tune placement during treatment.
  • systems including a guide catheter may also be employed to position the treatment catheter at the site of the disease to be treated, either as a separate catheter or as part of the treatment device.
  • a main guide catheter may be used to center a secondary positioning catheter that contains the treatment catheter over the aortic valve.
  • the treatment catheter may then be further articulated to provide even further directionality to the working end.
  • Various other apparatus and methods may be employed for positioning and stabilizing the treatment catheter, including shaped balloons, baskets or filters and methods of pacing the heart.
  • methods may be used to disrupt the calcified sites and trap and evacuate emboli and other debris from the treatment site, using filters located on the treatment catheter, suction housings located on the treatment catheter, perfusion balloons linked with aspiration devices, separate suction catheters, separate filter devices either at the treatment site or downstream from the treatment site, and/or external filter and perfusion systems.
  • Certain filter embodiments may be shaped to allow the treatment catheter to access the location to be treated, while still allowing flow through the valve (e.g. treating one leaflet at a time).
  • methods for treating cardiac valves comprise creating an emboli containment region over a calcific site and delivering energy (including cryotherapy) to disrupt said site and potentially create emboli which are contained in the containment region.
  • the containment regions will typically be localized directly over a target site, usually having a limited size so that the associated aorta or other blood vessel is not blocked or occluded.
  • the containment region may be created using a barrier, such as a filter structure, basket, or balloon over the calcified site. Alternatively or additionally, the containment region may be created by localized aspiration to remove substantially all emboli as they are formed.
  • the energy applied may be ultrasound, radiofrequency, microwave, mechanical, cryogenic, or any other type of energy capable of disrupting valve calcifications.
  • the methods may virtually disintegrate the calcification through the use a media that contains microspheres or microbubbles, such as OptisonTM sold by GE Healthcare (www.amershamhealth-us.com/optison/). Delivery of an ultrasound energy (or other foam of energy, for example, laser, RF, thermal, energy) to the media may cause the microspheres to rupture, which causes a release of energy toward the valve, which may help remove the calcification around and on the valve. Bioeffects Caused by Changes in Ascoustic Cavitation Bubble Density and Cell Concentration: A Unifed Explanation Based on Cell - to - Bubble Ratio and Blast Radius, Guzman, et al. Ultrasound in Med. & Biol., Vol. 29, No. 8, pp. 1211-1222 (2003).
  • Certain imaging and other monitoring modalities may be employed prior to, during or after the procedure of the present invention, utilizing a variety of techniques, such as intracardiac echocardiography (ICE), transesophageal echocardiography (TEE), fluoroscopy, intravascular ultrasound, angioscopy or systems which use infrared technology to “see through blood”, such as that under development by Cardio-Optics, Inc.
  • ICE intracardiac echocardiography
  • TEE transesophageal echocardiography
  • fluoroscopy fluoroscopy
  • intravascular ultrasound such as that under development by Cardio-Optics, Inc.
  • RF radio frequency
  • ultrasonic energy in various therapeutic ranges
  • mechanical (non-ultrasound) energy may be utilized to effect the treatment of the present invention.
  • the distal tips of the RF, ultrasonic treatment catheters, and mechanical treatment catheters of the present invention may have a variety of distal tip configurations, and be may be used in a variety of treatment patterns, and to target specific locations within the valve.
  • intravascular implants are contemplated by the present invention, including those placed within the valve annulus, supra annular, sub annular, or a combination thereof to assist in maintaining a functional valve orifice.
  • Such implants may incorporate various pharamacological agents to increase efficacy by reducing restenosis, and otherwise aiding valve function.
  • Implants may be formed of various metals, biodegradable materials, or combinations thereof.
  • These devices may all be introduced via either the retrograde approach, from the femoral artery, into the aorta and across the valve from the ascending aorta, or through the antegrade approach—transeptal, across the mitral valve, through the left ventricle and across the aortic valve.
  • the present invention provides an anti-restenosis system for aortic valve repair.
  • Acute interventions are performed at the time of the aortic repair or valvuloplasty and may take the form of a temporary or permanent implant.
  • implant devices may all be introduced via either the retrograde approach, from the femoral artery, into the aorta and across the valve from the ascending aorta, or through the antegrade approach—trans-septal, across the mitral valve, through the left ventricle and across the aortic valve, and will provide for delivery of anti-restenosis agents or energy to inhibit and/or repair valve restenosis.
  • FIG. 1 illustrates a suction catheter constructed in accordance with the principles of the present invention.
  • FIG. 2 is a cross-sectional view of the catheter of FIG. 1 .
  • FIGS. 3 and 4 are detailed views of the distal end of the catheter of FIG. 1 , with FIG. 4 showing a suction housing in an expanded configuration.
  • FIG. 5 is similar to FIG. 4 , showing the catheter without a guidewire.
  • FIGS. 6-8 show modified suction housings.
  • FIGS. 9 and 10 show suction housings having different depths.
  • FIGS. 11-13 show suction housings having rigid or semi-rigid members around their circumferences.
  • FIG. 14 shows a suction catheter having a stabilizing structure near its distal end.
  • FIG. 15 illustrates how a guiding catheter would be used to place the catheters of the present invention above a treatment area.
  • FIGS. 16 and 17 show how suction catheters would be placed through the guide catheters.
  • FIGS. 18-22 illustrate the use of treatment catheters having ultrasonic probes for decalcifying leaflets in accordance with the principles of the present invention.
  • FIG. 23 illustrates a catheter having a distal portion shaped to correspond to a shape of a targeted valve leaflet.
  • FIG. 24 illustrates a catheter having a distal end with an annular treatment surface adapted to apply energy to a valve annulus.
  • FIGS. 25A-25D illustrate catheters having different working ends in accordance with the principles of the present invention.
  • FIGS. 26-28 illustrate catheters having ultrasonic transmission members and enlarged working ends.
  • FIGS. 29-31 illustrate catheters having enlarged distal working ends with central lumens therethrough.
  • FIGS. 32 and 33 illustrate catheters having ultrasonic transmission elements adjacent a working end.
  • FIGS. 34-37 illustrate different patterns of motion which may be imparted by the electronic catheters of the present invention.
  • FIG. 38 illustrates a catheter having a force limiting feature.
  • FIGS. 39 and 40 illustrate a catheter having a deflectable distal end.
  • FIGS. 41 and 42 illustrate treatment catheters being advanced through a sheath.
  • FIG. 43 illustrates an ultrasonic catheter having a distal horn and a PZT stack.
  • FIG. 44 illustrates a suction housing placed over a PZT stack and ultrasonic horn in an embodiment of the present invention.
  • FIG. 45 illustrates a proximal housing for steering a distal end of the catheters of the present invention.
  • FIG. 46 illustrates use of a pair of suction catheters for treating a valve in accordance with the principles of the present invention.
  • FIG. 47 illustrates a catheter having an eccentrically loaded coil in the working end thereof
  • FIGS. 48 and 49 show variations on the coil of FIG. 47 .
  • FIGS. 50-52 illustrate catheters having mechanical elements in their distal ends.
  • FIGS. 53 and 54 show catheters having distal impellers and grinders.
  • FIGS. 55-57 illustrate catheters having disk-like grinders with abrasive surfaces.
  • FIGS. 58 and 59 illustrate rotating burrs which may be placed in the distal end of the catheters of the present invention.
  • FIG. 60 illustrates a catheter having a piezoelectric film element in its distal end.
  • FIGS. 61 and 62 show guiding catheters having filter elements at their distal ends which are used for introducing the catheters of the present invention.
  • FIG. 63 illustrates a filter device deployed to protect an entire region of treatment.
  • FIG. 64 illustrates a filter device covering a single leaflet.
  • FIG. 65 shows a filter shape optimized for a leaflet at the treatment site.
  • FIGS. 66-68 show catheter positions optimized for reducing calcium deposits.
  • FIG. 69 shows a device having an open lattice structure.
  • FIGS. 70-72 show implants formed from lattice wire structures.
  • FIGS. 73-76 illustrate implants having multiple loops.
  • FIGS. 77-80 show embodiments of the present invention for delivering drugs to the target treatment sites.
  • FIGS. 81 and 82 illustrate catheters having balloons with both drug release capability and blood perfusion capability.
  • FIGS. 83 and 84 show implantable devices having deployable struts.
  • FIGS. 85 and 86 show implantable devices having anchoring elements which lie against the wall of the aorta.
  • FIGS. 87-89 show embodiments where the device struts also provide for anchoring.
  • Treatment catheters 10 typically comprise an elongate catheter body 12 that comprises a proximal end 14 , a distal end 16 , and one or more lumens 18 , 20 ( FIG. 2 ) within the catheter body.
  • the distal end 16 may optionally comprise a suction housing 22 ( FIGS. 4 and 5 ) that extends distally from the distal end of the catheter body 12 for isolating the leaflet during treatment as well as providing a debris evacuation path during treatment and protecting the vasculature from adverse embolic events.
  • An energy transmission element 24 (e.g., a drive shaft, wire leads, or a waveguide-ultrasonic transmission element, or the like) may be positioned in one of the lumens in the elongate body 12 and will typically extend from the proximal end to the distal end of the catheter body.
  • a handle 26 is coupled to the proximal end 14 of the elongate catheter body 12 .
  • a generator e.g., RF generator, ultrasound generator, motor, optical energy source, etc.
  • the distal working element 28 may be coupled to the distal end of the energy transmission element 24 to facilitate delivery of the energy to the calcification on the aortic valve.
  • the treatment catheters 10 of the present invention are configured to be introduced to the target area “over the wire.”
  • the treatment catheters may be positioned adjacent the aortic valve through a guide catheter or sheath.
  • the treatment catheters of the present invention may comprise a central guidewire lumen 20 for receiving a guidewire GW ( FIG. 2 ).
  • the guidewire lumen 20 of the treatment catheters of the present invention may also be used for irrigating or aspirating the target area.
  • the handle may comprise one or more ports so as to allow for irrigation of the target leaflet and/or aspiration of the target area.
  • An irrigation source and/or an aspiration source may be coupled to the port(s), and the target area may be aspirated through one of the lumen of the catheter and/or irrigated through one of the lumens of the catheter.
  • one of the irrigation source and aspiration source may be coupled to the central guidewire lumen (central lumen) and the other of the aspiration source and the irrigation source may be coupled to the lumen that is coaxial to the guidewire lumen. In some embodiments, however, there will be no inner guidewire lumen and the guidewire will simply extend through the ultrasound waveguide and the rotatable drive shaft, as shown in FIGS. 3 , 4 and 6 .
  • the treatment catheters 10 of the present invention may comprise a suction housing positioned at the distal end of the catheter body having an expanded configuration and a retracted configuration and configured to conform to the valve leaflet to be treated. While the suction housing 22 may be fixedly attached at the distal end, in preferred embodiments, the suction housing is movable between a retracted configuration ( FIG. 3 ) and an expanded configuration ( FIGS. 4 and 5 ). A separate sheath may also be retracted to expose the suction housing and advanced to fold the housing.
  • the suction housing may be made from silicone or urethane and may be reinforced with an internal frame or mesh reinforcement to provide structural support or to enhance placement of the housing on a specified area of the valve leaflet. The housing may further act as an embolic filter as detailed later in this specification.
  • the energy transmission element 24 is advanced beyond the distal end of the catheter body 12 and into the suction housing 22 .
  • the guidewire GW is positioned through an opening in the distal tip.
  • the guidewire GW is withdrawn and the distal working element 28 is ready for use to treat the calcification.
  • the suction housing 22 is shaped to substantially conform to the shape of a bicuspid valve leaflet.
  • the suction housing may be better configured to isolate the target leaflet.
  • the suction housing may be shaped to substantially conform to a tricuspid valve ( FIGS. 7 and 8 ), etc.
  • the depth of the suction housing may take many forms such that it is compatible with the valve to be treated.
  • the suction housing 22 may be shallow ( FIG. 9 ) or deep ( FIG. 10 ).
  • the depth on the cup can reduce or eliminate obstructing the coronary ostia if one of the leaflets under treatment is a coronary leaflet.
  • the suction cups/housings may also have rigid or semi-rigid members around the circumference or part of the circumference of the housing to preferentially align the cup on certain valve features, such as the annulus.
  • the suction cup housings have a depth range of 0.1′′ to 0.5′′ and a diameter of 15 mm to 30 mm.
  • the cup or housing may have fingers 30 or longitudinal stabilizing elements 32 to assist in placing the housing against the valve as shown in FIGS. 11 , 12 , and 13 .
  • Such stabilizing elements may also be in the form of pleats, rings or hemispherical elements, or other reinforcements to assist the device to seat within the annulus of the valve or against the leaflet.
  • Such reinforcements or stabilizing elements may be formed of stainless steel, NiTi (superelastic or shape memory treated), Elgiloy®, cobalt chromium, various polymers, or may be in the form of an inflatable ringed cup.
  • the cup or housing of the present invention is intended to function to provide sufficient approximation with the treatment area so as to stabilize or localize the working element while also minimizing embolic events. It that sense, it is substantially sealing against the treatment region, but such seal is not necessarily an “airtight” seal, but an approximation that performs the desired functions listed above.
  • certain stabilizing devices 36 , 38 may be located on the main catheter shaft 12 to provide stability within the aorta, and may, in some cases, extend through the valve leaflets L below the valve to further stabilize the treatment device, as shown in FIG. 14 .
  • a system could include a main guide catheter GC placed over the treatment area as depicted in FIG. 15 :
  • the treatment area include the coronary leaflet (CL), the non-coronary leaflet (NCL) and the non-coronary leaflet (center) (NCLC).
  • CL coronary leaflet
  • NCL non-coronary leaflet
  • NCLC non-coronary leaflet
  • a first treatment catheter 40 having a distal housing 42 adapted to conform to the NCL is advanced as indicated by arrow S 1 .
  • the leaflet is treated and the NCL housing catheter is withdrawn as indicated by S 2 .
  • the guide catheter position is then adjusted as indicated by arrow S 3 to better approximate the CL.
  • CL housing catheter is the advanced through the guide as indicated by arrow S 4 .
  • the CL housing catheter is removed as indicated by arrow S 5 .
  • the guide catheter GC is then repositioned to treat NCLC as indicated by arrow S 6 , and finally the NCLC housing catheter is advanced through the guide according to arrow S 7 .
  • the NCLC is removed as indicated by arrow S 8 and the guide is removed and procedure completed.
  • one leaflet may be treated only, more than one leaflet, and in any order according to the type of calcification, health of the patient, geometry of the target region or preference of the operator.
  • a treatment catheter 50 having an ultrasonic probe for decalcifying the leaflet.
  • An ultrasonic probe 52 may be surrounded by a frame or sheath 54 . Both the frame and the sheath may be connected to a source of ultrasonic vibration (not shown).
  • the probe 52 is surrounded by a sheath or housing that enables the system to be substantially sealed against the treatment surface via a source of suction attached at the proximal end of the catheter system and connected to the catheter housing via a suction lumen in the catheter body.
  • the system may be placed or localized at the treatment site with a mechanical clip or interface that physically attaches the housing to the treatment area (annulus or leaflet).
  • the ultrasonic probe 52 is activated to disintegrate the calcium on the leaflets, creating debris that may then be removed through a suction lumen in the catheter body 50 .
  • FIG. 19 Another embodiment of an ultrasonic probe 60 having a silicone cup is shown in FIG. 19 where infusate is indicated by arrows 62 and aspirate is indicated by arrows 64 .
  • the ultrasonic probe 70 may be a separate element, allowing the ultrasonic treatment catheter 72 to move independently within the sealed region.
  • the treatment probe 70 may be operated in a variety of directions and patterns that are further detailed in the specification, including sweeping in a circular pattern along the cusp of each leaflet and creating concentric circles during treatment to effectively treat the entire leaflet, if necessary.
  • the ultrasonic element may be coaxial with the suction housing and adapted to move independently therewithin.
  • a treatment catheter 80 may be placed through a series of guide catheters 82 , 84 to assist placement accuracy.
  • the first guide member 84 may be placed and anchored in the aortic root using either the shape of the guide to anchor against the aortic wall, or a separate balloon or filter device to stabilize the guide or a stabilizing ring made from shape memory material or other suitable material that can provide stabilization to allow the catheter to be directed to the treatment site.
  • a second steerable or articulable catheter 82 may then be placed through the initial guide to direct the treatment catheter to one area of the leaflet or other.
  • the treatment catheter 80 may then be placed through the system once these guides are in place, and deployed directly to the targeted valve region.
  • the steerable guide may then be actuated to target the next treatment location, thereby directing the treatment catheter (and related filtering devices) to the next site. It may only be necessary to place one guide catheter prior to the treatment catheter, or alternatively, the treatment catheter may be steerable, allowing it to be placed directly to the treatment site without the aid of other guide catheters.
  • the guide catheter may also be steerable and an integral part of the treatment catheter. Steerable guides such as those depicted in US Patent Publications 2004/0092962 and 2004/0044350 are examples, the contents of which is expressly incorporated by reference in its entirety. Treatment device may then re-directed to a second treatment site, as shown in FIG. 22 .
  • the distal portion 90 of the treatment catheters of the present invention may be shaped to substantially correspond to a shape of the targeted leaflet L (e.g., formed to fit within shape of the leaflet cusp, with the mouth of the housing being shaped to conform to the leaflet shape as shown in FIG. 23 ). This also enables the surface of the leaflet to be stabilized for treatment.
  • the distal portion may have an internal frame that supports the distal section during deployment and treatment but is flexible such that it collapses into the treatment catheter or sheath to assist with withdrawal.
  • the treatment catheter 100 of the present invention may be formed having a circumferential, annular treatment 102 surface to apply energy/vibration to the annulus to be treated.
  • the catheter may be placed antegrade or retrograde, or two circumferential treatment surfaces may be used in conjunction with each other, as shown in FIG. 24 .
  • the distal tip of an ultrasonic catheter may be coupled to a ultrasound transmission member or waveguide.
  • the distal tip may be chosen from the various examples below, including a blunt tip, a beveled tip, a rounded tip, a pointed tip and may further include nodules or ribs ( FIG. 25C ) that protrude from the surface of the tip to enhance breakup of calcium. Arrows show exemplary patterns of use.
  • the distal tip of the ultrasonic catheters of the present invention may also take the shape of the waveguide tips that are shown and described in U.S. Pat. No. 5,304,115, the contents of which is expressly incorporated by reference herein.
  • U.S. Pat. No. 5,989,208 (“Nita”) the contents of which is expressly incorporated by reference herein, illustrate some additional tips in FIGS. 2-7A that may also be useful for decalcifying a valve leaflet.
  • the ultrasound transmission members of the present invention may comprise a solid tube that is coupled to an enlarged distal working end.
  • a central lumen may extend throughout the ultrasonic transmission member and may be used for aspiration, suction, and/or to receive a guidewire.
  • the enlarged working end 110 (which has a larger diameter than the elongate proximal portion), may comprise a cylindrical portion that comprises a plurality of elongated members 112 .
  • the elongated members are arranged in castellated pattern (e.g., a circular pattern in which each of the elongated members extend distally) and provide an opening along the longitudinal axis of the ultrasound transmission member. While the elongated members are cylindrically shaped, in other embodiments, the elongated members may be rounded, sharpened, or the like.
  • a central lumen may extend through the ultrasound transmission element and through the enlarged distal working end.
  • the distal working end 120 is enlarged and rounded.
  • the portion of the ultrasound transmission element (or waveguide) that is adjacent the distal working end may be modified to amplify the delivery of the ultrasonic waves from the working end.
  • the waveguide may comprises a plurality of axial slots in the tubing that act to create a plurality of “thin wires” from the tubing, which will cause the ultrasonic waves to move radially, rather than axially.
  • the enlarged distal working end may then be attached to the plurality of thin wires. Two embodiments of such a configuration are illustrated in FIGS. 32 and 33 .
  • each castellation may be housed on its own shaft extending back to the proximal end of the device. Other potential tip geometries are depicted below.
  • the ultrasonic catheters of the present invention may be adapted to impart motion to the distal tip that is oscillatory, dottering, circular, lateral or any combination thereof.
  • distal tips described herein, Applicants have found that the use of a small distal tip relative to the inner diameter of the catheter body provides a better amplitude of motion and may provide improved decalcification.
  • an ultrasonic tip of the present invention can be operated in a variety of treatment patterns, depending on the region of the leaflet or annulus that is being treated, among other things.
  • the treatment pattern either controlled by the user programmed into the treatment device, may be a circular motion to provide rings of decalcification on the surface being treated, a cross-hatching pattern to break up larger deposits of calcium ( FIG.
  • FIG. 24 or a hemispherical ( FIG. 36 ) or wedge-shaped ( FIG. 37 ) pattern when one leaflet or region is treated at a time. It is within the scope of the present invention to use combinations of any of the patterns listed, or to employ more random patterns, or simply a linear motion.
  • Certain safety mechanisms may be incorporated on the treatment catheter and related components to ensure that the treatment device does not perforate or otherwise degrade the leaflet.
  • a force limiting feature may be incorporated into the treatment catheter shaft as shown in FIG. 38 , where a structure 140 can contract in response to force applied to catheter 142 in the direction of arrows 144 .
  • features of the catheter shaft may limit the force that is delivered to the tissues.
  • the treatment catheter 200 may be advanced through a sheath 202 that acts as a depth limiter to the treatment catheter as shown in FIGS. 41 and 42 .
  • a sheath 202 that acts as a depth limiter to the treatment catheter as shown in FIGS. 41 and 42 .
  • FIG. 43 An assembly of an ultrasonic catheter of the present invention is shown in FIG. 43 , including an ultrasonic transmission member 210 , a transmission-head 212 , a guide wire GW, a suction cup 214 , a spring 216 , and catheter body 218 .
  • an ultrasonic catheter 220 includes a PZT stack 222 and a distal horn 224 at the distal end of the device as shown in FIG. 44
  • FIG. 44 The advantage of the embodiment of FIG. 44 that it eliminates a long waveguide and the losses that occur when using a long waveguide.
  • the suction housing would fit over the PZT stack and the ultrasonic horn.
  • Certain useful ultrasound elements are depicted in U.S. Pat. No. 5,725,494 to Brisken, U.S. Pat. No. 5,069,664 to Zalesky, U.S. Pat. No. 5,269,291 and U.S. Pat. No. 5,318,014 to Carter, the contents of which are expressly incorporated by reference in their entirety.
  • the proximal end of the ultrasonic catheter of the present invention may be configured according to the schematic depicted in FIG. 45 .
  • Knobs 230 on a proximal housing 232 are coupled to control wires that are connected to the distal end of the device. These knobs operate to tension the control wires thereby manipulating the angle of the distal end.
  • Controls 234 for the steerable guide, such as gearing, pins, and shafts, are housed in the control box 236 on which the knobs are located.
  • the main body of the treatment device further comprises an outer shaft and an inner shaft connected to slide knob.
  • the inner shaft is operatively connected at the distal end of the device to the housing such that when the slide knob is retracted the housing is translated from a retracted position to an extended position, or vice versa.
  • a drive shaft or drive coil 230 that is operatively connected to an energy source or prime mover, for imparting motion to the drive coil.
  • Drive coil terminates in the distal end of the device at the working element that contacts the tissue to be treated.
  • the ultrasonic waveguide or transmission element may be positioned within the outer shaft and/or inner shaft.
  • the catheters will comprise a catheter body that comprises one or more lumens.
  • a drive shaft (or similar element) may extend from a proximal end of one of the lumens to the distal end of the lumen.
  • a distal working element may be coupled to (or formed integrally from) the drive shaft and will be configured to extend at least partially beyond a distal end of the catheter body.
  • the proximal end of the drive shaft may be coupled to a source of mechanical motion (rotation, oscillation, and/or axial movement) to drive the drive shaft and distal working element.
  • the catheters of the present invention may use a variety of configurations to decalcify the leaflet. Some examples of the working elements and distal ends of the catheter body that may be used are described below.
  • the distal end of the catheter 240 comprises a suction housing 242 that may be used to contact and/or isolate the leaflet that is being decalcified. While the suction housing is illustrated as a funnel shaped element, in alternative embodiments, the suction housing may be of a similar shape as the leaflets that are to be treated (as described above).
  • the suction housing 242 may be fixedly coupled to the distal end of the catheter body 240 or it may be movably coupled to the distal end portion. In such movable embodiments, the suction housing may be moved from a retracted position (not shown), in which the suction housing is at least partially disposed within the lumen of the catheter body, to an expanded configuration (shown below).
  • a mechanical clip, clamp or other fixation element may be used to localize the treatment device at the annulus or leaflet to be treated such as that depicted below, including an element placed from the retrograde direction and the antegrade direction to secure the leaflets.
  • the distal working element may comprise a rotatable, eccentrically loaded coil 250 .
  • the distal portion of the coil may taper in the distal direction and may comprise a ball 252 (or other shaped element) at or near its distal end.
  • one or more weighted elements may be coupled along various portions of the coil to change the dynamics of the vibration of the coil. As can be appreciated, if the weight is positioned off of a longitudinal axis of the coil, the rotation profile of the coil will change. Consequently, strategic placement of the one or more weights could change the vibration of the coil from a simple rotation, to a coil that also has an axial vibration component.
  • the working element may comprise an eccentrically loaded non-tapering coil 260 .
  • the coil may or may not comprise a ball or weight at its distal tip.
  • the distal coil may comprise an elongated distal wire tip 270 in which at least a portion extends radially beyond an outer diameter of the distal coil working element.
  • the distal wire tip may comprise one (or more) balls or weights.
  • the distal wire tip may be curved, straight or a combination thereof
  • the distal working element may comprise a “drill bit” type impeller or a Dremel type oscillating or rotating member at the distal tip that is configured to contact the calcification and mechanically remove the calcification from the leaflet.
  • such embodiments will be rotated and oscillated in a non-ultrasonic range of operation, and typically about 10 Hz to 20,000 Hz, preferably 100 Hz to 1000 Hz.
  • rotation of the shaped impellers will typically cause the calcification debris to be moved proximally toward the lumen in the catheter body.
  • the impeller may comprise rounded edges so as to provide some protection to the leaflets.
  • a sheath may cover the rotating elements to provide protection or to provide more directed force by transmitting the rotational and axial movements through the sheath.
  • the working elements may also comprise mechanically rotating devices.
  • an oval shaped burr 280 is shown that the orientation of which ranges from vertically aligned with the central axis of the device (rotating axis) to 90 degrees or more from the central axis of the device.
  • This off axis orientation allows a range of debridement locations and may be more applicable for certain situations, such as stenoses that are located eccentrically within the valve annulus, or to treat leaflet surfaces that are angled with respect to the central axis of the device.
  • Angulation of the treatment tip relative to the central axis of the treatment device facilitates fragmentation of the calcification by providing increased velocity at the tip region.
  • a similar arrangement is shown in FIG.
  • FIG. 52 shows a burr element 284 in the form of a disk having holes in the face of the disk to allow evacuation of debris through the burr element.
  • any mechanical working elements may have a roughened surface, a carbide tip material, or diamond coating to enhance fragmentation of the targeted material.
  • Representative burr elements are manufactured by several companies such as Ditec Manufacturing (Carpenteria, Calif.), Diamond Tool (Providence, R.I.), and Carbide Grinding Co. (Waukesha, Wis.).
  • an impeller element 290 ( FIG. 53 ) proximal to the aortic valve and not actually contact the leaflets.
  • the rotation of the impeller may cause a vortex to remove calcific material off of the leaflet and into the suction housing and catheter body.
  • the impeller may take a variety of forms such as the one described in U.S. Pat. No. 4,747,821 to Kensey, the contents of which are expressly incorporated herein by reference.
  • a rotating grinder head 292 may be coupled to the distal coil 294 .
  • the rotating grinder distal tip can take a variety of shapes. In the configuration illustrated below, the grinder distal tip is convex shaped and comprises a plurality of holes that are in a radial circular pattern around a central opening that is in communication with an axial lumen of the drive shaft. In such a configuration, the grinder distal tip is symmetrically positioned about the longitudinal axis of the distal coil and the rest of the drive shaft. The radial openings allow for irrigation and aspiration of particles.
  • the grinder distal tip may comprise abrasive material, such as diamond dust, to assist in removal of the calcific material from the aortic valve.
  • the grinder distal tip may comprise a flat pate 300 .
  • the flat grinder distal tip may comprise an abrasive material, holes, and/or machined protrusions or nubs. Such elements may be used to enhance the calcification removal from the leaflet.
  • a grinder distal tip 304 may be mounted eccentrically about the distal coil 306 so that upon rotation, the grinder tips may cover a greater surface area of the leaflet without having to enlarge the size of the grinder distal tip.
  • the figure below illustrates the flat grinder distal tip, but it should be appreciated that any of the distal tips described herein may be mounted eccentrically with the distal coil.
  • the distal working element may comprise a castellated mechanical tip, such as that shown above for the ultrasonic working element.
  • the castellated tip may have an impeller that is set back from the distal tip.
  • the present invention may use the Rotablator device that is described in U.S. Pat. No. 5,314,407 or 6,818,001, the complete disclosure of which are expressly incorporated herein by reference, to decalcify a leaflet.
  • the Rotablator (as shown below) may be used as originally described, or the distal tip may be modified by flattening the tip, applying diamond dust on the tip, making the distal tip more bulbous, or the like. See FIG. 58 which is taken from the '407 patent.
  • the air turbine used for the Rotablator may be used to power some or all of the aforementioned mechanically-based treatment catheters.
  • the air turbine provides an appropriate amount of torque and speed for disruption of calcium on the leaflets.
  • the torque and speed combined with a low moment of inertia of the drive shaft and distal tips of the present invention, reduce the risk of catastrophic drive shaft failure. For example, when the distal tip becomes “loaded” due to contact with the calcific deposits, the speed of rotation will reduce to zero without snapping or wrapping up the drive shaft.
  • the treatment catheter may comprise an optional sheath that surrounds the distal working element.
  • the sheath may comprise a spherical shaped distal tip 310 that surrounds the distal working element.
  • An elongated proximal portion is attached to the spherical distal tip and is sized and shaped to cover some or all of the drive shaft that is within the lumen of the catheter body.
  • the spherical shaped distal tip may comprise an opening 312 that will allow for the delivery of a media (e.g., contrast media, coolant, etc.) and/or for passageway of a guidewire.
  • the mechanical element or ultrasonic transmission element may extend beyond the tip of the sheath.
  • a similar depiction is shown in U.S. Pat. No. 6,843,797 to Nash, the contents of which are expressly incorporated herein by reference.
  • the sheath may comprise bellows or a flexible portion that allows for the end of the sheath to bend, extend, and/or retract.
  • the sheath will typically not rotate, and the sheath will typically be sized to allow the distal working element and the drive shaft to rotate within the sheath. Rotation of the distal working element within the sheath will articulate the sheath (which will depend on the shape and type of actuation of the drive shaft) and may create a “scrubbing effect” on the calcific deposits.
  • the sheath will transmit the mechanical motion of the drive shaft, while providing a layer of protection to the leaflets by controlling the oscillation of the working element.
  • the sheath may be made of a variety of materials as known in the art and reinforced in such a way as to withstand the friction from the rotation of the distal working element within the spherical distal tip Consequently, one useful material for the sheath is steel, or a braided or other catheter reinforcement technique.
  • a cooling fluid may be to decrease the heat energy seen by the tissue, and assist in the removal of debris during debridement.
  • a fluid may also assist with tissue fragmentation by providing a cavitation effect in either the ultrasonic embodiments or the mechanical embodiments.
  • the ultrasound treatment catheters and the mechanical treatment catheters comprise a lumen that runs through the catheter body to the distal end. It may be useful to deliver a media, such as a cooling fluid, an ultrasound contrast fluid, or the like, through the lumen to the target leaflet to amplify the effect of the energy delivery to the embedded calcific nodules on the leaflet.
  • the media may comprise microspheres or microbubbles.
  • One useful contrast media that may be used with the methods and treatment catheters of the present invention is the OptisonTM contrast agent (GE Healthcare).
  • OptisonTM contrast agent GE Healthcare
  • Delivery of the ultrasonic wave through the contrast media that contains the microbubbles can increase the amount of cavitation or fragmentation energy delivered to the leaflet. Applying suction during the procedure can also enhance the fragmentation energy as described by Cimino and Bond, “Physics of Ultrasonic Surgery using Tissue Fragmentation: Part I and Part II”, Ultrasound in Medicine and Biology, Vol. 22, No. 1, pp. 89-100, and pp. 101-117, 1996. It has been described that the interaction of gas bodies (e.g., microbubbles) with ultrasound pulses enhances non-thermal perturbation (e.g., cavitation-related mechanical phenomena). Thus, using a controlled amount of contrast agent with microbubbles may enhance the removal of the calcification from the leaflets.
  • gas bodies e.g., microbubbles
  • non-thermal perturbation e.g., cavitation-related mechanical phenomena
  • the contrast media may be used with an RF catheter or a piezoelectric-based catheter.
  • the catheter body may comprise two RF electrodes positioned at or near the distal end of the catheter.
  • the media with the microbubbles may be delivered to the target leaflet through the lumen of the catheter, and an RF energy may be delivered between two leads to deliver energy to the microbubbles.
  • wire leads will extend through, within (or outside) the lumen of the catheter body and will be coupled to a generator. If the wire leads are disposed within the lumen of the catheter body, the catheter may comprise an inner tube to insulate the wires. The media may be delivered through the inner lumen of the catheter body and exposed to the piezo film at the distal end of the catheter body, and the energy may be delivered from the piezo film and into the media with the microbubbles.
  • protection devices and methods may be used to trap and evacuate debris from the treatment site.
  • a filter device 336 is located on the shaft of a guide catheter 338 . This structure may also provide anchoring of the guide catheter in the aortic root to provide a stable access system to the valve or placing additional treatment catheters.
  • a filter device is deployed to protect the entire region of treatment and may include a systemic filtering device 340 such as those where blood and aspirate are removed from the arterial side of the vasculature, filtered and then infused back into the venous circulation, further details in U.S. Pat. No. 6,423,032 to Parodi, the disclosure of which is expressly incorporated herein by reference.
  • a suction port 342 surrounds the ultrasound probe 344 at the distal end of catheter 346 .
  • filtering applied more locally closer to the treatment site (e.g. one leaflet at a time), to protect local structures such as the ostium of the coronaries located just above the aortic valve.
  • a filtering device may be used in conjunction with treatment devices, such as the ultrasonic suction catheter shown in FIG. 64 , where filter device 350 covers a single leaflet which is also engaged by ultrasonic probe 352 at suction port 354 .
  • the filter shape may be optimized to access the most relevant leaflet or treatment site, as shown in FIG. 6 . Any of the above filtering or protection systems may be used with any of the treatment catheters disclosed herein.
  • Certain features of the present invention aid in directing, positioning and stabilizing the treatment catheter optimally at the site of the disease to be treated.
  • certain methods may be used to position the catheter.
  • the heart may be connected to a pacing lead and the heart then paced at an increased rate, for example 200 beats per minute, which then holds the aortic leaflets in a relatively fixed location arresting blood flow and allowing the treatment catheter of the present invention to be applied to at least one leaflet.
  • pacing is stopped, and the remaining leaflets not engaged by the catheter, function normally.
  • ICE intracardiac echocardiography
  • TEE transesophageal echocardiography
  • IVUS intravascular ultrasound
  • angioscopy infrared, capacitive ultrasonic transducers (cMUTs) available from Sensant, Inc./Seimens (San Leandro, Calif.) or other means known in the art.
  • the treatment catheter may have an imaging device integrated into the housing or treatment element catheter shaft, such as a phased array intravascular ultrasound element.
  • Imaging may become critical at various stages of the procedure, including diagnosing the type and location of the disease, placing the treatment catheter, assessing the treatment process, and verifying the function of the valve once it is treated.
  • Imaging devices may be placed locally at the treatment site, such as on the catheter tip, or catheter body, alongside the treatment catheter, or in more remote locations such as known in the art (e.g. superior vena cava, esophagus, or right atrium). If the imaging element is placed on the treatment catheter, it may be adapted to be “forward looking” e.g. image in a plane or multiple planes in front of the treatment device.
  • Elastography in this context may be performed using an intravascular ultrasound (IVUS) catheter, either a mechanical transducer or phased array system, such as those described in “Characterization of plaque components and vulnerability with intravascular ultrasound elastography” Phys. Med. Biol. 45 (2000) 1465-1475, the contents of which is expressly incorporated by reference herein.
  • IVUS intravascular ultrasound
  • the transducer may be advanced to a treatment site on the valve, and using either externally applied force, or “periodic excitation” of the tissue region either by externally applied force or the naturally occurring movement in the tissue itself (such as the opening and closing of the valve leaflets), an initial baseline reading can be taken.
  • This baseline could be set by engaging the region or leaflet to be treated with a suction catheter of the present invention (including circulating fluid within the treatment site), inserting an ultrasound transducer through the treatment catheter up to the treatment site, and interrogating the targeted region with the ultrasound transducer to establish the elasticity of the region (stress/strain profile).
  • infusion can then be stopped, putting the leaflet under additional stress (by suction alone) and the displacement in the stress/strain profile can be noted and evaluated to direct the treatment device to those locations showing less elasticity (“stiffer” regions indicating the presence of calcific deposits. See also those techniques set forth in “Elastography—the movement begins” Phys. Med. Biol. 45 (2000) 1409-1421 and “Selected Methods for Imaging Elastic Properties of Biological Tissues” Annu. Rev. Biomed. Eng. (2003) 5:57-78, the contents of which are expressly incorporated by reference herein.
  • the same transducer or fiber optic that is used to interrogate or image the region may also be used to break up or treat the underlying calcific deposits. Certain parameters may be adjusted to transition the therapy device from diagnostic to therapeutic, including frequency, power, total energy delivered, etc.
  • characterization techniques may be employed to both target the calcific region to be treated or assess the result of a treatment, including MRI, Doppler, and techniques that utilize resistivity data, impedance/inductance feedback and the like.
  • imaging and other monitoring techniques such as those described, can result in a more targeted procedure that focuses on removing calcific deposits and limits potential tissue damage to the leaflet and annulus that can lead to an unwanted proliferative response.
  • a variety of energy modalities may be used in the treatment catheters envisioned by the present invention. Those modalities more specifically useful for breaking down or obliterating calcific deposits may be ultrasonic energy, laser energy and the like. Specifically, some Er:YAG lasers may specifically target calcium when operated in appropriate ranges. Some detail of targeted bone ablation supports this as found in “Scanning electron microscopy and Fourier transformed infrared spectroscopy analysis of bone removal using Er:YAG and CO 2 lasers” J Periodontol. 2002 June;73(6):643-52, the contents of which are expressly incorporated by reference herein.
  • energy may be delivered to selectively remove tissue from around or over a calcium deposit by employing a resurfacing laser that selectively targets water-containing tissue resulting in controlled tissue vaporization, such as a high-energy pulsed or scanned carbon dioxide laser, a short-pulsed Er:YAG, and modulated (short-and-long-pulsed) Er:YAG system.
  • a resurfacing laser that selectively targets water-containing tissue resulting in controlled tissue vaporization, such as a high-energy pulsed or scanned carbon dioxide laser, a short-pulsed Er:YAG, and modulated (short-and-long-pulsed) Er:YAG system.
  • This application of energy may be useful for accessing plaque or calcium that is distributed between the leaflets (spongiosa).
  • tissue destruction may also be applied to the removal of scar tissue or regions of hypertrophy within the valve annulus as part of the
  • the ultrasonic treatment catheters of the present invention may be operated in ranges between 5 and 100 kHz, for example 10-50 kHz, with an oscillation rate in the range of 10-200 microns, for example 75-150 microns (maximum travel between 20-400 microns).
  • an oscillation rate in the range of 10-200 microns, for example 75-150 microns (maximum travel between 20-400 microns).
  • FIGS. 66 , 67 , and 68 A schematic depiction of these various positions with the valve are depicted in FIGS. 66 , 67 , and 68 , where FIGS. 67 and 68 are cross-sections along lines A-A and B-B of FIG. 66 , respectively.
  • the treatment catheters of the present invention may also be utilized to not only remove calcium, but also to remove or obliterate the leaflet itself, such as in preparation for implantation of a minimally invasive prosthetic valve, such as those disclosed in U.S. Pat. Nos. 5,840,081 and 6,582,462 to Anderson, US Patent Application 2004/0092858 to Wilson, PCT Publication WO 2004/093728 to Khairkhahan, WO 2005/009285 to Hermann and the like, the disclosures of which are expressly incorporated herein by reference.
  • Pre-treatment with devices of the present invention may facilitate placement of such prosthetic valves since removing calcium from the site of implantation may reduce perivalvular leak, dislodgement, and may result in a larger prosthesis being implanted due to an increased effective valve orifice.
  • devices may be provided which are temporarily or permanently implanted across or within the aortic valve.
  • the devices which appear below are all intended to remain for at least a period of time within the body after the repair of the stenosis has been completed in order to prevent or delay the valves from degenerating, by either recalcifying, fusion of leaflets, and restenosing.
  • An implant of the present invention is depicted in FIG. 67 in either a sub annular 360 or supra annular position 362 .
  • an implant such as the coil depicted below, to extend both sub annular and supra annular to provide additional support to the valve and provide a greater treatment area across the valve.
  • the coil design of this embodiment has a single strut that joins the two ring portions but is low profile enough that is does not occlude the coronaries just above the valve annulus. See, FIG. 68 . Because of its open structure, the supra annular portion of the implant can extend above the coronaries into the aortic root for additional anchoring. See, FIG. 69 .
  • the implant may be formed of a wire, series of wire, or cellular structure similar to that used in peripheral or coronary stents. To better seat in the valve annulus, or below the valve, it may be advantageous to form the implant ring to follow the cusps of the valve, in a sinusoidal form.
  • the implant ring may have struts that extend to seat against the annulus of the valve to provide structure or further disseminate a pharmacologic coating at specific valve sites. See, FIGS. 70 , 71 , and 72 .
  • the implant may be formed of multiple loops, such as three loops 120 degrees from each other. See, FIGS. 73-76 .
  • the wire may have a diameter between 0.020′′ and 0.250′′ depending on the force desired.
  • the wire may be flat and the structure may include a mesh between the loops to provide a larger surface area for supporting the valve or delivery the pharmacologic agent.
  • the loops of this device may be moved distally and proximally in a cyclic way to further open the valve leaflets and disrupt plaque as a stand alone therapy.
  • the device may then be permanently implanted as detailed above. It may be desirable to recapture the device, either once the valve has been treated, or during positioning of the permanent implant to ensure proper placement.
  • a recapture device may be the delivery catheter from which the implant is deployed, or may include an expandable funnel on the distal end of a retrieval catheter or may include any number of mechanical devices including a grasper or a hook that mates with a hook on the implant, or grasps the implant at some point such that it may be drawn into the delivery sheath and removed from the body.
  • any of the implants described herein may have surface enhancements or coatings to make them radiopaque or echogenic for purposes of procedure assessment as is known in the art.
  • the devices described may be permanent, removable, or bio-erodable. They can incorporate anti-restenosis agents or materials such as those set forth above, in the form of coatings, holes, depots, pores or surface irregularities designed into or applied onto the devices.
  • the implants can be formed of certain calcification resistant materials such as those set forth in U.S. Pat. No. 6,254,635, the contents of which are expressly incorporated by reference herein. Further, implants of the present invention may be configured to emit a slight electrical charge.
  • Anti-restenosis agents which may be useful in this application may be chosen from any of the families of agents or energy modalities known in the art.
  • pharmaceutical agents or their analogues such as rapamycin, paclitaxel, sirolimus or nitric-oxide enhancing agents may be coated onto these devices using drug eluting coatings, incorporated into intentionally created surface irregularities or specific surface features such as holes or divots.
  • the devices may be designed for drug infusion through the incorporation of coatings or other surfaces to adhere the agents to the implants utilized to perform the procedures of the present invention, or may be prescribed for oral administration following procedures of the present invention.
  • a patient may be prescribed a dose of statins, ACE inhibitors or other drugs to prolong the valve function provided by the intervention.
  • FIGS. 77-89 represent various embodiments of systems intended for acute or sub-chronic procedures. These devices may be placed across the aortic valve and expanded to reopen the aortic valve, and then left in place for a period of time in order to expose the treated valve to anti-restenosis agents or energy modalities designed to facilitate the repair and/or to prevent restenosis.
  • the device shown in FIGS. 77 and 78 features mechanical vanes 400 which extend outward to engage and separate the fused leaflets at the commissures.
  • the vanes may be made of any suitable metal, plastic or combination.
  • vanes may be self expanding (made from nitinol or elgiloy, for instance) or they might be mechanically actuated using a pneumatic, hydraulic, threaded or other mechanical actuation system.
  • the vanes might be deformable members as shown above, or each vane might be made up of several more rigid parts connected at hinged portions to allow expansion and contraction of the unit.
  • the vanes may be designed with a cross section which is rectangular in shape, with the narrower edge designed to facilitate separation of fused leaflets and to fit within the commissures without impacting the ability if he valves to close. The wider face of these rectangular vanes would contact the newly separated edges of the leaflets.
  • the vanes might be designed to have more of a wing-shaped or other cross sectional shape to minimize turbulence within the bloodstream and to minimize trauma to the valve leaflets.
  • the device of FIGS. 79 and 80 shows a balloon system to be used in accordance with the inventive methods.
  • the balloon 410 may feature a plurality of holes 412 to be used for the infusion of anti-restenosis agents as described in more detail below. These holes maybe small enough to allow only a slight weeping of the agents to be infused, or they might be of a size which would allow more rapid infusion or a greater volume of infusate to be delivered.
  • the holes might be placed in even distribution around the circumference of the balloon, or they might be placed to align more directly with the location of the commissures.
  • the device of FIGS. 81 and 82 comprise a balloon system which combines features of FIGS. 77 and 78 with those of 79 and 80 .
  • Several balloons are placed such that each balloon aligns with a commissure 424 . Inflation of this device may allow continued perfusion of blood out of the heart and into the body which the device is in place. This in turn might low for more prolonged delivery of anti-restenosis agents.
  • Holes might be placed on the balloons of FIG. 3 similar to the description for the holes on the device in FIGS. 79 and 80 .
  • Anti-restenosis agents which may be useful in this application may be chosen from any of the families of agents or energy modalities known in the art.
  • pharmaceutical agents or their analogues such as rapamycin, paclitaxel, sirolimus or nitric-oxide enhancing agents may be coated onto any of the inventive devices using drug eluting coatings, incorporated into intentionally created surface irregularities or specific surface features such as holes or divots.
  • the devices may be designed for drug infusion through the incorporation of infusion channels and infusion holes in the work-performing elements of the devices such as the balloons or commissurotomy vanes shown in the drawings.
  • Radiofrequency energy delivery may be achieved by several different modalities and for different purposes.
  • Radiofrequency energy can be applied by energizing the commissurotomy vanes or by using the pores on the balloons to achieve a wet electrode.
  • Microwave, ultrasound, high frequency ultrasound energy or pulsed electric fields might be used by incorporating antennae or electrodes into the vanes, balloons or catheter shafts that support these work performing elements.
  • Cryotherapy can be achieved by circulating cooling fluids such as phase-change gases or liquid nitrogen through the work performing elements. Multiple modalities might be incorporated into a single device for achieving the goal of durable aortic valve repair.
  • This energy may be used to facilitate the valve repair, for instance by making easier the parting of fused leaflets.
  • the energy may be used to delay or prevent restenosis of the treated valve.
  • One example of the use of energy delivery for the prevention of restenosis is the use of pulsed electric fields to induce cellular apoptosis. It is known in the art that the application of pulses of electricity on the order of nanosecond duration can alter the intracellular apparatus of a cell and induce apoptosis, or programmed cell death, which is known to be a key aspect of the mechanism of action of the clinically proven anti-restenosis drugs such as paclitaxel or sirolimus.
  • agents or energy applications might be administered while the patient is in the catheterization lab, over the course of minutes to hours.
  • the devices may be designed to allow the patient to return to the hospital floor with the device in place, so that the infusion of agents or the application of energy could proceed over the course of hours or days.
  • devices may be provided which are temporarily or permanently implanted across or within the aortic valve.
  • the devices which appear below are all intended to remain for at least a period of time within the body after the repair of the stenosis has been completed in order to prevent or delay the valves from readhering to one another and restenosing.
  • the devices described may be permanent, removable, or bio-erodable. They can incorporate anti-restenosis agents or materials into coatings, holes, depots, pores or surface irregularities designed into or applied onto the devices
  • the struts 430 may be made of any suitable metal, plastic or combination as shown in FIGS. 83 and 84 . They may be self expanding (made from nitinol or elgiloy, for instance) or they might be mechanically actuated during implantation using a pneumatic, hydraulic, threaded or other mechanical actuation system and then locked into their final position prior to deployment of the device from the delivery system.
  • the struts might be deformable members as shown above, or each strut might be made up of several more rigid parts connected at hinged portions to allow expansion and contraction of the unit.
  • the struts may be designed with a cross section which is rectangular in shape, with the narrower edge designed to facilitate separation of fused leaflets and to fit within the commissures without impacting the ability if he valves to close. The wider face of these rectangular struts would contact the newly separated edges of the leaflets.
  • the struts might be designed to have more of a wing-shaped or other cross sectional shape to minimize turbulence within the bloodstream and to minimize trauma to the valve leaflets.
  • FIGS. 85-89 show alternate designs for the implantable device. It should be noted that any design for the implant which achieves the goals of providing long-term anti-restenosis agents or energy modalities to the treated regions of the repaired leaflets should be considered as subjects of this invention.
  • Anchoring elements which lie against the wall of theaorta and are generally contiguous with the strut the center of the aorta before reforming with the struts (as in FIGS. 85 and 86 ), or designs in which the struts themselves are the anchoring elements (as in FIGS. 87-89 ) are all embodiments of the subject invention.
  • the implantable and bio-erodable devices might all feature pharmaceutical agents or their analogues such as rapamycin, paclitaxel, sirolimus or nitric-oxide enhancing agents, which may be coated onto any of the inventive devices using drug eluting coatings, or incorporated into intentionally created surface irregularities or specific surface features such as holes or divots.
  • pharmaceutical agents or their analogues such as rapamycin, paclitaxel, sirolimus or nitric-oxide enhancing agents, which may be coated onto any of the inventive devices using drug eluting coatings, or incorporated into intentionally created surface irregularities or specific surface features such as holes or divots.
  • Additional anti-restenosis agents or energy modalities might be delivered separate from and/or in addition to those agents that are incorporated onto the implant, for instance as a feature of the delivery system.

Abstract

The present invention provides devices and methods for decalcifying an aortic valve. The methods and devices of the present invention break up or obliterate calcific deposits in and around the aortic valve through application or removal of heat energy from the calcific deposits.

Description

    CROSS-REFERENCES TO RELATED APPLICATIONS
  • This application is a divisional of U.S. patent application Ser. No. 11/299,246, filed Dec. 9, 2005, which claims the benefit of U.S. Provisional Application No. 60/635,275, filed Dec. 9, 2004; U.S. Provisional Application No. 60/662,764, filed Mar. 16, 2005; and U.S. Provisional Application No. 60/698,297, filed on Jul. 11, 2005; the entire contents of these applications are herein incorporated by reference for all purposes.
  • BACKGROUND OF THE INVENTION
  • Aortic valve stenosis is a common cardiac disease resulting in approximately 65,000 aortic valve replacement surgeries in the United States annually. Aortic valve stenosis can occur via several etiologies including rheumatic disease, congenital and degenerative calcific stenosis. In developing countries, rheumatic fever results in thickening and progressive immobility of the valve tissues. Calcific disease accounts for almost all of the cases of aortic stenosis in the United States and in developed nations where rheumatic disease is rare.
  • Over time, a build up of calcium can occur in the annulus of the valve, along the leaflet cusps and on or within the leaflets. This calcific material such as nodular calcific deposits may be superimposed on an underlying fibrotic aortic valve leaflet or calcific deposits may be diffusely distributed throughout the body (spongiosa) of the aortic valve leaflets. Although distribution and type of deposits may differ depending on valve geometry (bicuspid, tricuspid), the deposits generally contribute to leaflet immobility, thickening and other pathologies that lead to degenerative valve function. The presence and progression of this disease leads to a decreased functional area of the valve and dramatically reduced cardiac output.
  • In the late 1980s and early 1990s balloon dilation of the aortic valve, or valvuloplasty, became a popular therapy for aortic valve stenosis. Dilation of the aortic valve using large angioplasty balloons from either an antegrade (transeptal) or retrograde (aortic) approach resulted in improvements in left ventricular ejection fractions (increased cardiac output), decreases in pressure gradients across the valve, and increases in valve cross-sectional area. Various vavuloplasty balloon designs and other approaches, including energy based therapies, have been disclosed in U.S. Pat. No. 3,667,474 Lapkin, U.S. Pat. No. 4,484,579 Meno, U.S. Pat. No. 4,787,388 Hoffman, U.S. Pat. No. 4,777,951 Cribier, U.S. Pat. Nos. 4,878,495 and 4,796,629 to Grayzel, U.S. Pat. No. 4,819,751 Shimada, U.S. Pat. No. 4,986,830 Owens, U.S. Pat. Nos. 5,443,446 and 5,295,958 to Schturman, U.S. Pat. No. 5,904,679 Clayman, U.S. Pat. Nos. 5,352,199 and 6,746,463 to Tower, the disclosures of which are expressly incorporated herein by reference.
  • In addition, various surgical approaches to de-calcify the valve lesions were attempted utilizing ultrasonic devices to debride or obliterate the calcific material. Such devices include the CUSA Excel™ Ultrasonic Surgical Aspirator and handpieces (23 kHz and 36 kHz, Radionics, TYCO Healthcare, Mansfield, Mass.). Further work, approaches and results have been documented in “Contrasting Histoarchitecture of calcified leaflets from stenotic bicuspid versus stenotic tricuspid aortic valves,” Journal of American College of Cardiology 1990 April;15(5):1104-8, Ultrasonic Aortic Valve Decalcification: Serial Doppler Echocardiographic Follow Up” Journal of American College of Cardiology 1990 September; 16(3): 623-30, and “Percutaneous Balloon Aortic Valvuloplasty: Antegrade Transseptal vs. Conventional Retrograde Transarterial Approach” Catheterization and Cardiovascular inverventions 64:314-321 (2005), the disclosures of which are expressly incorporated by reference herein.
  • Devices and techniques have suffered from only a modest ability to increase valve cross-sectional area, however. For instance, many studies showed that a pre-dilatation area of about 0.6 cm2 could be opened to only between about 0.9 to about 1.0 cm2. It would be desirable to open such a stenosis to an area closer to about 1.2 to about 1.5 cm2. In addition to opening the cross-sectional area, it may be desirable to treat the leaflets and surrounding annulus to remove calcific deposits that stiffen the valve, impair flow dynamics, and otherwise degenerate valve function. Toward this end, other techniques such as direct surgical ultrasonic debridement of calcium deposits have had some success, but required an open surgical incision, thereby increasing the risk to the patient.
  • Although balloon dilatation offered patients a viable, less invasive alternative, it fell into disfavor in the early to mid 1990s primarily as a result of rapid restenosis of the valve post treatment. At six months, reports of restenosis rates were commonly in excess of 70-80%. Today, balloon valvuloplasty is primarily reserved for palliative care in elderly patients who are not candidates for surgical replacement due to comorbid conditions.
  • Recent clinical focus on technologies to place percutaneous valve replacement technologies have also caused some to revisit valvuloplasty and aortic valve repair. Corazon, Inc. is developing a system which isolates the leaflets of the aortic valve so that blood flow through the center of the device is preserved while calcium dissolving or softening agents are circulated over and around the leaflets. See for example, United States Patent Application Publication 2004/0082910, the disclosure of which is expressly incorporated herein by reference. The hope is that reducing the stiffness of the leaflets by softening the calcium will allow for more normal functioning of the valve and increased cardiac output. The system is complex, requires upwards of 30 minutes of softening agent exposure time, and has resulted in complete AV block and emergency pacemaker implantation in some patients.
  • In addition, other technologies have been documented to address aortic stenosis in various ways. U.S. Patent Application Publication 2005/007219 to Pederson discloses balloon materials and designs, as well as ring implants for use in vavuloplasty and treatment of aortic stenosis, the disclosure of which is expressly incorporated herein by reference. Further, Dr. Pederson recently presented initial results of the RADAR study for aortic valve stenosis therapy. This study combines traditional balloon valvuloplasty with external beam radiation to try to prevent the restenosis which occurs post-dilatation. While radiation therapy has been shown to have a positive impact on restenosis in coronary angioplasty, the methods employed in the RADAR study require that the patient undergo a minimum of 4-6 separate procedures, the initial valvuloplasty plus 3-5 separate radiation therapy sessions. These radiation therapy sessions are similar to those used for radiation treatment for cancer.
  • Over the past three years, dramatic advances in the prevention of restenosis after coronary balloon angioplasty and stenting have been made by the introduction of drug-eluting stents by companies like Boston Scientific and Johnson & Johnson. These devices deliver a controlled and prolonged dose of antiproliferative agents to the wall of the coronary artery in order to manage the sub-acute wound healing and prevent the long-term hyperproliferative healing response that caused restenosis in bare metal stents or in stand-alone angioplasty. Furthermore, various advances have been made on the administration of anti-calcification drugs, including ACE inhibitors, statins, and angiotensins, specifically angiotensin II, as detailed in United States Patent Application Publication 2004/0057955, the disclosure of which is expressly incorporated herein by reference.
  • While the conventional methods have proven to be reasonably successful, the problem of aortic valve stenosis and subsequent restenosis after valvuloplasty or other intervention still requires better solutions. The present invention provides various devices and methods that create more effective treatments for aortic stenosis and prevent or reduce the incidence and/or severity of aortic restenosis. In addition, the present inventions provides methods and devices for decalcification or debridement of aortic stenosis, either as a stand alone therapy or in conjunction with conventional techniques, such as traditional valvuloplasty, stenting, valve repair, and percutaneous or surgical valve replacement.
  • BRIEF SUMMARY OF THE INVENTION
  • The present invention relates to the repair of aortic and other cardiac valves, and more particularly devices and methods for calcium removal and anti-restenosis systems for achieving such repair. The invention can take a number of different forms, including apparatus, acute interventions performed at the time of the aortic repair or valvuloplasty, or temporary or permanent implant, and the like.
  • In one aspect, the methods and devices of the reduce or remove calcifications on or around the valve through application or removal of energy to disrupt the calcifications. The present invention may apply ultrasound energy, RF energy, a mechanical energy, or the like, to the valve to remove the calcification from the valve. Alternatively, it may be desirable to instead remove energy (e.g. cryogenically cooling) from the calcification to enhance the removal of the calcification from the valve. In all cases, it will be desirable to create an embolic containment region over a localized calcific site on or near the cardiac valve. Such containment may be achieved by creating a structure about the localized site and/or by actively aspirating embolic particles from the site as they are created. Suitable structures include filters, baskets, balloons, housings and the like.
  • In another aspect of the present invention, treatment catheters are provided to deliver a working element to the vicinity of the diseased valve. Working element can include an ultrasonic element, or any other delivery mechanism or element that is capable of disrupting, e.g., breaking up or obliterating calcific deposits in and around the cardiac valve. Such devices may be steerable or otherwise positionable to allow the user to direct the distal end of the catheter grossly for initial placement through the patient's arteries to the valve, and then precisely adjust placement prior to and/or during treatment.
  • In another aspect, the present invention provides a treatment catheter that comprises a mechanical element that can disrupt, e.g., mechanically break up, obliterate, and remove the calcific deposits in and around the aortic valve. Similar to the ultrasonic-based catheters, the catheter comprising the mechanical element may be steerable or otherwise articulable to allow the user to direct the distal end of the catheter grossly for initial placement, and then fine tune placement during treatment.
  • In a further aspect of the present invention, systems including a guide catheter may also be employed to position the treatment catheter at the site of the disease to be treated, either as a separate catheter or as part of the treatment device. In one embodiment, a main guide catheter may be used to center a secondary positioning catheter that contains the treatment catheter over the aortic valve. The treatment catheter may then be further articulated to provide even further directionality to the working end. Various other apparatus and methods may be employed for positioning and stabilizing the treatment catheter, including shaped balloons, baskets or filters and methods of pacing the heart.
  • In a further aspect of the present invention, methods may be used to disrupt the calcified sites and trap and evacuate emboli and other debris from the treatment site, using filters located on the treatment catheter, suction housings located on the treatment catheter, perfusion balloons linked with aspiration devices, separate suction catheters, separate filter devices either at the treatment site or downstream from the treatment site, and/or external filter and perfusion systems. Certain filter embodiments may be shaped to allow the treatment catheter to access the location to be treated, while still allowing flow through the valve (e.g. treating one leaflet at a time).
  • In particular, methods for treating cardiac valves according to the present invention comprise creating an emboli containment region over a calcific site and delivering energy (including cryotherapy) to disrupt said site and potentially create emboli which are contained in the containment region. The containment regions will typically be localized directly over a target site, usually having a limited size so that the associated aorta or other blood vessel is not blocked or occluded. The containment region may be created using a barrier, such as a filter structure, basket, or balloon over the calcified site. Alternatively or additionally, the containment region may be created by localized aspiration to remove substantially all emboli as they are formed. The energy applied may be ultrasound, radiofrequency, microwave, mechanical, cryogenic, or any other type of energy capable of disrupting valve calcifications.
  • In a further aspect of the present invention, the methods may virtually disintegrate the calcification through the use a media that contains microspheres or microbubbles, such as Optison™ sold by GE Healthcare (www.amershamhealth-us.com/optison/). Delivery of an ultrasound energy (or other foam of energy, for example, laser, RF, thermal, energy) to the media may cause the microspheres to rupture, which causes a release of energy toward the valve, which may help remove the calcification around and on the valve. Bioeffects Caused by Changes in Ascoustic Cavitation Bubble Density and Cell Concentration: A Unifed Explanation Based on Cell-to-Bubble Ratio and Blast Radius, Guzman, et al. Ultrasound in Med. & Biol., Vol. 29, No. 8, pp. 1211-1222 (2003).
  • Certain imaging and other monitoring modalities may be employed prior to, during or after the procedure of the present invention, utilizing a variety of techniques, such as intracardiac echocardiography (ICE), transesophageal echocardiography (TEE), fluoroscopy, intravascular ultrasound, angioscopy or systems which use infrared technology to “see through blood”, such as that under development by Cardio-Optics, Inc.
  • Various energy sources may be utilized to effect the treatment of the present invention, including RF, ultrasonic energy in various therapeutic ranges, and mechanical (non-ultrasound) energy. The distal tips of the RF, ultrasonic treatment catheters, and mechanical treatment catheters of the present invention may have a variety of distal tip configurations, and be may be used in a variety of treatment patterns, and to target specific locations within the valve.
  • In addition, intravascular implants are contemplated by the present invention, including those placed within the valve annulus, supra annular, sub annular, or a combination thereof to assist in maintaining a functional valve orifice. Such implants may incorporate various pharamacological agents to increase efficacy by reducing restenosis, and otherwise aiding valve function. Implants may be formed of various metals, biodegradable materials, or combinations thereof.
  • These devices may all be introduced via either the retrograde approach, from the femoral artery, into the aorta and across the valve from the ascending aorta, or through the antegrade approach—transeptal, across the mitral valve, through the left ventricle and across the aortic valve.
  • In other aspects, the present invention provides an anti-restenosis system for aortic valve repair. Acute interventions are performed at the time of the aortic repair or valvuloplasty and may take the form of a temporary or permanent implant.
  • These implant devices may all be introduced via either the retrograde approach, from the femoral artery, into the aorta and across the valve from the ascending aorta, or through the antegrade approach—trans-septal, across the mitral valve, through the left ventricle and across the aortic valve, and will provide for delivery of anti-restenosis agents or energy to inhibit and/or repair valve restenosis.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • FIG. 1 illustrates a suction catheter constructed in accordance with the principles of the present invention.
  • FIG. 2 is a cross-sectional view of the catheter of FIG. 1.
  • FIGS. 3 and 4 are detailed views of the distal end of the catheter of FIG. 1, with FIG. 4 showing a suction housing in an expanded configuration.
  • FIG. 5 is similar to FIG. 4, showing the catheter without a guidewire.
  • FIGS. 6-8 show modified suction housings.
  • FIGS. 9 and 10 show suction housings having different depths.
  • FIGS. 11-13 show suction housings having rigid or semi-rigid members around their circumferences.
  • FIG. 14 shows a suction catheter having a stabilizing structure near its distal end.
  • FIG. 15 illustrates how a guiding catheter would be used to place the catheters of the present invention above a treatment area.
  • FIGS. 16 and 17 show how suction catheters would be placed through the guide catheters.
  • FIGS. 18-22 illustrate the use of treatment catheters having ultrasonic probes for decalcifying leaflets in accordance with the principles of the present invention.
  • FIG. 23 illustrates a catheter having a distal portion shaped to correspond to a shape of a targeted valve leaflet.
  • FIG. 24 illustrates a catheter having a distal end with an annular treatment surface adapted to apply energy to a valve annulus.
  • FIGS. 25A-25D illustrate catheters having different working ends in accordance with the principles of the present invention.
  • FIGS. 26-28 illustrate catheters having ultrasonic transmission members and enlarged working ends.
  • FIGS. 29-31 illustrate catheters having enlarged distal working ends with central lumens therethrough.
  • FIGS. 32 and 33 illustrate catheters having ultrasonic transmission elements adjacent a working end.
  • FIGS. 34-37 illustrate different patterns of motion which may be imparted by the electronic catheters of the present invention.
  • FIG. 38 illustrates a catheter having a force limiting feature.
  • FIGS. 39 and 40 illustrate a catheter having a deflectable distal end.
  • FIGS. 41 and 42 illustrate treatment catheters being advanced through a sheath.
  • FIG. 43 illustrates an ultrasonic catheter having a distal horn and a PZT stack.
  • FIG. 44 illustrates a suction housing placed over a PZT stack and ultrasonic horn in an embodiment of the present invention.
  • FIG. 45 illustrates a proximal housing for steering a distal end of the catheters of the present invention.
  • FIG. 46 illustrates use of a pair of suction catheters for treating a valve in accordance with the principles of the present invention.
  • FIG. 47 illustrates a catheter having an eccentrically loaded coil in the working end thereof
  • FIGS. 48 and 49 show variations on the coil of FIG. 47.
  • FIGS. 50-52 illustrate catheters having mechanical elements in their distal ends.
  • FIGS. 53 and 54 show catheters having distal impellers and grinders.
  • FIGS. 55-57 illustrate catheters having disk-like grinders with abrasive surfaces.
  • FIGS. 58 and 59 illustrate rotating burrs which may be placed in the distal end of the catheters of the present invention.
  • FIG. 60 illustrates a catheter having a piezoelectric film element in its distal end.
  • FIGS. 61 and 62 show guiding catheters having filter elements at their distal ends which are used for introducing the catheters of the present invention.
  • FIG. 63 illustrates a filter device deployed to protect an entire region of treatment.
  • FIG. 64 illustrates a filter device covering a single leaflet.
  • FIG. 65 shows a filter shape optimized for a leaflet at the treatment site.
  • FIGS. 66-68 show catheter positions optimized for reducing calcium deposits.
  • FIG. 69 shows a device having an open lattice structure.
  • FIGS. 70-72 show implants formed from lattice wire structures.
  • FIGS. 73-76 illustrate implants having multiple loops.
  • FIGS. 77-80 show embodiments of the present invention for delivering drugs to the target treatment sites.
  • FIGS. 81 and 82 illustrate catheters having balloons with both drug release capability and blood perfusion capability.
  • FIGS. 83 and 84 show implantable devices having deployable struts.
  • FIGS. 85 and 86 show implantable devices having anchoring elements which lie against the wall of the aorta.
  • FIGS. 87-89 show embodiments where the device struts also provide for anchoring.
  • DETAILED DESCRIPTION OF THE INVENTION Treatment Catheter Design—General
  • Treatment catheters 10 (FIG. 1) of the present invention typically comprise an elongate catheter body 12 that comprises a proximal end 14, a distal end 16, and one or more lumens 18, 20 (FIG. 2) within the catheter body. The distal end 16 may optionally comprise a suction housing 22 (FIGS. 4 and 5) that extends distally from the distal end of the catheter body 12 for isolating the leaflet during treatment as well as providing a debris evacuation path during treatment and protecting the vasculature from adverse embolic events. An energy transmission element 24 (e.g., a drive shaft, wire leads, or a waveguide-ultrasonic transmission element, or the like) may be positioned in one of the lumens in the elongate body 12 and will typically extend from the proximal end to the distal end of the catheter body. A handle 26 is coupled to the proximal end 14 of the elongate catheter body 12. A generator (e.g., RF generator, ultrasound generator, motor, optical energy source, etc.) may be coupled to the handle to deliver energy to a distal waking end 28, the energy transmission element 24 that is disposed within a lumen of the catheter body. As described herein, the distal working element 28 may be coupled to the distal end of the energy transmission element 24 to facilitate delivery of the energy to the calcification on the aortic valve.
  • Typically, the treatment catheters 10 of the present invention are configured to be introduced to the target area “over the wire.” The treatment catheters may be positioned adjacent the aortic valve through a guide catheter or sheath. As such, the treatment catheters of the present invention may comprise a central guidewire lumen 20 for receiving a guidewire GW (FIG. 2). The guidewire lumen 20 of the treatment catheters of the present invention may also be used for irrigating or aspirating the target area. For example, while not shown, the handle may comprise one or more ports so as to allow for irrigation of the target leaflet and/or aspiration of the target area. An irrigation source and/or an aspiration source may be coupled to the port(s), and the target area may be aspirated through one of the lumen of the catheter and/or irrigated through one of the lumens of the catheter. In one embodiment, one of the irrigation source and aspiration source may be coupled to the central guidewire lumen (central lumen) and the other of the aspiration source and the irrigation source may be coupled to the lumen that is coaxial to the guidewire lumen. In some embodiments, however, there will be no inner guidewire lumen and the guidewire will simply extend through the ultrasound waveguide and the rotatable drive shaft, as shown in FIGS. 3, 4 and 6.
  • As noted above, the treatment catheters 10 of the present invention may comprise a suction housing positioned at the distal end of the catheter body having an expanded configuration and a retracted configuration and configured to conform to the valve leaflet to be treated. While the suction housing 22 may be fixedly attached at the distal end, in preferred embodiments, the suction housing is movable between a retracted configuration (FIG. 3) and an expanded configuration (FIGS. 4 and 5). A separate sheath may also be retracted to expose the suction housing and advanced to fold the housing. The suction housing may be made from silicone or urethane and may be reinforced with an internal frame or mesh reinforcement to provide structural support or to enhance placement of the housing on a specified area of the valve leaflet. The housing may further act as an embolic filter as detailed later in this specification.
  • In the embodiment of FIG. 4, the energy transmission element 24 is advanced beyond the distal end of the catheter body 12 and into the suction housing 22. The guidewire GW is positioned through an opening in the distal tip. As in FIG. 5, once the treatment catheter is positioned at the target area, the guidewire GW is withdrawn and the distal working element 28 is ready for use to treat the calcification.
  • In FIG. 6, the suction housing 22 is shaped to substantially conform to the shape of a bicuspid valve leaflet. By shaping the suction housing to conform to the shape of the leaflet, the suction housing may be better configured to isolate the target leaflet. In other embodiments, the suction housing may be shaped to substantially conform to a tricuspid valve (FIGS. 7 and 8), etc.
  • The depth of the suction housing may take many forms such that it is compatible with the valve to be treated. For example, the suction housing 22 may be shallow (FIG. 9) or deep (FIG. 10). The depth on the cup can reduce or eliminate obstructing the coronary ostia if one of the leaflets under treatment is a coronary leaflet.
  • The suction cups/housings may also have rigid or semi-rigid members around the circumference or part of the circumference of the housing to preferentially align the cup on certain valve features, such as the annulus. The suction cup housings have a depth range of 0.1″ to 0.5″ and a diameter of 15 mm to 30 mm. The cup or housing may have fingers 30 or longitudinal stabilizing elements 32 to assist in placing the housing against the valve as shown in FIGS. 11, 12, and 13.
  • Such stabilizing elements may also be in the form of pleats, rings or hemispherical elements, or other reinforcements to assist the device to seat within the annulus of the valve or against the leaflet. Such reinforcements or stabilizing elements may be formed of stainless steel, NiTi (superelastic or shape memory treated), Elgiloy®, cobalt chromium, various polymers, or may be in the form of an inflatable ringed cup. The cup or housing of the present invention is intended to function to provide sufficient approximation with the treatment area so as to stabilize or localize the working element while also minimizing embolic events. It that sense, it is substantially sealing against the treatment region, but such seal is not necessarily an “airtight” seal, but an approximation that performs the desired functions listed above.
  • In addition, certain stabilizing devices 36, 38 may be located on the main catheter shaft 12 to provide stability within the aorta, and may, in some cases, extend through the valve leaflets L below the valve to further stabilize the treatment device, as shown in FIG. 14.
  • Given the variety of leaflet geometries (e.g. size, curvature) from leaflet to leaflet, and patient to patient, it may be desirable to provide a main treatment catheter through which a variety of sized and shaped cups or housings can be passed, depending on the particular geometry to be treated. For example, a system could include a main guide catheter GC placed over the treatment area as depicted in FIG. 15: The treatment area (leaflets) include the coronary leaflet (CL), the non-coronary leaflet (NCL) and the non-coronary leaflet (center) (NCLC). As shown below in FIG. 16, once the guide catheter GC is in place a first treatment catheter 40 having a distal housing 42 adapted to conform to the NCL is advanced as indicated by arrow S1. The leaflet is treated and the NCL housing catheter is withdrawn as indicated by S2. The guide catheter position is then adjusted as indicated by arrow S3 to better approximate the CL. CL housing catheter is the advanced through the guide as indicated by arrow S4. Once the CL position is treated, the CL housing catheter is removed as indicated by arrow S5. As further depicted in FIG. 17, the guide catheter GC is then repositioned to treat NCLC as indicated by arrow S6, and finally the NCLC housing catheter is advanced through the guide according to arrow S7. Once the treatment is complete, the NCLC is removed as indicated by arrow S8 and the guide is removed and procedure completed.
  • It is within the scope of the present invention to use any one of these steps, in any order to treat the targeted region, for example, one leaflet may be treated only, more than one leaflet, and in any order according to the type of calcification, health of the patient, geometry of the target region or preference of the operator.
  • Ultrasound Treatment Catheters
  • In accordance with one aspect of the present invention a treatment catheter 50 is provided having an ultrasonic probe for decalcifying the leaflet. An ultrasonic probe 52 may be surrounded by a frame or sheath 54. Both the frame and the sheath may be connected to a source of ultrasonic vibration (not shown). In certain embodiments, the probe 52 is surrounded by a sheath or housing that enables the system to be substantially sealed against the treatment surface via a source of suction attached at the proximal end of the catheter system and connected to the catheter housing via a suction lumen in the catheter body. Alternatively, the system may be placed or localized at the treatment site with a mechanical clip or interface that physically attaches the housing to the treatment area (annulus or leaflet). In operation, the ultrasonic probe 52 is activated to disintegrate the calcium on the leaflets, creating debris that may then be removed through a suction lumen in the catheter body 50. In some cases it may be desirable to also infuse saline or other fluids into the housing area simultaneously or prior to application of suction. It may be advantageous to provide a cooling fluid to the ultrasonic waveguide as well and to other embodiments such as one with a PZT stack at the distal end of the device. It may also be advantageous to infuse anti-calcification therapy to the site of the valve, including a ferric and/or stannic salt, or other solution as in known in the art to tan or otherwise make the leaflets resistant to calcium buildup, such as the type set forth in U.S. Pat. No. 5,782,931, the contents of which is expressly incorporated by reference herein. Another embodiment of an ultrasonic probe 60 having a silicone cup is shown in FIG. 19 where infusate is indicated by arrows 62 and aspirate is indicated by arrows 64.
  • In embodiments where a filter device 74 is disposed on the main catheter shaft (shown in FIG. 20), the ultrasonic probe 70 may be a separate element, allowing the ultrasonic treatment catheter 72 to move independently within the sealed region. The treatment probe 70 may be operated in a variety of directions and patterns that are further detailed in the specification, including sweeping in a circular pattern along the cusp of each leaflet and creating concentric circles during treatment to effectively treat the entire leaflet, if necessary. In the absence of a filter device, the ultrasonic element may be coaxial with the suction housing and adapted to move independently therewithin.
  • As shown in FIG. 21, in accordance with another aspect of the present invention, a treatment catheter 80 may be placed through a series of guide catheters 82, 84 to assist placement accuracy. The first guide member 84 may be placed and anchored in the aortic root using either the shape of the guide to anchor against the aortic wall, or a separate balloon or filter device to stabilize the guide or a stabilizing ring made from shape memory material or other suitable material that can provide stabilization to allow the catheter to be directed to the treatment site. A second steerable or articulable catheter 82 may then be placed through the initial guide to direct the treatment catheter to one area of the leaflet or other. The treatment catheter 80 may then be placed through the system once these guides are in place, and deployed directly to the targeted valve region. In the case of a method that treats one leaflet at a time, the steerable guide may then be actuated to target the next treatment location, thereby directing the treatment catheter (and related filtering devices) to the next site. It may only be necessary to place one guide catheter prior to the treatment catheter, or alternatively, the treatment catheter may be steerable, allowing it to be placed directly to the treatment site without the aid of other guide catheters. The guide catheter may also be steerable and an integral part of the treatment catheter. Steerable guides such as those depicted in US Patent Publications 2004/0092962 and 2004/0044350 are examples, the contents of which is expressly incorporated by reference in its entirety. Treatment device may then re-directed to a second treatment site, as shown in FIG. 22.
  • The distal portion 90 of the treatment catheters of the present invention may be shaped to substantially correspond to a shape of the targeted leaflet L (e.g., formed to fit within shape of the leaflet cusp, with the mouth of the housing being shaped to conform to the leaflet shape as shown in FIG. 23). This also enables the surface of the leaflet to be stabilized for treatment. The distal portion may have an internal frame that supports the distal section during deployment and treatment but is flexible such that it collapses into the treatment catheter or sheath to assist with withdrawal.
  • Alternatively, the treatment catheter 100 of the present invention may be formed having a circumferential, annular treatment 102 surface to apply energy/vibration to the annulus to be treated. In this embodiment the catheter may be placed antegrade or retrograde, or two circumferential treatment surfaces may be used in conjunction with each other, as shown in FIG. 24.
  • Various ultrasonic working ends may be used, depending on the type and location of the disease to be treated. For example, the distal tip of an ultrasonic catheter may be coupled to a ultrasound transmission member or waveguide. The distal tip may be chosen from the various examples below, including a blunt tip, a beveled tip, a rounded tip, a pointed tip and may further include nodules or ribs (FIG. 25C) that protrude from the surface of the tip to enhance breakup of calcium. Arrows show exemplary patterns of use.
  • The distal tip of the ultrasonic catheters of the present invention may also take the shape of the waveguide tips that are shown and described in U.S. Pat. No. 5,304,115, the contents of which is expressly incorporated by reference herein. U.S. Pat. No. 5,989,208 (“Nita”), the contents of which is expressly incorporated by reference herein, illustrate some additional tips in FIGS. 2-7A that may also be useful for decalcifying a valve leaflet.
  • The ultrasound transmission members of the present invention may comprise a solid tube that is coupled to an enlarged distal working end. A central lumen may extend throughout the ultrasonic transmission member and may be used for aspiration, suction, and/or to receive a guidewire. In the embodiment illustrated in FIGS. 26, 27 and 28, the enlarged working end 110 (which has a larger diameter than the elongate proximal portion), may comprise a cylindrical portion that comprises a plurality of elongated members 112. In the illustrated configuration, the elongated members are arranged in castellated pattern (e.g., a circular pattern in which each of the elongated members extend distally) and provide an opening along the longitudinal axis of the ultrasound transmission member. While the elongated members are cylindrically shaped, in other embodiments, the elongated members may be rounded, sharpened, or the like.
  • In a further embodiment of the distal working end, similar to the embodiment illustrated above, a central lumen may extend through the ultrasound transmission element and through the enlarged distal working end. In the configuration illustrated in FIGS. 29, 30 and 31, the distal working end 120 is enlarged and rounded.
  • In alternative embodiments, the portion of the ultrasound transmission element (or waveguide) that is adjacent the distal working end may be modified to amplify the delivery of the ultrasonic waves from the working end. The waveguide may comprises a plurality of axial slots in the tubing that act to create a plurality of “thin wires” from the tubing, which will cause the ultrasonic waves to move radially, rather than axially. The enlarged distal working end may then be attached to the plurality of thin wires. Two embodiments of such a configuration are illustrated in FIGS. 32 and 33. In an alternative embodiment, each castellation may be housed on its own shaft extending back to the proximal end of the device. Other potential tip geometries are depicted below.
  • The ultrasonic catheters of the present invention may be adapted to impart motion to the distal tip that is oscillatory, dottering, circular, lateral or any combination thereof. For any of such distal tips described herein, Applicants have found that the use of a small distal tip relative to the inner diameter of the catheter body provides a better amplitude of motion and may provide improved decalcification. In addition, an ultrasonic tip of the present invention can be operated in a variety of treatment patterns, depending on the region of the leaflet or annulus that is being treated, among other things. For example, the treatment pattern, either controlled by the user programmed into the treatment device, may be a circular motion to provide rings of decalcification on the surface being treated, a cross-hatching pattern to break up larger deposits of calcium (FIG. 24), or a hemispherical (FIG. 36) or wedge-shaped (FIG. 37) pattern when one leaflet or region is treated at a time. It is within the scope of the present invention to use combinations of any of the patterns listed, or to employ more random patterns, or simply a linear motion.
  • Certain safety mechanisms may be incorporated on the treatment catheter and related components to ensure that the treatment device does not perforate or otherwise degrade the leaflet. In one embodiment, a force limiting feature may be incorporated into the treatment catheter shaft as shown in FIG. 38, where a structure 140 can contract in response to force applied to catheter 142 in the direction of arrows 144.
  • In another embodiment, features of the catheter shaft may limit the force that is delivered to the tissues. A soft distal tip 150 (FIG. 39) on a relatively rigid catheter shaft 152, where the forces can deflect the tip, as shown in FIG. 40.
  • In addition, the treatment catheter 200 may be advanced through a sheath 202 that acts as a depth limiter to the treatment catheter as shown in FIGS. 41 and 42. These various safety features may be incorporated into any of the treatment devices of the present invention, regardless of the energy employed.
  • An assembly of an ultrasonic catheter of the present invention is shown in FIG. 43, including an ultrasonic transmission member 210, a transmission-head 212, a guide wire GW, a suction cup 214, a spring 216, and catheter body 218.
  • Another embodiment of an ultrasonic catheter 220 includes a PZT stack 222 and a distal horn 224 at the distal end of the device as shown in FIG. 44
  • The advantage of the embodiment of FIG. 44 that it eliminates a long waveguide and the losses that occur when using a long waveguide. In this embodiment the suction housing would fit over the PZT stack and the ultrasonic horn. Certain useful ultrasound elements are depicted in U.S. Pat. No. 5,725,494 to Brisken, U.S. Pat. No. 5,069,664 to Zalesky, U.S. Pat. No. 5,269,291 and U.S. Pat. No. 5,318,014 to Carter, the contents of which are expressly incorporated by reference in their entirety.
  • The proximal end of the ultrasonic catheter of the present invention may be configured according to the schematic depicted in FIG. 45. Knobs 230 on a proximal housing 232 are coupled to control wires that are connected to the distal end of the device. These knobs operate to tension the control wires thereby manipulating the angle of the distal end. Controls 234 for the steerable guide, such as gearing, pins, and shafts, are housed in the control box 236 on which the knobs are located. The main body of the treatment device further comprises an outer shaft and an inner shaft connected to slide knob. In turn the inner shaft is operatively connected at the distal end of the device to the housing such that when the slide knob is retracted the housing is translated from a retracted position to an extended position, or vice versa. Further depicted in FIG. 45 is a drive shaft or drive coil 230 that is operatively connected to an energy source or prime mover, for imparting motion to the drive coil. Drive coil terminates in the distal end of the device at the working element that contacts the tissue to be treated. Alternatively, in designs utilizing ultrasound, the ultrasonic waveguide or transmission element may be positioned within the outer shaft and/or inner shaft.
  • Mechanical Treatment Catheter and Methods
  • In addition to ultrasound treatment catheters described above, the present invention further provides treatment catheters and methods that use mechanically activatable tips to mechanically disrupt or obliterate the calcium on the leaflets. In general, the catheters will comprise a catheter body that comprises one or more lumens. A drive shaft (or similar element) may extend from a proximal end of one of the lumens to the distal end of the lumen. A distal working element may be coupled to (or formed integrally from) the drive shaft and will be configured to extend at least partially beyond a distal end of the catheter body. The proximal end of the drive shaft may be coupled to a source of mechanical motion (rotation, oscillation, and/or axial movement) to drive the drive shaft and distal working element.
  • The catheters of the present invention may use a variety of configurations to decalcify the leaflet. Some examples of the working elements and distal ends of the catheter body that may be used are described below.
  • In one embodiment (FIG. 46), the distal end of the catheter 240 comprises a suction housing 242 that may be used to contact and/or isolate the leaflet that is being decalcified. While the suction housing is illustrated as a funnel shaped element, in alternative embodiments, the suction housing may be of a similar shape as the leaflets that are to be treated (as described above). The suction housing 242 may be fixedly coupled to the distal end of the catheter body 240 or it may be movably coupled to the distal end portion. In such movable embodiments, the suction housing may be moved from a retracted position (not shown), in which the suction housing is at least partially disposed within the lumen of the catheter body, to an expanded configuration (shown below). Alternatively, a mechanical clip, clamp or other fixation element may be used to localize the treatment device at the annulus or leaflet to be treated such as that depicted below, including an element placed from the retrograde direction and the antegrade direction to secure the leaflets.
  • In the configuration of FIG. 47, the distal working element may comprise a rotatable, eccentrically loaded coil 250. The distal portion of the coil may taper in the distal direction and may comprise a ball 252 (or other shaped element) at or near its distal end. Optionally, one or more weighted elements (not shown) may be coupled along various portions of the coil to change the dynamics of the vibration of the coil. As can be appreciated, if the weight is positioned off of a longitudinal axis of the coil, the rotation profile of the coil will change. Consequently, strategic placement of the one or more weights could change the vibration of the coil from a simple rotation, to a coil that also has an axial vibration component.
  • In another embodiment (FIG. 48), the working element may comprise an eccentrically loaded non-tapering coil 260. The coil may or may not comprise a ball or weight at its distal tip.
  • In yet another embodiment (FIG. 49), the distal coil may comprise an elongated distal wire tip 270 in which at least a portion extends radially beyond an outer diameter of the distal coil working element. As illustrated, the distal wire tip may comprise one (or more) balls or weights. The distal wire tip may be curved, straight or a combination thereof As an alternative to (or in addition to) the aforementioned distal coils, the distal working element may comprise a “drill bit” type impeller or a Dremel type oscillating or rotating member at the distal tip that is configured to contact the calcification and mechanically remove the calcification from the leaflet. As can be appreciated, such embodiments will be rotated and oscillated in a non-ultrasonic range of operation, and typically about 10 Hz to 20,000 Hz, preferably 100 Hz to 1000 Hz. In such configurations, rotation of the shaped impellers will typically cause the calcification debris to be moved proximally toward the lumen in the catheter body. In some configurations, the impeller may comprise rounded edges so as to provide some protection to the leaflets. In each of the above mentioned embodiments, a sheath may cover the rotating elements to provide protection or to provide more directed force by transmitting the rotational and axial movements through the sheath.
  • The working elements may also comprise mechanically rotating devices. In the embodiment of FIG. 50, an oval shaped burr 280 is shown that the orientation of which ranges from vertically aligned with the central axis of the device (rotating axis) to 90 degrees or more from the central axis of the device. This off axis orientation allows a range of debridement locations and may be more applicable for certain situations, such as stenoses that are located eccentrically within the valve annulus, or to treat leaflet surfaces that are angled with respect to the central axis of the device. Angulation of the treatment tip relative to the central axis of the treatment device facilitates fragmentation of the calcification by providing increased velocity at the tip region. A similar arrangement is shown in FIG. 51, but with a different shaped, more elongate burr 282. In addition, FIG. 52 shows a burr element 284 in the form of a disk having holes in the face of the disk to allow evacuation of debris through the burr element. It is within the scope of the present invention that any mechanical working elements may have a roughened surface, a carbide tip material, or diamond coating to enhance fragmentation of the targeted material. Representative burr elements are manufactured by several companies such as Ditec Manufacturing (Carpenteria, Calif.), Diamond Tool (Providence, R.I.), and Carbide Grinding Co. (Waukesha, Wis.).
  • In alternative methods, it may be possible to position an impeller element 290 (FIG. 53) proximal to the aortic valve and not actually contact the leaflets. The rotation of the impeller may cause a vortex to remove calcific material off of the leaflet and into the suction housing and catheter body. The impeller may take a variety of forms such as the one described in U.S. Pat. No. 4,747,821 to Kensey, the contents of which are expressly incorporated herein by reference.
  • In another configuration, a rotating grinder head 292 (FIG. 54) may be coupled to the distal coil 294. The rotating grinder distal tip can take a variety of shapes. In the configuration illustrated below, the grinder distal tip is convex shaped and comprises a plurality of holes that are in a radial circular pattern around a central opening that is in communication with an axial lumen of the drive shaft. In such a configuration, the grinder distal tip is symmetrically positioned about the longitudinal axis of the distal coil and the rest of the drive shaft. The radial openings allow for irrigation and aspiration of particles. In some configurations, the grinder distal tip may comprise abrasive material, such as diamond dust, to assist in removal of the calcific material from the aortic valve.
  • In another grinder distal tip configuration shown in FIGS. 55 and 56, the grinder distal tip may comprise a flat pate 300. The flat grinder distal tip may comprise an abrasive material, holes, and/or machined protrusions or nubs. Such elements may be used to enhance the calcification removal from the leaflet.
  • In an alternative configuration as shown in FIG. 57, a grinder distal tip 304 may be mounted eccentrically about the distal coil 306 so that upon rotation, the grinder tips may cover a greater surface area of the leaflet without having to enlarge the size of the grinder distal tip. The figure below illustrates the flat grinder distal tip, but it should be appreciated that any of the distal tips described herein may be mounted eccentrically with the distal coil.
  • In another embodiment, the distal working element may comprise a castellated mechanical tip, such as that shown above for the ultrasonic working element. Optionally, the castellated tip may have an impeller that is set back from the distal tip.
  • In yet another embodiment, the present invention may use the Rotablator device that is described in U.S. Pat. No. 5,314,407 or 6,818,001, the complete disclosure of which are expressly incorporated herein by reference, to decalcify a leaflet. The Rotablator (as shown below) may be used as originally described, or the distal tip may be modified by flattening the tip, applying diamond dust on the tip, making the distal tip more bulbous, or the like. See FIG. 58 which is taken from the '407 patent.
  • The air turbine used for the Rotablator may be used to power some or all of the aforementioned mechanically-based treatment catheters. The air turbine provides an appropriate amount of torque and speed for disruption of calcium on the leaflets. The torque and speed, combined with a low moment of inertia of the drive shaft and distal tips of the present invention, reduce the risk of catastrophic drive shaft failure. For example, when the distal tip becomes “loaded” due to contact with the calcific deposits, the speed of rotation will reduce to zero without snapping or wrapping up the drive shaft. As an alternative to the air turbine, it may also be possible to use a motor with an electronic feedback system that can sense torque and speeds such that the motor may be slowed down at appropriate times.
  • Some embodiments of the treatment catheter may comprise an optional sheath that surrounds the distal working element. As illustrated in FIG. 54, the sheath may comprise a spherical shaped distal tip 310 that surrounds the distal working element. An elongated proximal portion is attached to the spherical distal tip and is sized and shaped to cover some or all of the drive shaft that is within the lumen of the catheter body. The spherical shaped distal tip may comprise an opening 312 that will allow for the delivery of a media (e.g., contrast media, coolant, etc.) and/or for passageway of a guidewire. The mechanical element or ultrasonic transmission element may extend beyond the tip of the sheath. A similar depiction is shown in U.S. Pat. No. 6,843,797 to Nash, the contents of which are expressly incorporated herein by reference.
  • In some embodiments, the sheath may comprise bellows or a flexible portion that allows for the end of the sheath to bend, extend, and/or retract. The sheath will typically not rotate, and the sheath will typically be sized to allow the distal working element and the drive shaft to rotate within the sheath. Rotation of the distal working element within the sheath will articulate the sheath (which will depend on the shape and type of actuation of the drive shaft) and may create a “scrubbing effect” on the calcific deposits. Advantageously, the sheath will transmit the mechanical motion of the drive shaft, while providing a layer of protection to the leaflets by controlling the oscillation of the working element. The sheath may be made of a variety of materials as known in the art and reinforced in such a way as to withstand the friction from the rotation of the distal working element within the spherical distal tip Consequently, one useful material for the sheath is steel, or a braided or other catheter reinforcement technique.
  • In any of the mechanical embodiments, it may be desirable to circulate or inject a cooling fluid may be to decrease the heat energy seen by the tissue, and assist in the removal of debris during debridement. Such a fluid may also assist with tissue fragmentation by providing a cavitation effect in either the ultrasonic embodiments or the mechanical embodiments.
  • Virtual Decalcification Use of Microspheres and/or Microbubbles
  • As noted above, most embodiments of the ultrasound treatment catheters and the mechanical treatment catheters comprise a lumen that runs through the catheter body to the distal end. It may be useful to deliver a media, such as a cooling fluid, an ultrasound contrast fluid, or the like, through the lumen to the target leaflet to amplify the effect of the energy delivery to the embedded calcific nodules on the leaflet. In one preferred configuration, the media may comprise microspheres or microbubbles. One useful contrast media that may be used with the methods and treatment catheters of the present invention is the Optison™ contrast agent (GE Healthcare). Various depictions of techniques utilizing cavitation and/or microbubbles to enhance a therapeutic effect may be found in U.S. Pat. USRE036939 to Tachibana, and U.S. Pat. No. 6,321,109 to Ben-Haim, the contents of which are expressly incorporated by reference herein in their entirety.
  • Delivery of the ultrasonic wave through the contrast media that contains the microbubbles can increase the amount of cavitation or fragmentation energy delivered to the leaflet. Applying suction during the procedure can also enhance the fragmentation energy as described by Cimino and Bond, “Physics of Ultrasonic Surgery using Tissue Fragmentation: Part I and Part II”, Ultrasound in Medicine and Biology, Vol. 22, No. 1, pp. 89-100, and pp. 101-117, 1996. It has been described that the interaction of gas bodies (e.g., microbubbles) with ultrasound pulses enhances non-thermal perturbation (e.g., cavitation-related mechanical phenomena). Thus, using a controlled amount of contrast agent with microbubbles may enhance the removal of the calcification from the leaflets. A more complete description of the use of microbubbles with ultrasound energy is described in Guzman et al., “Bioeffects Caused by Changes in Acuostic Cavitation Bubble Density and Cell Concentration: A Unified Explanation Based on Cell-to-Bubble Ratio and Blast Radius,” Ultrasound in Med. & Biol., Vol. 29, No. 8, pp. 1211-1222, 2003 and Miller et al., “Lysis and Sonoporation of Epidermoid and Phagocytic Monolayer Cells by Diagnostic Ultrasound Activation of Contrast Agent Gas Bodies,” Ultrasound in Med. & Biol., Vol. 27, No. 8, pp 1107-1113, 2001, the complete disclosures of which are incorporated herein by reference.
  • It should be appreciated however, that the use of microbubbles are not limited to the ultrasound or mechanical treatment catheters. For example, as shown below, the contrast media may be used with an RF catheter or a piezoelectric-based catheter. In the RF catheter embodiment, the catheter body may comprise two RF electrodes positioned at or near the distal end of the catheter. The media with the microbubbles may be delivered to the target leaflet through the lumen of the catheter, and an RF energy may be delivered between two leads to deliver energy to the microbubbles. In some embodiments, it may be desirable to deliver RF energy to the calcification on the leaflets without the use of the microbubbles. In other embodiments, it may be desirable to use other types of energy sources to deliver energy to the leaflets.
  • As an alternative to RF electrodes, it may be possible to position a piezo film 330 at the distal tip of the catheter (FIG. 60). Wire leads will extend through, within (or outside) the lumen of the catheter body and will be coupled to a generator. If the wire leads are disposed within the lumen of the catheter body, the catheter may comprise an inner tube to insulate the wires. The media may be delivered through the inner lumen of the catheter body and exposed to the piezo film at the distal end of the catheter body, and the energy may be delivered from the piezo film and into the media with the microbubbles.
  • Protection
  • In a further aspect of the present invention, protection devices and methods may be used to trap and evacuate debris from the treatment site. In one embodiment shown in FIGS. 61 and 62, a filter device 336 is located on the shaft of a guide catheter 338. This structure may also provide anchoring of the guide catheter in the aortic root to provide a stable access system to the valve or placing additional treatment catheters.
  • In another embodiment (FIG. 63), a filter device is deployed to protect the entire region of treatment and may include a systemic filtering device 340 such as those where blood and aspirate are removed from the arterial side of the vasculature, filtered and then infused back into the venous circulation, further details in U.S. Pat. No. 6,423,032 to Parodi, the disclosure of which is expressly incorporated herein by reference. A suction port 342 surrounds the ultrasound probe 344 at the distal end of catheter 346.
  • It may be advantageous to have filtering applied more locally closer to the treatment site (e.g. one leaflet at a time), to protect local structures such as the ostium of the coronaries located just above the aortic valve. Such a filtering device may be used in conjunction with treatment devices, such as the ultrasonic suction catheter shown in FIG. 64, where filter device 350 covers a single leaflet which is also engaged by ultrasonic probe 352 at suction port 354. Further, the filter shape may be optimized to access the most relevant leaflet or treatment site, as shown in FIG. 6. Any of the above filtering or protection systems may be used with any of the treatment catheters disclosed herein.
  • Numerous features of the present invention aid in directing, positioning and stabilizing the treatment catheter optimally at the site of the disease to be treated. In addition to catheter and guide features, baskets, anchor or filter configurations that seat within the valve, certain methods may be used to position the catheter. For example, the heart may be connected to a pacing lead and the heart then paced at an increased rate, for example 200 beats per minute, which then holds the aortic leaflets in a relatively fixed location arresting blood flow and allowing the treatment catheter of the present invention to be applied to at least one leaflet. Following placement of the catheter, such as a suction housing, pacing is stopped, and the remaining leaflets not engaged by the catheter, function normally. In the event that all leaflets are engaged at once, it may be necessary to provide flow through the treatment catheter, such as in a perfusion balloon or device known in the art, some features of which are shown in U.S. Pat. No. 4,909,252 to Goldberg the disclosure of which is expressly incorporate by reference herein.
  • Imaging
  • Features of the present invention include various devices and methods for monitoring and imaging prior to, during and post procedure. Various imaging modalities may be employed for this purpose, including intracardiac echocardiography (ICE), transesophageal echocardiography (TEE), fluoroscopy, intravascular ultrasound (IVUS), angioscopy, infrared, capacitive ultrasonic transducers (cMUTs) available from Sensant, Inc./Seimens (San Leandro, Calif.) or other means known in the art. For example the treatment catheter may have an imaging device integrated into the housing or treatment element catheter shaft, such as a phased array intravascular ultrasound element. In some embodiments it may be advantageous to construct the device of the present invention so that they working element is a separate, removable element that is coaxial with the sheath to enable the operator to remove the working element and place an imaging element in its place.
  • Imaging may become critical at various stages of the procedure, including diagnosing the type and location of the disease, placing the treatment catheter, assessing the treatment process, and verifying the function of the valve once it is treated. Imaging devices may be placed locally at the treatment site, such as on the catheter tip, or catheter body, alongside the treatment catheter, or in more remote locations such as known in the art (e.g. superior vena cava, esophagus, or right atrium). If the imaging element is placed on the treatment catheter, it may be adapted to be “forward looking” e.g. image in a plane or multiple planes in front of the treatment device.
  • It is also within the scope of the present invention to employ interrogation techniques or other imaging modalities, such as infrared imaging to see through blood for direct visualization of the treatment site, or elastography, the ultrasonic measurement of tissue motion, to sense what type of tissue is targeted, e.g. leaflet tissue or calcium, or to sense the region of the valve that is most calcified. Elastography in this context may be performed using an intravascular ultrasound (IVUS) catheter, either a mechanical transducer or phased array system, such as those described in “Characterization of plaque components and vulnerability with intravascular ultrasound elastography” Phys. Med. Biol. 45 (2000) 1465-1475, the contents of which is expressly incorporated by reference herein. In practice, the transducer may be advanced to a treatment site on the valve, and using either externally applied force, or “periodic excitation” of the tissue region either by externally applied force or the naturally occurring movement in the tissue itself (such as the opening and closing of the valve leaflets), an initial baseline reading can be taken. This baseline could be set by engaging the region or leaflet to be treated with a suction catheter of the present invention (including circulating fluid within the treatment site), inserting an ultrasound transducer through the treatment catheter up to the treatment site, and interrogating the targeted region with the ultrasound transducer to establish the elasticity of the region (stress/strain profile). For a particular region of the leaflet, infusion can then be stopped, putting the leaflet under additional stress (by suction alone) and the displacement in the stress/strain profile can be noted and evaluated to direct the treatment device to those locations showing less elasticity (“stiffer” regions indicating the presence of calcific deposits. See also those techniques set forth in “Elastography—the movement begins” Phys. Med. Biol. 45 (2000) 1409-1421 and “Selected Methods for Imaging Elastic Properties of Biological Tissues” Annu. Rev. Biomed. Eng. (2003) 5:57-78, the contents of which are expressly incorporated by reference herein.
  • In some instances, for example with ultrasound or laser, the same transducer or fiber optic that is used to interrogate or image the region may also be used to break up or treat the underlying calcific deposits. Certain parameters may be adjusted to transition the therapy device from diagnostic to therapeutic, including frequency, power, total energy delivered, etc.
  • In addition, other characterization techniques may be employed to both target the calcific region to be treated or assess the result of a treatment, including MRI, Doppler, and techniques that utilize resistivity data, impedance/inductance feedback and the like. Using imaging and other monitoring techniques such as those described, can result in a more targeted procedure that focuses on removing calcific deposits and limits potential tissue damage to the leaflet and annulus that can lead to an unwanted proliferative response.
  • Energy Sources/Methods of Treatment
  • A variety of energy modalities may be used in the treatment catheters envisioned by the present invention. Those modalities more specifically useful for breaking down or obliterating calcific deposits may be ultrasonic energy, laser energy and the like. Specifically, some Er:YAG lasers may specifically target calcium when operated in appropriate ranges. Some detail of targeted bone ablation supports this as found in “Scanning electron microscopy and Fourier transformed infrared spectroscopy analysis of bone removal using Er:YAG and CO2 lasers” J Periodontol. 2002 June;73(6):643-52, the contents of which are expressly incorporated by reference herein. Alternatively, energy may be delivered to selectively remove tissue from around or over a calcium deposit by employing a resurfacing laser that selectively targets water-containing tissue resulting in controlled tissue vaporization, such as a high-energy pulsed or scanned carbon dioxide laser, a short-pulsed Er:YAG, and modulated (short-and-long-pulsed) Er:YAG system. This application of energy may be useful for accessing plaque or calcium that is distributed between the leaflets (spongiosa). In practice, it would be desirable to remove the layer of tissue covering the deposit so that the majority of the leaflet remained intact and shielded from unnecessary thermal damage. Further, such specific tissue destruction may also be applied to the removal of scar tissue or regions of hypertrophy within the valve annulus as part of the treatment of the present invention.
  • The ultrasonic treatment catheters of the present invention may be operated in ranges between 5 and 100 kHz, for example 10-50 kHz, with an oscillation rate in the range of 10-200 microns, for example 75-150 microns (maximum travel between 20-400 microns). In addition, to minimize potential for thermal damage or other tissue damage, it may be advantageous to operate the treatment devices in a pulsed manner, such as a 5-50% duty cycle, for example a 5-20% duty cycle, and to minimize the tissue that is exposed to the energy application by carefully targeting the delivery of energy to the most diseased regions.
  • In addition, it may be advantageous to focus the treatment on certain locations of the diseased valve where removing or reducing calcium deposits result in the greatest amount of restored leaflet mobility and resulting valve function. For example, deposits within the annulus of the valve, at the nadir of the leaflet, in the mid-section of the leaflet, or at the commissures may be initially targeted. A schematic depiction of these various positions with the valve are depicted in FIGS. 66, 67, and 68, where FIGS. 67 and 68 are cross-sections along lines A-A and B-B of FIG. 66, respectively.
  • Depending on the type and frequency of energy used, the treatment catheters of the present invention may also be utilized to not only remove calcium, but also to remove or obliterate the leaflet itself, such as in preparation for implantation of a minimally invasive prosthetic valve, such as those disclosed in U.S. Pat. Nos. 5,840,081 and 6,582,462 to Anderson, US Patent Application 2004/0092858 to Wilson, PCT Publication WO 2004/093728 to Khairkhahan, WO 2005/009285 to Hermann and the like, the disclosures of which are expressly incorporated herein by reference. Pre-treatment with devices of the present invention may facilitate placement of such prosthetic valves since removing calcium from the site of implantation may reduce perivalvular leak, dislodgement, and may result in a larger prosthesis being implanted due to an increased effective valve orifice.
  • Implantable Devices
  • A. As an alternative or adjunct to the devices described above which are removed once the repair is achieved, devices may be provided which are temporarily or permanently implanted across or within the aortic valve. The devices which appear below are all intended to remain for at least a period of time within the body after the repair of the stenosis has been completed in order to prevent or delay the valves from degenerating, by either recalcifying, fusion of leaflets, and restenosing. An implant of the present invention is depicted in FIG. 67 in either a sub annular 360 or supra annular position 362.
  • In some embodiments, it may be desirable to place an implant such as the coil depicted below, to extend both sub annular and supra annular to provide additional support to the valve and provide a greater treatment area across the valve. The coil design of this embodiment has a single strut that joins the two ring portions but is low profile enough that is does not occlude the coronaries just above the valve annulus. See, FIG. 68. Because of its open structure, the supra annular portion of the implant can extend above the coronaries into the aortic root for additional anchoring. See, FIG. 69.
  • In a further embodiment, the implant may be formed of a wire, series of wire, or cellular structure similar to that used in peripheral or coronary stents. To better seat in the valve annulus, or below the valve, it may be advantageous to form the implant ring to follow the cusps of the valve, in a sinusoidal form. In addition, the implant ring may have struts that extend to seat against the annulus of the valve to provide structure or further disseminate a pharmacologic coating at specific valve sites. See, FIGS. 70, 71, and 72.
  • In yet another embodiment, the implant may be formed of multiple loops, such as three loops 120 degrees from each other. See, FIGS. 73-76.
  • In this embodiment, and others depicting wire forms, the wire may have a diameter between 0.020″ and 0.250″ depending on the force desired. In addition, the wire may be flat and the structure may include a mesh between the loops to provide a larger surface area for supporting the valve or delivery the pharmacologic agent. The loops of this device may be moved distally and proximally in a cyclic way to further open the valve leaflets and disrupt plaque as a stand alone therapy. The device may then be permanently implanted as detailed above. It may be desirable to recapture the device, either once the valve has been treated, or during positioning of the permanent implant to ensure proper placement. A recapture device may be the delivery catheter from which the implant is deployed, or may include an expandable funnel on the distal end of a retrieval catheter or may include any number of mechanical devices including a grasper or a hook that mates with a hook on the implant, or grasps the implant at some point such that it may be drawn into the delivery sheath and removed from the body.
  • The structure of any of the implants described herein may have surface enhancements or coatings to make them radiopaque or echogenic for purposes of procedure assessment as is known in the art. As is further known in the art in the field of coronary artery stenting, the devices described may be permanent, removable, or bio-erodable. They can incorporate anti-restenosis agents or materials such as those set forth above, in the form of coatings, holes, depots, pores or surface irregularities designed into or applied onto the devices. In addition, the implants can be formed of certain calcification resistant materials such as those set forth in U.S. Pat. No. 6,254,635, the contents of which are expressly incorporated by reference herein. Further, implants of the present invention may be configured to emit a slight electrical charge. Since calcium is positively charged, it may be advantageous to repel calcium by positively charging the surface of the aortic implant. In addition, electrical energy may be supplied by the implant to minimize calcification by an implantable pacemaker type device as described in U.S. Pat. No. 6,505,080, which is expressly incorporated by reference herein.
  • Further, it is within the scope of the present invention to combine certain mechanical procedures and implants with various appropriate pharmacologic agents such as those listed previously. Anti-restenosis agents which may be useful in this application may be chosen from any of the families of agents or energy modalities known in the art. For example, pharmaceutical agents or their analogues such as rapamycin, paclitaxel, sirolimus or nitric-oxide enhancing agents may be coated onto these devices using drug eluting coatings, incorporated into intentionally created surface irregularities or specific surface features such as holes or divots. The devices may be designed for drug infusion through the incorporation of coatings or other surfaces to adhere the agents to the implants utilized to perform the procedures of the present invention, or may be prescribed for oral administration following procedures of the present invention. For example, following a treatment of the present invention, a patient may be prescribed a dose of statins, ACE inhibitors or other drugs to prolong the valve function provided by the intervention.
  • FIGS. 77-89 represent various embodiments of systems intended for acute or sub-chronic procedures. These devices may be placed across the aortic valve and expanded to reopen the aortic valve, and then left in place for a period of time in order to expose the treated valve to anti-restenosis agents or energy modalities designed to facilitate the repair and/or to prevent restenosis. The device shown in FIGS. 77 and 78 features mechanical vanes 400 which extend outward to engage and separate the fused leaflets at the commissures. The vanes may be made of any suitable metal, plastic or combination. They may be self expanding (made from nitinol or elgiloy, for instance) or they might be mechanically actuated using a pneumatic, hydraulic, threaded or other mechanical actuation system. The vanes might be deformable members as shown above, or each vane might be made up of several more rigid parts connected at hinged portions to allow expansion and contraction of the unit. The vanes may be designed with a cross section which is rectangular in shape, with the narrower edge designed to facilitate separation of fused leaflets and to fit within the commissures without impacting the ability if he valves to close. The wider face of these rectangular vanes would contact the newly separated edges of the leaflets. As an alternative to the rectangular cross section, the vanes might be designed to have more of a wing-shaped or other cross sectional shape to minimize turbulence within the bloodstream and to minimize trauma to the valve leaflets.
  • The device of FIGS. 79 and 80 shows a balloon system to be used in accordance with the inventive methods. The balloon 410 may feature a plurality of holes 412 to be used for the infusion of anti-restenosis agents as described in more detail below. These holes maybe small enough to allow only a slight weeping of the agents to be infused, or they might be of a size which would allow more rapid infusion or a greater volume of infusate to be delivered. The holes might be placed in even distribution around the circumference of the balloon, or they might be placed to align more directly with the location of the commissures.
  • The device of FIGS. 81 and 82 comprise a balloon system which combines features of FIGS. 77 and 78 with those of 79 and 80. Several balloons are placed such that each balloon aligns with a commissure 424. Inflation of this device may allow continued perfusion of blood out of the heart and into the body which the device is in place. This in turn might low for more prolonged delivery of anti-restenosis agents. Holes might be placed on the balloons of FIG. 3 similar to the description for the holes on the device in FIGS. 79 and 80.
  • Anti-restenosis agents which may be useful in this application may be chosen from any of the families of agents or energy modalities known in the art. For example, pharmaceutical agents or their analogues such as rapamycin, paclitaxel, sirolimus or nitric-oxide enhancing agents may be coated onto any of the inventive devices using drug eluting coatings, incorporated into intentionally created surface irregularities or specific surface features such as holes or divots. As described, the devices may be designed for drug infusion through the incorporation of infusion channels and infusion holes in the work-performing elements of the devices such as the balloons or commissurotomy vanes shown in the drawings.
  • Energy delivery may be achieved by several different modalities and for different purposes. Radiofrequency energy can be applied by energizing the commissurotomy vanes or by using the pores on the balloons to achieve a wet electrode. Microwave, ultrasound, high frequency ultrasound energy or pulsed electric fields (for the purpose of inducing cellular electroporation) might be used by incorporating antennae or electrodes into the vanes, balloons or catheter shafts that support these work performing elements. Cryotherapy can be achieved by circulating cooling fluids such as phase-change gases or liquid nitrogen through the work performing elements. Multiple modalities might be incorporated into a single device for achieving the goal of durable aortic valve repair.
  • This energy may be used to facilitate the valve repair, for instance by making easier the parting of fused leaflets. Alternatively, the energy may be used to delay or prevent restenosis of the treated valve. One example of the use of energy delivery for the prevention of restenosis is the use of pulsed electric fields to induce cellular apoptosis. It is known in the art that the application of pulses of electricity on the order of nanosecond duration can alter the intracellular apparatus of a cell and induce apoptosis, or programmed cell death, which is known to be a key aspect of the mechanism of action of the clinically proven anti-restenosis drugs such as paclitaxel or sirolimus.
  • These agents or energy applications might be administered while the patient is in the catheterization lab, over the course of minutes to hours. Alternatively, the devices may be designed to allow the patient to return to the hospital floor with the device in place, so that the infusion of agents or the application of energy could proceed over the course of hours or days.
  • B. As an alternative or adjunct to the devices described above which are removed once the repair is achieved and administration of the anti-restenosis agents is completed, devices may be provided which are temporarily or permanently implanted across or within the aortic valve. The devices which appear below are all intended to remain for at least a period of time within the body after the repair of the stenosis has been completed in order to prevent or delay the valves from readhering to one another and restenosing.
  • The devices described may be permanent, removable, or bio-erodable. They can incorporate anti-restenosis agents or materials into coatings, holes, depots, pores or surface irregularities designed into or applied onto the devices
  • The struts 430 may be made of any suitable metal, plastic or combination as shown in FIGS. 83 and 84. They may be self expanding (made from nitinol or elgiloy, for instance) or they might be mechanically actuated during implantation using a pneumatic, hydraulic, threaded or other mechanical actuation system and then locked into their final position prior to deployment of the device from the delivery system. The struts might be deformable members as shown above, or each strut might be made up of several more rigid parts connected at hinged portions to allow expansion and contraction of the unit. The struts may be designed with a cross section which is rectangular in shape, with the narrower edge designed to facilitate separation of fused leaflets and to fit within the commissures without impacting the ability if he valves to close. The wider face of these rectangular struts would contact the newly separated edges of the leaflets. As an alternative to the rectangular cross section, the struts might be designed to have more of a wing-shaped or other cross sectional shape to minimize turbulence within the bloodstream and to minimize trauma to the valve leaflets.
  • FIGS. 85-89 show alternate designs for the implantable device. It should be noted that any design for the implant which achieves the goals of providing long-term anti-restenosis agents or energy modalities to the treated regions of the repaired leaflets should be considered as subjects of this invention. Anchoring elements which lie against the wall of theaorta and are generally contiguous with the strut the center of the aorta before reforming with the struts (as in FIGS. 85 and 86), or designs in which the struts themselves are the anchoring elements (as in FIGS. 87-89) are all embodiments of the subject invention.
  • The implantable and bio-erodable devices might all feature pharmaceutical agents or their analogues such as rapamycin, paclitaxel, sirolimus or nitric-oxide enhancing agents, which may be coated onto any of the inventive devices using drug eluting coatings, or incorporated into intentionally created surface irregularities or specific surface features such as holes or divots.
  • Additional anti-restenosis agents or energy modalities might be delivered separate from and/or in addition to those agents that are incorporated onto the implant, for instance as a feature of the delivery system.
  • While the invention is susceptible to various modifications, and alternative forms, specific examples thereof have been shown in the drawings and are herein described in detail. It should be understood, however, that the invention is not to be limited to the particular forms or methods disclosed, but to the contrary, the invention is to cover all modifications, equivalents and alternatives falling within the spirit and scope of the disclosure and appended claims.

Claims (19)

1. A treatment catheter for cardiac valve repair, the treatment catheter comprising:
a catheter body comprising a proximal end and a distal end;
means near the distal end of the catheter body for creating an embolic containment region over a localized calcific site on or near a cardiac valve; and
a working element adapted to disrupt the calcific site, said working element being positionable within the embolized containment region.
2. The treatment catheter of claim 1 wherein the working element comprises an energy delivery element such as ultrasonic element delivering energy under conditions selected to disrupt calcific deposits at the calcific site.
3. The treatment catheter of claim 1 wherein the catheter body is steerable or otherwise positionable to allow a user to direct the distal end toward the calcific site.
4. The treatment catheter of claim 1 further comprising a positioning structure on the catheter body for positioning and/or stabilizing the working element adjacent the calcific site.
5. The treatment catheter of claim 1 wherein the embolic containment creating means comprise a shaped balloon, a basket, or a filter.
6. The treatment catheter of claim 5 wherein the embolic containment means comprise a filter located on the treatment catheter, a perfusion balloon linked with an aspiration device, a suction catheter, a separate filter device either at the treatment site or downstream from the treatment site, or an external filter and perfusion system.
7. The treatment catheter of claim 6 wherein the protection device comprises a filter that is shaped to allow the treatment catheter to access a location to be treated, while still allowing flow through the diseased aortic valve.
8. The treatment catheter of claim 1 comprising a protection device that traps and/or evacuates debris from a treatment site around the diseased aortic valve.
9. The treatment catheter of claim 1 further comprising an imaging assembly.
10. The treatment catheter of claim 9 wherein the imaging element comprises an intracardiac echocardiography (ICE) assembly, transesophageal echocardiography (TEE) assembly, intravascular ultrasound assembly, or angioscopy assembly.
11. A system comprising the treatment catheter of claim 1, further comprising a guide catheter comprising an inner lumen that is configured to receive the treatment catheter.
12. The system of claim 11 further comprising a secondary positioning catheter that is positionable within the inner lumen of the guide catheter and around the treatment catheter.
13. The treatment catheter of claim 1 wherein the working element comprises an RF electrode.
14. The treatment catheter of claim 1 wherein the working element comprises a rotatable tip.
15. The treatment catheter of claim 14 wherein the rotatable tip comprises a coil.
16. The treatment catheter of claim 14 wherein the rotatable tip comprises an impeller.
17. The treatment catheter of claim 14 wherein the rotatable tip comprises a grinder.
18. The treatment catheter of claim 14 comprising a sheath that is disposed over the rotatable tip.
19. The treatment catheter of claim 1 wherein the distal end of the catheter body comprises a suction housing.
US12/870,270 2004-12-09 2010-08-27 Aortic Valve Repair Abandoned US20100324554A1 (en)

Priority Applications (4)

Application Number Priority Date Filing Date Title
US12/870,270 US20100324554A1 (en) 2004-12-09 2010-08-27 Aortic Valve Repair
US13/692,613 US9414852B2 (en) 2004-12-09 2012-12-03 Aortic valve repair
US15/212,797 US10350004B2 (en) 2004-12-09 2016-07-18 Intravascular treatment catheters
US16/511,947 US11272982B2 (en) 2004-12-09 2019-07-15 Intravascular treatment catheters

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
US63527504P 2004-12-09 2004-12-09
US66276405P 2005-03-16 2005-03-16
US69829705P 2005-07-11 2005-07-11
US11/299,246 US7803168B2 (en) 2004-12-09 2005-12-09 Aortic valve repair
US12/870,270 US20100324554A1 (en) 2004-12-09 2010-08-27 Aortic Valve Repair

Related Parent Applications (1)

Application Number Title Priority Date Filing Date
US11/299,246 Division US7803168B2 (en) 2004-12-09 2005-12-09 Aortic valve repair

Related Child Applications (1)

Application Number Title Priority Date Filing Date
US13/692,613 Continuation US9414852B2 (en) 2004-12-09 2012-12-03 Aortic valve repair

Publications (1)

Publication Number Publication Date
US20100324554A1 true US20100324554A1 (en) 2010-12-23

Family

ID=36578602

Family Applications (5)

Application Number Title Priority Date Filing Date
US11/299,246 Active 2026-02-16 US7803168B2 (en) 2004-12-09 2005-12-09 Aortic valve repair
US12/870,270 Abandoned US20100324554A1 (en) 2004-12-09 2010-08-27 Aortic Valve Repair
US13/692,613 Active 2026-12-19 US9414852B2 (en) 2004-12-09 2012-12-03 Aortic valve repair
US15/212,797 Active 2026-08-01 US10350004B2 (en) 2004-12-09 2016-07-18 Intravascular treatment catheters
US16/511,947 Active 2027-01-23 US11272982B2 (en) 2004-12-09 2019-07-15 Intravascular treatment catheters

Family Applications Before (1)

Application Number Title Priority Date Filing Date
US11/299,246 Active 2026-02-16 US7803168B2 (en) 2004-12-09 2005-12-09 Aortic valve repair

Family Applications After (3)

Application Number Title Priority Date Filing Date
US13/692,613 Active 2026-12-19 US9414852B2 (en) 2004-12-09 2012-12-03 Aortic valve repair
US15/212,797 Active 2026-08-01 US10350004B2 (en) 2004-12-09 2016-07-18 Intravascular treatment catheters
US16/511,947 Active 2027-01-23 US11272982B2 (en) 2004-12-09 2019-07-15 Intravascular treatment catheters

Country Status (5)

Country Link
US (5) US7803168B2 (en)
EP (1) EP1819304B1 (en)
JP (1) JP5219518B2 (en)
CN (1) CN101076290B (en)
WO (1) WO2006063199A2 (en)

Cited By (34)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20100114020A1 (en) * 2008-11-05 2010-05-06 Daniel Hawkins Shockwave valvuloplasty catheter system
US20120289951A1 (en) * 2011-05-12 2012-11-15 Kassab Ghassan S Systems and methods for cryoblation of a tissue
US20140005529A1 (en) * 2007-08-31 2014-01-02 BiO2 Medical, Inc. Ivc filter catheter with imaging modality
WO2014025981A1 (en) * 2012-08-08 2014-02-13 Shockwave Medical, Inc. Shockwave valvuloplasty with multiple balloons
US8709075B2 (en) 2011-11-08 2014-04-29 Shockwave Medical, Inc. Shock wave valvuloplasty device with moveable shock wave generator
US8948848B2 (en) 2011-01-07 2015-02-03 Innovative Cardiovascular Solutions, Llc Angiography catheter
US9034032B2 (en) 2011-10-19 2015-05-19 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US9125740B2 (en) 2011-06-21 2015-09-08 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US9220521B2 (en) 2012-08-06 2015-12-29 Shockwave Medical, Inc. Shockwave catheter
US9254192B2 (en) 2007-09-13 2016-02-09 Georg Lutter Truncated cone heart valve stent
US9414852B2 (en) 2004-12-09 2016-08-16 Twelve, Inc. Aortic valve repair
US9421098B2 (en) 2010-12-23 2016-08-23 Twelve, Inc. System for mitral valve repair and replacement
US9579114B2 (en) 2008-05-07 2017-02-28 Northgate Technologies Inc. Radially-firing electrohydraulic lithotripsy probe
US9579198B2 (en) 2012-03-01 2017-02-28 Twelve, Inc. Hydraulic delivery systems for prosthetic heart valve devices and associated methods
US9655722B2 (en) 2011-10-19 2017-05-23 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US9763780B2 (en) 2011-10-19 2017-09-19 Twelve, Inc. Devices, systems and methods for heart valve replacement
US9901443B2 (en) 2011-10-19 2018-02-27 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US10111747B2 (en) 2013-05-20 2018-10-30 Twelve, Inc. Implantable heart valve devices, mitral valve repair devices and associated systems and methods
US10238490B2 (en) 2015-08-21 2019-03-26 Twelve, Inc. Implant heart valve devices, mitral valve repair devices and associated systems and methods
US10265172B2 (en) 2016-04-29 2019-04-23 Medtronic Vascular, Inc. Prosthetic heart valve devices with tethered anchors and associated systems and methods
US10357264B2 (en) 2016-12-06 2019-07-23 Shockwave Medical, Inc. Shock wave balloon catheter with insertable electrodes
US10433961B2 (en) 2017-04-18 2019-10-08 Twelve, Inc. Delivery systems with tethers for prosthetic heart valve devices and associated methods
US10575950B2 (en) 2017-04-18 2020-03-03 Twelve, Inc. Hydraulic systems for delivering prosthetic heart valve devices and associated methods
US10603058B2 (en) 2013-03-11 2020-03-31 Northgate Technologies, Inc. Unfocused electrohydraulic lithotripter
US10646240B2 (en) 2016-10-06 2020-05-12 Shockwave Medical, Inc. Aortic leaflet repair using shock wave applicators
US10646338B2 (en) 2017-06-02 2020-05-12 Twelve, Inc. Delivery systems with telescoping capsules for deploying prosthetic heart valve devices and associated methods
US10702380B2 (en) 2011-10-19 2020-07-07 Twelve, Inc. Devices, systems and methods for heart valve replacement
US10702378B2 (en) 2017-04-18 2020-07-07 Twelve, Inc. Prosthetic heart valve device and associated systems and methods
US10709591B2 (en) 2017-06-06 2020-07-14 Twelve, Inc. Crimping device and method for loading stents and prosthetic heart valves
US10729541B2 (en) 2017-07-06 2020-08-04 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US10786352B2 (en) 2017-07-06 2020-09-29 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US10792151B2 (en) 2017-05-11 2020-10-06 Twelve, Inc. Delivery systems for delivering prosthetic heart valve devices and associated methods
US11071844B2 (en) 2018-03-07 2021-07-27 Innovative Cardiovascular Solutions, Llc Embolic protection device
US11202704B2 (en) 2011-10-19 2021-12-21 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods

Families Citing this family (374)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8241274B2 (en) 2000-01-19 2012-08-14 Medtronic, Inc. Method for guiding a medical device
US10835307B2 (en) 2001-06-12 2020-11-17 Ethicon Llc Modular battery powered handheld surgical instrument containing elongated multi-layered shaft
US7756583B2 (en) 2002-04-08 2010-07-13 Ardian, Inc. Methods and apparatus for intravascularly-induced neuromodulation
US8150519B2 (en) 2002-04-08 2012-04-03 Ardian, Inc. Methods and apparatus for bilateral renal neuromodulation
US7617005B2 (en) 2002-04-08 2009-11-10 Ardian, Inc. Methods and apparatus for thermally-induced renal neuromodulation
US8347891B2 (en) 2002-04-08 2013-01-08 Medtronic Ardian Luxembourg S.A.R.L. Methods and apparatus for performing a non-continuous circumferential treatment of a body lumen
DE202004021943U1 (en) 2003-09-12 2013-05-13 Vessix Vascular, Inc. Selectable eccentric remodeling and / or ablation of atherosclerotic material
US7854761B2 (en) 2003-12-19 2010-12-21 Boston Scientific Scimed, Inc. Methods for venous valve replacement with a catheter
US8128681B2 (en) 2003-12-19 2012-03-06 Boston Scientific Scimed, Inc. Venous valve apparatus, system, and method
US8182501B2 (en) 2004-02-27 2012-05-22 Ethicon Endo-Surgery, Inc. Ultrasonic surgical shears and method for sealing a blood vessel using same
US7566343B2 (en) 2004-09-02 2009-07-28 Boston Scientific Scimed, Inc. Cardiac valve, system, and method
US8396548B2 (en) 2008-11-14 2013-03-12 Vessix Vascular, Inc. Selective drug delivery in a lumen
US9713730B2 (en) 2004-09-10 2017-07-25 Boston Scientific Scimed, Inc. Apparatus and method for treatment of in-stent restenosis
US20060079879A1 (en) 2004-10-08 2006-04-13 Faller Craig N Actuation mechanism for use with an ultrasonic surgical instrument
US20060173490A1 (en) 2005-02-01 2006-08-03 Boston Scientific Scimed, Inc. Filter system and method
US7867274B2 (en) 2005-02-23 2011-01-11 Boston Scientific Scimed, Inc. Valve apparatus, system and method
US7722666B2 (en) 2005-04-15 2010-05-25 Boston Scientific Scimed, Inc. Valve apparatus, system and method
US8012198B2 (en) 2005-06-10 2011-09-06 Boston Scientific Scimed, Inc. Venous valve, system, and method
US7569071B2 (en) 2005-09-21 2009-08-04 Boston Scientific Scimed, Inc. Venous valve, system, and method with sinus pocket
US20070191713A1 (en) 2005-10-14 2007-08-16 Eichmann Stephen E Ultrasonic device for cutting and coagulating
US7621930B2 (en) 2006-01-20 2009-11-24 Ethicon Endo-Surgery, Inc. Ultrasound medical instrument having a medical ultrasonic blade
US8019435B2 (en) 2006-05-02 2011-09-13 Boston Scientific Scimed, Inc. Control of arterial smooth muscle tone
WO2007140331A2 (en) 2006-05-25 2007-12-06 Medtronic, Inc. Methods of using high intensity focused ultrasound to form an ablated tissue area containing a plurality of lesions
US20080097251A1 (en) * 2006-06-15 2008-04-24 Eilaz Babaev Method and apparatus for treating vascular obstructions
WO2008049082A2 (en) 2006-10-18 2008-04-24 Minnow Medical, Inc. Inducing desirable temperature effects on body tissue
WO2008049087A2 (en) 2006-10-18 2008-04-24 Minnow Medical, Inc. System for inducing desirable temperature effects on body tissue
EP2954868A1 (en) 2006-10-18 2015-12-16 Vessix Vascular, Inc. Tuned rf energy and electrical tissue characterization for selective treatment of target tissues
US8070799B2 (en) 2006-12-19 2011-12-06 Sorin Biomedica Cardio S.R.L. Instrument and method for in situ deployment of cardiac valve prostheses
US20080147181A1 (en) * 2006-12-19 2008-06-19 Sorin Biomedica Cardio S.R.L. Device for in situ axial and radial positioning of cardiac valve prostheses
US8133270B2 (en) 2007-01-08 2012-03-13 California Institute Of Technology In-situ formation of a valve
US7967853B2 (en) 2007-02-05 2011-06-28 Boston Scientific Scimed, Inc. Percutaneous valve, system and method
US8911460B2 (en) 2007-03-22 2014-12-16 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US8226675B2 (en) 2007-03-22 2012-07-24 Ethicon Endo-Surgery, Inc. Surgical instruments
US8142461B2 (en) 2007-03-22 2012-03-27 Ethicon Endo-Surgery, Inc. Surgical instruments
US20080234709A1 (en) 2007-03-22 2008-09-25 Houser Kevin L Ultrasonic surgical instrument and cartilage and bone shaping blades therefor
US8057498B2 (en) 2007-11-30 2011-11-15 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instrument blades
JP2010527678A (en) * 2007-05-23 2010-08-19 オスシロン リミテッド Apparatus and method for guided penetration of chronic total occlusion
EP2157916A2 (en) * 2007-06-04 2010-03-03 Mor Research Applications Ltd. Cardiac valve leaflet augmentation
US8858490B2 (en) 2007-07-18 2014-10-14 Silk Road Medical, Inc. Systems and methods for treating a carotid artery
US8523889B2 (en) 2007-07-27 2013-09-03 Ethicon Endo-Surgery, Inc. Ultrasonic end effectors with increased active length
US8882791B2 (en) 2007-07-27 2014-11-11 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US8808319B2 (en) 2007-07-27 2014-08-19 Ethicon Endo-Surgery, Inc. Surgical instruments
US8430898B2 (en) 2007-07-31 2013-04-30 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US9044261B2 (en) 2007-07-31 2015-06-02 Ethicon Endo-Surgery, Inc. Temperature controlled ultrasonic surgical instruments
US8512365B2 (en) 2007-07-31 2013-08-20 Ethicon Endo-Surgery, Inc. Surgical instruments
US8556880B2 (en) * 2007-09-06 2013-10-15 Boston Scientific Scimed, Inc. Methods and devices for local therapeutic agent delivery to heart valves
US8114154B2 (en) 2007-09-07 2012-02-14 Sorin Biomedica Cardio S.R.L. Fluid-filled delivery system for in situ deployment of cardiac valve prostheses
US8808367B2 (en) 2007-09-07 2014-08-19 Sorin Group Italia S.R.L. Prosthetic valve delivery system including retrograde/antegrade approach
JP2010540186A (en) 2007-10-05 2010-12-24 エシコン・エンド−サージェリィ・インコーポレイテッド Ergonomic surgical instrument
US9895158B2 (en) * 2007-10-26 2018-02-20 University Of Virginia Patent Foundation Method and apparatus for accelerated disintegration of blood clot
US10010339B2 (en) 2007-11-30 2018-07-03 Ethicon Llc Ultrasonic surgical blades
US8767514B2 (en) * 2007-12-03 2014-07-01 Kolo Technologies, Inc. Telemetric sensing using micromachined ultrasonic transducer
CN101868981B (en) * 2007-12-03 2014-05-07 科隆科技公司 Stacked transducing devices
CN101868185B (en) * 2007-12-03 2013-12-11 科隆科技公司 CMUT packaging for ultrasound system
CN103446636B (en) * 2007-12-20 2016-01-20 沃特克斯医学公司 For removing the system of the undesirably object in blood circulation
US10517617B2 (en) 2007-12-20 2019-12-31 Angiodynamics, Inc. Systems and methods for removing undesirable material within a circulatory system utilizing a balloon catheter
US11589880B2 (en) 2007-12-20 2023-02-28 Angiodynamics, Inc. System and methods for removing undesirable material within a circulatory system utilizing during a surgical procedure
US7892276B2 (en) 2007-12-21 2011-02-22 Boston Scientific Scimed, Inc. Valve with delayed leaflet deployment
US8175679B2 (en) 2007-12-26 2012-05-08 St. Jude Medical, Atrial Fibrillation Division, Inc. Catheter electrode that can simultaneously emit electrical energy and facilitate visualization by magnetic resonance imaging
US9675410B2 (en) 2007-12-28 2017-06-13 St. Jude Medical, Atrial Fibrillation Division, Inc. Flexible polymer electrode for MRI-guided positioning and radio frequency ablation
US20090204005A1 (en) * 2008-02-07 2009-08-13 Broncus Technologies, Inc. Puncture resistant catheter for sensing vessels and for creating passages in tissue
US9125562B2 (en) 2009-07-01 2015-09-08 Avinger, Inc. Catheter-based off-axis optical coherence tomography imaging system
US8062316B2 (en) * 2008-04-23 2011-11-22 Avinger, Inc. Catheter system and method for boring through blocked vascular passages
US9440054B2 (en) * 2008-05-14 2016-09-13 Onset Medical Corporation Expandable transapical sheath and method of use
US9101735B2 (en) * 2008-07-07 2015-08-11 Intuitive Surgical Operations, Inc. Catheter control systems
EP2326264B1 (en) * 2008-07-27 2017-11-15 Pi-R-Squared Ltd. Fracturing calcifications in heart valves
US9089360B2 (en) 2008-08-06 2015-07-28 Ethicon Endo-Surgery, Inc. Devices and techniques for cutting and coagulating tissue
US8058771B2 (en) 2008-08-06 2011-11-15 Ethicon Endo-Surgery, Inc. Ultrasonic device for cutting and coagulating with stepped output
US8574245B2 (en) 2008-08-13 2013-11-05 Silk Road Medical, Inc. Suture delivery device
CN101380244B (en) * 2008-10-06 2010-12-08 丁起武 Intra-cavity milling type stone breaking device in urinary system
WO2010041629A1 (en) * 2008-10-07 2010-04-15 オリンパスメディカルシステムズ株式会社 Bloodstream detecting device
EP2355737B1 (en) 2008-11-17 2021-08-11 Boston Scientific Scimed, Inc. Selective accumulation of energy without knowledge of tissue topography
WO2010129075A1 (en) 2009-04-28 2010-11-11 Avinger, Inc. Guidewire support catheter
US8353953B2 (en) 2009-05-13 2013-01-15 Sorin Biomedica Cardio, S.R.L. Device for the in situ delivery of heart valves
US9168105B2 (en) 2009-05-13 2015-10-27 Sorin Group Italia S.R.L. Device for surgical interventions
US8403982B2 (en) 2009-05-13 2013-03-26 Sorin Group Italia S.R.L. Device for the in situ delivery of heart valves
US9700339B2 (en) 2009-05-20 2017-07-11 Ethicon Endo-Surgery, Inc. Coupling arrangements and methods for attaching tools to ultrasonic surgical instruments
CN102460118B (en) 2009-05-28 2015-03-25 阿维格公司 Optical coherence tomography for biological imaging
US8650728B2 (en) 2009-06-24 2014-02-18 Ethicon Endo-Surgery, Inc. Method of assembling a transducer for a surgical instrument
EP2448502B1 (en) 2009-07-01 2022-04-06 Avinger, Inc. Atherectomy catheter with laterally-displaceable tip
US8663220B2 (en) 2009-07-15 2014-03-04 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US8461744B2 (en) 2009-07-15 2013-06-11 Ethicon Endo-Surgery, Inc. Rotating transducer mount for ultrasonic surgical instruments
US9017326B2 (en) 2009-07-15 2015-04-28 Ethicon Endo-Surgery, Inc. Impedance monitoring apparatus, system, and method for ultrasonic surgical instruments
US8177835B2 (en) * 2009-08-21 2012-05-15 Siemens Aktiengesellschaft Method of imaging for heart valve implant procedure
DE102009042465A1 (en) * 2009-09-23 2011-03-31 Fehling Instruments Gmbh & Co. Kg Instrument for the surgical treatment of aortic valve defects
US11090104B2 (en) 2009-10-09 2021-08-17 Cilag Gmbh International Surgical generator for ultrasonic and electrosurgical devices
US8951248B2 (en) 2009-10-09 2015-02-10 Ethicon Endo-Surgery, Inc. Surgical generator for ultrasonic and electrosurgical devices
USRE47996E1 (en) 2009-10-09 2020-05-19 Ethicon Llc Surgical generator for ultrasonic and electrosurgical devices
US10441345B2 (en) 2009-10-09 2019-10-15 Ethicon Llc Surgical generator for ultrasonic and electrosurgical devices
US9168054B2 (en) 2009-10-09 2015-10-27 Ethicon Endo-Surgery, Inc. Surgical generator for ultrasonic and electrosurgical devices
US9554816B2 (en) * 2009-12-05 2017-01-31 Pi-Cardia Ltd. Fracturing calcifications in heart valves
AU2010328106A1 (en) 2009-12-08 2012-07-05 Avalon Medical Ltd. Device and system for transcatheter mitral valve replacement
WO2011072068A2 (en) 2009-12-08 2011-06-16 Avinger, Inc. Devices and methods for predicting and preventing restenosis
US8531064B2 (en) 2010-02-11 2013-09-10 Ethicon Endo-Surgery, Inc. Ultrasonically powered surgical instruments with rotating cutting implement
US8951272B2 (en) 2010-02-11 2015-02-10 Ethicon Endo-Surgery, Inc. Seal arrangements for ultrasonically powered surgical instruments
US8486096B2 (en) 2010-02-11 2013-07-16 Ethicon Endo-Surgery, Inc. Dual purpose surgical instrument for cutting and coagulating tissue
US8579928B2 (en) 2010-02-11 2013-11-12 Ethicon Endo-Surgery, Inc. Outer sheath and blade arrangements for ultrasonic surgical instruments
US8469981B2 (en) 2010-02-11 2013-06-25 Ethicon Endo-Surgery, Inc. Rotatable cutting implement arrangements for ultrasonic surgical instruments
US8961547B2 (en) 2010-02-11 2015-02-24 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments with moving cutting implement
US8545552B2 (en) * 2010-02-26 2013-10-01 Silk Road Medical, Inc. Systems and methods for transcatheter aortic valve treatment
WO2011126572A2 (en) 2010-04-07 2011-10-13 Office Of Technology Transfer An expandable stent that collapses into a non-convex shape and expands into an expanded, convex shape
JP2013523318A (en) 2010-04-09 2013-06-17 べシックス・バスキュラー・インコーポレイテッド Power generation and control equipment for tissue treatment
US8998980B2 (en) * 2010-04-09 2015-04-07 Medtronic, Inc. Transcatheter prosthetic heart valve delivery system with recapturing feature and method
US9192790B2 (en) 2010-04-14 2015-11-24 Boston Scientific Scimed, Inc. Focused ultrasonic renal denervation
GB2480498A (en) 2010-05-21 2011-11-23 Ethicon Endo Surgery Inc Medical device comprising RF circuitry
US8473067B2 (en) 2010-06-11 2013-06-25 Boston Scientific Scimed, Inc. Renal denervation and stimulation employing wireless vascular energy transfer arrangement
CA2803992C (en) 2010-07-01 2018-03-20 Avinger, Inc. Atherectomy catheters with longitudinally displaceable drive shafts
US11382653B2 (en) 2010-07-01 2022-07-12 Avinger, Inc. Atherectomy catheter
WO2014039096A1 (en) 2012-09-06 2014-03-13 Avinger, Inc. Re-entry stylet for catheter
US8795327B2 (en) 2010-07-22 2014-08-05 Ethicon Endo-Surgery, Inc. Electrosurgical instrument with separate closure and cutting members
US9192431B2 (en) 2010-07-23 2015-11-24 Ethicon Endo-Surgery, Inc. Electrosurgical cutting and sealing instrument
US9155589B2 (en) 2010-07-30 2015-10-13 Boston Scientific Scimed, Inc. Sequential activation RF electrode set for renal nerve ablation
US9463062B2 (en) 2010-07-30 2016-10-11 Boston Scientific Scimed, Inc. Cooled conductive balloon RF catheter for renal nerve ablation
US9358365B2 (en) 2010-07-30 2016-06-07 Boston Scientific Scimed, Inc. Precision electrode movement control for renal nerve ablation
US9084609B2 (en) 2010-07-30 2015-07-21 Boston Scientific Scime, Inc. Spiral balloon catheter for renal nerve ablation
US9408661B2 (en) 2010-07-30 2016-08-09 Patrick A. Haverkost RF electrodes on multiple flexible wires for renal nerve ablation
US8974451B2 (en) 2010-10-25 2015-03-10 Boston Scientific Scimed, Inc. Renal nerve ablation using conductive fluid jet and RF energy
US9220558B2 (en) 2010-10-27 2015-12-29 Boston Scientific Scimed, Inc. RF renal denervation catheter with multiple independent electrodes
US9028485B2 (en) 2010-11-15 2015-05-12 Boston Scientific Scimed, Inc. Self-expanding cooling electrode for renal nerve ablation
US9668811B2 (en) 2010-11-16 2017-06-06 Boston Scientific Scimed, Inc. Minimally invasive access for renal nerve ablation
US9089350B2 (en) 2010-11-16 2015-07-28 Boston Scientific Scimed, Inc. Renal denervation catheter with RF electrode and integral contrast dye injection arrangement
US9326751B2 (en) 2010-11-17 2016-05-03 Boston Scientific Scimed, Inc. Catheter guidance of external energy for renal denervation
US9060761B2 (en) 2010-11-18 2015-06-23 Boston Scientific Scime, Inc. Catheter-focused magnetic field induced renal nerve ablation
US9192435B2 (en) 2010-11-22 2015-11-24 Boston Scientific Scimed, Inc. Renal denervation catheter with cooled RF electrode
US9023034B2 (en) 2010-11-22 2015-05-05 Boston Scientific Scimed, Inc. Renal ablation electrode with force-activatable conduction apparatus
US20120157993A1 (en) 2010-12-15 2012-06-21 Jenson Mark L Bipolar Off-Wall Electrode Device for Renal Nerve Ablation
WO2012100095A1 (en) 2011-01-19 2012-07-26 Boston Scientific Scimed, Inc. Guide-compatible large-electrode catheter for renal nerve ablation with reduced arterial injury
US20120209375A1 (en) * 2011-02-11 2012-08-16 Gilbert Madrid Stability device for use with percutaneous delivery systems
EP2688516B1 (en) 2011-03-21 2022-08-17 Cephea Valve Technologies, Inc. Disk-based valve apparatus
WO2012145133A2 (en) 2011-03-28 2012-10-26 Avinger, Inc. Occlusion-crossing devices, imaging, and atherectomy devices
US9949754B2 (en) 2011-03-28 2018-04-24 Avinger, Inc. Occlusion-crossing devices
KR20130131471A (en) 2011-04-08 2013-12-03 코비디엔 엘피 Iontophoresis drug delivery system and method for denervation of the renal sympathetic nerve and iontophoretic drug delivery
CN104840249B (en) * 2011-04-08 2017-04-12 柯惠有限合伙公司 Coupler
EP2699312A1 (en) * 2011-04-20 2014-02-26 Cardiac Pacemakers, Inc. Ultrasonic monitoring of implantable medical devices
EP2701623B1 (en) 2011-04-25 2016-08-17 Medtronic Ardian Luxembourg S.à.r.l. Apparatus related to constrained deployment of cryogenic balloons for limited cryogenic ablation of vessel walls
US20120303048A1 (en) 2011-05-24 2012-11-29 Sorin Biomedica Cardio S.R.I. Transapical valve replacement
US9579030B2 (en) 2011-07-20 2017-02-28 Boston Scientific Scimed, Inc. Percutaneous devices and methods to visualize, target and ablate nerves
US9259265B2 (en) 2011-07-22 2016-02-16 Ethicon Endo-Surgery, Llc Surgical instruments for tensioning tissue
CN103813829B (en) 2011-07-22 2016-05-18 波士顿科学西美德公司 There is the neuromodulation system of the neuromodulation element that can be positioned in spiral guiding piece
US9668859B2 (en) 2011-08-05 2017-06-06 California Institute Of Technology Percutaneous heart valve delivery systems
US9480559B2 (en) 2011-08-11 2016-11-01 Tendyne Holdings, Inc. Prosthetic valves and related inventions
US9186210B2 (en) 2011-10-10 2015-11-17 Boston Scientific Scimed, Inc. Medical devices including ablation electrodes
US9420955B2 (en) 2011-10-11 2016-08-23 Boston Scientific Scimed, Inc. Intravascular temperature monitoring system and method
US10085799B2 (en) 2011-10-11 2018-10-02 Boston Scientific Scimed, Inc. Off-wall electrode device and methods for nerve modulation
US9364284B2 (en) 2011-10-12 2016-06-14 Boston Scientific Scimed, Inc. Method of making an off-wall spacer cage
EP3653151A1 (en) 2011-10-17 2020-05-20 Avinger, Inc. Atherectomy catheters and non-contact actuation mechanism for catheters
WO2013059202A1 (en) 2011-10-18 2013-04-25 Boston Scientific Scimed, Inc. Integrated crossing balloon catheter
US9162046B2 (en) 2011-10-18 2015-10-20 Boston Scientific Scimed, Inc. Deflectable medical devices
US9084627B2 (en) * 2011-10-18 2015-07-21 Boston Scientific Scimed, Inc. Atherectomy positioning device
EP3366250A1 (en) 2011-11-08 2018-08-29 Boston Scientific Scimed, Inc. Ostial renal nerve ablation
US9345406B2 (en) 2011-11-11 2016-05-24 Avinger, Inc. Occlusion-crossing devices, atherectomy devices, and imaging
US9119600B2 (en) 2011-11-15 2015-09-01 Boston Scientific Scimed, Inc. Device and methods for renal nerve modulation monitoring
US9119632B2 (en) 2011-11-21 2015-09-01 Boston Scientific Scimed, Inc. Deflectable renal nerve ablation catheter
WO2013078235A1 (en) 2011-11-23 2013-05-30 Broncus Medical Inc Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall
WO2013085934A1 (en) * 2011-12-05 2013-06-13 Pi-R-Squared Ltd. Fracturing calcifications in heart valves
US9730609B2 (en) 2011-12-15 2017-08-15 Siemens Healthcare Gmbh Method and system for aortic valve calcification evaluation
US9827092B2 (en) 2011-12-16 2017-11-28 Tendyne Holdings, Inc. Tethers for prosthetic mitral valve
US9265969B2 (en) 2011-12-21 2016-02-23 Cardiac Pacemakers, Inc. Methods for modulating cell function
JP6130397B2 (en) 2011-12-23 2017-05-17 べシックス・バスキュラー・インコーポレイテッド Device for remodeling tissue in or adjacent to a body passage
WO2013101452A1 (en) 2011-12-28 2013-07-04 Boston Scientific Scimed, Inc. Device and methods for nerve modulation using a novel ablation catheter with polymeric ablative elements
US9050106B2 (en) 2011-12-29 2015-06-09 Boston Scientific Scimed, Inc. Off-wall electrode device and methods for nerve modulation
WO2013119545A1 (en) 2012-02-10 2013-08-15 Ethicon-Endo Surgery, Inc. Robotically controlled surgical instrument
US20130226287A1 (en) * 2012-02-23 2013-08-29 Boston Scientific Scimed, Inc. Valvuloplasty device
US9439668B2 (en) 2012-04-09 2016-09-13 Ethicon Endo-Surgery, Llc Switch arrangements for ultrasonic surgical instruments
US9237921B2 (en) 2012-04-09 2016-01-19 Ethicon Endo-Surgery, Inc. Devices and techniques for cutting and coagulating tissue
US9724118B2 (en) 2012-04-09 2017-08-08 Ethicon Endo-Surgery, Llc Techniques for cutting and coagulating tissue for ultrasonic surgical instruments
US9241731B2 (en) 2012-04-09 2016-01-26 Ethicon Endo-Surgery, Inc. Rotatable electrical connection for ultrasonic surgical instruments
US9226766B2 (en) 2012-04-09 2016-01-05 Ethicon Endo-Surgery, Inc. Serial communication protocol for medical device
CN102614017B (en) * 2012-04-20 2015-09-30 中国人民解放军第二军医大学 Untouchable for bronchial lumen internal therapy microwave device
WO2013169927A1 (en) 2012-05-08 2013-11-14 Boston Scientific Scimed, Inc. Renal nerve modulation devices
US9557156B2 (en) 2012-05-14 2017-01-31 Avinger, Inc. Optical coherence tomography with graded index fiber for biological imaging
US9345398B2 (en) 2012-05-14 2016-05-24 Avinger, Inc. Atherectomy catheter drive assemblies
WO2013172970A1 (en) 2012-05-14 2013-11-21 Avinger, Inc. Atherectomy catheters with imaging
US20140005705A1 (en) 2012-06-29 2014-01-02 Ethicon Endo-Surgery, Inc. Surgical instruments with articulating shafts
US9198714B2 (en) 2012-06-29 2015-12-01 Ethicon Endo-Surgery, Inc. Haptic feedback devices for surgical robot
US9351754B2 (en) 2012-06-29 2016-05-31 Ethicon Endo-Surgery, Llc Ultrasonic surgical instruments with distally positioned jaw assemblies
US20140005702A1 (en) 2012-06-29 2014-01-02 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments with distally positioned transducers
US9820768B2 (en) 2012-06-29 2017-11-21 Ethicon Llc Ultrasonic surgical instruments with control mechanisms
US9283045B2 (en) 2012-06-29 2016-03-15 Ethicon Endo-Surgery, Llc Surgical instruments with fluid management system
US9393037B2 (en) 2012-06-29 2016-07-19 Ethicon Endo-Surgery, Llc Surgical instruments with articulating shafts
US9226767B2 (en) 2012-06-29 2016-01-05 Ethicon Endo-Surgery, Inc. Closed feedback control for electrosurgical device
US9326788B2 (en) 2012-06-29 2016-05-03 Ethicon Endo-Surgery, Llc Lockout mechanism for use with robotic electrosurgical device
US9408622B2 (en) 2012-06-29 2016-08-09 Ethicon Endo-Surgery, Llc Surgical instruments with articulating shafts
WO2014022124A1 (en) 2012-07-28 2014-02-06 Tendyne Holdings, Inc. Improved multi-component designs for heart valve retrieval device, sealing structures and stent assembly
WO2014021905A1 (en) 2012-07-30 2014-02-06 Tendyne Holdings, Inc. Improved delivery systems and methods for transcatheter prosthetic valves
WO2014032016A1 (en) 2012-08-24 2014-02-27 Boston Scientific Scimed, Inc. Intravascular catheter with a balloon comprising separate microporous regions
JP6523170B2 (en) 2012-09-06 2019-05-29 アビンガー・インコーポレイテッドAvinger, Inc. Atheroma catheter and atheroma assembly
US11284916B2 (en) 2012-09-06 2022-03-29 Avinger, Inc. Atherectomy catheters and occlusion crossing devices
US9498247B2 (en) 2014-02-06 2016-11-22 Avinger, Inc. Atherectomy catheters and occlusion crossing devices
WO2014043687A2 (en) 2012-09-17 2014-03-20 Boston Scientific Scimed, Inc. Self-positioning electrode system and method for renal nerve modulation
US10398464B2 (en) 2012-09-21 2019-09-03 Boston Scientific Scimed, Inc. System for nerve modulation and innocuous thermal gradient nerve block
WO2014047454A2 (en) 2012-09-21 2014-03-27 Boston Scientific Scimed, Inc. Self-cooling ultrasound ablation catheter
BR112015007010B1 (en) 2012-09-28 2022-05-31 Ethicon Endo-Surgery, Inc end actuator
EP2906135A2 (en) 2012-10-10 2015-08-19 Boston Scientific Scimed, Inc. Renal nerve modulation devices and methods
US9095367B2 (en) 2012-10-22 2015-08-04 Ethicon Endo-Surgery, Inc. Flexible harmonic waveguides/blades for surgical instruments
US10201365B2 (en) 2012-10-22 2019-02-12 Ethicon Llc Surgeon feedback sensing and display methods
US9675456B2 (en) * 2012-11-02 2017-06-13 Medtronic, Inc. Transcatheter valve prosthesis delivery system with recapturing feature and method
US20140135804A1 (en) 2012-11-15 2014-05-15 Ethicon Endo-Surgery, Inc. Ultrasonic and electrosurgical devices
US9693821B2 (en) 2013-03-11 2017-07-04 Boston Scientific Scimed, Inc. Medical devices for modulating nerves
WO2014163987A1 (en) 2013-03-11 2014-10-09 Boston Scientific Scimed, Inc. Medical devices for modulating nerves
US9808311B2 (en) 2013-03-13 2017-11-07 Boston Scientific Scimed, Inc. Deflectable medical devices
US10226273B2 (en) 2013-03-14 2019-03-12 Ethicon Llc Mechanical fasteners for use with surgical energy devices
US10265122B2 (en) 2013-03-15 2019-04-23 Boston Scientific Scimed, Inc. Nerve ablation devices and related methods of use
US9241728B2 (en) 2013-03-15 2016-01-26 Ethicon Endo-Surgery, Inc. Surgical instrument with multiple clamping mechanisms
JP6220044B2 (en) 2013-03-15 2017-10-25 ボストン サイエンティフィック サイムド,インコーポレイテッドBoston Scientific Scimed,Inc. Medical device for renal nerve ablation
US9854979B2 (en) 2013-03-15 2018-01-02 Avinger, Inc. Chronic total occlusion crossing devices with imaging
JP6291025B2 (en) 2013-03-15 2018-03-14 アビンガー・インコーポレイテッドAvinger, Inc. Optical pressure sensor assembly
EP2967507B1 (en) 2013-03-15 2018-09-05 Avinger, Inc. Tissue collection device for catheter
EP2967945B1 (en) 2013-03-15 2020-10-28 California Institute of Technology Handle mechanism and functionality for repositioning and retrieval of transcatheter heart valves
WO2014149690A2 (en) 2013-03-15 2014-09-25 Boston Scientific Scimed, Inc. Medical devices and methods for treatment of hypertension that utilize impedance compensation
US9486306B2 (en) 2013-04-02 2016-11-08 Tendyne Holdings, Inc. Inflatable annular sealing device for prosthetic mitral valve
US11224510B2 (en) 2013-04-02 2022-01-18 Tendyne Holdings, Inc. Prosthetic heart valve and systems and methods for delivering the same
US10463489B2 (en) 2013-04-02 2019-11-05 Tendyne Holdings, Inc. Prosthetic heart valve and systems and methods for delivering the same
US10478293B2 (en) 2013-04-04 2019-11-19 Tendyne Holdings, Inc. Retrieval and repositioning system for prosthetic heart valve
US9610159B2 (en) 2013-05-30 2017-04-04 Tendyne Holdings, Inc. Structural members for prosthetic mitral valves
CN105473091B (en) 2013-06-21 2020-01-21 波士顿科学国际有限公司 Renal denervation balloon catheter with co-movable electrode supports
US10022182B2 (en) 2013-06-21 2018-07-17 Boston Scientific Scimed, Inc. Medical devices for renal nerve ablation having rotatable shafts
US9707036B2 (en) 2013-06-25 2017-07-18 Boston Scientific Scimed, Inc. Devices and methods for nerve modulation using localized indifferent electrodes
JP6461122B2 (en) 2013-06-25 2019-01-30 テンダイン ホールディングス,インコーポレイテッド Thrombus management and structural compliance features of prosthetic heart valves
CN105592808B (en) * 2013-06-26 2018-11-09 Sat集团(控股)有限公司 Orienting device for mitral valve reparation
WO2015002787A1 (en) 2013-07-01 2015-01-08 Boston Scientific Scimed, Inc. Medical devices for renal nerve ablation
JP6517198B2 (en) 2013-07-08 2019-05-22 アビンガー・インコーポレイテッドAvinger, Inc. Identification of elastic layers guiding interventions
US10660698B2 (en) 2013-07-11 2020-05-26 Boston Scientific Scimed, Inc. Devices and methods for nerve modulation
WO2015006573A1 (en) 2013-07-11 2015-01-15 Boston Scientific Scimed, Inc. Medical device with stretchable electrode assemblies
US8870948B1 (en) 2013-07-17 2014-10-28 Cephea Valve Technologies, Inc. System and method for cardiac valve repair and replacement
US9925001B2 (en) 2013-07-19 2018-03-27 Boston Scientific Scimed, Inc. Spiral bipolar electrode renal denervation balloon
CN105392435B (en) 2013-07-22 2018-11-09 波士顿科学国际有限公司 Renal nerve ablation catheter with twisting sacculus
US10342609B2 (en) 2013-07-22 2019-07-09 Boston Scientific Scimed, Inc. Medical devices for renal nerve ablation
JP6465883B2 (en) 2013-08-01 2019-02-06 テンダイン ホールディングス,インコーポレイテッド Epicardial anchor device and method
EP4049605A1 (en) 2013-08-22 2022-08-31 Boston Scientific Scimed Inc. Flexible circuit having improved adhesion to a renal nerve modulation balloon
WO2015035047A1 (en) 2013-09-04 2015-03-12 Boston Scientific Scimed, Inc. Radio frequency (rf) balloon catheter having flushing and cooling capability
US9814514B2 (en) 2013-09-13 2017-11-14 Ethicon Llc Electrosurgical (RF) medical instruments for cutting and coagulating tissue
EP3043733A1 (en) 2013-09-13 2016-07-20 Boston Scientific Scimed, Inc. Ablation balloon with vapor deposited cover layer
US9687166B2 (en) 2013-10-14 2017-06-27 Boston Scientific Scimed, Inc. High resolution cardiac mapping electrode array catheter
US11246654B2 (en) 2013-10-14 2022-02-15 Boston Scientific Scimed, Inc. Flexible renal nerve ablation devices and related methods of use and manufacture
WO2015057584A1 (en) 2013-10-15 2015-04-23 Boston Scientific Scimed, Inc. Medical device balloon
US9770606B2 (en) 2013-10-15 2017-09-26 Boston Scientific Scimed, Inc. Ultrasound ablation catheter with cooling infusion and centering basket
WO2015058039A1 (en) 2013-10-17 2015-04-23 Robert Vidlund Apparatus and methods for alignment and deployment of intracardiac devices
EP3057521B1 (en) 2013-10-18 2020-03-25 Boston Scientific Scimed, Inc. Balloon catheters with flexible conducting wires
EP3060153A1 (en) 2013-10-25 2016-08-31 Boston Scientific Scimed, Inc. Embedded thermocouple in denervation flex circuit
CN105682611B (en) 2013-10-28 2018-06-01 坦迪尼控股股份有限公司 Prosthetic heart valve and the system and method for conveying prosthetic heart valve
US9526611B2 (en) 2013-10-29 2016-12-27 Tendyne Holdings, Inc. Apparatus and methods for delivery of transcatheter prosthetic valves
US9265926B2 (en) 2013-11-08 2016-02-23 Ethicon Endo-Surgery, Llc Electrosurgical devices
US9913655B2 (en) * 2013-11-18 2018-03-13 Ethicon Llc Surgical instrument with active element and suction cage
GB2521228A (en) 2013-12-16 2015-06-17 Ethicon Endo Surgery Inc Medical device
GB2521229A (en) 2013-12-16 2015-06-17 Ethicon Endo Surgery Inc Medical device
CN105899157B (en) 2014-01-06 2019-08-09 波士顿科学国际有限公司 Tear-proof flexible circuit assembly
US9795436B2 (en) 2014-01-07 2017-10-24 Ethicon Llc Harvesting energy from a surgical generator
US11000679B2 (en) 2014-02-04 2021-05-11 Boston Scientific Scimed, Inc. Balloon protection and rewrapping devices and related methods of use
EP3102136B1 (en) 2014-02-04 2018-06-27 Boston Scientific Scimed, Inc. Alternative placement of thermal sensors on bipolar electrode
WO2015120122A2 (en) 2014-02-05 2015-08-13 Robert Vidlund Apparatus and methods for transfemoral delivery of prosthetic mitral valve
EP3102127B1 (en) 2014-02-06 2019-10-09 Avinger, Inc. Atherectomy catheter
US9986993B2 (en) 2014-02-11 2018-06-05 Tendyne Holdings, Inc. Adjustable tether and epicardial pad system for prosthetic heart valve
AU2015229708B2 (en) 2014-03-10 2019-08-15 Tendyne Holdings, Inc. Devices and methods for positioning and monitoring tether load for prosthetic mitral valve
US9554854B2 (en) 2014-03-18 2017-01-31 Ethicon Endo-Surgery, Llc Detecting short circuits in electrosurgical medical devices
US10463421B2 (en) 2014-03-27 2019-11-05 Ethicon Llc Two stage trigger, clamp and cut bipolar vessel sealer
US10092310B2 (en) 2014-03-27 2018-10-09 Ethicon Llc Electrosurgical devices
US11903833B2 (en) 2014-03-29 2024-02-20 Cormatrix Cardiovascular, Inc. Prosthetic venous valves
US20210169643A1 (en) * 2014-03-29 2021-06-10 CorMatrix Cardiovascular Prosthetic Heart Valves
US9737355B2 (en) 2014-03-31 2017-08-22 Ethicon Llc Controlling impedance rise in electrosurgical medical devices
US9913680B2 (en) 2014-04-15 2018-03-13 Ethicon Llc Software algorithms for electrosurgical instruments
US10709490B2 (en) 2014-05-07 2020-07-14 Medtronic Ardian Luxembourg S.A.R.L. Catheter assemblies comprising a direct heating element for renal neuromodulation and associated systems and methods
FR3021859A1 (en) * 2014-06-05 2015-12-11 Bernard Pain DEVICE FOR CUTTING AND REMOVING CALCIFIED TISSUES FROM A HEART VALVE
CA2955242A1 (en) 2014-07-08 2016-01-14 Avinger, Inc. High speed chronic total occlusion crossing devices
US10285724B2 (en) 2014-07-31 2019-05-14 Ethicon Llc Actuation mechanisms and load adjustment assemblies for surgical instruments
WO2016046710A1 (en) * 2014-09-24 2016-03-31 Koninklijke Philips N.V. Endoluminal filter having enhanced echogenic properties
US20160089172A1 (en) * 2014-09-30 2016-03-31 Boston Scientific Scimed, Inc. Devices and methods for applying suction
US10639092B2 (en) 2014-12-08 2020-05-05 Ethicon Llc Electrode configurations for surgical instruments
WO2016093877A1 (en) 2014-12-09 2016-06-16 Cephea Valve Technologies, Inc. Replacement cardiac valves and methods of use and manufacture
CN107405195B (en) 2015-01-07 2020-09-08 坦迪尼控股股份有限公司 Artificial mitral valve and apparatus and method for delivering artificial mitral valve
TWI529391B (en) * 2015-01-22 2016-04-11 國立臺灣大學 System and method for using photoacoustic effect
CA2975294A1 (en) 2015-02-05 2016-08-11 Tendyne Holdings, Inc. Expandable epicardial pads and devices and methods for delivery of same
US10245095B2 (en) 2015-02-06 2019-04-02 Ethicon Llc Electrosurgical instrument with rotation and articulation mechanisms
US10342602B2 (en) 2015-03-17 2019-07-09 Ethicon Llc Managing tissue treatment
US10321950B2 (en) 2015-03-17 2019-06-18 Ethicon Llc Managing tissue treatment
US10595929B2 (en) 2015-03-24 2020-03-24 Ethicon Llc Surgical instruments with firing system overload protection mechanisms
US10485563B2 (en) * 2015-03-27 2019-11-26 Terumo Kabushiki Kaisha Calculus/calculi retrieving device and method
EP3283010B1 (en) 2015-04-16 2020-06-17 Tendyne Holdings, Inc. Apparatus for delivery and repositioning of transcatheter prosthetic valves
US10849746B2 (en) 2015-05-14 2020-12-01 Cephea Valve Technologies, Inc. Cardiac valve delivery devices and systems
EP3294221B1 (en) 2015-05-14 2024-03-06 Cephea Valve Technologies, Inc. Replacement mitral valves
US10034684B2 (en) 2015-06-15 2018-07-31 Ethicon Llc Apparatus and method for dissecting and coagulating tissue
US11020140B2 (en) 2015-06-17 2021-06-01 Cilag Gmbh International Ultrasonic surgical blade for use with ultrasonic surgical instruments
US10765470B2 (en) 2015-06-30 2020-09-08 Ethicon Llc Surgical system with user adaptable techniques employing simultaneous energy modalities based on tissue parameters
US11051873B2 (en) 2015-06-30 2021-07-06 Cilag Gmbh International Surgical system with user adaptable techniques employing multiple energy modalities based on tissue parameters
US10357303B2 (en) 2015-06-30 2019-07-23 Ethicon Llc Translatable outer tube for sealing using shielded lap chole dissector
US10034704B2 (en) 2015-06-30 2018-07-31 Ethicon Llc Surgical instrument with user adaptable algorithms
US11129669B2 (en) 2015-06-30 2021-09-28 Cilag Gmbh International Surgical system with user adaptable techniques based on tissue type
US10898256B2 (en) 2015-06-30 2021-01-26 Ethicon Llc Surgical system with user adaptable techniques based on tissue impedance
US10154852B2 (en) 2015-07-01 2018-12-18 Ethicon Llc Ultrasonic surgical blade with improved cutting and coagulation features
EP3322338A4 (en) 2015-07-13 2019-03-13 Avinger, Inc. Micro-molded anamorphic reflector lens for image guided therapeutic/diagnostic catheters
EP3322357B8 (en) * 2015-07-16 2020-01-15 Perflow Medical Ltd. Apparatus for vessel occlusion removal
US10327894B2 (en) 2015-09-18 2019-06-25 Tendyne Holdings, Inc. Methods for delivery of prosthetic mitral valves
US11058475B2 (en) 2015-09-30 2021-07-13 Cilag Gmbh International Method and apparatus for selecting operations of a surgical instrument based on user intention
AU2016335755B2 (en) 2015-10-07 2021-07-01 Mayo Foundation For Medical Education And Research Electroporation for obesity or diabetes treatment
US10595930B2 (en) 2015-10-16 2020-03-24 Ethicon Llc Electrode wiping surgical device
EP3383322B1 (en) 2015-12-03 2020-02-12 Tendyne Holdings, Inc. Frame features for prosthetic mitral valves
CA3006010C (en) 2015-12-28 2023-09-26 Tendyne Holdings, Inc. Atrial pocket closures for prosthetic heart valves
US10179022B2 (en) 2015-12-30 2019-01-15 Ethicon Llc Jaw position impedance limiter for electrosurgical instrument
US10575892B2 (en) 2015-12-31 2020-03-03 Ethicon Llc Adapter for electrical surgical instruments
US11129670B2 (en) 2016-01-15 2021-09-28 Cilag Gmbh International Modular battery powered handheld surgical instrument with selective application of energy based on button displacement, intensity, or local tissue characterization
US10709469B2 (en) 2016-01-15 2020-07-14 Ethicon Llc Modular battery powered handheld surgical instrument with energy conservation techniques
US11229471B2 (en) 2016-01-15 2022-01-25 Cilag Gmbh International Modular battery powered handheld surgical instrument with selective application of energy based on tissue characterization
US10716615B2 (en) 2016-01-15 2020-07-21 Ethicon Llc Modular battery powered handheld surgical instrument with curved end effectors having asymmetric engagement between jaw and blade
US11278248B2 (en) 2016-01-25 2022-03-22 Avinger, Inc. OCT imaging catheter with lag correction
US10555769B2 (en) 2016-02-22 2020-02-11 Ethicon Llc Flexible circuits for electrosurgical instrument
WO2017173370A1 (en) 2016-04-01 2017-10-05 Avinger, Inc. Atherectomy catheter with serrated cutter
US10646269B2 (en) 2016-04-29 2020-05-12 Ethicon Llc Non-linear jaw gap for electrosurgical instruments
US10702329B2 (en) 2016-04-29 2020-07-07 Ethicon Llc Jaw structure with distal post for electrosurgical instruments
US10485607B2 (en) 2016-04-29 2019-11-26 Ethicon Llc Jaw structure with distal closure for electrosurgical instruments
US10456193B2 (en) 2016-05-03 2019-10-29 Ethicon Llc Medical device with a bilateral jaw configuration for nerve stimulation
US10470877B2 (en) 2016-05-03 2019-11-12 Tendyne Holdings, Inc. Apparatus and methods for anterior valve leaflet management
US11344327B2 (en) 2016-06-03 2022-05-31 Avinger, Inc. Catheter device with detachable distal end
WO2017218375A1 (en) 2016-06-13 2017-12-21 Tendyne Holdings, Inc. Sequential delivery of two-part prosthetic mitral valve
US11331187B2 (en) 2016-06-17 2022-05-17 Cephea Valve Technologies, Inc. Cardiac valve delivery devices and systems
CN109414273B (en) 2016-06-30 2023-02-17 阿维格公司 Atherectomy catheter with shapeable distal tip
US11419619B2 (en) * 2016-06-30 2022-08-23 Les Solutions Médicales Soundbite Inc. Method and system for treating lesions
US11090157B2 (en) 2016-06-30 2021-08-17 Tendyne Holdings, Inc. Prosthetic heart valves and apparatus and methods for delivery of same
US10245064B2 (en) 2016-07-12 2019-04-02 Ethicon Llc Ultrasonic surgical instrument with piezoelectric central lumen transducer
EP3484411A1 (en) 2016-07-12 2019-05-22 Tendyne Holdings, Inc. Apparatus and methods for trans-septal retrieval of prosthetic heart valves
US10893883B2 (en) 2016-07-13 2021-01-19 Ethicon Llc Ultrasonic assembly for use with ultrasonic surgical instruments
US10456283B2 (en) 2016-07-13 2019-10-29 Boston Scientific Scimed, Inc. Apparatus and method for maintaining patency in a vessel adjacent to nearby surgery
US10842522B2 (en) 2016-07-15 2020-11-24 Ethicon Llc Ultrasonic surgical instruments having offset blades
US10376305B2 (en) 2016-08-05 2019-08-13 Ethicon Llc Methods and systems for advanced harmonic energy
US10285723B2 (en) 2016-08-09 2019-05-14 Ethicon Llc Ultrasonic surgical blade with improved heel portion
USD847990S1 (en) 2016-08-16 2019-05-07 Ethicon Llc Surgical instrument
US10952759B2 (en) 2016-08-25 2021-03-23 Ethicon Llc Tissue loading of a surgical instrument
US10736649B2 (en) 2016-08-25 2020-08-11 Ethicon Llc Electrical and thermal connections for ultrasonic transducer
KR20180034117A (en) 2016-09-27 2018-04-04 삼성메디슨 주식회사 Ultrasound diagnostic apparatus and operating method for the same
US10603064B2 (en) 2016-11-28 2020-03-31 Ethicon Llc Ultrasonic transducer
US11266430B2 (en) 2016-11-29 2022-03-08 Cilag Gmbh International End effector control and calibration
AU2018210334B2 (en) 2017-01-20 2020-09-03 W. L. Gore & Associates, Inc. Embolic filter system
CA3051272C (en) 2017-01-23 2023-08-22 Cephea Valve Technologies, Inc. Replacement mitral valves
EP4209196A1 (en) 2017-01-23 2023-07-12 Cephea Valve Technologies, Inc. Replacement mitral valves
US11690645B2 (en) 2017-05-03 2023-07-04 Medtronic Vascular, Inc. Tissue-removing catheter
WO2018204704A1 (en) 2017-05-03 2018-11-08 Medtronic Vascular, Inc. Tissue-removing catheter
US10820920B2 (en) 2017-07-05 2020-11-03 Ethicon Llc Reusable ultrasonic medical devices and methods of their use
EP3651695B1 (en) 2017-07-13 2023-04-19 Tendyne Holdings, Inc. Prosthetic heart valves and apparatus for delivery of same
EP3672530A4 (en) 2017-08-25 2021-04-14 Neovasc Tiara Inc. Sequentially deployed transcatheter mitral valve prosthesis
AU2018323900A1 (en) 2017-08-28 2020-02-27 Tendyne Holdings, Inc. Prosthetic heart valves with tether coupling features
CA3075678A1 (en) * 2017-09-12 2019-03-21 Enrico Pasquino Transcatheter device for the treatment of calcified heart valve leaflets
US11026791B2 (en) 2018-03-20 2021-06-08 Medtronic Vascular, Inc. Flexible canopy valve repair systems and methods of use
US11285003B2 (en) 2018-03-20 2022-03-29 Medtronic Vascular, Inc. Prolapse prevention device and methods of use thereof
EP3796873B1 (en) 2018-05-23 2022-04-27 Corcym S.r.l. A cardiac valve prosthesis
JP7260930B2 (en) 2018-11-08 2023-04-19 ニオバスク ティアラ インコーポレイテッド Ventricular deployment of a transcatheter mitral valve prosthesis
CN112969426A (en) 2018-11-14 2021-06-15 美敦力公司 Device and method for preparing a valve for a transcatheter valve replacement procedure
US11357534B2 (en) 2018-11-16 2022-06-14 Medtronic Vascular, Inc. Catheter
JP2022517817A (en) 2019-01-23 2022-03-10 アトリキュア, インコーポレイテッド High frequency ablation device
WO2020191387A1 (en) 2019-03-21 2020-09-24 Illumina, Inc. Artificial intelligence-based base calling
US11819236B2 (en) 2019-05-17 2023-11-21 Medtronic Vascular, Inc. Tissue-removing catheter
CA3140925A1 (en) 2019-05-20 2020-11-26 Neovasc Tiara Inc. Introducer with hemostasis mechanism
WO2021046643A1 (en) * 2019-09-11 2021-03-18 North Star Specialists Inc. Catheter, sheath or dilator for heart valve decalcification treatment and method of use thereof
EP4044942A4 (en) 2019-10-18 2023-11-15 Avinger, Inc. Occlusion-crossing devices
EP3831343B1 (en) 2019-12-05 2024-01-31 Tendyne Holdings, Inc. Braided anchor for mitral valve
US11648114B2 (en) 2019-12-20 2023-05-16 Tendyne Holdings, Inc. Distally loaded sheath and loading funnel
US11707318B2 (en) 2019-12-30 2023-07-25 Cilag Gmbh International Surgical instrument with jaw alignment features
US11696776B2 (en) 2019-12-30 2023-07-11 Cilag Gmbh International Articulatable surgical instrument
US20210196358A1 (en) 2019-12-30 2021-07-01 Ethicon Llc Electrosurgical instrument with electrodes biasing support
US11779387B2 (en) 2019-12-30 2023-10-10 Cilag Gmbh International Clamp arm jaw to minimize tissue sticking and improve tissue control
US11452525B2 (en) 2019-12-30 2022-09-27 Cilag Gmbh International Surgical instrument comprising an adjustment system
US11660089B2 (en) 2019-12-30 2023-05-30 Cilag Gmbh International Surgical instrument comprising a sensing system
US20210196359A1 (en) 2019-12-30 2021-07-01 Ethicon Llc Electrosurgical instruments with electrodes having energy focusing features
US11759251B2 (en) 2019-12-30 2023-09-19 Cilag Gmbh International Control program adaptation based on device status and user input
US11812957B2 (en) 2019-12-30 2023-11-14 Cilag Gmbh International Surgical instrument comprising a signal interference resolution system
US11786291B2 (en) 2019-12-30 2023-10-17 Cilag Gmbh International Deflectable support of RF energy electrode with respect to opposing ultrasonic blade
US11911063B2 (en) 2019-12-30 2024-02-27 Cilag Gmbh International Techniques for detecting ultrasonic blade to electrode contact and reducing power to ultrasonic blade
US11779329B2 (en) 2019-12-30 2023-10-10 Cilag Gmbh International Surgical instrument comprising a flex circuit including a sensor system
US11648020B2 (en) 2020-02-07 2023-05-16 Angiodynamics, Inc. Device and method for manual aspiration and removal of an undesirable material
US11678980B2 (en) 2020-08-19 2023-06-20 Tendyne Holdings, Inc. Fully-transseptal apical pad with pulley for tensioning
US11523841B2 (en) 2020-09-03 2022-12-13 Cardiovascular Systems, Inc. Systems, methods and devices for removal of thrombus and/or soft plaque with asymmetric mass distribution within working region of impeller
CN112168282B (en) * 2020-09-29 2022-04-15 河南省洛阳正骨医院(河南省骨科医院) Marrow cavity focus reducing scraping device
WO2022177552A1 (en) * 2021-02-17 2022-08-25 Cormatrix Cardiovascular, Inc. Prosthetic venous valves
EP4313246A1 (en) * 2021-03-29 2024-02-07 Elixir Medical Corporation Methods and apparatus for plaque disruption
CN113907840B (en) * 2021-08-31 2023-08-29 山东大学第二医院 Device for taking gall-stone
CN114869380B (en) * 2022-03-24 2022-12-06 江苏省肿瘤医院 Vibration sleeve-removing device for plug coil

Citations (92)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3526219A (en) * 1967-07-21 1970-09-01 Ultrasonic Systems Method and apparatus for ultrasonically removing tissue from a biological organism
US3565062A (en) * 1968-06-13 1971-02-23 Ultrasonic Systems Ultrasonic method and apparatus for removing cholesterol and other deposits from blood vessels and the like
US3589363A (en) * 1967-07-25 1971-06-29 Cavitron Corp Material removal apparatus and method employing high frequency vibrations
US3667474A (en) * 1970-01-05 1972-06-06 Konstantin Vasilievich Lapkin Dilator for performing mitral and tricuspidal commissurotomy per atrium cordis
US3823717A (en) * 1972-04-22 1974-07-16 R Pohlman Apparatus for disintegrating concretions in body cavities of living organisms by means of an ultrasonic probe
US3861391A (en) * 1972-07-02 1975-01-21 Blackstone Corp Apparatus for disintegration of urinary calculi
US3896811A (en) * 1972-08-31 1975-07-29 Karl Storz Ultrasonic surgical instrument
US4042979A (en) * 1976-07-12 1977-08-23 Angell William W Valvuloplasty ring and prosthetic method
US4188952A (en) * 1973-12-28 1980-02-19 Loschilov Vladimir I Surgical instrument for ultrasonic separation of biological tissue
US4431006A (en) * 1982-01-07 1984-02-14 Technicare Corporation Passive ultrasound needle probe locator
US4445509A (en) * 1982-02-04 1984-05-01 Auth David C Method and apparatus for removal of enclosed abnormal deposits
US4484579A (en) * 1982-07-19 1984-11-27 University Of Pittsburgh Commissurotomy catheter apparatus and method
US4587958A (en) * 1983-04-04 1986-05-13 Sumitomo Bakelite Company Limited Ultrasonic surgical device
US4589419A (en) * 1984-11-01 1986-05-20 University Of Iowa Research Foundation Catheter for treating arterial occlusion
US4646736A (en) * 1984-09-10 1987-03-03 E. R. Squibb & Sons, Inc. Transluminal thrombectomy apparatus
US4692139A (en) * 1984-03-09 1987-09-08 Stiles Frank B Catheter for effecting removal of obstructions from a biological duct
US4747821A (en) * 1986-10-22 1988-05-31 Intravascular Surgical Instruments, Inc. Catheter with high speed moving working head
US4750902A (en) * 1985-08-28 1988-06-14 Sonomed Technology, Inc. Endoscopic ultrasonic aspirators
US4777951A (en) * 1986-09-19 1988-10-18 Mansfield Scientific, Inc. Procedure and catheter instrument for treating patients for aortic stenosis
US4787388A (en) * 1985-11-29 1988-11-29 Schneider - Shiley Ag Method for opening constricted regions in the cardiovascular system
US4796629A (en) * 1987-06-03 1989-01-10 Joseph Grayzel Stiffened dilation balloon catheter device
US4808153A (en) * 1986-11-17 1989-02-28 Ultramed Corporation Device for removing plaque from arteries
US4819751A (en) * 1987-10-16 1989-04-11 Baxter Travenol Laboratories, Inc. Valvuloplasty catheter and method
US4841977A (en) * 1987-05-26 1989-06-27 Inter Therapy, Inc. Ultra-thin acoustic transducer and balloon catheter using same in imaging array subassembly
US4870953A (en) * 1987-11-13 1989-10-03 Donmicheal T Anthony Intravascular ultrasonic catheter/probe and method for treating intravascular blockage
US4878495A (en) * 1987-05-15 1989-11-07 Joseph Grayzel Valvuloplasty device with satellite expansion means
US4898575A (en) * 1987-08-31 1990-02-06 Medinnovations, Inc. Guide wire following tunneling catheter system and method for transluminal arterial atherectomy
US4909252A (en) * 1988-05-26 1990-03-20 The Regents Of The Univ. Of California Perfusion balloon catheter
US4919133A (en) * 1988-08-18 1990-04-24 Chiang Tien Hon Catheter apparatus employing shape memory alloy structures
US4920954A (en) * 1988-08-05 1990-05-01 Sonic Needle Corporation Ultrasonic device for applying cavitation forces
US4936281A (en) * 1989-04-13 1990-06-26 Everest Medical Corporation Ultrasonically enhanced RF ablation catheter
US4960411A (en) * 1984-09-18 1990-10-02 Medtronic Versaflex, Inc. Low profile sterrable soft-tip catheter
US4986830A (en) * 1989-09-22 1991-01-22 Schneider (U.S.A.) Inc. Valvuloplasty catheter with balloon which remains stable during inflation
US4990134A (en) * 1986-01-06 1991-02-05 Heart Technology, Inc. Transluminal microdissection device
US5058570A (en) * 1986-11-27 1991-10-22 Sumitomo Bakelite Company Limited Ultrasonic surgical apparatus
US5106302A (en) * 1990-09-26 1992-04-21 Ormco Corporation Method of fracturing interfaces with an ultrasonic tool
US5248296A (en) * 1990-12-24 1993-09-28 Sonic Needle Corporation Ultrasonic device having wire sheath
US5295958A (en) * 1991-04-04 1994-03-22 Shturman Cardiology Systems, Inc. Method and apparatus for in vivo heart valve decalcification
US5304115A (en) * 1991-01-11 1994-04-19 Baxter International Inc. Ultrasonic angioplasty device incorporating improved transmission member and ablation probe
US5314407A (en) * 1986-11-14 1994-05-24 Heart Technology, Inc. Clinically practical rotational angioplasty system
US5318014A (en) * 1992-09-14 1994-06-07 Coraje, Inc. Ultrasonic ablation/dissolution transducer
US5352199A (en) * 1993-05-28 1994-10-04 Numed, Inc. Balloon catheter
US5356418A (en) * 1992-10-28 1994-10-18 Shturman Cardiology Systems, Inc. Apparatus and method for rotational atherectomy
US5397293A (en) * 1992-11-25 1995-03-14 Misonix, Inc. Ultrasonic device with sheath and transverse motion damping
US5489297A (en) * 1992-01-27 1996-02-06 Duran; Carlos M. G. Bioprosthetic heart valve with absorbable stent
US5609151A (en) * 1994-09-08 1997-03-11 Medtronic, Inc. Method for R-F ablation
US5662671A (en) * 1996-07-17 1997-09-02 Embol-X, Inc. Atherectomy device having trapping and excising means for removal of plaque from the aorta and other arteries
US5681336A (en) * 1995-09-07 1997-10-28 Boston Scientific Corporation Therapeutic device for treating vien graft lesions
US5725494A (en) * 1995-11-30 1998-03-10 Pharmasonics, Inc. Apparatus and methods for ultrasonically enhanced intraluminal therapy
US5782931A (en) * 1996-07-30 1998-07-21 Baxter International Inc. Methods for mitigating calcification and improving durability in glutaraldehyde-fixed bioprostheses and articles manufactured by such methods
US5827229A (en) * 1995-05-24 1998-10-27 Boston Scientific Corporation Northwest Technology Center, Inc. Percutaneous aspiration thrombectomy catheter system
US5840081A (en) * 1990-05-18 1998-11-24 Andersen; Henning Rud System and method for implanting cardiac valves
US5873811A (en) * 1997-01-10 1999-02-23 Sci-Med Life Systems Composition containing a radioactive component for treatment of vessel wall
US5904679A (en) * 1989-01-18 1999-05-18 Applied Medical Resources Corporation Catheter with electrosurgical cutter
US5957882A (en) * 1991-01-11 1999-09-28 Advanced Cardiovascular Systems, Inc. Ultrasound devices for ablating and removing obstructive matter from anatomical passageways and blood vessels
US5989208A (en) * 1997-05-16 1999-11-23 Nita; Henry Therapeutic ultrasound system
US6047700A (en) * 1998-03-30 2000-04-11 Arthrocare Corporation Systems and methods for electrosurgical removal of calcified deposits
US6129734A (en) * 1997-01-21 2000-10-10 Shturman Cardiology Systems, Inc. Rotational atherectomy device with radially expandable prime mover coupling
US6132444A (en) * 1997-08-14 2000-10-17 Shturman Cardiology Systems, Inc. Eccentric drive shaft for atherectomy device and method for manufacture
USRE36936E (en) * 1992-09-28 2000-10-31 Advanced Silicon Materials, Inc. Production of high-purity polycrystalline silicon rod for semiconductor applications
US6168579B1 (en) * 1999-08-04 2001-01-02 Scimed Life Systems, Inc. Filter flush system and methods of use
US6217595B1 (en) * 1996-11-18 2001-04-17 Shturman Cardiology Systems, Inc. Rotational atherectomy device
US6254635B1 (en) * 1998-02-02 2001-07-03 St. Jude Medical, Inc. Calcification-resistant medical articles
US6295712B1 (en) * 1996-07-15 2001-10-02 Shturman Cardiology Systems, Inc. Rotational atherectomy device
US6321109B2 (en) * 1996-02-15 2001-11-20 Biosense, Inc. Catheter based surgery
US20020007192A1 (en) * 1999-06-17 2002-01-17 Pederson Gary J. Stent securement by balloon modification
US20020082637A1 (en) * 2000-12-22 2002-06-27 Cardiovascular Systems, Inc. Catheter and method for making the same
US20020099139A1 (en) * 1999-12-16 2002-07-25 Young Chang Chemical Co., Ltd. Dendritic polyetherketone and heat-resistant blend of PVC with the same
US20020099439A1 (en) * 2000-09-29 2002-07-25 Schwartz Robert S. Venous valvuloplasty device and method
US6454737B1 (en) * 1991-01-11 2002-09-24 Advanced Cardiovascular Systems, Inc. Ultrasonic angioplasty-atherectomy catheter and method of use
US6505080B1 (en) * 1999-05-04 2003-01-07 Medtronic, Inc. Method and apparatus for inhibiting or minimizing calcification of aortic valves
US6565588B1 (en) * 2000-04-05 2003-05-20 Pathway Medical Technologies, Inc. Intralumenal material removal using an expandable cutting device
US6579308B1 (en) * 2000-11-28 2003-06-17 Scimed Life Systems, Inc. Stent devices with detachable distal or proximal wires
US20030139689A1 (en) * 2001-11-19 2003-07-24 Leonid Shturman High torque, low profile intravascular guidewire system
US6623452B2 (en) * 2000-12-19 2003-09-23 Scimed Life Systems, Inc. Drug delivery catheter having a highly compliant balloon with infusion holes
US20040006358A1 (en) * 2000-04-05 2004-01-08 Pathway Medical Technologies, Inc. Intralumenal material removal using a cutting device for differential cutting
US6689086B1 (en) * 1994-10-27 2004-02-10 Advanced Cardiovascular Systems, Inc. Method of using a catheter for delivery of ultrasonic energy and medicament
US20040039412A1 (en) * 2002-08-20 2004-02-26 Takaaki Isshiki Thrombus capture catheter
US20040044350A1 (en) * 1999-04-09 2004-03-04 Evalve, Inc. Steerable access sheath and methods of use
US6702748B1 (en) * 2002-09-20 2004-03-09 Flowcardia, Inc. Connector for securing ultrasound catheter to transducer
US20040057955A1 (en) * 2001-10-05 2004-03-25 O'brien Kevin D. Methods of inhibition of stenosis and/or sclerosis of the aortic valve
US20040082910A1 (en) * 2002-10-29 2004-04-29 Constantz Brent R. Devices and methods for treating aortic valve stenosis
US20040092989A1 (en) * 2002-08-28 2004-05-13 Heart Leaflet Technologies, Inc Delivery device for leaflet valve
US20040092962A1 (en) * 1999-04-09 2004-05-13 Evalve, Inc., A Delaware Corporation Multi-catheter steerable guiding system and methods of use
US6746463B1 (en) * 2003-01-27 2004-06-08 Scimed Life Systems, Inc Device for percutaneous cutting and dilating a stenosis of the aortic valve
US20050007219A1 (en) * 2002-07-11 2005-01-13 Qing Ma Microelectromechanical (MEMS) switching apparatus
US6843797B2 (en) * 1996-07-26 2005-01-18 Kensey Nash Corporation System and method of use for revascularizing stenotic bypass grafts and other occluded blood vessels
US6852118B2 (en) * 2001-10-19 2005-02-08 Shturman Cardiology Systems, Inc. Self-indexing coupling for rotational angioplasty device
US6855123B2 (en) * 2002-08-02 2005-02-15 Flow Cardia, Inc. Therapeutic ultrasound system
US6869439B2 (en) * 1996-09-19 2005-03-22 United States Surgical Corporation Ultrasonic dissector
US20050075662A1 (en) * 2003-07-18 2005-04-07 Wesley Pedersen Valvuloplasty catheter
US7803168B2 (en) * 2004-12-09 2010-09-28 The Foundry, Llc Aortic valve repair

Family Cites Families (587)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US931795A (en) 1908-11-30 1909-08-24 George James Packe Bottle for teething liquids and other liquids or materials.
US3752162A (en) 1972-04-10 1973-08-14 Dow Corning Artificial cutaneous stoma
US6014590A (en) 1974-03-04 2000-01-11 Ep Technologies, Inc. Systems and methods employing structures having asymmetric mechanical properties to support diagnostic or therapeutic elements in contact with tissue in interior body regions
US4046150A (en) 1975-07-17 1977-09-06 American Hospital Supply Corporation Medical instrument for locating and removing occlusive objects
US4787495A (en) 1984-11-30 1988-11-29 Creative Technology, Inc. Method and apparatus for selective scrap metal collection
US4824436A (en) 1985-04-09 1989-04-25 Harvey Wolinsky Method for the prevention of restenosis
US4790812A (en) * 1985-11-15 1988-12-13 Hawkins Jr Irvin F Apparatus and method for removing a target object from a body passsageway
FR2592791A1 (en) 1986-01-14 1987-07-17 Ire Celltarg Sa PHARMACEUTICAL COMPOSITION CONTAINING A LOCAL ANESTHETIC AND / OR A CENTRAL ANALGESIC ENCAPSULATED IN LIPOSOMES
US4709698A (en) 1986-05-14 1987-12-01 Thomas J. Fogarty Heatable dilation catheter
US4950483A (en) 1988-06-30 1990-08-21 Collagen Corporation Collagen wound healing matrices and process for their production
US5087244A (en) 1989-01-31 1992-02-11 C. R. Bard, Inc. Catheter and method for locally applying medication to the wall of a blood vessel or other body lumen
US5078717A (en) 1989-04-13 1992-01-07 Everest Medical Corporation Ablation catheter with selectively deployable electrodes
US5058670A (en) 1989-05-15 1991-10-22 Crawford Douglas W Oriented valve and latch for side pocket mandrel
US5156610A (en) 1989-08-18 1992-10-20 Evi Corporation Catheter atherotome
US5211651A (en) 1989-08-18 1993-05-18 Evi Corporation Catheter atherotome
JP3036835B2 (en) 1989-08-18 2000-04-24 イーブイアイ コーポレイション Catheter atherotome
US5282484A (en) 1989-08-18 1994-02-01 Endovascular Instruments, Inc. Method for performing a partial atherectomy
US5071424A (en) 1989-08-18 1991-12-10 Evi Corporation Catheter atherotome
JP2984056B2 (en) 1989-09-08 1999-11-29 ボストン サイエンティフィック コーポレイション Physiological low pressure angioplasty
US5076276A (en) 1989-11-01 1991-12-31 Olympus Optical Co., Ltd. Ultrasound type treatment apparatus
US5344395A (en) 1989-11-13 1994-09-06 Scimed Life Systems, Inc. Apparatus for intravascular cavitation or delivery of low frequency mechanical energy
US5069664A (en) 1990-01-25 1991-12-03 Inter Therapy, Inc. Intravascular ultrasonic angioplasty probe
US5158564A (en) 1990-02-14 1992-10-27 Angiomed Ag Atherectomy apparatus
US5084006A (en) 1990-03-30 1992-01-28 Alza Corporation Iontopheretic delivery device
US5236413B1 (en) 1990-05-07 1996-06-18 Andrew J Feiring Method and apparatus for inducing the permeation of medication into internal tissue
US5190540A (en) 1990-06-08 1993-03-02 Cardiovascular & Interventional Research Consultants, Inc. Thermal balloon angioplasty
US5269291A (en) 1990-12-10 1993-12-14 Coraje, Inc. Miniature ultrasonic transducer for plaque ablation
JP3041967B2 (en) 1990-12-13 2000-05-15 ソニー株式会社 Digital signal coding device
US6524274B1 (en) 1990-12-28 2003-02-25 Scimed Life Systems, Inc. Triggered release hydrogel drug delivery system
US5102402A (en) 1991-01-04 1992-04-07 Medtronic, Inc. Releasable coatings on balloon catheters
US5170802A (en) 1991-01-07 1992-12-15 Medtronic, Inc. Implantable electrode for location within a blood vessel
US5267954A (en) 1991-01-11 1993-12-07 Baxter International Inc. Ultra-sound catheter for removing obstructions from tubular anatomical structures such as blood vessels
US5997497A (en) 1991-01-11 1999-12-07 Advanced Cardiovascular Systems Ultrasound catheter having integrated drug delivery system and methods of using same
GB9101456D0 (en) 1991-01-23 1991-03-06 Exxon Chemical Patents Inc Process for producing substantially binder-free zeolite
EP0497041B1 (en) 1991-01-31 1997-01-08 Baxter International Inc. Automated infusion pump with replaceable memory cartridges
US5465717A (en) 1991-02-15 1995-11-14 Cardiac Pathways Corporation Apparatus and Method for ventricular mapping and ablation
US5345936A (en) 1991-02-15 1994-09-13 Cardiac Pathways Corporation Apparatus with basket assembly for endocardial mapping
EP0732106A3 (en) 1991-03-22 2003-04-09 Katsuro Tachibana Microbubbles containing booster for therapy of disease with ultrasound
US6309379B1 (en) 1991-05-23 2001-10-30 Lloyd K. Willard Sheath for selective delivery of multiple intravascular devices and methods of use thereof
WO1992020291A1 (en) 1991-05-24 1992-11-26 Applied Medical Resources, Inc. Articulating tissue cutter assembly
US6866650B2 (en) * 1991-07-16 2005-03-15 Heartport, Inc. System for cardiac procedures
US5419767A (en) 1992-01-07 1995-05-30 Thapliyal And Eggers Partners Methods and apparatus for advancing catheters through severely occluded body lumens
US5306250A (en) 1992-04-02 1994-04-26 Indiana University Foundation Method and apparatus for intravascular drug delivery
US5255679A (en) 1992-06-02 1993-10-26 Cardiac Pathways Corporation Endocardial catheter for mapping and/or ablation with an expandable basket structure having means for providing selective reinforcement and pressure sensing mechanism for use therewith, and method
US5782239A (en) 1992-06-30 1998-07-21 Cordis Webster, Inc. Unique electrode configurations for cardiovascular electrode catheter with built-in deflection method and central puller wire
US5772590A (en) 1992-06-30 1998-06-30 Cordis Webster, Inc. Cardiovascular catheter with laterally stable basket-shaped electrode array with puller wire
US5411025A (en) * 1992-06-30 1995-05-02 Cordis Webster, Inc. Cardiovascular catheter with laterally stable basket-shaped electrode array
US5304120A (en) 1992-07-01 1994-04-19 Btx Inc. Electroporation method and apparatus for insertion of drugs and genes into endothelial cells
US5538504A (en) 1992-07-14 1996-07-23 Scimed Life Systems, Inc. Intra-extravascular drug delivery catheter and method
US5471982A (en) 1992-09-29 1995-12-05 Ep Technologies, Inc. Cardiac mapping and ablation systems
WO1994007446A1 (en) 1992-10-05 1994-04-14 Boston Scientific Corporation Device and method for heating tissue
CA2107741C (en) 1992-10-07 2000-06-27 Peter T. Keith Ablation devices and methods of use
US5634901A (en) 1992-11-02 1997-06-03 Localmed, Inc. Method of using a catheter sleeve
US5571122A (en) 1992-11-09 1996-11-05 Endovascular Instruments, Inc. Unitary removal of plaque
US5807306A (en) 1992-11-09 1998-09-15 Cortrak Medical, Inc. Polymer matrix drug delivery apparatus
US5797960A (en) 1993-02-22 1998-08-25 Stevens; John H. Method and apparatus for thoracoscopic intracardiac procedures
US6346074B1 (en) 1993-02-22 2002-02-12 Heartport, Inc. Devices for less invasive intracardiac interventions
US5476495A (en) 1993-03-16 1995-12-19 Ep Technologies, Inc. Cardiac mapping and ablation systems
WO1994021168A1 (en) 1993-03-16 1994-09-29 Ep Technologies, Inc. Cardiac mapping and ablation systems
US5893847A (en) 1993-03-16 1999-04-13 Ep Technologies, Inc. Multiple electrode support structures with slotted hub and hoop spline elements
US5636634A (en) 1993-03-16 1997-06-10 Ep Technologies, Inc. Systems using guide sheaths for introducing, deploying, and stabilizing cardiac mapping and ablation probes
US5523092A (en) 1993-04-14 1996-06-04 Emory University Device for local drug delivery and methods for using the same
US5590654A (en) 1993-06-07 1997-01-07 Prince; Martin R. Method and apparatus for magnetic resonance imaging of arteries using a magnetic resonance contrast agent
DE69432148T2 (en) 1993-07-01 2003-10-16 Boston Scient Ltd CATHETER FOR IMAGE DISPLAY, DISPLAY OF ELECTRICAL SIGNALS AND ABLATION
US5860974A (en) 1993-07-01 1999-01-19 Boston Scientific Corporation Heart ablation catheter with expandable electrode and method of coupling energy to an electrode on a catheter shaft
WO1995010319A1 (en) 1993-10-15 1995-04-20 Ep Technologies, Inc. Electrodes for creating lesions in body tissue
US5991650A (en) 1993-10-15 1999-11-23 Ep Technologies, Inc. Surface coatings for catheters, direct contacting diagnostic and therapeutic devices
AU1301095A (en) 1993-12-13 1995-07-03 Brigham And Women's Hospital Aortic valve supporting device
DE4408108A1 (en) 1994-03-10 1995-09-14 Bavaria Med Tech Catheter for injecting a fluid or a drug
US5588962A (en) 1994-03-29 1996-12-31 Boston Scientific Corporation Drug treatment of diseased sites deep within the body
US5464395A (en) 1994-04-05 1995-11-07 Faxon; David P. Catheter for delivering therapeutic and/or diagnostic agents to the tissue surrounding a bodily passageway
US6056744A (en) 1994-06-24 2000-05-02 Conway Stuart Medical, Inc. Sphincter treatment apparatus
US6405732B1 (en) 1994-06-24 2002-06-18 Curon Medical, Inc. Method to treat gastric reflux via the detection and ablation of gastro-esophageal nerves and receptors
US6009877A (en) 1994-06-24 2000-01-04 Edwards; Stuart D. Method for treating a sphincter
US5857998A (en) 1994-06-30 1999-01-12 Boston Scientific Corporation Stent and therapeutic delivery system
US5514092A (en) 1994-08-08 1996-05-07 Schneider (Usa) Inc. Drug delivery and dilatation-drug delivery catheters in a rapid exchange configuration
WO1996010366A1 (en) 1994-10-03 1996-04-11 Heart Technology, Inc. Transluminal thrombectomy apparatus
US5876336A (en) 1994-10-11 1999-03-02 Ep Technologies, Inc. Systems and methods for guiding movable electrode elements within multiple-electrode structure
US5722401A (en) 1994-10-19 1998-03-03 Cardiac Pathways Corporation Endocardial mapping and/or ablation catheter probe
US5817144A (en) 1994-10-25 1998-10-06 Latis, Inc. Method for contemporaneous application OF laser energy and localized pharmacologic therapy
US5588960A (en) 1994-12-01 1996-12-31 Vidamed, Inc. Transurethral needle delivery device with cystoscope and method for treatment of urinary incontinence
US6251104B1 (en) 1995-05-10 2001-06-26 Eclipse Surgical Technologies, Inc. Guiding catheter system for ablating heart tissue
US5865801A (en) 1995-07-18 1999-02-02 Houser; Russell A. Multiple compartmented balloon catheter with external pressure sensing
US6763261B2 (en) 1995-09-20 2004-07-13 Board Of Regents, The University Of Texas System Method and apparatus for detecting vulnerable atherosclerotic plaque
US6283951B1 (en) 1996-10-11 2001-09-04 Transvascular, Inc. Systems and methods for delivering drugs to selected locations within the body
US8865788B2 (en) * 1996-02-13 2014-10-21 The General Hospital Corporation Radiation and melt treated ultra high molecular weight polyethylene prosthetic devices
US6152899A (en) 1996-03-05 2000-11-28 Vnus Medical Technologies, Inc. Expandable catheter having improved electrode design, and method for applying energy
DE19610461C2 (en) 1996-03-16 1999-02-11 Osypka Peter Catheter with an insertion tube
US5843016A (en) 1996-03-18 1998-12-01 Physion S.R.L. Electromotive drug administration for treatment of acute urinary outflow obstruction
US7022105B1 (en) 1996-05-06 2006-04-04 Novasys Medical Inc. Treatment of tissue in sphincters, sinuses and orifices
US5713923A (en) 1996-05-13 1998-02-03 Medtronic, Inc. Techniques for treating epilepsy by brain stimulation and drug infusion
US5704908A (en) 1996-10-10 1998-01-06 Genetronics, Inc. Electroporation and iontophoresis catheter with porous balloon
US6464697B1 (en) 1998-02-19 2002-10-15 Curon Medical, Inc. Stomach and adjoining tissue regions in the esophagus
US5904651A (en) 1996-10-28 1999-05-18 Ep Technologies, Inc. Systems and methods for visualizing tissue during diagnostic or therapeutic procedures
US5848969A (en) 1996-10-28 1998-12-15 Ep Technologies, Inc. Systems and methods for visualizing interior tissue regions using expandable imaging structures
US5910129A (en) * 1996-12-19 1999-06-08 Ep Technologies, Inc. Catheter distal assembly with pull wires
CA2225521C (en) 1996-12-27 2004-04-06 Eclipse Surgical Technologies, Inc. Laser assisted drug delivery apparatus
US6416510B1 (en) 1997-03-13 2002-07-09 Biocardia, Inc. Drug delivery catheters that attach to tissue and methods for their use
JP3041967U (en) 1997-03-28 1997-10-03 明男 中村 Flame detection system
US6634363B1 (en) 1997-04-07 2003-10-21 Broncus Technologies, Inc. Methods of treating lungs having reversible obstructive pulmonary disease
US7425212B1 (en) 1998-06-10 2008-09-16 Asthmatx, Inc. Devices for modification of airways by transfer of energy
US6488673B1 (en) 1997-04-07 2002-12-03 Broncus Technologies, Inc. Method of increasing gas exchange of a lung
US6117128A (en) 1997-04-30 2000-09-12 Kenton W. Gregory Energy delivery catheter and method for the use thereof
US6723063B1 (en) 1998-06-29 2004-04-20 Ekos Corporation Sheath for use with an ultrasound element
US6024740A (en) 1997-07-08 2000-02-15 The Regents Of The University Of California Circumferential ablation device assembly
US6500174B1 (en) 1997-07-08 2002-12-31 Atrionix, Inc. Circumferential ablation device assembly and methods of use and manufacture providing an ablative circumferential band along an expandable member
US6997925B2 (en) 1997-07-08 2006-02-14 Atrionx, Inc. Tissue ablation device assembly and method for electrically isolating a pulmonary vein ostium from an atrial wall
US6547788B1 (en) 1997-07-08 2003-04-15 Atrionx, Inc. Medical device with sensor cooperating with expandable member
US6966908B2 (en) 1997-07-08 2005-11-22 Atrionix, Inc. Tissue ablation device assembly and method for electrically isolating a pulmonary vein ostium from an atrial wall
US6869431B2 (en) 1997-07-08 2005-03-22 Atrionix, Inc. Medical device with sensor cooperating with expandable member
US6117101A (en) 1997-07-08 2000-09-12 The Regents Of The University Of California Circumferential ablation device assembly
IL133901A (en) 1997-07-08 2005-09-25 Univ Emory Circumferential ablation device assembly and method
US9023031B2 (en) 1997-08-13 2015-05-05 Verathon Inc. Noninvasive devices, methods, and systems for modifying tissues
US6494890B1 (en) 1997-08-14 2002-12-17 Shturman Cardiology Systems, Inc. Eccentric rotational atherectomy device
US6258084B1 (en) 1997-09-11 2001-07-10 Vnus Medical Technologies, Inc. Method for applying energy to biological tissue including the use of tumescent tissue compression
US8257725B2 (en) 1997-09-26 2012-09-04 Abbott Laboratories Delivery of highly lipophilic agents via medical devices
US6238389B1 (en) 1997-09-30 2001-05-29 Boston Scientific Corporation Deflectable interstitial ablation device
US6231516B1 (en) 1997-10-14 2001-05-15 Vacusense, Inc. Endoluminal implant with therapeutic and diagnostic capability
US6217527B1 (en) * 1998-09-30 2001-04-17 Lumend, Inc. Methods and apparatus for crossing vascular occlusions
US7921855B2 (en) 1998-01-07 2011-04-12 Asthmatx, Inc. Method for treating an asthma attack
US6622367B1 (en) * 1998-02-03 2003-09-23 Salient Interventional Systems, Inc. Intravascular device and method of manufacture and use
EP1054634A4 (en) 1998-02-10 2006-03-29 Artemis Medical Inc Entrapping apparatus and method for use
US7165551B2 (en) 1998-02-19 2007-01-23 Curon Medical, Inc. Apparatus to detect and treat aberrant myoelectric activity
US6273886B1 (en) 1998-02-19 2001-08-14 Curon Medical, Inc. Integrated tissue heating and cooling apparatus
JP2002505138A (en) 1998-03-06 2002-02-19 キューロン メディカル,インコーポレイテッド Instrument for electrosurgically treating the esophageal sphincter
US6423032B2 (en) 1998-03-13 2002-07-23 Arteria Medical Science, Inc. Apparatus and methods for reducing embolization during treatment of carotid artery disease
US6115626A (en) 1998-03-26 2000-09-05 Scimed Life Systems, Inc. Systems and methods using annotated images for controlling the use of diagnostic or therapeutic instruments in instruments in interior body regions
US6134444A (en) 1998-03-30 2000-10-17 Motorola, Inc. Method and apparatus for balancing uplink and downlink transmissions in a communication system
WO1999049908A1 (en) 1998-03-31 1999-10-07 University Of Cincinnati Temperature controlled solute delivery system
AU742057B2 (en) 1998-04-14 2001-12-13 Gmp Drug Delivery, Inc. Iontophoresis, electroporation and combination catheters for local drug delivery to arteries and other body tissues
US6219577B1 (en) 1998-04-14 2001-04-17 Global Vascular Concepts, Inc. Iontophoresis, electroporation and combination catheters for local drug delivery to arteries and other body tissues
US6364856B1 (en) 1998-04-14 2002-04-02 Boston Scientific Corporation Medical device with sponge coating for controlled drug release
US6161047A (en) 1998-04-30 2000-12-12 Medtronic Inc. Apparatus and method for expanding a stimulation lead body in situ
US6508815B1 (en) 1998-05-08 2003-01-21 Novacept Radio-frequency generator for powering an ablation device
US6022901A (en) 1998-05-13 2000-02-08 Pharmascience Inc. Administration of resveratrol to prevent or treat restenosis following coronary intervention
US6231572B1 (en) 1998-05-29 2001-05-15 Applied Medical Resources Corporation Electrosurgical catheter apparatus and method
US7198635B2 (en) 2000-10-17 2007-04-03 Asthmatx, Inc. Modification of airways by application of energy
US6292695B1 (en) 1998-06-19 2001-09-18 Wilton W. Webster, Jr. Method and apparatus for transvascular treatment of tachycardia and fibrillation
JP2000005189A (en) * 1998-06-24 2000-01-11 Terumo Corp Catheter for removing foreign matter
US6322559B1 (en) 1998-07-06 2001-11-27 Vnus Medical Technologies, Inc. Electrode catheter having coil structure
US6152943A (en) 1998-08-14 2000-11-28 Incept Llc Methods and apparatus for intraluminal deposition of hydrogels
US6319251B1 (en) 1998-09-24 2001-11-20 Hosheng Tu Medical device and methods for treating intravascular restenosis
US6036689A (en) * 1998-09-24 2000-03-14 Tu; Lily Chen Ablation device for treating atherosclerotic tissues
US8257724B2 (en) 1998-09-24 2012-09-04 Abbott Laboratories Delivery of highly lipophilic agents via medical devices
US20060240070A1 (en) 1998-09-24 2006-10-26 Cromack Keith R Delivery of highly lipophilic agents via medical devices
US6231513B1 (en) * 1998-10-14 2001-05-15 Daum Gmbh Contrast agent for ultrasonic imaging
US6575933B1 (en) 1998-11-30 2003-06-10 Cryocath Technologies Inc. Mechanical support for an expandable membrane
US6129725A (en) 1998-12-04 2000-10-10 Tu; Lily Chen Methods for reduction of restenosis
US6296619B1 (en) 1998-12-30 2001-10-02 Pharmasonics, Inc. Therapeutic ultrasonic catheter for delivering a uniform energy dose
US7481803B2 (en) 2000-11-28 2009-01-27 Flowmedica, Inc. Intra-aortic renal drug delivery catheter
US7329236B2 (en) 1999-01-11 2008-02-12 Flowmedica, Inc. Intra-aortic renal drug delivery catheter
US7780628B1 (en) 1999-01-11 2010-08-24 Angiodynamics, Inc. Apparatus and methods for treating congestive heart disease
US6749598B1 (en) 1999-01-11 2004-06-15 Flowmedica, Inc. Apparatus and methods for treating congestive heart disease
US6695830B2 (en) 1999-01-15 2004-02-24 Scimed Life Systems, Inc. Method for delivering medication into an arterial wall for prevention of restenosis
US6236883B1 (en) 1999-02-03 2001-05-22 The Trustees Of Columbia University In The City Of New York Methods and systems for localizing reentrant circuits from electrogram features
US6484052B1 (en) 1999-03-30 2002-11-19 The Regents Of The University Of California Optically generated ultrasound for enhanced drug delivery
US6692738B2 (en) 2000-01-27 2004-02-17 The General Hospital Corporation Delivery of therapeutic biologicals from implantable tissue matrices
US6409723B1 (en) 1999-04-02 2002-06-25 Stuart D. Edwards Treating body tissue by applying energy and substances
US20010007070A1 (en) 1999-04-05 2001-07-05 Medtronic, Inc. Ablation catheter assembly and method for isolating a pulmonary vein
US6325797B1 (en) 1999-04-05 2001-12-04 Medtronic, Inc. Ablation catheter and method for isolating a pulmonary vein
US6149647A (en) 1999-04-19 2000-11-21 Tu; Lily Chen Apparatus and methods for tissue treatment
US6514236B1 (en) 1999-04-23 2003-02-04 Alexander A. Stratienko Method for treating a cardiovascular condition
US6595959B1 (en) 1999-04-23 2003-07-22 Alexander A. Stratienko Cardiovascular sheath/catheter
US6245045B1 (en) 1999-04-23 2001-06-12 Alexander Andrew Stratienko Combination sheath and catheter for cardiovascular use
US6302870B1 (en) 1999-04-29 2001-10-16 Precision Vascular Systems, Inc. Apparatus for injecting fluids into the walls of blood vessels, body cavities, and the like
WO2000066017A1 (en) 1999-05-04 2000-11-09 Curon Medical, Inc. Electrodes for creating lesions in tissue regions at or near a sphincter
US6648854B1 (en) 1999-05-14 2003-11-18 Scimed Life Systems, Inc. Single lumen balloon-tipped micro catheter with reinforced shaft
AU5275600A (en) 1999-05-18 2000-12-05 Silhouette Medical Inc. Surgical weight control device
US6692490B1 (en) 1999-05-18 2004-02-17 Novasys Medical, Inc. Treatment of urinary incontinence and other disorders by application of energy and drugs
DE29909082U1 (en) 1999-05-25 1999-07-22 Starck Stimulation, sensing and / or defibrillation electrode and balloon catheter for inserting the electrode
US7171263B2 (en) 1999-06-04 2007-01-30 Impulse Dynamics Nv Drug delivery device
CA2376903A1 (en) 1999-06-25 2001-01-04 Emory University Devices and methods for vagus nerve stimulation
US7426409B2 (en) 1999-06-25 2008-09-16 Board Of Regents, The University Of Texas System Method and apparatus for detecting vulnerable atherosclerotic plaque
US6283947B1 (en) 1999-07-13 2001-09-04 Advanced Cardiovascular Systems, Inc. Local drug delivery injection catheter
US6235044B1 (en) 1999-08-04 2001-05-22 Scimed Life Systems, Inc. Percutaneous catheter and guidewire for filtering during ablation of mycardial or vascular tissue
US7175644B2 (en) 2001-02-14 2007-02-13 Broncus Technologies, Inc. Devices and methods for maintaining collateral channels in tissue
US9694121B2 (en) 1999-08-09 2017-07-04 Cardiokinetix, Inc. Systems and methods for improving cardiac function
US6767544B2 (en) 2002-04-01 2004-07-27 Allergan, Inc. Methods for treating cardiovascular diseases with botulinum toxin
US6454775B1 (en) 1999-12-06 2002-09-24 Bacchus Vascular Inc. Systems and methods for clot disruption and retrieval
US6829497B2 (en) 1999-09-21 2004-12-07 Jamil Mogul Steerable diagnostic catheters
AU7735200A (en) 1999-09-28 2001-04-30 Novasys Medical, Inc. Treatment of tissue by application of energy and drugs
US6529756B1 (en) 1999-11-22 2003-03-04 Scimed Life Systems, Inc. Apparatus for mapping and coagulating soft tissue in or around body orifices
US6494891B1 (en) 1999-12-30 2002-12-17 Advanced Cardiovascular Systems, Inc. Ultrasonic angioplasty transmission member
US6447443B1 (en) 2001-01-13 2002-09-10 Medtronic, Inc. Method for organ positioning and stabilization
US7706882B2 (en) 2000-01-19 2010-04-27 Medtronic, Inc. Methods of using high intensity focused ultrasound to form an ablated tissue area
US6623453B1 (en) 2000-01-19 2003-09-23 Vanny Corporation Chemo-thermo applicator for cancer treatment
US20010031981A1 (en) 2000-03-31 2001-10-18 Evans Michael A. Method and device for locating guidewire and treating chronic total occlusions
US20040243162A1 (en) 2000-04-05 2004-12-02 Pathway Medical Technologies, Inc. Interventional catheter assemblies and control systems
US8475484B2 (en) 2000-04-05 2013-07-02 Medrad, Inc. Liquid seal assembly for a rotating torque tube
AU2001253173B2 (en) 2000-04-05 2005-05-12 Boston Scientific Limited Intralumenal material removal systems and methods
US10092313B2 (en) 2000-04-05 2018-10-09 Boston Scientific Limited Medical sealed tubular structures
US6558382B2 (en) 2000-04-27 2003-05-06 Medtronic, Inc. Suction stabilized epicardial ablation devices
AU2001253654A1 (en) 2000-04-27 2001-11-12 Medtronic, Inc. Vibration sensitive ablation apparatus and method
WO2001082814A2 (en) 2000-05-03 2001-11-08 C.R. Bard, Inc. Apparatus and methods for mapping and ablation in electrophysiology procedures
US20010044596A1 (en) 2000-05-10 2001-11-22 Ali Jaafar Apparatus and method for treatment of vascular restenosis by electroporation
US20040243097A1 (en) * 2000-05-12 2004-12-02 Robert Falotico Antiproliferative drug and delivery device
DE60109444T2 (en) 2000-06-13 2006-04-13 Atrionix, Inc., Irwindale SURGICAL ABLATION PROBE FOR FORMING A RINGED LESION
US7837720B2 (en) 2000-06-20 2010-11-23 Boston Scientific Corporation Apparatus for treatment of tissue adjacent a bodily conduit with a gene or drug-coated compression balloon
US6477426B1 (en) 2000-06-20 2002-11-05 Celsion Corporation System and method for heating the prostate gland to treat and prevent the growth and spread of prostate tumors
EP1512383B1 (en) 2000-06-26 2013-02-20 Rex Medical, L.P. A vascular system for valve leaflet apposition
US20040073243A1 (en) * 2000-06-29 2004-04-15 Concentric Medical, Inc., A Delaware Corporation Systems, methods and devices for removing obstructions from a blood vessel
AU2001279026B2 (en) * 2000-07-25 2005-12-22 Angiodynamics, Inc. Apparatus for detecting and treating tumors using localized impedance measurement
US6497711B1 (en) * 2000-08-16 2002-12-24 Scimed Life Systems, Inc. Therectomy device having a light weight drive shaft and an imaging device
US20020103445A1 (en) 2000-08-24 2002-08-01 Rahdert David A. Thermography catheter with flexible circuit temperature sensors
US6511496B1 (en) 2000-09-12 2003-01-28 Advanced Cardiovascular Systems, Inc. Embolic protection device for use in interventional procedures
US6893459B1 (en) 2000-09-20 2005-05-17 Ample Medical, Inc. Heart valve annulus device and method of using same
US6845267B2 (en) 2000-09-28 2005-01-18 Advanced Bionics Corporation Systems and methods for modulation of circulatory perfusion by electrical and/or drug stimulation
US6640120B1 (en) 2000-10-05 2003-10-28 Scimed Life Systems, Inc. Probe assembly for mapping and ablating pulmonary vein tissue and method of using same
AU2002211581A1 (en) 2000-10-06 2002-04-15 University Of Washington Methods of inhibition of stenosis and/or sclerosis of the aortic valve
US7104987B2 (en) 2000-10-17 2006-09-12 Asthmatx, Inc. Control system and process for application of energy to airway walls and other mediums
US6616624B1 (en) 2000-10-30 2003-09-09 Cvrx, Inc. Systems and method for controlling renovascular perfusion
US6676657B2 (en) 2000-12-07 2004-01-13 The United States Of America As Represented By The Department Of Health And Human Services Endoluminal radiofrequency cauterization system
US6544223B1 (en) 2001-01-05 2003-04-08 Advanced Cardiovascular Systems, Inc. Balloon catheter for delivering therapeutic agents
DE10103503A1 (en) 2001-01-26 2002-08-14 Fraunhofer Ges Forschung Endoluminal expandable implant with integrated sensors
US6623444B2 (en) 2001-03-21 2003-09-23 Advanced Medical Applications, Inc. Ultrasonic catheter drug delivery method and device
US6733525B2 (en) 2001-03-23 2004-05-11 Edwards Lifesciences Corporation Rolled minimally-invasive heart valves and methods of use
US6500186B2 (en) * 2001-04-17 2002-12-31 Scimed Life Systems, Inc. In-stent ablative tool
US6645223B2 (en) 2001-04-30 2003-11-11 Advanced Cardiovascular Systems, Inc. Deployment and recovery control systems for embolic protection devices
US6972016B2 (en) 2001-05-01 2005-12-06 Cardima, Inc. Helically shaped electrophysiology catheter
US7127284B2 (en) 2001-06-11 2006-10-24 Mercator Medsystems, Inc. Electroporation microneedle and methods for its use
US20040043030A1 (en) 2001-07-31 2004-03-04 Immunomedics, Inc. Polymeric delivery systems
US6547803B2 (en) 2001-09-20 2003-04-15 The Regents Of The University Of California Microfabricated surgical device for interventional procedures
US7547294B2 (en) 2001-09-20 2009-06-16 The Regents Of The University Of California Microfabricated surgical device for interventional procedures
US20030082225A1 (en) 2001-10-19 2003-05-01 Mason Paul Arthur Sterile, breathable patch for treating wound pain
US6849075B2 (en) 2001-12-04 2005-02-01 Estech, Inc. Cardiac ablation devices and methods
US6811801B2 (en) 2001-12-12 2004-11-02 Abbott Laboratories Methods and compositions for brightening the color of thermally processed nutritionals
US6748255B2 (en) 2001-12-14 2004-06-08 Biosense Webster, Inc. Basket catheter with multiple location sensors
US20060189941A1 (en) 2002-01-22 2006-08-24 Mercator Medsystems, Inc. Methods and kits for volumetric distribution of pharmaceutical agents via the vascular adventitia and microcirculation
US7744584B2 (en) 2002-01-22 2010-06-29 Mercator Medsystems, Inc. Methods and kits for volumetric distribution of pharmaceutical agents via the vascular adventitia and microcirculation
US20030171734A1 (en) 2002-01-22 2003-09-11 Endobionics, Inc. Methods and kits for delivering pharmaceutical agents into the coronary vascular adventitia
US6814733B2 (en) 2002-01-31 2004-11-09 Biosense, Inc. Radio frequency pulmonary vein isolation
US8133501B2 (en) 2002-02-08 2012-03-13 Boston Scientific Scimed, Inc. Implantable or insertable medical devices for controlled drug delivery
US20070078620A1 (en) 2002-02-13 2007-04-05 Mercator Medsystems Inc. Methods and kits for delivering pharmaceutical agents into the coronary vascular adventitia
US7236821B2 (en) 2002-02-19 2007-06-26 Cardiac Pacemakers, Inc. Chronically-implanted device for sensing and therapy
WO2003082080A2 (en) 2002-03-27 2003-10-09 Cvrx, Inc. Electrode structures and methods for their use in cardiovascular reflex control
US7617005B2 (en) 2002-04-08 2009-11-10 Ardian, Inc. Methods and apparatus for thermally-induced renal neuromodulation
US7162303B2 (en) 2002-04-08 2007-01-09 Ardian, Inc. Renal nerve stimulation method and apparatus for treatment of patients
US6978174B2 (en) 2002-04-08 2005-12-20 Ardian, Inc. Methods and devices for renal nerve blocking
US20080213331A1 (en) 2002-04-08 2008-09-04 Ardian, Inc. Methods and devices for renal nerve blocking
US8347891B2 (en) 2002-04-08 2013-01-08 Medtronic Ardian Luxembourg S.A.R.L. Methods and apparatus for performing a non-continuous circumferential treatment of a body lumen
US7653438B2 (en) 2002-04-08 2010-01-26 Ardian, Inc. Methods and apparatus for renal neuromodulation
US8131371B2 (en) 2002-04-08 2012-03-06 Ardian, Inc. Methods and apparatus for monopolar renal neuromodulation
US8145316B2 (en) 2002-04-08 2012-03-27 Ardian, Inc. Methods and apparatus for renal neuromodulation
US7620451B2 (en) 2005-12-29 2009-11-17 Ardian, Inc. Methods and apparatus for pulsed electric field neuromodulation via an intra-to-extravascular approach
US7141041B2 (en) 2003-03-19 2006-11-28 Mercator Medsystems, Inc. Catheters having laterally deployable needles
US7070606B2 (en) 2002-05-28 2006-07-04 Mercator Medsystems, Inc. Methods and apparatus for aspiration and priming of inflatable structures in catheters
US6748953B2 (en) 2002-06-11 2004-06-15 Scimed Life Systems, Inc. Method for thermal treatment of type II endoleaks in arterial aneurysms
JP2004016333A (en) 2002-06-13 2004-01-22 Unique Medical Co Ltd Catheter for extradural anesthesia, and electrostimulator using the catheter for extradural anesthesia
US7465298B2 (en) 2002-06-28 2008-12-16 Mercator Medsystems, Inc. Methods and systems for delivering liquid substances to tissues surrounding body lumens
US8172856B2 (en) 2002-08-02 2012-05-08 Cedars-Sinai Medical Center Methods and apparatus for atrioventricular valve repair
US6893414B2 (en) 2002-08-12 2005-05-17 Breg, Inc. Integrated infusion and aspiration system and method
JP2004097807A (en) * 2002-08-20 2004-04-02 Nipro Corp Thrombus capturing catheter
US6991617B2 (en) 2002-08-21 2006-01-31 Hektner Thomas R Vascular treatment method and device
US6712767B2 (en) * 2002-08-29 2004-03-30 Volcano Therapeutics, Inc. Ultrasonic imaging devices and methods of fabrication
US6780183B2 (en) 2002-09-16 2004-08-24 Biosense Webster, Inc. Ablation catheter having shape-changing balloon
WO2004030718A2 (en) 2002-09-20 2004-04-15 Flowmedica, Inc. Method and apparatus for intra aortic substance delivery to a branch vessel
US7063679B2 (en) 2002-09-20 2006-06-20 Flowmedica, Inc. Intra-aortic renal delivery catheter
WO2004028583A2 (en) 2002-09-26 2004-04-08 Angiotech International Ag Perivascular wraps
US7282213B2 (en) 2002-09-30 2007-10-16 Medtronic, Inc. Method for applying a drug coating to a medical device
AU2003279842A1 (en) 2002-10-04 2004-05-04 Microchips, Inc. Medical device for controlled drug delivery and cardiac monitoring and/or stimulation
US20040082947A1 (en) 2002-10-25 2004-04-29 The Regents Of The University Of Michigan Ablation catheters
DE10257146A1 (en) 2002-12-06 2004-06-24 Admedes Schuessler Gmbh Thermal ablation probe for minimal invasive body tissue high frequency thermal treatment has temperature sensor on star shaped flexible arms with adjustable protrusion from insulating sheath
DE10252325B4 (en) 2002-11-11 2012-10-25 Admedes Schuessler Gmbh Radiofrequency thermal ablation probe and method of making the same
US7599730B2 (en) 2002-11-19 2009-10-06 Medtronic Navigation, Inc. Navigation system for cardiac therapies
US20040106952A1 (en) 2002-12-03 2004-06-03 Lafontaine Daniel M. Treating arrhythmias by altering properties of tissue
CA2514392A1 (en) 2003-01-29 2004-08-12 E-Pill Pharma Ltd. Active drug delivery in the gastrointestinal tract
US6806821B2 (en) 2003-03-12 2004-10-19 Itt Manufacturing Enterprises, Inc. Apparatus and method for rapid detection of objects with time domain impulsive signals
US7972330B2 (en) 2003-03-27 2011-07-05 Terumo Kabushiki Kaisha Methods and apparatus for closing a layered tissue defect
US8021362B2 (en) 2003-03-27 2011-09-20 Terumo Kabushiki Kaisha Methods and apparatus for closing a layered tissue defect
US8083707B2 (en) 2003-04-17 2011-12-27 Tosaya Carol A Non-contact damage-free ultrasonic cleaning of implanted or natural structures having moving parts and located in a living body
US7175656B2 (en) 2003-04-18 2007-02-13 Alexander Khairkhahan Percutaneous transcatheter heart valve replacement
US20040213770A1 (en) 2003-04-22 2004-10-28 Endobionics, Inc. Methods and systems for treating ischemic cardiac and other tissues
US7279002B2 (en) 2003-04-25 2007-10-09 Boston Scientific Scimed, Inc. Cutting stent and balloon
JP2004337400A (en) 2003-05-16 2004-12-02 Terumo Corp Medication kit
WO2005000398A2 (en) 2003-06-04 2005-01-06 Synecor Intravascular electrophysiological system and methods
US20040260394A1 (en) 2003-06-20 2004-12-23 Medtronic Vascular, Inc. Cardiac valve annulus compressor system
EP1648339B2 (en) 2003-07-08 2020-06-17 Ventor Technologies Ltd. Implantable prosthetic devices particularly for transarterial delivery in the treatment of aortic stenosis, and methods of implanting such devices
CA2532112C (en) 2003-07-14 2012-09-18 Nmt Medical, Inc. Tubular patent foramen ovale (pfo) closure device with catch system
US7670335B2 (en) 2003-07-21 2010-03-02 Biosense Webster, Inc. Ablation device with spiral array ultrasound transducer
US7621948B2 (en) 2003-07-21 2009-11-24 The Trustees Of The University Of Pennsylvania Percutaneous heart valve
WO2005009506A2 (en) 2003-07-22 2005-02-03 Corazon Technologies, Inc. Devices and methods for treating aortic valve stenosis
DE202004021943U1 (en) 2003-09-12 2013-05-13 Vessix Vascular, Inc. Selectable eccentric remodeling and / or ablation of atherosclerotic material
WO2005039689A2 (en) 2003-10-24 2005-05-06 Sinus Rhythm Technologies, Inc. Methods and devices for creating cardiac electrical blocks
EP1691852A2 (en) 2003-11-10 2006-08-23 Angiotech International AG Medical implants and fibrosis-inducing agents
WO2005046747A2 (en) 2003-11-10 2005-05-26 Angiotech International Ag Intravascular devices and fibrosis-inducing agents
US7273469B1 (en) 2003-12-31 2007-09-25 Advanced Cardiovascular Systems, Inc. Modified needle catheter for directional orientation delivery
US7871435B2 (en) 2004-01-23 2011-01-18 Edwards Lifesciences Corporation Anatomically approximate prosthetic mitral heart valve
US20050182479A1 (en) 2004-02-13 2005-08-18 Craig Bonsignore Connector members for stents
EP2308425B2 (en) 2004-03-11 2023-10-18 Percutaneous Cardiovascular Solutions Pty Limited Percutaneous Heart Valve Prosthesis
US8007495B2 (en) 2004-03-31 2011-08-30 Biosense Webster, Inc. Catheter for circumferential ablation at or near a pulmonary vein
US20050228286A1 (en) 2004-04-07 2005-10-13 Messerly Jeffrey D Medical system having a rotatable ultrasound source and a piercing tip
US20060018949A1 (en) 2004-04-07 2006-01-26 Bausch & Lomb Incorporated Injectable biodegradable drug delivery system
DE102004021942A1 (en) 2004-05-04 2005-12-01 Adam Opel Ag Locking device for motor vehicle door, has electrical actuators which are operated to move blocking bolt and locking bolt, respectively, where bus bar is coupled/decoupled with bolt, in respective unloaded/loaded condition of store
US20050267556A1 (en) 2004-05-28 2005-12-01 Allan Shuros Drug eluting implants to prevent cardiac apoptosis
US7640046B2 (en) 2004-06-18 2009-12-29 Cardiac Pacemakers, Inc. Methods and apparatuses for localizing myocardial infarction during catheterization
US7197354B2 (en) 2004-06-21 2007-03-27 Mediguide Ltd. System for determining the position and orientation of a catheter
KR101049126B1 (en) 2004-07-20 2011-07-14 엘지전자 주식회사 LED window structure of the control panel
JP2008508024A (en) 2004-07-28 2008-03-21 アーディアン インコーポレイテッド Renal nerve blocking method and apparatus
US9713730B2 (en) 2004-09-10 2017-07-25 Boston Scientific Scimed, Inc. Apparatus and method for treatment of in-stent restenosis
US8396548B2 (en) 2008-11-14 2013-03-12 Vessix Vascular, Inc. Selective drug delivery in a lumen
WO2006031899A2 (en) 2004-09-10 2006-03-23 The Cleveland Clinic Foundation Intraluminal electrode assembly
EP1796597B1 (en) 2004-09-14 2013-01-09 Edwards Lifesciences AG Device for treatment of heart valve regurgitation
US7937143B2 (en) 2004-11-02 2011-05-03 Ardian, Inc. Methods and apparatus for inducing controlled renal neuromodulation
US7200445B1 (en) 2005-10-21 2007-04-03 Asthmatx, Inc. Energy delivery devices and methods
US7949407B2 (en) 2004-11-05 2011-05-24 Asthmatx, Inc. Energy delivery devices and methods
WO2006052940A2 (en) 2004-11-05 2006-05-18 Asthmatx, Inc. Medical device with procedure improvement features
US20060129128A1 (en) 2004-11-15 2006-06-15 Sampson Russel M Method and system for drug delivery
WO2006054299A2 (en) 2004-11-18 2006-05-26 Transpharma Medical Ltd. Combined micro-channel generation and iontophoresis for transdermal delivery of pharmaceutical agents
WO2006102359A2 (en) 2005-03-23 2006-09-28 Abbott Laboratories Delivery of highly lipophilic agents via medical devices
EP3045110B1 (en) 2005-03-28 2019-07-31 Vessix Vascular, Inc. Intraluminal electrical tissue characterization and tuned rf energy for selective treatment of atheroma and other target tissues
SE531468C2 (en) 2005-04-21 2009-04-14 Edwards Lifesciences Ag An apparatus for controlling blood flow
EP1874211B1 (en) 2005-04-21 2017-05-31 Boston Scientific Scimed, Inc. Control devices for energy delivery
US20070248639A1 (en) 2005-05-20 2007-10-25 Omeros Corporation Cyclooxygenase inhibitor and calcium channel antagonist compositions and methods for use in urological procedures
EP2759276A1 (en) 2005-06-20 2014-07-30 Medtronic Ablation Frontiers LLC Ablation catheter
WO2007002304A2 (en) 2005-06-22 2007-01-04 Vnus Medical Technologies, Inc. Methods and apparatus for introducing tumescent fluid to body tissue
CN2855350Y (en) 2005-09-01 2007-01-10 迈德医疗科技(上海)有限公司 Probe electrode device for RF ablation treatment
US20080317818A1 (en) 2005-09-09 2008-12-25 May Griffith Interpenetrating Networks, and Related Methods and Compositions
US8140170B2 (en) 2005-09-12 2012-03-20 The Cleveland Clinic Foundation Method and apparatus for renal neuromodulation
WO2007041593A2 (en) 2005-10-03 2007-04-12 Combinatorx, Incorporated Anti-scarring drug combinations and use thereof
US20070299043A1 (en) 2005-10-03 2007-12-27 Hunter William L Anti-scarring drug combinations and use thereof
US8257338B2 (en) 2006-10-27 2012-09-04 Artenga, Inc. Medical microbubble generation
EP1782852A1 (en) 2005-11-04 2007-05-09 F.Hoffmann-La Roche Ag Device for automatic delivery of a liquid medicament into the body of a patient
US20080045890A1 (en) 2005-12-16 2008-02-21 Mercator Medsystems, Inc. Methods and systems for ablating tissue
CA2641117C (en) 2006-01-31 2018-01-02 Nanocopoeia, Inc. Nanoparticle coating of surfaces
US8585753B2 (en) 2006-03-04 2013-11-19 John James Scanlon Fibrillated biodegradable prosthesis
US20070219576A1 (en) 2006-03-16 2007-09-20 Medtronic Vascular, Inc. Reversibly and Radially Expandable Electroactive Polymer Element for Temporary Occlusion of a Vessel
US7806926B2 (en) 2006-04-14 2010-10-05 Edwards Lifesciences Corporation Holders for prosthetic aortic heart valves
US8019435B2 (en) 2006-05-02 2011-09-13 Boston Scientific Scimed, Inc. Control of arterial smooth muscle tone
US20070269385A1 (en) 2006-05-18 2007-11-22 Mercator Medsystems, Inc Devices, methods, and systems for delivering therapeutic agents for the treatment of sinusitis, rhinitis, and other disorders
US8932348B2 (en) 2006-05-18 2015-01-13 Edwards Lifesciences Corporation Device and method for improving heart valve function
WO2007135431A2 (en) 2006-05-24 2007-11-29 Emcision Limited Vessel sealing device and methods
WO2007140331A2 (en) 2006-05-25 2007-12-06 Medtronic, Inc. Methods of using high intensity focused ultrasound to form an ablated tissue area containing a plurality of lesions
US20080004596A1 (en) 2006-05-25 2008-01-03 Palo Alto Institute Delivery of agents by microneedle catheter
CN102283721B (en) 2006-06-01 2015-08-26 爱德华兹生命科学公司 For improving the prosthetic insert of heart valve function
US20070287994A1 (en) 2006-06-12 2007-12-13 Pankaj Amrit Patel Endoscopically Introducible Expandable Bipolar Probe
EP2037840B2 (en) 2006-06-28 2019-02-20 Medtronic Ardian Luxembourg S.à.r.l. Systems for thermally-induced renal neuromodulation
EP2046227A2 (en) 2006-08-03 2009-04-15 Hansen Medical, Inc. Systems for performing minimally invasive procedures
US20080039727A1 (en) 2006-08-08 2008-02-14 Eilaz Babaev Ablative Cardiac Catheter System
US20090221955A1 (en) 2006-08-08 2009-09-03 Bacoustics, Llc Ablative ultrasonic-cryogenic methods
WO2008031033A2 (en) 2006-09-07 2008-03-13 Spence Paul A Ultrasonic implant, systems and methods related to diverting material in blood flow away from the head
WO2008031077A2 (en) 2006-09-08 2008-03-13 Hansen Medical, Inc. Robotic surgical system with forward-oriented field of view guide instrument navigation
JP2010502468A (en) 2006-09-11 2010-01-28 エンバイオ リミテッド Surface doping method
US7691080B2 (en) 2006-09-21 2010-04-06 Mercator Medsystems, Inc. Dual modulus balloon for interventional procedures
US8641660B2 (en) 2006-10-04 2014-02-04 P Tech, Llc Methods and devices for controlling biologic microenvironments
US8388680B2 (en) 2006-10-18 2013-03-05 Guided Delivery Systems, Inc. Methods and devices for catheter advancement and delivery of substances therethrough
EP2954868A1 (en) 2006-10-18 2015-12-16 Vessix Vascular, Inc. Tuned rf energy and electrical tissue characterization for selective treatment of target tissues
US8226648B2 (en) 2007-12-31 2012-07-24 St. Jude Medical, Atrial Fibrillation Division, Inc. Pressure-sensitive flexible polymer bipolar electrode
US20080208162A1 (en) 2007-02-26 2008-08-28 Joshi Ashok V Device and Method For Thermophoretic Fluid Delivery
EP2144600A4 (en) 2007-04-04 2011-03-16 Massachusetts Inst Technology Poly (amino acid) targeting moieties
US9259233B2 (en) 2007-04-06 2016-02-16 Hologic, Inc. Method and device for distending a gynecological cavity
US8588885B2 (en) 2007-05-09 2013-11-19 St. Jude Medical, Atrial Fibrillation Division, Inc. Bendable catheter arms having varied flexibility
EP2139416B1 (en) 2007-05-09 2015-08-19 Irvine Biomedical, Inc. Basket catheter having multiple electrodes
US11395694B2 (en) 2009-05-07 2022-07-26 St. Jude Medical, Llc Irrigated ablation catheter with multiple segmented ablation electrodes
US8263104B2 (en) 2007-06-08 2012-09-11 Northwestern University Polymer nanofilm coatings
US9566178B2 (en) 2010-06-24 2017-02-14 Edwards Lifesciences Cardiaq Llc Actively controllable stent, stent graft, heart valve and method of controlling same
US9283034B2 (en) 2007-09-26 2016-03-15 Retrovascular, Inc. Recanalization system using radiofrequency energy
EP2190385B8 (en) 2007-09-26 2017-06-07 St. Jude Medical, LLC Collapsible prosthetic heart valves
WO2009045334A1 (en) 2007-09-28 2009-04-09 St. Jude Medical, Inc. Collapsible/expandable prosthetic heart valves with native calcified leaflet retention features
WO2009045331A1 (en) 2007-09-28 2009-04-09 St. Jude Medical, Inc. Two-stage collapsible/expandable prosthetic heart valves and anchoring systems
US8613721B2 (en) 2007-11-14 2013-12-24 Medrad, Inc. Delivery and administration of compositions using interventional catheters
US20090287120A1 (en) 2007-12-18 2009-11-19 Searete Llc, A Limited Liability Corporation Of The State Of Delaware Circulatory monitoring systems and methods
US9204927B2 (en) 2009-05-13 2015-12-08 St. Jude Medical, Atrial Fibrillation Division, Inc. System and method for presenting information representative of lesion formation in tissue during an ablation procedure
US8858609B2 (en) 2008-02-07 2014-10-14 Intuitive Surgical Operations, Inc. Stent delivery under direct visualization
US7925352B2 (en) 2008-03-27 2011-04-12 Synecor Llc System and method for transvascularly stimulating contents of the carotid sheath
US20090276040A1 (en) 2008-05-01 2009-11-05 Edwards Lifesciences Corporation Device and method for replacing mitral valve
US20100069837A1 (en) 2008-09-16 2010-03-18 Boston Scientific Scimed, Inc. Balloon Assembly and Method for Therapeutic Agent Delivery
CA2749026C (en) 2008-09-29 2018-01-09 Impala, Inc. Heart valve
US9289132B2 (en) 2008-10-07 2016-03-22 Mc10, Inc. Catheter balloon having stretchable integrated circuitry and sensor array
EP3173043A1 (en) 2008-11-11 2017-05-31 Shifamed Holdings, LLC Low profile electrode assembly
US8317810B2 (en) 2008-12-29 2012-11-27 St. Jude Medical, Atrial Fibrillation Division, Inc. Tissue puncture assemblies and methods for puncturing tissue
US8712550B2 (en) 2008-12-30 2014-04-29 Biosense Webster, Inc. Catheter with multiple electrode assemblies for use at or near tubular regions of the heart
WO2010088301A1 (en) 2009-01-27 2010-08-05 Boveda Marco Medical Llc Catheters and methods for performing electrophysiological interventions
US8808366B2 (en) 2009-02-27 2014-08-19 St. Jude Medical, Inc. Stent features for collapsible prosthetic heart valves
US20100249702A1 (en) 2009-03-24 2010-09-30 Abbott Cardiovascular Systems Inc. Porous catheter balloon and method of making same
US9011522B2 (en) 2009-04-10 2015-04-21 Lon Sutherland ANNEST Device and method for temporary or permanent suspension of an implantable scaffolding containing an orifice for placement of a prosthetic or bio-prosthetic valve
BRPI1015460A2 (en) 2009-04-22 2020-08-18 Mercator Medsystems, Inc. guanetidine for use in the treatment of hypertension and hypertension treatment system
US8551096B2 (en) 2009-05-13 2013-10-08 Boston Scientific Scimed, Inc. Directional delivery of energy and bioactives
CN102573703B (en) 2009-08-27 2014-12-10 麦德托尼克公司 Transcatheter valve delivery systems and methods
CN107049479B (en) 2009-10-27 2020-10-16 努瓦拉公司 Delivery device with coolable energy emitting assembly
KR101673574B1 (en) 2009-10-30 2016-11-07 레코 메디컬, 인코포레이티드 Method and apparatus for treatment of hypertension through percutaneous ultrasound renal denervation
WO2011055143A2 (en) 2009-11-04 2011-05-12 Emcision Limited Lumenal remodelling device and methods
JP6000851B2 (en) 2009-11-11 2016-10-05 ホライラ, インコーポレイテッド Systems, devices, and methods for tissue treatment and stenosis control
CA2781951A1 (en) 2009-11-13 2011-05-19 St. Jude Medical, Inc. Assembly of staggered ablation elements
AU2010328106A1 (en) 2009-12-08 2012-07-05 Avalon Medical Ltd. Device and system for transcatheter mitral valve replacement
US20110137155A1 (en) 2009-12-09 2011-06-09 Boston Scientific Scimed, Inc. Delivery device for localized delivery of a therapeutic agent
US20110263921A1 (en) 2009-12-31 2011-10-27 Anthony Vrba Patterned Denervation Therapy for Innervated Renal Vasculature
US20160008387A9 (en) 2010-01-26 2016-01-14 Northwind Medical, Inc. Agents and devices for affecting nerve function
WO2013169741A1 (en) 2012-05-08 2013-11-14 Stein Emily A Agents and devices for affecting nerve function
WO2011094367A1 (en) 2010-01-26 2011-08-04 Evans Michael A Methods, devices, and agents for denervation
JP2013521995A (en) 2010-03-24 2013-06-13 シファメド・ホールディングス・エルエルシー Endovascular tissue destruction
WO2011127216A2 (en) 2010-04-06 2011-10-13 Innovative Pulmonary Solutions, Inc. System and method for pulmonary treatment
US20110264086A1 (en) 2010-04-14 2011-10-27 Frank Ingle Renal artery denervation apparatus employing helical shaping arrangement
US8285328B2 (en) 2010-04-20 2012-10-09 Minipumps, Llc Remote-controlled drug pump devices
EP2560589B1 (en) 2010-04-23 2018-06-06 Medtronic, Inc. Delivery systems for prosthetic heart valves
US8579964B2 (en) 2010-05-05 2013-11-12 Neovasc Inc. Transcatheter mitral valve prosthesis
AU2011252976A1 (en) 2010-05-12 2012-11-08 Shifamed Holdings, Llc Low profile electrode assembly
EP2582326B1 (en) 2010-06-21 2016-05-18 Edwards Lifesciences CardiAQ LLC Replacement heart valve
US9763657B2 (en) 2010-07-21 2017-09-19 Mitraltech Ltd. Techniques for percutaneous mitral valve replacement and sealing
US8992604B2 (en) 2010-07-21 2015-03-31 Mitraltech Ltd. Techniques for percutaneous mitral valve replacement and sealing
US20120029505A1 (en) 2010-07-30 2012-02-02 Jenson Mark L Self-Leveling Electrode Sets for Renal Nerve Ablation
US9408661B2 (en) 2010-07-30 2016-08-09 Patrick A. Haverkost RF electrodes on multiple flexible wires for renal nerve ablation
US9155589B2 (en) 2010-07-30 2015-10-13 Boston Scientific Scimed, Inc. Sequential activation RF electrode set for renal nerve ablation
BR112013003601A2 (en) 2010-08-17 2016-08-16 St Jude Medical placement system for placing a flexible prosthetic heart valve, and method for producing a delivery system
US20120089134A1 (en) 2010-10-11 2012-04-12 Christopher Horvath Contactless Photodisruptive Laser assisted Cataract Surgery
EP2640297B1 (en) 2010-11-19 2016-03-30 Boston Scientific Scimed, Inc. Renal nerve detection and ablation apparatus
US20120157992A1 (en) 2010-12-15 2012-06-21 Scott Smith Off-wall electrode device for renal nerve ablation
EP2645955B1 (en) 2010-12-01 2016-10-26 Boston Scientific Scimed, Inc. Expandable angular vascular electrode for renal nerve ablation
US20120157993A1 (en) 2010-12-15 2012-06-21 Jenson Mark L Bipolar Off-Wall Electrode Device for Renal Nerve Ablation
US20130296853A1 (en) 2010-12-21 2013-11-07 Terumo Kabushiki Kaisha Balloon catheter and electrification system
US9687342B2 (en) 2011-01-11 2017-06-27 Hans Reiner Figulla Valve prosthesis for replacing an atrioventricular valve of the heart with anchoring element
US20120184952A1 (en) 2011-01-19 2012-07-19 Jenson Mark L Low-profile off-wall electrode device for renal nerve ablation
AU2012219251B2 (en) 2011-02-18 2016-05-12 Medivation Technologies, Inc. Compounds and methods for treatment of hypertension
CN202069688U (en) 2011-03-11 2011-12-14 北京天助畅运医疗技术股份有限公司 Radio frequency ablation electrode capable of treating resistant hypertension
WO2012130337A1 (en) 2011-04-01 2012-10-04 Flux Medical N.V. System, device and method for ablation of a vessel's wall from the inside
CN104840249B (en) 2011-04-08 2017-04-12 柯惠有限合伙公司 Coupler
KR20130131471A (en) 2011-04-08 2013-12-03 코비디엔 엘피 Iontophoresis drug delivery system and method for denervation of the renal sympathetic nerve and iontophoretic drug delivery
US8663190B2 (en) 2011-04-22 2014-03-04 Ablative Solutions, Inc. Expandable catheter system for peri-ostial injection and muscle and nerve fiber ablation
US9237925B2 (en) 2011-04-22 2016-01-19 Ablative Solutions, Inc. Expandable catheter system for peri-ostial injection and muscle and nerve fiber ablation
US9061014B2 (en) 2011-04-28 2015-06-23 Abraxis Bioscience, Llc Intravascular delivery of nanoparticle compositions and uses thereof
CN102274074A (en) 2011-05-03 2011-12-14 上海微创电生理医疗科技有限公司 Multi-electrode open-type radio frequency ablation catheter
WO2012158864A1 (en) 2011-05-18 2012-11-22 St. Jude Medical, Inc. Apparatus and method of assessing transvascular denervation
US8909316B2 (en) 2011-05-18 2014-12-09 St. Jude Medical, Cardiology Division, Inc. Apparatus and method of assessing transvascular denervation
US20120296232A1 (en) 2011-05-18 2012-11-22 St. Jude Medical, Inc. Method and apparatus of assessing transvascular denervation
EP2717795A4 (en) 2011-06-06 2015-01-28 St Jude Medical Renal denervation system and method
EP2731671B1 (en) 2011-07-11 2019-04-03 Interventional Autonomics Corporation Catheter system for acute neuromodulation
CN103987334A (en) 2011-07-12 2014-08-13 沃夫医药公司 Renal nerve denervation via the renal pelvis
US9480559B2 (en) 2011-08-11 2016-11-01 Tendyne Holdings, Inc. Prosthetic valves and related inventions
US20130274674A1 (en) 2011-08-24 2013-10-17 Ablative Solutions, Inc. Intravascular ablation catheter with precision depth of penetration calibration
US20130274673A1 (en) 2011-08-24 2013-10-17 Ablative Solutions, Inc. Intravascular ablation catheter with enhanced fluoroscopic visibility
US20130053792A1 (en) 2011-08-24 2013-02-28 Ablative Solutions, Inc. Expandable catheter system for vessel wall injection and muscle and nerve fiber ablation
US9056185B2 (en) 2011-08-24 2015-06-16 Ablative Solutions, Inc. Expandable catheter system for fluid injection into and deep to the wall of a blood vessel
US9278196B2 (en) 2011-08-24 2016-03-08 Ablative Solutions, Inc. Expandable catheter system for vessel wall injection and muscle and nerve fiber ablation
US20130053732A1 (en) 2011-08-24 2013-02-28 Richard R. Heuser Devices and methods for treating hypertension with energy
EP2747691B1 (en) 2011-08-26 2019-10-09 Symap Medical (Suzhou) Ltd System for locating and identifying functional nerves innervating wall of arteries
US8702619B2 (en) 2011-08-26 2014-04-22 Symap Holding Limited Mapping sympathetic nerve distribution for renal ablation and catheters for same
DE102014102653A1 (en) 2014-02-28 2015-09-03 Highlife Sas Transcatheter valve prosthesis
DE102014102725A1 (en) 2014-02-28 2015-09-17 Highlife Sas Transcatheter valve prosthesis
US9549817B2 (en) 2011-09-22 2017-01-24 Transmural Systems Llc Devices, systems and methods for repairing lumenal systems
ES2757682T3 (en) 2011-09-30 2020-04-29 Covidien Lp Power delivery device and usage procedures
US9186210B2 (en) 2011-10-10 2015-11-17 Boston Scientific Scimed, Inc. Medical devices including ablation electrodes
US10085799B2 (en) 2011-10-11 2018-10-02 Boston Scientific Scimed, Inc. Off-wall electrode device and methods for nerve modulation
US9364284B2 (en) 2011-10-12 2016-06-14 Boston Scientific Scimed, Inc. Method of making an off-wall spacer cage
WO2013059202A1 (en) 2011-10-18 2013-04-25 Boston Scientific Scimed, Inc. Integrated crossing balloon catheter
US20130096550A1 (en) 2011-10-18 2013-04-18 Boston Scientific Scimed, Inc. Ablative catheter with electrode cooling and related methods of use
CA2887597C (en) 2011-10-19 2018-01-09 Mercator Medsystems, Inc. Localized modulation of tissues and cells to enhance therapeutic effects including renal denervation
EP2770992A4 (en) 2011-10-26 2015-12-30 Emily A Stein Agents, methods, and devices for affecting nerve function
US20130110106A1 (en) 2011-10-28 2013-05-02 Boston Scientific Scimed, Inc. Expandable structure for off-wall ablation electrode
EP3366250A1 (en) 2011-11-08 2018-08-29 Boston Scientific Scimed, Inc. Ostial renal nerve ablation
US9119600B2 (en) 2011-11-15 2015-09-01 Boston Scientific Scimed, Inc. Device and methods for renal nerve modulation monitoring
JP5729660B2 (en) 2011-11-21 2015-06-03 株式会社ディナーヴ Catheter and system for renal artery ablation
CN107080561B (en) 2011-12-09 2020-09-11 麦特文申公司 Apparatus, system and method for neuromodulation
US9827092B2 (en) 2011-12-16 2017-11-28 Tendyne Holdings, Inc. Tethers for prosthetic mitral valve
US20130158509A1 (en) 2011-12-19 2013-06-20 Paul M. Consigny System, apparatus, and method for denervating an artery
US9131980B2 (en) 2011-12-19 2015-09-15 Medtronic Advanced Energy Llc Electrosurgical devices
CN202426647U (en) 2011-12-22 2012-09-12 王涛 Multi-pole radio frequency ablation electrode with variable-diameter net basket
US8825130B2 (en) 2011-12-30 2014-09-02 St. Jude Medical, Atrial Fibrillation Division, Inc. Electrode support structure assemblies
AU2013211951B2 (en) 2012-01-26 2017-02-16 Autonomix Medical, Inc. Controlled sympathectomy and micro-ablation systems and methods
US9089341B2 (en) 2012-02-28 2015-07-28 Surefire Medical, Inc. Renal nerve neuromodulation device
EP2819604A1 (en) 2012-03-01 2015-01-07 Boston Scientific Scimed, Inc. Off-wall and contact electrode devices and methods for nerve modulation
US20130231658A1 (en) 2012-03-01 2013-09-05 Boston Scientific Scimed, Inc. Expandable ablation device and methods for nerve modulation
CN104284636A (en) 2012-03-19 2015-01-14 波士顿科学西美德公司 Expandable electrode device and methods for nerve modulation
US9439598B2 (en) 2012-04-12 2016-09-13 NeuroMedic, Inc. Mapping and ablation of nerves within arteries and tissues
US9113929B2 (en) 2012-04-19 2015-08-25 St. Jude Medical, Cardiology Division, Inc. Non-electric field renal denervation electrode
US20130289369A1 (en) 2012-04-27 2013-10-31 Volcano Corporation Methods and Apparatus for Renal Neuromodulation
US20130289686A1 (en) 2012-04-29 2013-10-31 Synecor Llc Intravascular electrode arrays for neuromodulation
US20130289699A1 (en) 2012-04-30 2013-10-31 St. Jude Medical, Cardiology Division, Inc. Aortic valve holder with stent protection and/or ability to decrease valve profile
US20140207136A1 (en) 2012-05-04 2014-07-24 St. Jude Medical, Inc. Multiple staggered electrodes connected via flexible joints
US8562573B1 (en) 2012-06-05 2013-10-22 Fischell Innovations, Llc Guiding catheter for accessing the renal arteries
US20150151077A1 (en) 2012-06-13 2015-06-04 Douglas C. Harrington Devices And Methods For Renal Denervation
WO2014015065A1 (en) 2012-07-17 2014-01-23 Boston Scientific Scimed, Inc. Renal nerve modulation catheter design
WO2014021905A1 (en) 2012-07-30 2014-02-06 Tendyne Holdings, Inc. Improved delivery systems and methods for transcatheter prosthetic valves
US9693862B2 (en) 2012-07-31 2017-07-04 Edwards Lifesciences Corporation Holders for prosthetic heart valves
US9033917B2 (en) 2012-08-15 2015-05-19 Abbott Cardiovascular Systems Inc. Needle catheter for delivery of agents directly into vessel wall
WO2014031165A1 (en) 2012-08-22 2014-02-27 Medivation Technologies, Inc. Compounds and methods of treating diabetes
US9987086B2 (en) 2012-08-22 2018-06-05 Boston Scientific Scimed, Inc. Multiple electrode RF ablation catheter and method
US20140067029A1 (en) 2012-08-28 2014-03-06 Boston Scientific Scimed, Inc. Renal nerve modulation and ablation catheter electrode design
CN202843784U (en) 2012-08-29 2013-04-03 中国人民解放军第三军医大学第一附属医院 Renal sympathetic nerve ablation catheter system
CN102908188B (en) 2012-08-29 2015-04-08 中国人民解放军第三军医大学第一附属医院 Radio frequency ablation (RFA) catheter system for denervation of renal sympathetic nerves
CN202761434U (en) 2012-08-29 2013-03-06 中国人民解放军第三军医大学第一附属医院 Kidney sympathetic denervation multifunctional ablation catheter system
WO2014056460A1 (en) 2012-08-29 2014-04-17 第三军医大学第一附属医院 Multifunctional ablation catheter system for renal sympathetic denervation
CN102885648B (en) 2012-08-29 2015-03-18 中国人民解放军第三军医大学第一附属医院 Sympathetic nerve denervation ablation catheter system for kidneys
CN102885649B (en) 2012-08-29 2015-01-21 中国人民解放军第三军医大学第一附属医院 Radio frequency cable controlled ablation catheter system for removing sympathetic nerve from kidney
CN102908189B (en) 2012-08-29 2015-04-08 中国人民解放军第三军医大学第一附属医院 Multifunctional ablation catheter system for denervation of renal sympathetic nerves
JP2014054430A (en) 2012-09-13 2014-03-27 Nippon Koden Corp Catheter
CN104768487A (en) 2012-09-13 2015-07-08 波士顿科学西美德公司 Renal nerve modulation balloon and methods of making and using the same
US9610156B2 (en) 2012-09-14 2017-04-04 Millipede, Inc. Mitral valve inversion prostheses
WO2014043687A2 (en) 2012-09-17 2014-03-20 Boston Scientific Scimed, Inc. Self-positioning electrode system and method for renal nerve modulation
US10226278B2 (en) 2012-10-29 2019-03-12 Ablative Solutions, Inc. Method for painless renal denervation using a peri-vascular tissue ablation catheter with support structures
US9301795B2 (en) 2012-10-29 2016-04-05 Ablative Solutions, Inc. Transvascular catheter for extravascular delivery
US8740849B1 (en) 2012-10-29 2014-06-03 Ablative Solutions, Inc. Peri-vascular tissue ablation catheter with support structures
US9554849B2 (en) 2012-10-29 2017-01-31 Ablative Solutions, Inc. Transvascular method of treating hypertension
US9526827B2 (en) 2012-10-29 2016-12-27 Ablative Solutions, Inc. Peri-vascular tissue ablation catheter with support structures
JP6389185B2 (en) 2012-11-02 2018-09-12 ニューロトロニック・インコーポレイテッドNeurotronic, Inc. Formulation for chemical ablation and method for treating various diseases
US10537375B2 (en) 2015-04-24 2020-01-21 Neurotronic, Inc. Chemical ablation and method of treatment for various diseases
CA2889674C (en) 2012-11-05 2023-02-28 Autonomix Medical, Inc. Systems, methods, and devices for monitoring and treatment of tissues within and/or through a lumen wall
WO2014071372A1 (en) 2012-11-05 2014-05-08 Boston Scientific Scimed, Inc. Devices for delivering energy to body lumens
US10272269B2 (en) 2012-11-13 2019-04-30 Silk Road Medical, Inc. Devices and methods for endoluminal delivery of either fluid or energy for denervation
US20140316496A1 (en) 2012-11-21 2014-10-23 NeuroTronik IP Holding (Jersey) Limited Intravascular Electrode Arrays for Neuromodulation
CN202960760U (en) 2012-12-13 2013-06-05 乐普(北京)医疗器械股份有限公司 Multi-point radiofrequency ablation electrode used for operation of renal sympathetic nerve removal
US20140180077A1 (en) 2012-12-21 2014-06-26 Volcano Corporation Tissue ablation catheter and methods of ablating tissue
US20140188103A1 (en) 2012-12-31 2014-07-03 Volcano Corporation Methods and Apparatus for Neuromodulation Utilizing Optical-Acoustic Sensors
US20140200578A1 (en) 2013-01-14 2014-07-17 Boston Scientific Scimed, Inc. Renal nerve ablation catheter
WO2014118734A2 (en) 2013-01-31 2014-08-07 David Prutchi Unipolar and/or bipolar ablation catheter
EP2954865B1 (en) 2013-02-07 2022-04-06 Shanghai Golden Leaf Med Tec Co., Ltd Radio frequency ablation method, system and radio frequency ablation device thereof
US20140228829A1 (en) 2013-02-13 2014-08-14 St. Jude Medical, Cardiology Division, Inc. Laser-based devices and methods for renal denervation
US9844435B2 (en) 2013-03-01 2017-12-19 St. Jude Medical, Cardiology Division, Inc. Transapical mitral valve replacement
US20140246465A1 (en) 2013-03-03 2014-09-04 Joan Darnell Peterson Fish n stow
US20140303617A1 (en) 2013-03-05 2014-10-09 Neuro Ablation, Inc. Intravascular nerve ablation devices & methods
US9119713B2 (en) 2013-03-11 2015-09-01 St. Jude Medical, Cardiology Division, Inc. Transcatheter valve replacement
WO2014163990A1 (en) 2013-03-12 2014-10-09 Boston Scientific Scimed, Inc. Medical systems and methods for modulating nerves
US9510902B2 (en) 2013-03-13 2016-12-06 St. Jude Medical, Cardiology Division, Inc. Ablation catheters and systems including rotational monitoring means
US9861431B2 (en) 2013-03-13 2018-01-09 Kyphon SÀRL Radiofrequency inflatable device
US8876813B2 (en) 2013-03-14 2014-11-04 St. Jude Medical, Inc. Methods, systems, and apparatus for neural signal detection
US9730791B2 (en) 2013-03-14 2017-08-15 Edwards Lifesciences Cardiaq Llc Prosthesis for atraumatically grasping intralumenal tissue and methods of delivery
US9681951B2 (en) 2013-03-14 2017-06-20 Edwards Lifesciences Cardiaq Llc Prosthesis with outer skirt and anchors
US20140271717A1 (en) 2013-03-14 2014-09-18 Kyphon Sarl Devices containing a chemical denervation agent and methods for treating chronic back pain using chemical denervation
US9108030B2 (en) 2013-03-14 2015-08-18 Covidien Lp Fluid delivery catheter with pressure-actuating needle deployment and retraction
US9131982B2 (en) 2013-03-14 2015-09-15 St. Jude Medical, Cardiology Division, Inc. Mediguide-enabled renal denervation system for ensuring wall contact and mapping lesion locations
US9028488B2 (en) 2013-03-14 2015-05-12 Kyphon Sarl Radio frequency catheter to target ligamentum flavum
US9186212B2 (en) 2013-03-15 2015-11-17 St. Jude Medical, Cardiology Division, Inc. Feedback systems and methods utilizing two or more sites along denervation catheter
US9179973B2 (en) 2013-03-15 2015-11-10 St. Jude Medical, Cardiology Division, Inc. Feedback systems and methods for renal denervation utilizing balloon catheter
EP2967702A1 (en) 2013-03-15 2016-01-20 St. Jude Medical, Cardiology Division, Inc. Multi-electrode ablation system with means for determining a common path impedance
US9987070B2 (en) 2013-03-15 2018-06-05 St. Jude Medical, Cardiology Division, Inc. Ablation system, methods, and controllers
US9333113B2 (en) 2013-03-15 2016-05-10 Abbott Cardiovascular Systems Inc. System and method for denervation
US9974477B2 (en) 2013-03-15 2018-05-22 St. Jude Medical, Cardiology Division, Inc. Quantification of renal denervation via alterations in renal blood flow pre/post ablation
WO2014152344A2 (en) 2013-03-15 2014-09-25 St. Jude Medical, Atrial Fibrillation Division, Inc. Device for intravascular therapy and/or diagnosis
US20140276756A1 (en) 2013-03-15 2014-09-18 Boston Scientific Scimed, Inc. Wall-sparing renal nerve ablation catheter with spaced electrode structures
US9173701B2 (en) 2013-03-15 2015-11-03 Warsaw Orthopedic, Inc. RF enabled inflatable bone tamp
US10265122B2 (en) 2013-03-15 2019-04-23 Boston Scientific Scimed, Inc. Nerve ablation devices and related methods of use
US10350002B2 (en) 2013-04-25 2019-07-16 St. Jude Medical, Cardiology Division, Inc. Electrode assembly for catheter system
WO2014179768A1 (en) 2013-05-02 2014-11-06 Harrington Douglas C Devices and methods for detection and treatment of the aorticorenal ganglion
JP6515088B2 (en) 2013-05-20 2019-05-15 エドワーズ ライフサイエンシーズ コーポレイションEdwards Lifesciences Corporation Prosthetic heart valve delivery device
EP2999423B1 (en) 2013-05-20 2021-03-31 Mayo Foundation For Medical Education And Research Devices for ablation of tissue
EP2805683A3 (en) 2013-05-21 2015-03-25 St. Jude Medical, Cardiology Division, Inc. Electrode assembly for catheter system
US10813751B2 (en) 2013-05-22 2020-10-27 Valcare, Inc. Transcatheter prosthetic valve for mitral or tricuspid valve replacement
US9814618B2 (en) 2013-06-06 2017-11-14 Boston Scientific Scimed, Inc. Devices for delivering energy and related methods of use
US10660698B2 (en) 2013-07-11 2020-05-26 Boston Scientific Scimed, Inc. Devices and methods for nerve modulation
US8870948B1 (en) 2013-07-17 2014-10-28 Cephea Valve Technologies, Inc. System and method for cardiac valve repair and replacement
JP6465883B2 (en) 2013-08-01 2019-02-06 テンダイン ホールディングス,インコーポレイテッド Epicardial anchor device and method
US9839511B2 (en) 2013-10-05 2017-12-12 Sino Medical Sciences Technology Inc. Device and method for mitral valve regurgitation treatment
US20150105772A1 (en) 2013-10-14 2015-04-16 Boston Scientific Scimed, Inc. Devices and methods for nerve modulation
US9770606B2 (en) 2013-10-15 2017-09-26 Boston Scientific Scimed, Inc. Ultrasound ablation catheter with cooling infusion and centering basket
US10856936B2 (en) 2013-10-23 2020-12-08 St. Jude Medical, Cardiology Division, Inc. Electrode assembly for catheter system including thermoplastic-based struts
CN106061420B (en) 2013-10-25 2021-12-07 消融系统有限公司 Intravascular catheter with perivascular nerve activity sensor
US9949652B2 (en) 2013-10-25 2018-04-24 Ablative Solutions, Inc. Apparatus for effective ablation and nerve sensing associated with denervation
US9526611B2 (en) 2013-10-29 2016-12-27 Tendyne Holdings, Inc. Apparatus and methods for delivery of transcatheter prosthetic valves
EP3572047A1 (en) 2013-11-06 2019-11-27 St. Jude Medical, Cardiology Division, Inc. Reduced profile prosthetic heart valve
SG10201804045TA (en) 2013-11-11 2018-06-28 Edwards Lifesciences Cardiaq Llc Systems and methods for manufacturing a stent frame
EP3263049A1 (en) 2013-11-12 2018-01-03 St. Jude Medical, Cardiology Division, Inc. Transfemoral mitral valve repair delivery device
US9848880B2 (en) 2013-11-20 2017-12-26 James E. Coleman Adjustable heart valve implant
CN103549993B (en) 2013-11-21 2016-01-13 廖申扬 The orthosympathetic wire catheter system of radiofrequency ablation of renal artery
US9901444B2 (en) 2013-12-17 2018-02-27 Edwards Lifesciences Corporation Inverted valve structure
CN106572875A (en) 2014-02-07 2017-04-19 沃夫医药公司 Methods and systems for ablation of the renal pelvis
US9687343B2 (en) 2014-03-11 2017-06-27 Highlife Sas Transcatheter valve prosthesis
EP3119351B1 (en) 2014-03-18 2021-10-20 St. Jude Medical, Cardiology Division, Inc. Mitral valve replacement toggle cell securement
WO2015179423A1 (en) 2014-05-19 2015-11-26 Cardiaq Valve Technologies, Inc. Replacement mitral valve with annular flap
US9180005B1 (en) 2014-07-17 2015-11-10 Millipede, Inc. Adjustable endolumenal mitral valve ring
US10016272B2 (en) 2014-09-12 2018-07-10 Mitral Valve Technologies Sarl Mitral repair and replacement devices and methods
FR3027212A1 (en) 2014-10-16 2016-04-22 Seguin Jacques INTERVALVULAR IMPLANT FOR MITRAL VALVE
US9750607B2 (en) 2014-10-23 2017-09-05 Caisson Interventional, LLC Systems and methods for heart valve therapy
US9750605B2 (en) 2014-10-23 2017-09-05 Caisson Interventional, LLC Systems and methods for heart valve therapy
JP6383250B2 (en) 2014-10-28 2018-08-29 テルモ株式会社 Ablation catheter
JP2016086999A (en) 2014-10-31 2016-05-23 テルモ株式会社 Ablation catheter
WO2016083551A1 (en) 2014-11-26 2016-06-02 Konstantinos Spargias Transcatheter prosthetic heart valve and delivery system
WO2016093877A1 (en) 2014-12-09 2016-06-16 Cephea Valve Technologies, Inc. Replacement cardiac valves and methods of use and manufacture
US9861477B2 (en) 2015-01-26 2018-01-09 Boston Scientific Scimed Inc. Prosthetic heart valve square leaflet-leaflet stitch
CN111110401B (en) 2015-02-13 2022-03-29 波士顿科学国际有限公司 Valve replacement using a rotating anchor
CN112603597A (en) 2015-02-20 2021-04-06 4C医学技术有限公司 Devices, systems, and methods for cardiac therapy
EP3273910A2 (en) 2015-03-24 2018-01-31 St. Jude Medical, Cardiology Division, Inc. Mitral heart valve replacement
EP3294221B1 (en) 2015-05-14 2024-03-06 Cephea Valve Technologies, Inc. Replacement mitral valves
US10238495B2 (en) 2015-10-09 2019-03-26 Evalve, Inc. Delivery catheter handle and methods of use
US11259920B2 (en) 2015-11-03 2022-03-01 Edwards Lifesciences Corporation Adapter for prosthesis delivery device and methods of use
US10376364B2 (en) 2015-11-10 2019-08-13 Edwards Lifesciences Corporation Implant delivery capsule
EP3383322B1 (en) 2015-12-03 2020-02-12 Tendyne Holdings, Inc. Frame features for prosthetic mitral valves
CN105581858B (en) 2015-12-15 2018-04-10 先健科技(深圳)有限公司 Prosthetic heart valve holder and heart valve prosthesis
PL3184081T3 (en) 2015-12-22 2021-10-04 Medira Ag Prosthetic mitral valve coaptation enhancement device
JP7006940B2 (en) 2016-01-29 2022-01-24 ニオバスク ティアラ インコーポレイテッド Artificial valve to avoid blockage of outflow
JP2019503813A (en) 2016-02-04 2019-02-14 ミリピード, インコーポレイテッドMillipede, Inc. Mitral valve reversal prosthesis
US10667904B2 (en) 2016-03-08 2020-06-02 Edwards Lifesciences Corporation Valve implant with integrated sensor and transmitter
DE102016106575A1 (en) 2016-04-11 2017-10-12 Biotronik Ag Heart valve prosthesis
US10470877B2 (en) 2016-05-03 2019-11-12 Tendyne Holdings, Inc. Apparatus and methods for anterior valve leaflet management
US10172710B2 (en) 2016-05-10 2019-01-08 William Joseph Drasler Two component mitral valve
EP3454787A1 (en) 2016-05-12 2019-03-20 St. Jude Medical, Cardiology Division, Inc. Mitral heart valve replacement
EP3439582A4 (en) 2016-05-13 2019-11-27 Cardiosolutions, Inc. Heart valve implant and methods for delivering and implanting same
US10624740B2 (en) 2016-05-13 2020-04-21 St. Jude Medical, Cardiology Division, Inc. Mitral valve delivery device
US20170360558A1 (en) 2016-06-16 2017-12-21 Jianlu Ma Method and design for a mitral regurgitation treatment device
US10350062B2 (en) 2016-07-21 2019-07-16 Edwards Lifesciences Corporation Replacement heart valve prosthesis

Patent Citations (100)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3526219A (en) * 1967-07-21 1970-09-01 Ultrasonic Systems Method and apparatus for ultrasonically removing tissue from a biological organism
US3589363A (en) * 1967-07-25 1971-06-29 Cavitron Corp Material removal apparatus and method employing high frequency vibrations
US3565062A (en) * 1968-06-13 1971-02-23 Ultrasonic Systems Ultrasonic method and apparatus for removing cholesterol and other deposits from blood vessels and the like
US3667474A (en) * 1970-01-05 1972-06-06 Konstantin Vasilievich Lapkin Dilator for performing mitral and tricuspidal commissurotomy per atrium cordis
US3823717A (en) * 1972-04-22 1974-07-16 R Pohlman Apparatus for disintegrating concretions in body cavities of living organisms by means of an ultrasonic probe
US3861391A (en) * 1972-07-02 1975-01-21 Blackstone Corp Apparatus for disintegration of urinary calculi
US3896811A (en) * 1972-08-31 1975-07-29 Karl Storz Ultrasonic surgical instrument
US4188952A (en) * 1973-12-28 1980-02-19 Loschilov Vladimir I Surgical instrument for ultrasonic separation of biological tissue
US4042979A (en) * 1976-07-12 1977-08-23 Angell William W Valvuloplasty ring and prosthetic method
US4431006A (en) * 1982-01-07 1984-02-14 Technicare Corporation Passive ultrasound needle probe locator
US4445509A (en) * 1982-02-04 1984-05-01 Auth David C Method and apparatus for removal of enclosed abnormal deposits
US4484579A (en) * 1982-07-19 1984-11-27 University Of Pittsburgh Commissurotomy catheter apparatus and method
US4587958A (en) * 1983-04-04 1986-05-13 Sumitomo Bakelite Company Limited Ultrasonic surgical device
US4692139A (en) * 1984-03-09 1987-09-08 Stiles Frank B Catheter for effecting removal of obstructions from a biological duct
US4646736A (en) * 1984-09-10 1987-03-03 E. R. Squibb & Sons, Inc. Transluminal thrombectomy apparatus
US4960411A (en) * 1984-09-18 1990-10-02 Medtronic Versaflex, Inc. Low profile sterrable soft-tip catheter
US4589419A (en) * 1984-11-01 1986-05-20 University Of Iowa Research Foundation Catheter for treating arterial occlusion
US4750902A (en) * 1985-08-28 1988-06-14 Sonomed Technology, Inc. Endoscopic ultrasonic aspirators
US4787388A (en) * 1985-11-29 1988-11-29 Schneider - Shiley Ag Method for opening constricted regions in the cardiovascular system
US4990134A (en) * 1986-01-06 1991-02-05 Heart Technology, Inc. Transluminal microdissection device
US4990134B1 (en) * 1986-01-06 1996-11-05 Heart Techn Inc Transluminal microdissection device
US4777951A (en) * 1986-09-19 1988-10-18 Mansfield Scientific, Inc. Procedure and catheter instrument for treating patients for aortic stenosis
US4747821A (en) * 1986-10-22 1988-05-31 Intravascular Surgical Instruments, Inc. Catheter with high speed moving working head
US5314407A (en) * 1986-11-14 1994-05-24 Heart Technology, Inc. Clinically practical rotational angioplasty system
US4808153A (en) * 1986-11-17 1989-02-28 Ultramed Corporation Device for removing plaque from arteries
US5058570A (en) * 1986-11-27 1991-10-22 Sumitomo Bakelite Company Limited Ultrasonic surgical apparatus
US4878495A (en) * 1987-05-15 1989-11-07 Joseph Grayzel Valvuloplasty device with satellite expansion means
US4841977A (en) * 1987-05-26 1989-06-27 Inter Therapy, Inc. Ultra-thin acoustic transducer and balloon catheter using same in imaging array subassembly
US4796629A (en) * 1987-06-03 1989-01-10 Joseph Grayzel Stiffened dilation balloon catheter device
US4898575A (en) * 1987-08-31 1990-02-06 Medinnovations, Inc. Guide wire following tunneling catheter system and method for transluminal arterial atherectomy
US4819751A (en) * 1987-10-16 1989-04-11 Baxter Travenol Laboratories, Inc. Valvuloplasty catheter and method
US4870953A (en) * 1987-11-13 1989-10-03 Donmicheal T Anthony Intravascular ultrasonic catheter/probe and method for treating intravascular blockage
US4909252A (en) * 1988-05-26 1990-03-20 The Regents Of The Univ. Of California Perfusion balloon catheter
US4920954A (en) * 1988-08-05 1990-05-01 Sonic Needle Corporation Ultrasonic device for applying cavitation forces
US4919133A (en) * 1988-08-18 1990-04-24 Chiang Tien Hon Catheter apparatus employing shape memory alloy structures
US5904679A (en) * 1989-01-18 1999-05-18 Applied Medical Resources Corporation Catheter with electrosurgical cutter
US4936281A (en) * 1989-04-13 1990-06-26 Everest Medical Corporation Ultrasonically enhanced RF ablation catheter
US4986830A (en) * 1989-09-22 1991-01-22 Schneider (U.S.A.) Inc. Valvuloplasty catheter with balloon which remains stable during inflation
US6582462B1 (en) * 1990-05-18 2003-06-24 Heartport, Inc. Valve prosthesis for implantation in the body and a catheter for implanting such valve prosthesis
US5840081A (en) * 1990-05-18 1998-11-24 Andersen; Henning Rud System and method for implanting cardiac valves
US5106302A (en) * 1990-09-26 1992-04-21 Ormco Corporation Method of fracturing interfaces with an ultrasonic tool
US5248296A (en) * 1990-12-24 1993-09-28 Sonic Needle Corporation Ultrasonic device having wire sheath
US5304115A (en) * 1991-01-11 1994-04-19 Baxter International Inc. Ultrasonic angioplasty device incorporating improved transmission member and ablation probe
US5957882A (en) * 1991-01-11 1999-09-28 Advanced Cardiovascular Systems, Inc. Ultrasound devices for ablating and removing obstructive matter from anatomical passageways and blood vessels
US6454757B1 (en) * 1991-01-11 2002-09-24 Advanced Cardiovascular Systems, Inc. Ultrasonic method for ablating and removing obstructive matter from anatomical passageways and blood vessels
US6454737B1 (en) * 1991-01-11 2002-09-24 Advanced Cardiovascular Systems, Inc. Ultrasonic angioplasty-atherectomy catheter and method of use
US5443446A (en) * 1991-04-04 1995-08-22 Shturman Cardiology Systems, Inc. Method and apparatus for in vivo heart valve decalcification
US5295958A (en) * 1991-04-04 1994-03-22 Shturman Cardiology Systems, Inc. Method and apparatus for in vivo heart valve decalcification
US5489297A (en) * 1992-01-27 1996-02-06 Duran; Carlos M. G. Bioprosthetic heart valve with absorbable stent
US5318014A (en) * 1992-09-14 1994-06-07 Coraje, Inc. Ultrasonic ablation/dissolution transducer
USRE36936E (en) * 1992-09-28 2000-10-31 Advanced Silicon Materials, Inc. Production of high-purity polycrystalline silicon rod for semiconductor applications
US5356418A (en) * 1992-10-28 1994-10-18 Shturman Cardiology Systems, Inc. Apparatus and method for rotational atherectomy
US5397293A (en) * 1992-11-25 1995-03-14 Misonix, Inc. Ultrasonic device with sheath and transverse motion damping
US5352199A (en) * 1993-05-28 1994-10-04 Numed, Inc. Balloon catheter
US5609151A (en) * 1994-09-08 1997-03-11 Medtronic, Inc. Method for R-F ablation
US6689086B1 (en) * 1994-10-27 2004-02-10 Advanced Cardiovascular Systems, Inc. Method of using a catheter for delivery of ultrasonic energy and medicament
US5827229A (en) * 1995-05-24 1998-10-27 Boston Scientific Corporation Northwest Technology Center, Inc. Percutaneous aspiration thrombectomy catheter system
US5681336A (en) * 1995-09-07 1997-10-28 Boston Scientific Corporation Therapeutic device for treating vien graft lesions
US5725494A (en) * 1995-11-30 1998-03-10 Pharmasonics, Inc. Apparatus and methods for ultrasonically enhanced intraluminal therapy
US6321109B2 (en) * 1996-02-15 2001-11-20 Biosense, Inc. Catheter based surgery
US6295712B1 (en) * 1996-07-15 2001-10-02 Shturman Cardiology Systems, Inc. Rotational atherectomy device
US5662671A (en) * 1996-07-17 1997-09-02 Embol-X, Inc. Atherectomy device having trapping and excising means for removal of plaque from the aorta and other arteries
US6843797B2 (en) * 1996-07-26 2005-01-18 Kensey Nash Corporation System and method of use for revascularizing stenotic bypass grafts and other occluded blood vessels
US5782931A (en) * 1996-07-30 1998-07-21 Baxter International Inc. Methods for mitigating calcification and improving durability in glutaraldehyde-fixed bioprostheses and articles manufactured by such methods
US6869439B2 (en) * 1996-09-19 2005-03-22 United States Surgical Corporation Ultrasonic dissector
US6217595B1 (en) * 1996-11-18 2001-04-17 Shturman Cardiology Systems, Inc. Rotational atherectomy device
US5873811A (en) * 1997-01-10 1999-02-23 Sci-Med Life Systems Composition containing a radioactive component for treatment of vessel wall
US6129734A (en) * 1997-01-21 2000-10-10 Shturman Cardiology Systems, Inc. Rotational atherectomy device with radially expandable prime mover coupling
US5989208A (en) * 1997-05-16 1999-11-23 Nita; Henry Therapeutic ultrasound system
US6638288B1 (en) * 1997-08-14 2003-10-28 Shturman Cardiology Systems, Inc. Eccentric drive shaft for atherectomy device and method for manufacture
US6132444A (en) * 1997-08-14 2000-10-17 Shturman Cardiology Systems, Inc. Eccentric drive shaft for atherectomy device and method for manufacture
US6254635B1 (en) * 1998-02-02 2001-07-03 St. Jude Medical, Inc. Calcification-resistant medical articles
US6047700A (en) * 1998-03-30 2000-04-11 Arthrocare Corporation Systems and methods for electrosurgical removal of calcified deposits
US20040092962A1 (en) * 1999-04-09 2004-05-13 Evalve, Inc., A Delaware Corporation Multi-catheter steerable guiding system and methods of use
US20040044350A1 (en) * 1999-04-09 2004-03-04 Evalve, Inc. Steerable access sheath and methods of use
US6505080B1 (en) * 1999-05-04 2003-01-07 Medtronic, Inc. Method and apparatus for inhibiting or minimizing calcification of aortic valves
US20020007192A1 (en) * 1999-06-17 2002-01-17 Pederson Gary J. Stent securement by balloon modification
US6168579B1 (en) * 1999-08-04 2001-01-02 Scimed Life Systems, Inc. Filter flush system and methods of use
US20020099139A1 (en) * 1999-12-16 2002-07-25 Young Chang Chemical Co., Ltd. Dendritic polyetherketone and heat-resistant blend of PVC with the same
US20040006358A1 (en) * 2000-04-05 2004-01-08 Pathway Medical Technologies, Inc. Intralumenal material removal using a cutting device for differential cutting
US6565588B1 (en) * 2000-04-05 2003-05-20 Pathway Medical Technologies, Inc. Intralumenal material removal using an expandable cutting device
US20020099439A1 (en) * 2000-09-29 2002-07-25 Schwartz Robert S. Venous valvuloplasty device and method
US6579308B1 (en) * 2000-11-28 2003-06-17 Scimed Life Systems, Inc. Stent devices with detachable distal or proximal wires
US6623452B2 (en) * 2000-12-19 2003-09-23 Scimed Life Systems, Inc. Drug delivery catheter having a highly compliant balloon with infusion holes
US20020082637A1 (en) * 2000-12-22 2002-06-27 Cardiovascular Systems, Inc. Catheter and method for making the same
US20040057955A1 (en) * 2001-10-05 2004-03-25 O'brien Kevin D. Methods of inhibition of stenosis and/or sclerosis of the aortic valve
US6852118B2 (en) * 2001-10-19 2005-02-08 Shturman Cardiology Systems, Inc. Self-indexing coupling for rotational angioplasty device
US20030139689A1 (en) * 2001-11-19 2003-07-24 Leonid Shturman High torque, low profile intravascular guidewire system
US20050007219A1 (en) * 2002-07-11 2005-01-13 Qing Ma Microelectromechanical (MEMS) switching apparatus
US6855123B2 (en) * 2002-08-02 2005-02-15 Flow Cardia, Inc. Therapeutic ultrasound system
US20040039412A1 (en) * 2002-08-20 2004-02-26 Takaaki Isshiki Thrombus capture catheter
US20040092858A1 (en) * 2002-08-28 2004-05-13 Heart Leaflet Technologies, Inc. Leaflet valve
US20040127979A1 (en) * 2002-08-28 2004-07-01 Heart Leaflet Technologies, Inc Method of treating diseased valve
US20040092989A1 (en) * 2002-08-28 2004-05-13 Heart Leaflet Technologies, Inc Delivery device for leaflet valve
US6702748B1 (en) * 2002-09-20 2004-03-09 Flowcardia, Inc. Connector for securing ultrasound catheter to transducer
US20040082910A1 (en) * 2002-10-29 2004-04-29 Constantz Brent R. Devices and methods for treating aortic valve stenosis
US20040199191A1 (en) * 2003-01-27 2004-10-07 Leonard Schwartz Device for percutaneous cutting and dilating a stenosis of the aortic valve
US6746463B1 (en) * 2003-01-27 2004-06-08 Scimed Life Systems, Inc Device for percutaneous cutting and dilating a stenosis of the aortic valve
US20050075662A1 (en) * 2003-07-18 2005-04-07 Wesley Pedersen Valvuloplasty catheter
US7803168B2 (en) * 2004-12-09 2010-09-28 The Foundry, Llc Aortic valve repair

Cited By (94)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10350004B2 (en) 2004-12-09 2019-07-16 Twelve, Inc. Intravascular treatment catheters
US9414852B2 (en) 2004-12-09 2016-08-16 Twelve, Inc. Aortic valve repair
US11272982B2 (en) 2004-12-09 2022-03-15 Twelve, Inc. Intravascular treatment catheters
US9039729B2 (en) * 2007-08-31 2015-05-26 BiO2 Medical, Inc. IVC filter catheter with imaging modality
US20140005529A1 (en) * 2007-08-31 2014-01-02 BiO2 Medical, Inc. Ivc filter catheter with imaging modality
US9254192B2 (en) 2007-09-13 2016-02-09 Georg Lutter Truncated cone heart valve stent
US11213387B2 (en) 2007-09-13 2022-01-04 Georg Lutter Truncated cone heart valve stent
US9579114B2 (en) 2008-05-07 2017-02-28 Northgate Technologies Inc. Radially-firing electrohydraulic lithotripsy probe
US11559318B2 (en) 2008-05-07 2023-01-24 Northgate Technologies Inc. Radially-firing electrohydraulic lithotripsy probe
US9421025B2 (en) 2008-11-05 2016-08-23 Shockwave Medical, Inc. Shockwave valvuloplasty catheter system
US9044619B2 (en) 2008-11-05 2015-06-02 Shockwave Medical, Inc. Shockwave valvuloplasty catheter system
US9044618B2 (en) 2008-11-05 2015-06-02 Shockwave Medical, Inc. Shockwave valvuloplasty catheter system
US10149690B2 (en) 2008-11-05 2018-12-11 Shockwave Medical, Inc. Shockwave valvuloplasty catheter system
US20100114020A1 (en) * 2008-11-05 2010-05-06 Daniel Hawkins Shockwave valvuloplasty catheter system
US11000299B2 (en) 2008-11-05 2021-05-11 Shockwave Medical, Inc. Shockwave valvuloplasty catheter system
US9770331B2 (en) 2010-12-23 2017-09-26 Twelve, Inc. System for mitral valve repair and replacement
US10517725B2 (en) 2010-12-23 2019-12-31 Twelve, Inc. System for mitral valve repair and replacement
US11571303B2 (en) 2010-12-23 2023-02-07 Twelve, Inc. System for mitral valve repair and replacement
US9421098B2 (en) 2010-12-23 2016-08-23 Twelve, Inc. System for mitral valve repair and replacement
US8948848B2 (en) 2011-01-07 2015-02-03 Innovative Cardiovascular Solutions, Llc Angiography catheter
US10543033B2 (en) 2011-05-12 2020-01-28 Cvdevices, Llc Systems and methods for cryoablation of a tissue
US9198706B2 (en) * 2011-05-12 2015-12-01 Cvdevices, Llc Systems and methods for cryoblation of a tissue
US20120289951A1 (en) * 2011-05-12 2012-11-15 Kassab Ghassan S Systems and methods for cryoblation of a tissue
US9730747B2 (en) 2011-05-12 2017-08-15 Cvdevices, Llc Systems and methods for cryoablation of a tissue
US9579196B2 (en) 2011-06-21 2017-02-28 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US10028827B2 (en) 2011-06-21 2018-07-24 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US9585751B2 (en) 2011-06-21 2017-03-07 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US11523900B2 (en) 2011-06-21 2022-12-13 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US11712334B2 (en) 2011-06-21 2023-08-01 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US9572662B2 (en) 2011-06-21 2017-02-21 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US10751173B2 (en) 2011-06-21 2020-08-25 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US9125740B2 (en) 2011-06-21 2015-09-08 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US10034750B2 (en) 2011-06-21 2018-07-31 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US11202704B2 (en) 2011-10-19 2021-12-21 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US10702380B2 (en) 2011-10-19 2020-07-07 Twelve, Inc. Devices, systems and methods for heart valve replacement
US9901443B2 (en) 2011-10-19 2018-02-27 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US10052204B2 (en) 2011-10-19 2018-08-21 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US11826249B2 (en) 2011-10-19 2023-11-28 Twelve, Inc. Devices, systems and methods for heart valve replacement
US11628063B2 (en) 2011-10-19 2023-04-18 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US11617648B2 (en) 2011-10-19 2023-04-04 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US9034032B2 (en) 2011-10-19 2015-05-19 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US9034033B2 (en) 2011-10-19 2015-05-19 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US10299927B2 (en) 2011-10-19 2019-05-28 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US10299917B2 (en) 2011-10-19 2019-05-28 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US10335278B2 (en) 2011-10-19 2019-07-02 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US9763780B2 (en) 2011-10-19 2017-09-19 Twelve, Inc. Devices, systems and methods for heart valve replacement
US11497603B2 (en) 2011-10-19 2022-11-15 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US9039757B2 (en) 2011-10-19 2015-05-26 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US10016271B2 (en) 2011-10-19 2018-07-10 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US9655722B2 (en) 2011-10-19 2017-05-23 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US11197758B2 (en) 2011-10-19 2021-12-14 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US9295552B2 (en) 2011-10-19 2016-03-29 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US10945835B2 (en) 2011-10-19 2021-03-16 Twelve, Inc. Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods
US10478202B2 (en) 2011-11-08 2019-11-19 Shockwave Medical, Inc. Shock wave valvuloplasty device with moveable shock wave generator
US8709075B2 (en) 2011-11-08 2014-04-29 Shockwave Medical, Inc. Shock wave valvuloplasty device with moveable shock wave generator
US9289224B2 (en) 2011-11-08 2016-03-22 Shockwave Medical, Inc. Shock wave valvuloplasty device with moveable shock wave generator
US9814476B2 (en) 2011-11-08 2017-11-14 Shockwave Medical, Inc. Shock wave valvuloplasty device with moveable shock wave generator
US11129714B2 (en) 2012-03-01 2021-09-28 Twelve, Inc. Hydraulic delivery systems for prosthetic heart valve devices and associated methods
US10258468B2 (en) 2012-03-01 2019-04-16 Twelve, Inc. Hydraulic delivery systems for prosthetic heart valve devices and associated methods
US9579198B2 (en) 2012-03-01 2017-02-28 Twelve, Inc. Hydraulic delivery systems for prosthetic heart valve devices and associated methods
US9220521B2 (en) 2012-08-06 2015-12-29 Shockwave Medical, Inc. Shockwave catheter
US10758255B2 (en) 2012-08-08 2020-09-01 Shockwave Medical, Inc. Shock wave valvuloplasty with multiple balloons
US9554815B2 (en) 2012-08-08 2017-01-31 Shockwave Medical, Inc. Shockwave valvuloplasty with multiple balloons
WO2014025981A1 (en) * 2012-08-08 2014-02-13 Shockwave Medical, Inc. Shockwave valvuloplasty with multiple balloons
US11766271B2 (en) 2012-08-08 2023-09-26 Shockwave Medical, Inc. Shock wave valvuloplasty with multiple balloons
US11559319B2 (en) 2013-03-11 2023-01-24 Northgate Technologies Inc. Unfocused electrohydraulic lithotripter
US10603058B2 (en) 2013-03-11 2020-03-31 Northgate Technologies, Inc. Unfocused electrohydraulic lithotripter
US11234821B2 (en) 2013-05-20 2022-02-01 Twelve, Inc. Implantable heart valve devices, mitral valve repair devices and associated systems and methods
US10111747B2 (en) 2013-05-20 2018-10-30 Twelve, Inc. Implantable heart valve devices, mitral valve repair devices and associated systems and methods
US10238490B2 (en) 2015-08-21 2019-03-26 Twelve, Inc. Implant heart valve devices, mitral valve repair devices and associated systems and methods
US11576782B2 (en) 2015-08-21 2023-02-14 Twelve, Inc. Implantable heart valve devices, mitral valve repair devices and associated systems and methods
US10820996B2 (en) 2015-08-21 2020-11-03 Twelve, Inc. Implantable heart valve devices, mitral valve repair devices and associated systems and methods
US10265172B2 (en) 2016-04-29 2019-04-23 Medtronic Vascular, Inc. Prosthetic heart valve devices with tethered anchors and associated systems and methods
US11033390B2 (en) 2016-04-29 2021-06-15 Medtronic Vascular, Inc. Prosthetic heart valve devices with tethered anchors and associated systems and methods
US10646240B2 (en) 2016-10-06 2020-05-12 Shockwave Medical, Inc. Aortic leaflet repair using shock wave applicators
US11517337B2 (en) 2016-10-06 2022-12-06 Shockwave Medical, Inc. Aortic leaflet repair using shock wave applicators
US10357264B2 (en) 2016-12-06 2019-07-23 Shockwave Medical, Inc. Shock wave balloon catheter with insertable electrodes
US10575950B2 (en) 2017-04-18 2020-03-03 Twelve, Inc. Hydraulic systems for delivering prosthetic heart valve devices and associated methods
US11389295B2 (en) 2017-04-18 2022-07-19 Twelve, Inc. Delivery systems with tethers for prosthetic heart valve devices and associated methods
US10433961B2 (en) 2017-04-18 2019-10-08 Twelve, Inc. Delivery systems with tethers for prosthetic heart valve devices and associated methods
US10702378B2 (en) 2017-04-18 2020-07-07 Twelve, Inc. Prosthetic heart valve device and associated systems and methods
US11654021B2 (en) 2017-04-18 2023-05-23 Twelve, Inc. Prosthetic heart valve device and associated systems and methods
US11737873B2 (en) 2017-04-18 2023-08-29 Twelve, Inc. Hydraulic systems for delivering prosthetic heart valve devices and associated methods
US10792151B2 (en) 2017-05-11 2020-10-06 Twelve, Inc. Delivery systems for delivering prosthetic heart valve devices and associated methods
US11786370B2 (en) 2017-05-11 2023-10-17 Twelve, Inc. Delivery systems for delivering prosthetic heart valve devices and associated methods
US10646338B2 (en) 2017-06-02 2020-05-12 Twelve, Inc. Delivery systems with telescoping capsules for deploying prosthetic heart valve devices and associated methods
US11559398B2 (en) 2017-06-02 2023-01-24 Twelve, Inc. Delivery systems with telescoping capsules for deploying prosthetic heart valve devices and associated methods
US11464659B2 (en) 2017-06-06 2022-10-11 Twelve, Inc. Crimping device for loading stents and prosthetic heart valves
US10709591B2 (en) 2017-06-06 2020-07-14 Twelve, Inc. Crimping device and method for loading stents and prosthetic heart valves
US10786352B2 (en) 2017-07-06 2020-09-29 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US10729541B2 (en) 2017-07-06 2020-08-04 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US11877926B2 (en) 2017-07-06 2024-01-23 Twelve, Inc. Prosthetic heart valve devices and associated systems and methods
US11717390B2 (en) 2018-03-07 2023-08-08 Innovative Cardiovascular Solutions, Llc Embolic protection device
US11071844B2 (en) 2018-03-07 2021-07-27 Innovative Cardiovascular Solutions, Llc Embolic protection device

Also Published As

Publication number Publication date
US20060229659A1 (en) 2006-10-12
US9414852B2 (en) 2016-08-16
EP1819304B1 (en) 2023-01-25
JP5219518B2 (en) 2013-06-26
JP2008522755A (en) 2008-07-03
US11272982B2 (en) 2022-03-15
US10350004B2 (en) 2019-07-16
CN101076290B (en) 2011-11-23
US20190350651A1 (en) 2019-11-21
US7803168B2 (en) 2010-09-28
EP1819304A4 (en) 2015-04-15
WO2006063199A2 (en) 2006-06-15
EP1819304A2 (en) 2007-08-22
WO2006063199A3 (en) 2007-07-19
US20130345715A1 (en) 2013-12-26
US20170014183A1 (en) 2017-01-19
CN101076290A (en) 2007-11-21

Similar Documents

Publication Publication Date Title
US11272982B2 (en) Intravascular treatment catheters
JP6358762B2 (en) Apparatus and method for forming and maintaining an intraatrial pressure relief opening
US20230111554A1 (en) Catheter with Shock Wave Electrodes Aligned on Longitudinal Axis
US20200046603A1 (en) Vibratory Energy Systems and Methods for Occluded Body Cavities
US10292690B2 (en) Apparatus and methods to create and maintain an intra-atrial pressure relief opening
US8372069B2 (en) Methods for removing a valve from a vessel
EP3870079A1 (en) Devices and techniques for cardiovascular intervention
JP2015524709A (en) Shock wave valve formation with multiple balloons
CN111526823B (en) Transcatheter device for treating calcified heart valve leaflets
US20230079043A1 (en) Tip assemblies, systems, and methods for fracturing a frame of a deployed prosthesis
US20240023948A1 (en) Apparatus and methods to create and maintain an intra-atrial pressure relief opening
CN218500771U (en) Shock wave medicine saccule conduit device
US20220361908A1 (en) Percutaneous device for intentional laceration of anterior mitral valve leaflet
CN115990049A (en) Shock wave medicine saccule catheter device
CN114641250A (en) Catheter, sheath or dilator for cardiac valve decalcification treatment and method of use thereof

Legal Events

Date Code Title Description
STCB Information on status: application discontinuation

Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION

AS Assignment

Owner name: FOUNDRY NEWCO XII, INC., CALIFORNIA

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:FOUNDRY, LLC;REEL/FRAME:030655/0390

Effective date: 20130523

AS Assignment

Owner name: TWELVE, INC., CALIFORNIA

Free format text: CHANGE OF NAME;ASSIGNOR:FOUNDRY NEWCO XII, INC.;REEL/FRAME:031957/0319

Effective date: 20131112