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11.发明授权Method and apparatus for creation of drug delivery and/or stimulation pockets in myocardium 失效用于在心肌中产生药物递送和/或刺激袋的方法和装置公开(公告)号：US06482220B1
公开(公告)日：2002-11-19
申请号：US09444772
申请日：1999-11-22
申请人： Richard L. Mueller
发明人： Richard L. Mueller
IPC分类号： A61B1732
CPC分类号： A61B18/08 , A61B2017/00247 , A61B2017/22082 , A61B2018/00392
摘要： An apparatus and method for creating drug-filled pockets within muscle tissue, such as myocardium of the heart for increasing angiogenesis. More particularly, the apparatus has an excising assembly with a dilator tip for penetrating and advancing through the surface and body of a muscle or organ, such as the heart. Preferably, the dilator tip has a low level laser optical fiber emission to ease the passage of the excising assembly and provide thermal damage which also stimulates angiogenesis. More preferably, the dilator tip also disperses a pharmacologically active substance as the apparatus is passed through the tissue and/or creates pockets. The excising assembly is connected to a hand-held control device from which the operator pushes a switch to activate a punching mechanism within the excising assembly. The punching mechanism cuts a discrete piece of muscle tissue and traps it within the excising assembly leaving a pocket in the remaining muscle tissue. The excising assembly may also optionally release a bolus of the pharmacologically active substance into the pocket so created. Most preferably, there is a timing mechanism to measure the contraction of the heart, and the timing mechanism is synchronized with the operator's switch on the hand-held device to ensure that the punching occurs at maximum contraction of systole. A measurement guide determines how much excised tissue is trapped in the reservoir of the excising assembly. At a threshold level of filling, the surgeon will remove the excising assembly from the hand-held control device and open the punching mechanism for release of tissue. More preferably, the threshold level of filling will automatically turn off the switch to the punching mechanism to indicate to the surgeon the need to empty the excising assembly of tissue.
摘要翻译： 用于在肌肉组织内产生药物填充袋的装置和方法，例如用于增加血管生成的心脏心肌。 更具体地，该装置具有带有扩张器尖端的切除组件，该扩张器尖端用于穿过并穿过诸如心脏的肌肉或器官的表面和身体。 优选地，扩张器尖端具有低水平的激光光纤发射以便于切除组件的通过并且提供也刺激血管发生的热损伤。 更优选地，当装置通过组织和/或产生袋时，扩张器尖端还分散药理活性物质。 切除组件连接到手持控制装置，操作者从该手持式控制装置推动开关以激活切割组件内的冲压机构。 冲孔机构切割离散的肌肉组织并将其捕获在切除组件内，留下剩余的肌肉组织中的口袋。 切除组件还可以任选地将药物活性物质的推注物释放到如此产生的口袋中。 最优选地，存在测量心脏收缩的定时机构，并且定时机构与手持装置上的操作者开关同步，以确保在收缩最大收缩时发生冲孔。 测量指南确定在切除组件的储存器中多少切除的组织被捕获。 在阈值的灌注水平下，外科医生将从手持控制装置移除切除组件，并打开用于释放组织的冲压机构。 更优选地，填充的阈值水平将自动关闭切换到冲压机构以向外科医生指示需要清空组织的切除组件。
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12.发明授权公开(公告)号：US06391021B1
公开(公告)日：2002-05-21
申请号：US09327938
申请日：1999-06-08
IPC分类号： A61B1824
CPC分类号： A61B18/24 , A61B2017/00247 , A61B2017/00703 , A61B2018/00392
摘要： A method of selecting laser parameters for performing laser-assisted myocardial revascularization to avoid inducing undesired cardiac arrhythmia without synchronization of delivery of laser energy and the patient's cardiac cycle, the method comprising the steps of minimizing the power level of laser energy used, thereby decreasing the overall trauma to the heart, selecting a pulse frequency as great as possible while avoiding adverse summation effects, selecting a pulse width as wide as possible to prevent excessively high peak powers per pulse and not so wide as to cause undesired thermal damage, selecting an energy flux rate, shaping the front end of each pulse of laser energy to provide efficient, non-explosive TMR channeling, and correcting the selected power level, pulse width, pulse frequency and energy flux rate for mechanical events, including method of access to the heart, position of selected portions of myocardium in the heart, temporal duration of the procedure, natural movement of the heart, specific heart geometry, pre-existing heart arrhythmia and other factors causing a predisposition to heart arrhythmia. A method for performing laser-assisted transmyocardial revascularization (TMR) and percutaneous transluminal myocardial revascularization (PTMR) using such laser energy with parameters selected to avoid inducing undesired cardiac arrhythmia, the method comprising the steps of generating laser energy having a predetermined non-square wave shape, a predetermined wavelength, a predetermined energy flux and a predetermined power level, and delivering the laser energy in a plurality of pulses, the plurality of pulses having a predetermined pulse frequency and a predetermined pulse width, to selected portions of myocardium to form TMR and PTMR channels without synchronizing delivery of the laser beam with the cardiac cycle.
摘要翻译： 选择用于执行激光辅助心肌血运重建的激光参数以避免诱导不需要的心律失常而不发送激光能量和患者的心动周期的方法，所述方法包括以下步骤：使所使用的激光能量的功率水平最小化，从而减少 对心脏的整体创伤，尽可能选择脉冲频率，同时避免不利的相加效应，尽可能选择尽可能宽的脉冲宽度，以防止每个脉冲过高的峰值功率，而不是很宽，从而导致不必要的热损伤，选择能量 通量速率，对激光能量的每个脉冲的前端进行整形，以提供有效的非爆炸性TMR通道，并且对机械事件的选择功率电平，脉冲宽度，脉冲频率和能量通量率进行校正，包括进入心脏的方法 心脏心脏选择部位的位置，手术的时间持续时间，自然运动 心脏的特征，特定的心脏几何形状，预先存在的心律失常等导致心律失常倾向的因素。 一种使用具有选择的参数的激光能量进行激光辅助心肌血运重建术（TMR）和经皮腔内心肌血运重建术（PTMR）的方法，该方法包括以下步骤：产生具有预定非方波的激光能量 形状，预定波长，预定能量通量和预定功率电平，并将激光能量以预定的脉冲频率和预定脉冲宽度的多个脉冲输送到心肌的选定部分以形成TMR 和PTMR通道，而不使激光束与心动周期同步传送。
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公开(公告)号：US5871495A
公开(公告)日：1999-02-16
申请号：US713531
申请日：1996-09-13
申请人： Richard L. Mueller
发明人： Richard L. Mueller
CPC分类号： A61B10/0275 , A61B17/320016 , A61B10/04 , A61B17/32002 , A61B17/32053 , A61B2010/0208 , A61B2017/00247 , A61B2017/00292 , A61B2017/306 , A61B2018/00392
摘要： An apparatus for creating revascularization channels in tissue, such as the myocardium of the heart, mechanically cuts the channels using a hand piece with easily removable cutting tip assemblies having angled, sharpened edges to allow rapid tip replacement. The cutting tip assembly has an inner needle within an outer hollow needle with each needle attached to the hand piece for independent rotation and axial movement. The inner needle may be hollow, or formed with a pointed tip, and may rotate counter to the outer needle to enhance gripping and storage of the tissue excised by the outer needle. The hand piece may attach a cylindrical magazine of cutting tip assemblies or one cutting tip assembly. The cutting tip assembly may be heated to provide thermal damage to the heart muscle during the creation of the channel, providing some of the advantages of the laser method of TMR.
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公开(公告)号：USD389574S
公开(公告)日：1998-01-20
申请号：US63126
申请日：1996-11-27
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公开(公告)号：US5569277A
公开(公告)日：1996-10-29
申请号：US359239
申请日：1994-12-19
申请人： Michael Evans , Richard L. Mueller
发明人： Michael Evans , Richard L. Mueller
CPC分类号： A61B17/320783 , A61B2017/22054 , A61B2017/320052
摘要： An atherectomy catheter includes a catheter body having a cylindrical housing at its distal end. The cylindrical housing includes an elongate cutting aperture on one side thereof and a mechanism for severing atheroma which enters within the opening. In a first embodiment, the cutting mechanism comprises a circular cutting blade which is advanced over an elongate guide member which defines a path for the blade. Use of the guide means helps assure that the cutting blade will not be lost from the housing during use. In a second embodiment, a rotatable helical cutting blade is mounted within the housing. In that particular embodiment, the helical cutting blade can serve as the guide member for the circular cutting blade.
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公开(公告)号：US5181920A
公开(公告)日：1993-01-26
申请号：US624855
申请日：1990-12-10
CPC分类号： A61B17/3207 , A61M2025/1097 , A61M25/104
摘要： An atherectomy device for reducing stenosis material from a vascular vessel is provided. The atherectomy device includes an elongated flexible tubular member having at least one lumen extending therethrough and having proximal and distal extremities. A flexible drive means disposed within the tubular members is free to move both rotationally and axially therein. A cutting assembly is carried by the distal extremity of the flexible tubular member with a cutter being carried by the distal extremity of the flexible drive means for removing a portion of the stenosis from the vessel wall. An inflatable dilation balloon is carried by the tubular member proximally of the cutter for further reducing the stenosis after initial reduction by the cutter. A perfusion channel maintains blood flow past the dilation balloon. Methods of the present invention include cutting and dilating a stenosis, cutting then immediately dilating a stenosis, and dilating then immediately cutting a stenosis.
摘要翻译： 提供了用于从血管容器减少狭窄物质的粥样斑块切除装置。 粥样斑块切除装置包括细长的柔性管状构件，其具有延伸穿过其中并具有近端和远端的至少一个内腔。 设置在管状构件内的柔性驱动装置自由地在其中旋转地和轴向地移动。 切割组件由柔性管状构件的远端承载，切割器由柔性驱动装置的远端承载，用于从血管壁去除一部分狭窄。 可膨胀的膨胀气囊由切割器的近侧的管状构件承载，以进一步减少由切割器初始还原之后的狭窄。 灌注通道保持血液流过扩张气球。 本发明的方法包括切割和扩张狭窄，切割然后立即扩张狭窄，并且立即扩张然后立即切开狭窄。
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公开(公告)号：US5084010A
公开(公告)日：1992-01-28
申请号：US482421
申请日：1990-02-20
申请人： Mark Plaia , Richard L. Mueller , Chris Decaria
发明人： Mark Plaia , Richard L. Mueller , Chris Decaria
CPC分类号： A61B17/3207 , A61B2017/00464 , A61B90/39
摘要： A catheter system comprises a flexible catheter tube or body having a housing secured to its distal end. A plurality of structurally distinct terminal components are provided to attach to the forward end of the housing, while a plurality of interchangeable interventional elements are provided to attach to a drive member within the catheter. By properly selecting the terminal components and the interventional elements, a wide variety of specific therapeutic and diagnostic capabilities may be provided.
摘要翻译： 导管系统包括柔性导管管或本体，其具有固定到其远端的壳体。 提供多个结构不同的端子部件以附接到壳体的前端，同时提供多个可互换的介入元件以附接到导管内的驱动构件。 通过适当地选择终端组件和介入元件，可以提供各种具体的治疗和诊断能力。
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公开(公告)号：US5071425A
公开(公告)日：1991-12-10
申请号：US711506
申请日：1991-06-03
IPC分类号： A61B17/22
CPC分类号： A61B17/320783 , A61B2017/22038 , A61B2017/22075
摘要： An atherectomy device includes a transparent lumen for providing inflation medium to an inflatable balloon. A dual lumen flexible tube includes an opaque flexible torque member in a first lumen, while the second lumen serves as an inflation lumen. The distal end of the inflation lumen is expanded to define the balloon, and no seals are needed between the balloon and the inflation lumen.
摘要翻译： 粥样斑块切除装置包括用于向充气气囊提供充气介质的透明内腔。 双腔柔性管包括在第一腔中的不透明柔性扭矩构件，而第二腔用作充气腔。 膨胀腔的远端被扩张以限定球囊，并且在球囊和充气腔之间不需要密封。
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公开(公告)号：US5053044A
公开(公告)日：1991-10-01
申请号：US142382
申请日：1988-01-11
IPC分类号： A61B17/22
CPC分类号： A61B17/320725 , A61B17/3209 , A61B2017/32113
摘要： A vascular catheter includes a blade tip at its distal end. In the specific embodiments, a blade is mounted within the blade tip and a mechanism provided for extending the blade transversely when the blade tip is located within a region of stenosis. By extending the blade and axially translating the catheter so that the blade forms an incision within the region of stenosis, improved angioplastic treatment can be achieved.
摘要翻译： 血管导管在其远端包括叶片尖端。 在具体实施例中，叶片安装在叶片尖端内，并且设置用于当叶片尖端位于狭窄区域内时横向延伸叶片的机构。 通过延伸叶片并轴向平移导管，使得叶片在狭窄区域内形成切口，可以实现改进的血管生成处理。
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公开(公告)号：US4801297A
公开(公告)日：1989-01-31
申请号：US616036
申请日：1984-06-01
申请人： Richard L. Mueller
发明人： Richard L. Mueller
IPC分类号： A61M25/00
CPC分类号： A61M25/0075 , A61M25/0045 , A61M25/0054 , A61M25/0068 , A61M25/008 , A61M2025/0073 , A61M2025/0081 , A61M25/007
摘要： The present catheter employee a series of axial slits adjacent to its tip. The slits act to increase the flexibility of the catheter adjacent the tip thereby providing pressure relief in the event of blockage of the lumen at the tip. In addition, by forming the slits as slots, i.e. by removing material from the slits, it is possible to provide a catheter having flow through the sides adjacent to the tip for any desired purpose.
摘要翻译： 本导管员工与其尖端相邻的一系列轴向切口。 狭缝用于增加邻近尖端的导管的柔性，从而在尖端处的内腔阻塞的情况下提供压力释放。 此外，通过形成狭缝作为狭缝，即通过从狭缝中去除材料，可以提供一种导管，其通过与尖端相邻的侧面流过任何所需目的。
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