公开(公告)号：US06984239B1

公开(公告)日：2006-01-10

申请号：US08351602

申请日：1994-12-08

申请人： William J. Drasler ,  Robert G. Dutcher ,  Mark L. Jenson ,  Joseph M. Thielen ,  Emmanuil I. Protonotarios

发明人： William J. Drasler ,  Robert G. Dutcher ,  Mark L. Jenson ,  Joseph M. Thielen ,  Emmanuil I. Protonotarios

IPC分类号： A61B12/32

CPC分类号： A61B17/32037 ,  A61B17/3203

摘要： A device for removing a thrombus or other tissue deposit from the cardiovascular system, natural or synthetic tubule or cavity found in the human body of a patient without the need to surgically access the location of the thrombus or other tissue deposit via a cut-down or other surgical procedure. A flexible metal or high pressure plastic tube conveys an extremely high pressure stream of sterile saline or other physiologic solution to at least one jet at the distal end of the catheter. At least one jet is directed at the opening of a large exhaust lumen or other target. The jet(s) is responsible for providing a localized negative pressure which entrains tissue into the jet from break-up of the debris. This jet(s) can also provide stagnation pressure in the exhaust lumen which drives the tissue or thrombotic debris out of the exhaust lumen. Operation of the device with tip pressure greater than 500 psi provides this device with the entrainment and exhaust characteristics which contribute to its effectiveness. The rate of exhaust of tissue debris is metered to ensure minimal local impact on the vasculature at the site of the thrombus deposit. A fluid metering means, such as a roller pump, controls the rate of exhaust such that it is in balance with the saline input or can be adjusted to be greater or less than the input. A positive displacement pump operating at steady or pulsatile flow provides the high pressure saline to the tip of the catheter.

摘要翻译： 一种用于从心血管系统去除血栓或其他组织沉积物的装置，在患者的人体中发现的天然或合成的小管或腔，而不需要经由切口或外科手术来进入血栓或其他组织沉积物的位置 其他外科手术。 柔性金属或高压塑料管将非常高压的无菌盐水或其他生理溶液流输送到导管远端处的至少一个射流。 至少一个射流指向大排气腔或其他靶的开口。 喷气机负责提供局部的负压，其将组织夹带到喷射器中从碎片的分解中。 这种喷射器还可以在排气腔中提供停滞压力，其将组织或血栓形成的碎片驱动出排出管腔。 尖端压力大于500 psi的设备的操作为该设备提供了有助于其有效性的夹带和排气特性。 计量组织碎片的排气速率，以确保局部对血栓沉积部位脉管系统的局部影响最小。 诸如辊式泵的流体计量装置控制排气速率，使其与盐水输入平衡，或者可以将其调节为大于或小于输入。 以稳定或脉动流动运行的容积式泵向导管的尖端提供高压盐水。

公开(公告)号：US06676637B1

公开(公告)日：2004-01-13

申请号：US09888454

申请日：2001-06-25

申请人： Michael J. Bonnette ,  Hieu V. Le ,  John Edward Morris ,  Stephen E. Weisel ,  Debra M. Kozak ,  Robert G. Dutcher

发明人： Michael J. Bonnette ,  Hieu V. Le ,  John Edward Morris ,  Stephen E. Weisel ,  Debra M. Kozak ,  Robert G. Dutcher

IPC分类号： A61M5178

CPC分类号： A61B17/32037 ,  A61B2090/034 ,  Y10T83/0443 ,  Y10T83/0453

摘要： A single operator exchange fluid jet thrombectomy method employing a single operator exchange fluid jet thrombectomy device having an outer catheter assembly and separable and exchangeable components in the form of an inner catheter assembly allowing functioning as a rheolytic thrombectomy catheter or as a crossflow thrombectomy catheter. The outer catheter assembly is common to any mode of usage and includes a guide catheter having a lumen through which a guidewire and the greater portion of a hypo-tube carrying a jet emanator and a flow director are passed and advanced. In the method, thrombus is dislodged, entrained, and broken into pieces by fluid jets and evacuated through the lumen of the guide catheter.

摘要翻译： 单个操作者交换流体喷射血栓切除术方法，其使用具有外部导管组件的单个操作者交换流体喷射血栓切除装置，以及允许作为溶血性血栓切除术导管或横流血栓切除术导管起作用的内部导管组件形式的可分离和可更换部件。 外导管组件对于任何使用模式都是共同的，并且包括具有内腔的引导导管，通过该导管将导丝和携带喷射发生器和导流器的下管的较大部分通过并前进。 在该方法中，通过流体射流将血栓移出，夹带并分裂成碎片，并通过引导导管的内腔排出。

公开(公告)号：US06224570B1

公开(公告)日：2001-05-01

申请号：US09188633

申请日：1998-11-09

申请人： Hieu V. Le ,  Michael J. Bonnette ,  John Edward Morris ,  Steven E. Wiesel ,  Debra M. Kozak ,  Cindy M. Setum ,  Robert G. Dutcher

发明人： Hieu V. Le ,  Michael J. Bonnette ,  John Edward Morris ,  Steven E. Wiesel ,  Debra M. Kozak ,  Cindy M. Setum ,  Robert G. Dutcher

IPC分类号： A61M5178

CPC分类号： A61B17/32037 ,  A61B2090/034

摘要： A rheolytic thrombectomy catheter and method of using same to remove thrombus from a body vessel or other body cavity. Several embodiments are disclosed. All embodiments include an outer catheter having a lumen and an inner high pressure tube of a size to enable it to be passed through the lumen of the catheter. The distal end of the inner high pressure tube extends beyond the distal end of the catheter and carries a jet cap for directing one or more jets of saline proximally toward the distal end of the catheter. In some embodiments, the catheter has a distally located inwardly directed stationary stop and the inner high pressure tube includes a distally located outwardly directed transitional stop for engaging the inwardly directed stationary stop to thereby position the jet cap at a defined distance from the distal end of the catheter. In other embodiments, a stationary stop is located at the proximal end of the catheter and a transitional stop is carried on the proximal end of the inner high pressure tube. In the embodiments having the stationary and transitional stops located proximally, the inner high pressure tube includes a flow director at its distal end. In use, thrombus is dislodged, entrained, and broken into pieces by the saline jets and evacuated proximally through the lumen of the catheter.

摘要翻译： 一种溶解性血栓切除术导管及其使用方法，从身体血管或其他体腔去除血栓。 公开了几个实施例。 所有实施例包括具有内腔和内部高压管的外导管，其尺寸使其能够穿过导管的内腔。 内部高压管的远端延伸超过导管的远端，并且携带用于将一个或多个盐水向近端引导到导管的远端的喷射帽。 在一些实施例中，导管具有远侧定位的向内指向的固定止动件，并且内部高压管包括远侧定位的向外指向的过渡止动件，用于接合向内指向的固定止动件，从而将喷射盖定位在距离 导管。 在其他实施例中，静止止动件位于导管的近端处，并且过渡停止件承载在内部高压管的近端上。 在具有位于近侧的静止和过渡止动件的实施例中，内部高压管在其远端包括导流器。 在使用中，血栓被移出，夹带并通过盐水喷射器破碎成碎片，并通过导管的内腔向近端排出。

公开(公告)号：US6135977A

公开(公告)日：2000-10-24

申请号：US377995

申请日：1995-01-25

申请人： William J. Drasler ,  Robert G. Dutcher ,  Mark L. Jenson ,  Joseph M. Thielen ,  Emmanuil I. Protonotarios

发明人： William J. Drasler ,  Robert G. Dutcher ,  Mark L. Jenson ,  Joseph M. Thielen ,  Emmanuil I. Protonotarios

IPC分类号： A61B17/22 ,  A61B19/00 ,  A61B17/20

CPC分类号： A61B17/32037 ,  A61B2090/3784

摘要： A technique for treatment of plaque deposits on the arterial wall of a patient. The technique employs a high pressure jet of sterile saline solution directed at the plaque deposit. The high pressure jet is located at the distal end of a guide wire or catheter which is advanced through the vascular system to the site of the plaque deposit. Optional removal of the debris is via an evacuation lumen within the catheter. This particular technique directs the high pressure jet of fluid distal to the distal tip of the guide wire or catheter. This permits treatment of arteries, which are totally occluded, because the device need not transit the lesion to be effective. Some applications will use the high pressure jet of fluid to open a sufficient passage within the occlusion to permit further dilatation using a balloon integral to or passed over the device. An ultrasonic transducer array located adjacent the high pressure jet permits the attending physician to monitor the procedure. This may be particularly important for those embodiments for which the high pressure jet of fluid may be inadvertently directed toward the vessel wall at short range. The ultrasound device ensures that the jet of fluid is directed at plaque, rather than the native vessel.

摘要翻译： 一种治疗患者动脉壁上斑块沉积物的技术。 该技术采用针对斑块沉积物的无菌盐水溶液的高压射流。 高压喷射器位于导丝或导管的远端，导丝或导管通过血管系统前进到斑块沉积物的位置。 通过导管内的抽空腔可选地去除碎屑。 这种特殊技术引导流体远离引导线或导管远端的高压射流。 这允许治疗完全闭塞的动脉，因为该装置不需要将损伤转移到有效的位置。 一些应用将使用高压喷射流体在堵塞内打开足够的通道，以允许使用集成在或穿过该装置的球囊进一步扩张。 位于邻近高压射流的超声换能器阵列允许主治医师监视手术。 对于那些高压喷射流体可能在短时间内无意地指向血管壁的实施例，这可能是特别重要的。 超声装置确保流体射流指向斑块，而不是天然血管。

公开(公告)号：US5785675A

公开(公告)日：1998-07-28

申请号：US349664

申请日：1994-12-05

申请人： William J. Drasler ,  Robert G. Dutcher ,  Mark L. Jenson ,  Joseph M. Thielen ,  Emmanuil I. Protonotarios

发明人： William J. Drasler ,  Robert G. Dutcher ,  Mark L. Jenson ,  Joseph M. Thielen ,  Emmanuil I. Protonotarios

IPC分类号： A61B17/00 ,  A61B17/22 ,  A61B17/32 ,  A61M25/00 ,  A61B17/20

CPC分类号： A61B17/32037 ,  A61B17/3203

摘要： A method of and apparatus for removing a thrombus deposit from the cardiovascular system of a patient without the need to surgically access the location of the thrombus deposit via a cut-down or other surgical procedure. A catheter is inserted percutaneously into the patient at a convenient location either directly or over a previously positioned guide wire. The distal end of the catheter is advanced under fluoroscopy to the site of the thrombus deposit. A balloon is inflated to stabilize the position of the distal end of the catheter within the center of the vessel lumen. A flexible metal tube conveys an extremely high pressure stream of sterile saline solution to at least one jet at the distal end of the catheter. At least one jet positions the thrombus deposit for emulsification by at least one other jet. By directing the jets toward the orifice of the large evacuation lumen of the catheter, a stagnation pressure is induced which propels the emulsion proximally for disposal. The rate of proximal flow of effluent is metered to correspond with the distal flow of saline solution to ensure minimal local impact on the vasculature at the site of the thrombus deposit.

摘要翻译： 一种用于从患者的心血管系统中去除血栓沉积物的方法和装置，而不需要通过切割或其它外科手术手术地进入血栓沉积物的位置。 在方便的位置，将导管经皮插入患者中，直接或超过预先定位的导丝。 导管的远端在荧光透视下前进到血栓沉积部位。 气囊膨胀以将导管的远端的位置稳定在血管内腔的中心内。 柔性金属管将非常高压的无菌盐水溶液流传送到导管远端处的至少一个射流。 至少一个喷射器通过至少一个其它喷射器将血栓沉积物定位成乳化。 通过将射流引导到导管的大抽空腔的孔口，引起停滞压力，其推动乳剂向近端处理。 流出物的近端流量计量以与盐溶液的远端流动相对应，以确保对血栓沉积部位的脉管系统的局部影响最小。

公开(公告)号：US5179962A

公开(公告)日：1993-01-19

申请号：US718377

申请日：1991-06-20

申请人： Robert G. Dutcher ,  Brian M. Packard ,  Robert J. Scott

发明人： Robert G. Dutcher ,  Brian M. Packard ,  Robert J. Scott

IPC分类号： A61N1/05

CPC分类号： A61N1/0573

摘要： A cardiac lead has an electrode and fixation assembly including a plurality of fixation members movable to extended positions into heart tissue to retain the electrode in intimate engagement with heart tissue. An elongated stylet is used to move the fixation members to their extended positions into the heart tissue and retract the fixation members into the fixation assembly to allow the lead to be removed from the heart and body of a person.

摘要翻译： 心脏引线具有电极和固定组件，其包括可移动到延伸位置进入心脏组织的多个固定构件，以将电极保持与心脏组织的紧密接合。 细长的探针用于将固定构件移动到其延伸位置进入心脏组织，并将固定构件缩回到固定组件中，以允许导线从人的心脏和身体移除。

公开(公告)号：US5143090A

公开(公告)日：1992-09-01

申请号：US707681

申请日：1991-05-30

申请人： Robert G. Dutcher ,  John C. Hill ,  Robert J. Scott

发明人： Robert G. Dutcher ,  John C. Hill ,  Robert J. Scott

IPC分类号： A61N1/05 ,  A61N1/375

CPC分类号： A61N1/375 ,  A61N1/0587

摘要： A cardiac lead for transmitting electric current to the heart and/or sensing and monitoring electrical activity of the heart has an elongated electrical conductor connected to a head. An electrode mounted on the head comprises a helical wire adapted to be turned into heart tissue. A second electrode having an irregular or non-flat surface surrounds the helical wire. The non-flat surface may be a wire mesh, a segmented plate and an annular plate supporting one or more coiled wires.

摘要翻译： 用于将电流传输到心脏和/或感测和监测心脏的电活动的心脏引线具有连接到头部的细长电导体。 安装在头部上的电极包括适于变成心脏组织的螺旋线。 具有不规则或非平坦表面的第二电极围绕螺旋线。 非平坦表面可以是金属丝网，分段板和支撑一个或多个螺旋线的环形板。

公开(公告)号：US4972847A

公开(公告)日：1990-11-27

申请号：US430596

申请日：1989-11-02

申请人： Robert G. Dutcher ,  John C. Hill

发明人： Robert G. Dutcher ,  John C. Hill

IPC分类号： A61N1/05 ,  A61N1/372 ,  A61N1/375

CPC分类号： A61N1/0587 ,  A61N1/375

摘要： A tool for implanting a pacing lead into heart tissue has a pair of side-by-side beams pivoted together at the opposite ends thereof. The beams have jaws that grip a lead head supporting a helical electrode and a groove for accommodating a section of the lead extended from the head. A releasable lock interposed between the beams operates to hold the beams in jaw closed position to grip the head of the electrode. The lock has flexible fingers and a movable sleeve that allows one hand operation to selectively lock and release of the jaws. The helical electrode has an external layer of platinum black particles resulting in decreased electrical losses at the electrode-tissue interface, increased current density, lower stimulation thresholds, and increased amplitude of sensed electrical signals from the heart tissue.

摘要翻译： 用于将起搏引线植入心脏组织的工具具有在其相对端枢转在一起的一对并排梁。 梁具有夹持支撑螺旋电极的引导头和用于容纳从头部延伸的引线的一部分的凹槽的钳口。 插入在梁之间的可释放的锁操作以将梁保持在闭合位置以夹紧电极的头部。 锁具有柔性指状物和可移动套筒，其允许单手操作来选择性地锁定和释放钳口。 螺旋电极具有铂黑色颗粒的外层，导致电极 - 组织界面处的电损耗降低，电流密度增加，刺激阈值增加，并且来自心脏组织的感测电信号的幅度增加。

公开(公告)号：US4381013A

公开(公告)日：1983-04-26

申请号：US244933

申请日：1981-03-19

申请人： Robert G. Dutcher

发明人： Robert G. Dutcher

IPC分类号： A61N1/05 ,  A61N1/36

CPC分类号： A61N1/056

摘要： A body implantable lead having a two-piece stylet. An inner solid portion of the stylet enables a shape to be imparted to the stylet to allow proper maneuvering of the lead during implant. A second portion of the stylet is slideably located coaxially about the first portion. The second portion of the stylet permits the imposition of a torque at the distal end of the implantable lead by the turning of a knob fixedly attached to the proximal end of the second portion of the stylet. The second portion of the stylet is a helically wound coil. The two-piece stylet is inserted into the proximal end of the body implantable lead. The distal end of the body implantable lead is located in the position desired through the use of the solid inner first portion of the stylet in which a bend or other desired shape has been introduced. The body implantable lead is permanently attached to the muscle tissue by a fixation device activated through the torque supplied by the second portion of the stylet. The two portions of the stylet may be fabricated from a variety of materials.

摘要翻译： 身体植入式导线，其具有两片通管心。 探针的内部实心部分能够将形状赋予探针，以允许在植入期间适当地操纵引线。 探针的第二部分可滑动地位于第一部分的同轴位置。 管心针的第二部分允许通过转动固定地附接到通球针的第二部分的近端的旋钮在可植入引线的远端施加扭矩。 探针的第二部分是螺旋卷绕的线圈。 将两片通管插入体内可植入引线的近端。 身体可植入引线的远端通过使用已经引入弯曲或其它所需形状的探针的固体内部第一部分位于期望的位置。 通过由探针的第二部分提供的扭矩激活的固定装置将身体可植入的引线永久地附接到肌肉组织。 探针的两个部分可以由各种材料制成。

公开(公告)号：US4350169A

公开(公告)日：1982-09-21

申请号：US176410

申请日：1980-08-08

申请人： Robert G. Dutcher ,  James E. Upton

发明人： Robert G. Dutcher ,  James E. Upton

IPC分类号： A61N1/05

CPC分类号： A61N1/056

摘要： A body implantable lead and a stiffening stylet with a flexible tip for imparting rigidity to the lead to facilitate attachment of the lead to an internal body organ and for transmitting torque to the distal end of the lead. A flexible tip stiffening stylet is provided for insertion into a lumen in the lead extending from a pin at its proximal end along the length of the lead conductor to the electrode. A portion of the stylet wire inserted in the lumen has a thinner diameter over a portion of its length near the distal end to permit smooth transmission of torque by rotation of the stylet wire even in applications where the lead and stylet are tightly bent in the vicinity of the thinned portion of the lead.

摘要翻译： 身体可植入引线和具有柔性尖端的加强型管心针，用于赋予引线刚性，便于将引线附接到内部身体器官并将扭矩传递到引线的远端。 提供柔性尖端加强导管，用于插入到引线中的内腔中，该引线从其引线沿着引线导体的长度从电极延伸到电极。 插入管腔中的探针线的一部分在远端附近的一部分长度上具有较薄的直径，以允许通过心跳线的旋转来平稳地传递扭矩，即使在铅和探针在附近紧密弯曲的应用中 的引线的变薄部分。