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1.发明授权
公开(公告)号：US5785702A
公开(公告)日：1998-07-28
申请号：US729325
申请日：1996-10-15
CPC分类号： A61B18/24 , A61B2017/00247 , A61B2017/00703 , A61B2018/00392
摘要： A method of selecting laser parameters for performing laser-assisted transmyocardial revascularization (TMR) 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) 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 channels in myocardium 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（TMR）的激光参数以避免诱导不期望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：最小化所使用的激光能量的功率水平， 从而减少对心脏的整体创伤，尽可能地选择脉冲频率，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，以防止每脉冲过高的峰值功率，而不会导致不希望的热损伤， 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，并校正机械事件的选定功率电平，脉冲宽度，脉冲频率和能量通量率，包括访问 心脏，心脏中选定部分心脏的位置，手术的持续时间， 心脏的自然运动，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。 一种使用这样的激光能量进行激光辅助心肌血运重建（TMR）的方法，所述激光能量选择为避免诱发不期望的心律失常，所述方法包括以下步骤：产生具有预定非方波形状，预定波长，预定波长的激光能量 能量通量和预定的功率水平，并且将多个脉冲具有预定的脉冲频率和预定的脉冲宽度的激光能量输送到心肌的选定部分以在心肌中形成TMR通道而不同步输送 激光束与心动周期。
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公开(公告)号：US06551302B1
公开(公告)日：2003-04-22
申请号：US09697672
申请日：2000-10-26
申请人： Michael J. Rosinko , Alexander Khairkhahan , Michael Horzewski , Stuart D. Harman , Richard L. Mueller , Douglas R. Murphy-Chutorian
发明人： Michael J. Rosinko , Alexander Khairkhahan , Michael Horzewski , Stuart D. Harman , Richard L. Mueller , Douglas R. Murphy-Chutorian
IPC分类号： A61M3100
CPC分类号： A61M25/0147 , A61B8/06 , A61B8/12 , A61M25/0084 , A61M25/0136 , A61M2025/0089
摘要： A steerable percutaneous catheter for guiding at least one functional device to selected surfaces of a body for treatment thereon, particularly adapted for laser-assisted Percutaneous Transmyocardial Revascularization (PTMR). The steerable catheter has a handle portion at its proximal end and a controllably deflectable end portion at its distal end. The distal end of the catheter and the distal end of the functional device maintain alignment automatically during deflection. The invention also includes a surface contact detection system to detect contact with an interior body surface, such as the heart wall.
摘要翻译： 一种可导向的经皮导管，用于将至少一个功能装置引导到身体的选定表面上用于在其上进行治疗，特别适用于激光辅助经皮心肌血运重建术（PTMR）。 可操纵的导管在其近端处具有手柄部分，在其远端具有可控制地偏转的端部。 导管的远端和功能装置的远端在偏转期间自动保持对准。 本发明还包括一个表面接触检测系统，用于检测与诸如心脏壁的内部身体表面的接触。
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公开(公告)号：USD389578S
公开(公告)日：1998-01-20
申请号：US63101
申请日：1996-11-27
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公开(公告)号：USD392040S
公开(公告)日：1998-03-10
申请号：US56972
申请日：1996-07-12
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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：US06179809B2
公开(公告)日：2001-01-30
申请号：US09156964
申请日：1998-09-18
申请人： Alexander Khairkhahan , Michael J. Horzewski , Stuart D. Harman , Richard L. Mueller , Douglas R. Murphy-Chutorian
发明人： Alexander Khairkhahan , Michael J. Horzewski , Stuart D. Harman , Richard L. Mueller , Douglas R. Murphy-Chutorian
IPC分类号： A61M3700
CPC分类号： A61M25/0147 , A61M25/0084 , A61M25/0136 , A61M2025/0089
摘要： A steerable drug delivery catheter and method of use, particularly adapted for percutaneous use. The distal end of the drug delivery catheter is deflectable. The catheter has a relative movement compensation mechanism for maintaining positioning between the distal end of the drug delivery catheter and the distal end of the drug delivery device therein.
摘要翻译： 可导向的药物输送导管和使用方法，特别适用于经皮使用。 药物输送导管的远端是可偏转的。 导管具有相对运动补偿机构，用于保持药物输送导管的远端与药物输送装置的远端之间的定位。
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7.发明授权Apparatus for laser-assisted intra-coronary transmyocardial revascularization and other applications 失效用于激光辅助冠状动脉心肌血运重建和其他应用的装置
公开(公告)号：US5891133A
公开(公告)日：1999-04-06
申请号：US627699
申请日：1996-03-29
CPC分类号： A61F2/2493 , A61B18/24 , A61B2017/00247 , A61B2018/00392 , A61F2/90
摘要： Improved methods and apparatuses related to laser-assisted intra-coronary transmyocardial revascularization (ITMR), and more particularly, to improved methods and apparatuses for directing an interventional catheter device, via percutaneous or other entry into the vasculature, for example at the femoral artery, over the aortic arch, through the ascending aorta and over the coronary ostia such that the laser delivery means can be positioned inside a coronary artery and laser energy is used to create a plurality of small channels through the coronary artery into the tissue of the myocardium. An proximal hub portion and method of using it are described, the proximal hub portion adapted for attachment to a central, elongated lumen portion, the proximal hub portion optionally having a plurality of branched extending arms, the sheath and associated branched arms having individual blood loss seals and individually capable of receiving a laser delivery means, visualization or marking means, or other tools. The interventional catheter device has a distal end with, optionally, a guide means for directing an advancing laser delivery or other device to an angle with respect to the central axis of the catheter device, the distal end optionally comprising a radio-opaque portion for visualization via a fluoroscope or other means, the distal end of the catheter device further comprising an ultrasound transducer for visualizing the orientation and firing angles of the catheter device. The methods of use also comprise placing channel opening blockers, such as an angioplasty-type inflatable balloon or an axially compressible, radially expandable stainless steel wire mesh or other material stent in place inside the coronary artery, thereby preventing undesired bleeding from the coronary artery.
摘要翻译： 改进的与激光辅助冠状动脉内心肌血运重建术（ITMR）相关的方法和装置，更具体地，涉及用于通过经皮或其他进入脉管系统（例如股动脉）来引导介入导管装置的改进方法和装置， 通过主动脉弓，通过升主动脉和冠状动脉口，使得激光输送装置可以位于冠状动脉内部，并且激光能量用于通过冠状动脉产生多个通过心肌组织的小通道。 描述了近端毂部分及其使用方法，所述近侧毂部适于附接到中央细长的内腔部分，所述近侧毂部分可选地具有多个分支延伸的臂，所述护套和相关联的分支臂具有各自的失血 密封件和单独地能够接收激光输送装置，可视化或标记装置或其它工具。 介入导管装置具有远端，可选地具有用于将前进的激光输送或其它装置引导至相对于导管装置的中心轴线成一定角度的引导装置，远端可选地包括用于可视化的不透射线部分 通过荧光镜或其他方式，导管装置的远端还包括用于使导管装置的取向和触发角度可视化的超声换能器。 使用的方法还包括将通道开放阻滞剂例如血管成形术型可膨胀气囊或可轴向压缩的可径向扩张的不锈钢丝网或其他材料支架放置在冠状动脉内的适当位置，从而防止冠状动脉的不期望的出血。
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公开(公告)号：US6056742A
公开(公告)日：2000-05-02
申请号：US852011
申请日：1997-05-06
CPC分类号： A61B18/24 , A61B2017/00247 , A61B2017/00973 , A61B2018/00392
摘要： Apparatus for treating a patient's heart by stimulating revascularization of the heart or creating channels in the heart. The apparatus includes a catheter, a laser energy source coupled to the catheter, and a control circuit. The control circuit is configured to cause the laser energy source to deliver an output of laser energy over a first time period shorter than a heart beat cycle.
摘要翻译： 用于通过刺激心脏血运重建或在心脏中产生通道来治疗患者心脏的装置。 该装置包括导管，耦合到导管的激光能量源和控制电路。 控制电路被配置为使得激光能量源在比心跳周期短的第一时间段内传递激光能量的输出。
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公开(公告)号：US5855577A
公开(公告)日：1999-01-05
申请号：US797239
申请日：1997-02-07
CPC分类号： A61B18/24 , A61B2017/00247 , A61B2018/00392 , A61B2018/2211 , A61B90/39
摘要： A bow shaped, integrated wire catheter apparatus and method of use for access to, and laser or other treatment within, cavities and organs in the human body, the apparatus having a curvilinear shape but flexible enough to assume a generally elongated shape such that the apparatus can be extended through the vasculature in the generally elongated shape and can assume the curvilinear shape when extended into a body cavity or organ, the curvilinear shape serving to securely position the apparatus adjacent a selected surface within the body cavity or organ for laser or other treatment with a laser delivery device or other functional device thereon, the apparatus having a central axis, the apparatus comprising a main catheter shaft having a proximal end and an apex seeking and stabilizing distal end, the main catheter shaft having material of construction or other mechanism or means for causing a portion of the catheter shaft to have a bowed shape adjacent its distal end, the main catheter shaft having at least one hollow lumen extending axially and at least partially therethrough such that a bow shaped portion defines and distinguishes an outer arcuate sidewall for placement in contact with the selected area or areas for laser or other treatment thereon, and an inner arcuate sidewall, at least the outer arcuate sidewall having one or more guide holes disposed thereon for selectively providing laser or other treatment on the selected surface by controllably advancing a laser delivery device or other functional device selectively through the one or more guide holes to the selected surface. The catheter apparatus can be made at least partially of superelastic and/or shape memory materials of construction.
摘要翻译： 一种弓形，集成的导丝管装置和用于在人体内进入和激光或其他处理的空腔和器官的方法，该装置具有曲线形状，但足够柔软以呈现大致细长的形状，使得装置 可延伸通过脉管系统以大致细长的形状，并且当延伸到体腔或器官时可以呈现曲线形状，曲线形状用于将设备可靠地定位在体腔或器官内的选定表面以用于激光或其他治疗 其上具有激光输送装置或其它功能装置，所述装置具有中心轴线，所述装置包括主导管轴，所述主导管轴具有近端和寻求并稳定的远端的顶点，所述主导管轴具有构造材料或其它机构或 用于使导管轴的一部分具有邻近其远端（即主导管）的弓形的装置 轴具有轴向和至少部分地穿过其中延伸的至少一个中空腔，使得弓形部分限定和区分外弧形侧壁，用于与用于激光或其它处理的所选择的区域或区域接触，以及内弧形侧壁， 至少外弧形侧壁具有设置在其上的一个或多个引导孔，用于通过可选地将激光输送装置或其它功能装置选择性地推进到所选择的表面的一个或多个引导孔来选择性地在所选择的表面上提供激光或其他处理。 导管装置可以至少部分地由构造的超弹性和/或形状记忆材料制成。
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10.发明授权
公开(公告)号：US4993412A
公开(公告)日：1991-02-19
申请号：US388685
申请日：1989-08-02
CPC分类号： A61B18/245 , A61B17/320783 , A61B2017/22039 , A61B2017/22048
摘要： A catheter device and a method for using same to facilitate removal of obstructive material in a human body channel. The catheter comprises an elongated body with a distal end portion adapted to be inserted within the channel and a proximal end portion. A lumen, extending lengthwise through said catheter body, supports a guidewire having a distal end along which the catheter body can be moved within the channel. A series of parallel, closely spaced fiber members extend through the catheter body from its proximal end and terminate near a distal end face of said catheter. Laser energy supplied at the catheter's proximal end is transmitted along the fiber members and is emitted forwardly therefrom at the catheter's distal end face. In one embodiment the catheter has a tapered nose portion for displacing obstructive material in the body channel before the emission of laser energy. In another embodiment, the fiber members are movable longitudinally in unison to sever and trap obstructive material which is removed from the body channel.
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