U.S. patent application number 11/475425 was filed with the patent office on 2007-01-18 for wire torque apparatus, wire insertion devices, improved aneurysm clips and improved aneurysm clip applicators.
Invention is credited to Alexander Charles Mamourian.
Application Number | 20070016105 11/475425 |
Document ID | / |
Family ID | 37662559 |
Filed Date | 2007-01-18 |
United States Patent
Application |
20070016105 |
Kind Code |
A1 |
Mamourian; Alexander
Charles |
January 18, 2007 |
Wire torque apparatus, wire insertion devices, improved aneurysm
clips and improved aneurysm clip applicators
Abstract
Wire torque apparatus and methods for engaging a wire torque
apparatus are disclosed. Wire insertion devices and methods for
inserting a wire into a catheter are disclosed. An improved
aneurysm clip utilizes non-metallic material. An improvement to an
aneurysm clip applicator tool includes a power supply to power an
electromagnet, an adjustable counter element that is attracted to
the electromagnet when the electromagnet is magnetized, and a
switch to disengage the electromagnet. When the electromagnet is
magnetized and comes within a certain proximity to the counter
element, the electromagnet and the counter element attract and
cling to one another. They are released by activating a switch.
Inventors: |
Mamourian; Alexander Charles;
(Hanover, NH) |
Correspondence
Address: |
LATHROP & GAGE LC
4845 PEARL EAST CIRCLE
SUITE 300
BOULDER
CO
80301
US
|
Family ID: |
37662559 |
Appl. No.: |
11/475425 |
Filed: |
June 27, 2006 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60694271 |
Jun 27, 2005 |
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Current U.S.
Class: |
600/585 |
Current CPC
Class: |
A61M 2025/09116
20130101; A61M 25/09041 20130101 |
Class at
Publication: |
600/585 |
International
Class: |
A61M 25/00 20060101
A61M025/00 |
Claims
1. Wire torque apparatus, comprising: a handle element and a cap,
the handle element comprising a handle and a plurality of segmented
cylinder elements, and forming a first lengthwise slot, the cap
being capable of engaging the handle element, the cap forming a
conical cavity and a second lengthwise slot; wherein the first and
second lengthwise slots are configured to accommodate passage of a
length of wire therethrough when the slots are aligned, and wherein
the segmented cylinder elements are configured to grip the wire
within the conical cavity when the cap engages the handle
element.
2. Wire torque apparatus, comprising: a block forming (a) a first
slot, bounded by a first surface and a second surface, that extends
lengthwise through the block, and forming (b) a second slot that
extends from one side of the block through the first surface; and a
cam that rotates within the second slot about an axle; wherein the
first slot is configured to accommodate a length of wire, and
wherein the cam is operable to grip the wire against the second
surface.
3. Wire torque apparatus, comprising a first block forming (a) a
first lengthwise slot and (b) a tapered internally threaded cavity;
and a second block forming (a) a second lengthwise slot and (b) a
plurality of tapered externally threaded elements; wherein the
first and second lengthwise slots are configured to accommodate
passage of a length of wire therethrough when the slots are
aligned, and wherein the threaded elements are configured to screw
into the cavity to engage the wire.
4. An improved wire torque apparatus of a type that is configured
to clamp a length of wire therein, the improvement wherein
structure of the apparatus forms a lengthwise slot configured to
accommodate passage of the wire such that the apparatus can clamp
onto the wire without threading an end of the wire through the
apparatus.
5. Wire insertion device, comprising a triangular base with side
walls, and an insertion sleeve that forms a lengthwise slit, the
base and side walls configured to facilitate positioning of an
angiography wire within the insertion sleeve.
6. Wire insertion device, comprising first and second wire
threading elements forming a groove therebetween, the first and
second elements having an open position configured to receive a
wire and a closed position configured to facilitate insertion of
the wire into a catheter.
7. Improved aneurysm clip, the improvement wherein the clip
comprises non-metallic material.
8. Improved aneurysm clip of claim 7, the clip configured to reduce
flare in angiography images of the clip.
9. Improved aneurysm clip of claim 7, the non-metallic material
forming blades of the clip.
10. In an aneurysm clip applicator having handles that operate jaws
configured for gripping an aneurysm clip, the improvement
comprising: a power supply; an electromagnet affixed to a first one
of the handles; a counter element affixed to a second one of the
handles; and a switch; wherein, alternatively, the switch supplies
current from the power supply to the electromagnet such that the
electromagnet attracts the counter element, latching the handles in
a closed position and holding the aneurysm clip in an open
position, and the switch disconnects the electromagnet from the
power supply, releasing the electromagnet from the counter element,
such that the handles return to an open position, releasing the
aneurysm clip.
11. Aneurysm clip applicator of claim 10, the power supply, the
electromagnet, the counter element and the switch being
retrofittable to the applicator.
12. Aneurysm clip applicator of claim 10, further comprising a
damping mechanism for damping motion of the jaws during
closure.
13. Aneurysm clip applicator of claim 10, wherein the handles, the
power supply, the electromagnet, the counter element and the switch
form an actuator, and the jaws removably couple with the
actuator.
14. Aneurysm clip applicator of claim 13, the actuator being
sterilizable and reusable.
15. Aneurysm clip applicator of claim 13, the actuator being
disposable.
16. Aneurysm clip applicator of claim 10, wherein one or more of
the power supply, the electromagnet, the counter element and the
switch are formed integrally with the handles.
17. Aneurysm clip applicator of claim 10, wherein positioning of
the magnet is adjustable.
18. Aneurysm clip applicator of claim 10, the counter element
comprising steel.
19. Aneurysm clip applicator of claim 10, further comprising a
spring for biasing the handles toward the open position.
20. Method of applying an aneurysm clip, the method comprising
squeezing handles of an applicator into a closed position with jaws
of the applicator squeezing an aneurysm clip into an open position,
activating a switch to hold the applicator in the closed position
and the clip in the open position, positioning the clip, and
activating the switch to release the handles so that the jaws of
the applicator release the clip.
21. Method of claim 20, wherein the step of activating the switch
to hold the applicator in the closed position comprises connecting
a power supply, through the switch, to an electromagnet, and the
step of activating the switch to release the handles comprises
disconnecting the power supply from the electromagnet.
Description
RELATED APPLICATION
[0001] This application claims priority to U.S. provisional
application Ser. No. 60/694,271, filed Jun. 27, 2005 and hereby
incorporated by reference.
BACKGROUND
[0002] Angiography procedures often use catheters manipulated with
the assistance of wires such as shaped wires, micro wires and glide
wires. Such wires allow a practitioner (e.g., a physician, surgeon,
or nurse) to guide a catheter within vasculature of a patient being
imaged (e.g., to guide the catheter into an appropriate blood
vessel). Manipulating such wires may be difficult with gloved
hands.
[0003] One task that may be difficult to perform is threading a
shaped wire into a catheter. This task may be required at the
beginning of a procedure, or when a procedure requires removal and
re-insertion of the wire. Usually an insertion tool resembles a
short, hollow cylinder: a wire is loaded into the cylinder and
pushed through it into the catheter. In some cases, loading the
wire involves pushing a proximal (e.g., patient) end of the wire
into the cylinder. However, some wires have a curved proximal end
that does not easily insert into the cylinder; in these cases, a
distal end of the wire is threaded into a proximal end of the
cylinder, and the device is manipulated along the full length of
the wire to insert the curved end of the wire into an open end of
the catheter. Once insertion is complete, the device is manipulated
along the full length of the wire and removed. Guide wires may be
over 100 cm in length, so threading the insertion device on, off
and along the wire may consume enough time that this time has to be
factored into a practitioner's decision to remove and re-engage the
wire during a procedure. Re-insertion also provides an unwanted
opportunity to drop or contaminate the wire. Also, threading a full
length of the wire increases risk of damaging or stripping special
coatings (e.g., coatings that allow them to move smoothly within
the catheter) of certain wires.
[0004] Once a wire is installed in a catheter, the practitioner may
need to push, pull and/or twist the wire to direct the wire and the
catheter within the subject. Existing torque devices may be helpful
in directing the wire, but as with the insertion tool, the torque
device must be threaded onto the distal (straight) end of the wire,
which may also be time consuming.
[0005] FIG. 1A shows a perspective view of one prior art device 10
for manipulating a wire (not shown). Device 10 is made of plastic
and has a cap 20 and a handle element 30, as shown. Handle element
30 has a handle 40 coupled with a cylindrical element 50 and
segmented cylinder elements 60(1)-60(4). Cylindrical element 50 has
threads 55. Handle element 30 forms a central hole (see FIG. 1B)
about a wire path 5. Cap 20 has a cylindrical portion 70 and a
conical portion 72. Cap 20 forms a central hole 74 along wire path
5. Threads 55 engage corresponding threads inside cap 20, such that
cap 20 can screw onto handle element 30. Handle 40 and/or
cylindrical portion 70 may have gripping features 45, as shown.
[0006] FIG. 1B shows an end view of handle element 30, as seen from
cap 20. Each of segmented cylinder elements 60(1)-60(4) is
separated from two other such elements by a slot 75, as shown. Wire
path 5 (not labeled in FIG. 1B) passes through a central hole 15.
In use, a practitioner threads a wire through hole 15 and hole 74
and then screws cap 20 onto handle element 30, forcing elements
60(1)-60(4) into conical portion 72 and squeezing elements
60(1)-60(4) together about the wire. This holds the wire in place
so that the practitioner can manipulate the wire by manipulating
handle 40.
[0007] Other devices for manipulating a wire are shown in U.S. Pat.
No. 6,533,772 to Sherts et al., which is incorporated herein by
reference.
[0008] An aneurysm is a localized dilation of a blood vessel caused
by disease or weakening of the vessel wall, and may form a
"balloon" shape projecting from the vessel. Rupture of a cerebral
aneurysm may cause a stroke. Aneurysm clips are sometimes used to
close off an aneurysm to prevent its rupture. Diagnosis and
post-treatment assessment of aneurysms may utilize angiography.
[0009] FIG. 2A shows a top view of one prior art aneurysm clip 80.
Clip 80 is made of titanium, for example. Clip 80 has a spring 82
that biases jaws 86(1) and 86(2) into a closed position. A
practitioner applying clip 80 uses an aneurysm clip applicator
(e.g., as shown in FIG. 3A and FIG. 3B, or FIG. 18A and FIG. 18B)
to squeeze clip 80 at points 84, forcing jaws 86(1) and 86(2) apart
so that they may be positioned about a base of an aneurysm. The
practitioner utilizes the applicator to manipulate clip 80 until
the clip is positioned with jaws 86(1) and 86(2) on either side of
the aneurysm, whereupon the practitioner releases the applicator
from points 84, returning jaws 86(1) and 86(2) to the closed
position and freeing the applicator from clip 80. FIG. 2B shows a
side view of clip 80; relative to FIG. 2A, clip 80 is rolled
towards the viewer so that jaw 86(1) is in front of, and blocks
view of, jaw 86(2).
[0010] Because aneurysm clip 80 is made of metal, it may introduce
unwanted "flare" and other artifacts into computerized tomography
("CT") and CT angiography images made after its installation. Such
artifacts may obscure important details in the images (for example,
details relating to residual aneurysm) and generally interfere with
interpretation of the images. Furthermore, clip 80, if manufactured
of certain materials (e.g., cobalt alloy steel) may be moved by a
strong magnetic field such as the 3 Tesla field of magnetic
resonance ("MR") systems currently being installed in clinical
practices. Movement of clip 80 presents a risk of injury or death
to a patient.
[0011] FIG. 3A and FIG. 3B show a prior art aneurysm clip
applicator 1210 in "open" and "closed" positions respectively.
Applicator 1210 has handles 1260(1) and 1260(2) that a practitioner
compresses to "open" an aneurysm clip 1205. Applicator 1210 also
has a flat spring 1275, and latch portions 1220(1) and 1220(2)
(attached to handles 1260(1) and 1260(2) respectively). In FIG. 3A,
handles 1260(1) and 1260(2) and spring 1275 are not compressed, and
applicator 1210 is in an "open" position with jaws 1240(1) and
1240(2) in a position to grab and manipulate clip 1205 (which is in
a "closed" position). Pivot points 1230 and 1250 allow movement of
applicator 1210 from the "open" position shown in FIG. 3A to the
"closed" position shown in FIG. 3B. Latch portions 1220(1) and
1220(2) are disengaged while applicator 1210 is in the "open"
position.
[0012] In FIG. 3B, handles 1260(1) and 1260(2), and spring 1275
have been compressed by a practitioner, placing jaws 1240(1) and
1240(2) in the "closed" position, and clip 1205 in the "open"
position. When jaws 1240(1) and 1240(2) are in the "closed"
position, the practitioner may engage latch portions 1220(1) and
1220(2), as shown, to keep them in the "closed" position without
the practitioner having to maintain pressure on handles 1260(1) and
1260(2). When clip 1205 is in a final position for clipping an
aneurysm, the practitioner must compress handles 1260(1) and
1260(2) in order to disengage latch portion 1220(1) from 1220(2) to
close clip 1205. The additional compression motion required by the
practitioner to disengage latch portions 1220(1) and 1220(2) may be
disadvantageous because it may "jiggle" clip 1205, potentially
causing clip 1205 to be misplaced relative to its intended
placement. Some practitioners bend off latch portions 1220(1)
and/or 1220(2) in order to avoid such a motion. However, when latch
portions 1220(1) and/or 1220(2) are bent off, the practitioner must
maintain pressure on handles 1260(1) and 1260(2) to keep them in
the "closed" position, which may impair the practitioner's ability
to maneuver clip 1205 and may again result in misplacement of clip
1205.
SUMMARY
[0013] In one embodiment, a wire torque apparatus includes a handle
element and a cap. The handle element includes a handle and at
least two segmented cylinder elements, and the handle forms a
lengthwise slot. The cap can engage the handle element, and forms a
conical cavity and a lengthwise slot. The lengthwise slots of the
handle and cap are configured to allow a wire to pass through when
the slots are aligned, and the segmented cylinder elements are
configured to grip the wire within the conical cavity when the cap
engages the handle element.
[0014] In one embodiment, a wire torque apparatus includes a block
forming (a) a first slot, bounded by a first surface and a second
surface, that extends lengthwise through the block, and (b) a
second slot that extends from one side of the block through the
first surface. A cam rotates within the second slot about an axle.
The first slot is configured to accommodate a length of wire, and
the cam is operable to grip the wire against the second
surface.
[0015] A method of engaging a wire torque apparatus about a wire
includes rotating a cam in a first direction so that a gripping
surface of the cam withdraws from a surface of the apparatus. The
wire positions into a slot between the gripping surface and the
surface of the apparatus. The cam rotates in a direction opposite
the first direction so that the gripping surface engages the wire
against the surface of the apparatus.
[0016] In one embodiment, a wire torque apparatus includes a first
block forming (a) a lengthwise slot and (b) a tapered internally
threaded cavity; and a second block forming (a) a lengthwise slot
and (b) at least two tapered externally threaded elements. The
lengthwise slots are configured to allow a wire to pass through
when the slots are aligned, and the threaded elements are
configured to screw into the cavity to engage the wire.
[0017] In one embodiment, an improved wire torque apparatus is of a
type that is configured to clamp a length of wire therein, and
includes structure of the apparatus forming a lengthwise slot
configured to allow the wire to pass through such that the
apparatus can clamp onto the wire without threading an end of the
wire through the apparatus.
[0018] A method of engaging a wire torque apparatus about a wire
includes aligning at least two portions of the apparatus such that
slots in each portion align. The wire positions into each of the
slots. The portions are manipulated so that the apparatus engages
the wire.
[0019] In one embodiment, a wire insertion device includes a
triangular base with side walls, and an insertion sleeve that forms
a lengthwise slit. The base and side walls are configured to
facilitate positioning of an angiography wire within the insertion
sleeve.
[0020] A method of inserting a wire into a catheter includes
placing a proximal end of the wire between side walls of a wire
insertion device. The proximal end is manipulated against the side
walls so that the proximal end passes through a slot into an
insertion sleeve. The insertion sleeve is inserted into the
catheter, and the wire is pushed through the insertion sleeve into
the catheter.
[0021] In one embodiment, a wire insertion device includes first
and second wire threading elements forming a groove therebetween.
The first and second elements have an open position configured to
receive a wire and a closed position configured to facilitate
insertion of the wire into a catheter.
[0022] A method of inserting a wire into a catheter includes
separating wire threading elements of a wire insertion device. A
portion of the wire is placed between the threading elements, which
close about the portion of the wire. A tip formed by portions of
the threading elements is placed into a catheter. The wire is
pushed through the threading elements into the catheter.
[0023] In one embodiment, an improved aneurysm clip utilizes
non-metallic material.
[0024] In one embodiment, an improvement to an aneurysm clip
applicator tool includes a power supply to power an electromagnet,
an adjustable counter element that is attracted to the
electromagnet when the electromagnet is magnetized, and a switch to
disengage the electromagnet. When the electromagnet is magnetized
and comes within a certain proximity to the counter element, the
electromagnet and the counter element attract and cling to one
another. They are released by activating a switch.
[0025] A method of applying an aneurysm clip includes squeezing
handles of an applicator into a closed position with jaws of the
applicator squeezing an aneurysm clip into an open position.
Activating a switch holds the applicator in the closed position and
the clip in the open position. The clip is positioned, and the
switch is activated to release the handles so that the jaws of the
applicator release the clip.
BRIEF DESCRIPTION OF DRAWINGS
[0026] FIG. 4A shows a perspective view of one angiography
apparatus 110 for manipulating a wire.
[0027] FIG. 4B shows an end view of a handle element of the
angiography apparatus of FIG. 4A.
[0028] FIG. 5A is a perspective view of one angiography wire torque
apparatus, in accord with an embodiment.
[0029] FIG. 5B shows a cross-sectional view of the angiography wire
torque apparatus of FIG. 5A, with a cam in an "open" position.
[0030] FIG. 5C shows a cross-sectional view of the angiography wire
torque apparatus of FIG. 5A, with the cam in a "gripping"
position.
[0031] FIG. 6A is a perspective view of one angiography wire torque
apparatus, in accord with an embodiment.
[0032] FIG. 6B is a side view of two blocks of the angiography wire
torque apparatus of FIG. 6A.
[0033] FIG. 6C is an end view of one of the blocks of the
angiography wire torque apparatus of FIG. 6A.
[0034] FIG. 7A is a perspective view of one angiography wire torque
apparatus, in accord with an embodiment.
[0035] FIG. 7B is a side view of two blocks of the angiography wire
torque apparatus of FIG. 7A.
[0036] FIG. 7C, FIG. 7D, and FIG. 7E are cross-sectional views of
one block of the angiography wire torque apparatus of FIG. 7A.
[0037] FIG. 8A is a top view of a wire insertion device, in accord
with an embodiment.
[0038] FIG. 8B is a side view of the wire insertion device of FIG.
8A.
[0039] FIG. 8C is an end view of the wire insertion device of FIG.
8A.
[0040] FIG. 9A, FIG. 9B and FIG. 9C illustrate use of the wire
insertion device of FIG. 8A with an angiography wire.
[0041] FIG. 10A is a side view of a wire insertion device, in
accord with an embodiment.
[0042] FIG. 10B and FIG. 10C are a front view and a side view,
respectively, of the wire insertion device of FIG. 10A.
[0043] FIG. 10D is a side view of the wire insertion device of FIG.
10A in an open position.
[0044] FIG. 10E is an enlarged detail of a wire threading element
and a handle of the wire insertion device of FIG. 10A.
[0045] FIG. 11 shows a side view of a wire insertion device, in
accord with an embodiment.
[0046] FIG. 12A is a side view of a wire insertion device.
[0047] FIG. 12B shows an enlarged end view of a region of the wire
insertion device of FIG. 12A.
[0048] FIG. 12C is a perspective view illustrating the wire
insertion device of FIG. 12A during use.
[0049] FIG. 13A shows a wire insertion device.
[0050] FIG. 13B is a top view of the wire insertion device of FIG.
13A.
[0051] FIG. 13C shows the wire insertion device of FIG. 13A in an
open position.
[0052] FIG. 14A shows an aneurysm clip.
[0053] FIG. 14B shows a side view of the aneurysm clip of FIG.
14A.
[0054] FIG. 15A through FIG. 15D show aneurysm clips.
[0055] FIG. 15E and FIG. 15F are cross-sections of non-metallic
blades of the aneurysm clip of FIG. 15D.
[0056] FIG. 16A through FIG. 16E demonstrate the reduced "flare" in
angiographic images produced by aneurysm clips of FIG. 14A or FIG.
15A through 15D, as compared to prior art clips.
[0057] FIG. 17 shows a CT image reformatted from the stack of
images from which FIG. 16A through FIG. 16E were selected.
[0058] FIG. 18A and FIG. 18B show an aneurysm clip applicator in
"open" and "closed" positions respectively.
[0059] FIG. 19A shows an aneurysm clip applicator with a distal
portion in an "open" position.
[0060] FIG. 19B shows an actuator portion that may be form part of
the aneurysm clip applicator of FIG. 19A.
[0061] FIG. 19C is an exploded diagram illustrating how an actuator
portion and the distal portion of FIG. 19A may cooperate to form an
aneurysm clip applicator, according to an embodiment.
DETAILED DESCRIPTION OF DRAWINGS
[0062] FIG. 4A shows a perspective view of one angiography wire
torque apparatus 110, in accord with an embodiment, for
manipulating a wire (not shown). FIG. 4A may not be drawn to scale.
Device 110 may be made of, for example, plastic, metal, or
combinations thereof (e.g., metal parts with plastic coatings).
Device 110 includes a cap 120 and a handle element 130, as shown.
Handle element 130 has a diameter 132, and has a handle 140 that
couples with a cylindrical element 150 and with segmented cylinder
elements 160(1)-160(4). Cylindrical element 150 has threads 155.
Handle element 130 forms a slot 135 (also see FIG. 4B) about a wire
path 105. Cap 120 has a cylindrical portion 170 and a conical
portion 172. Inside cylindrical portion 170 (hidden in the view of
FIG. 4A) are threads that mate with threads 155 of handle element
30; an inside surface of conical portion 172 forms a conical
cavity. Cap 120 forms a slot 125 along wire path 105. Threads 155
engage corresponding threads inside cap 120, such that cap 120 can
screw onto handle element 130. Each of handle 140 and cylindrical
portion 170 may have gripping features 145, as shown.
[0063] FIG. 4B shows an end view of handle element 130, as seen
from cap 120. FIG. 4B may not be drawn to scale. Each of segmented
cylinder elements 160(1)-160(4) is separated from two other such
elements by slots 135 or 175, as shown. Wire path 105 (not labeled
in FIG. 4B) passes through slot 135.
[0064] When angiography wire torque apparatus 110 is used, a
practitioner positions a wire into wire path 105 through slots 125
and 135, and engages cap 120 onto handle element 130 (by, for
example, screwing threads 155 into corresponding threads in cap
120), forcing segmented cylinder elements 160(1)-160(4) into
conical portion 180. This squeezes elements 160(1)-160(4) together
about the wire, holding the wire in place so that the practitioner
can manipulate the wire by manipulating handle 140. Slots 125 and
135 allow positioning of the wire along wire path 105 along any
part of the wire that is accessible, so that the wire need not
thread through apparatus 110 from an end of the wire. Similarly,
wire torque apparatus 110 need not pass over the full length of the
wire to disengage from the wire; the practitioner can disengage cap
120 from handle element 130, and pass the wire out of cap 120 and
handle element 130 through slots 125 and 135.
[0065] It is appreciated that variations on angiography wire torque
apparatus 110 are within the scope of this disclosure. For example,
a diameter 132 of torque apparatus 110 may vary to suit the
preference of a practitioner. Certain practitioners may find that a
diameter 132 of less than 5 mm is too small to grasp effectively
with gloves, that a diameter 132 of 20 mm or more is unnecessarily
large and awkward, and that a diameter 132 of 7 mm to 9 mm is large
enough to grip securely yet small enough to use with precision.
Similar issues of practitioner preference may also apply to a type
and size of gripping features 145, as discussed below with respect
to gripping features of other devices. Although torque apparatus
110 is shown with four segmented cylinder elements 160, a wire
torque apparatus may utilize fewer or more of such elements.
Although torque apparatus 110 is shown with threads 155 for
engaging cap 120 to handle element 130, a wire torque apparatus may
utilize other mechanisms, such as protrusions that fit into mating
slots, or elements that snap together, for engaging cap 120 to
handle element 130.
[0066] FIG. 5A is a perspective view of one angiography wire torque
apparatus 210, in accord with an embodiment. FIG. 5A may not be
drawn to scale. Apparatus 210 includes a block 212 that forms a
slot 215 for an angiography wire 205. Block 212 is hexagonal in
cross section, and presents faces 250(1)-250(6) that may be useful
for gripping apparatus 210; however, it will be appreciated that
block 212 may have a different shape and/or texture for gripping.
Block 212 forms buttons 240 at an outer edge of slot 215; buttons
240 are sized such that wire 205 snaps past buttons 240 as it
passes into and out of slot 215. A cam 220 with a gripping element
222 and a handle 224 rotates within a slot 218 about an axle 230.
Slot 218 extends from top surface 250(5) of block 212 through top
surface 216 of slot 215. Axle 230 is shown in FIG. 5A (and FIG. 5B
and FIG. 5C) as an element that is separate from cam 220; however
axle 230 and cam 220 may be a single structure (e.g., a single
piece of molded plastic). Gripping element 222 rotates
eccentrically about axle 230. Rotating handle 224 in the direction
of arrow A increases clearance between gripping element 222 and a
bottom surface 217 of block 212 by moving a large portion 222' of
gripping element 222 away from surface 217 and lowering a smaller
portion 222'' towards surface 217. Rotating handle 224 in the
opposite direction of arrow A decreases clearance between gripping
element 222 and surface 217 until gripping element 222 contacts
surface 217.
[0067] FIG. 5B shows a cross-sectional view of apparatus 210 taken
along plane 4B-4B indicated in FIG. 5A, with cam 220 rotated in the
direction of arrow A; in this configuration, cam 220 is in an
"open" position. FIG. 5B may not be drawn to scale. Angiography
wire 205 is shown within slot 215 adjacent to bottom surface 217.
Cam 220 has a concave gripping surface 223 that clears wire 25 when
cam 220 is in the open position shown in FIG. 5B.
[0068] A practitioner uses apparatus 210 as follows. The
practitioner first opens cam 220 by rotating it about axle 230 in
the direction of arrow A, so that gripping element 222 clears
bottom surface 217 of slot 215, as shown in FIG. 5B. The
practitioner snaps angiography wire 205 past buttons 240 into slot
215 and rotates cam 220 about axle 230 into a "closed" position,
gripping wire 205 between gripping element 222 and surface 217 of
block 212.
[0069] FIG. 5C shows a cross-sectional view of apparatus 210 taken
along plane 4B-4B indicated in FIG. 5A, with cam 220 rotated in the
opposite direction of arrow A, such that cam 220 grips wire 205
against bottom surface 217, forming the closed position. Wire 205
nestles within concave gripping surface 223 and may compress
gripping surface 223 and bottom surface 217.
[0070] With cam 220 gripping wire 205 against surface 217, the
practitioner can manipulate wire 5 by manipulating apparatus 210.
Manipulation of apparatus 210 may be easier and more precise than
manipulating wire 205 by itself. Furthermore, inserting and
removing wire 205 through slot 215 may be easier and faster than
threading wire 205 through an end of a torque device, saving the
practitioner valuable time during angiography or other
catheterization procedures. Buttons 240 provide tactile feedback to
the practitioner when inserting wire 205 into slot 215. Buttons 240
may also serve to hold apparatus 210 loosely onto wire 205 when cam
220 is in the open position, so that once wire 205 snaps within
buttons 240, the practitioner can use apparatus 210 without concern
that apparatus 210 will fall if dropped.
[0071] FIG. 6A is a perspective view of one angiography wire torque
apparatus 310, in accord with an embodiment. FIG. 6A may not be
drawn to scale. Apparatus 310 includes two blocks 320 and 330
forming slots 325 and 335, respectively. Apparatus 310 may be made
of, for example, plastic, metal, or combinations thereof (e.g.,
metal parts with plastic coatings). In apparatus 310, blocks 320
and 330 are hexagonal in cross section; it will be appreciated that
blocks 320 and 330 may have shapes other than the hexagonal shape
shown. FIG. 6A shows blocks 320 and 330 engaged about wire 305 by
rotating block 330 in the direction of arrow C relative to block
320, so that apparatus 310 is in a "closed" position, as discussed
below.
[0072] FIG. 6B is a side view of blocks 320 and 330 of apparatus
310 disengaged from each other (i.e., in an "open" position). FIG.
6B may not be drawn to scale. Block 330 includes segmented threaded
elements 340(1)-340(4). Threaded elements 340(1)-340(4) (similar to
segmented cylindrical elements 160(1)-160(4) of FIG. 4B) are
separated by slots; three of the slots extend only through elements
340(1)-340(4); the fourth slot is slot 335, which extends to the
other end of block 330, as shown. Block 320 includes a threaded
receptacle 350 having a steeply tapered region 352, that intersects
slot 325.
[0073] FIG. 6C is an end view of block 330 of apparatus 310, as
seen from block 320. FIG. 6C may not be drawn to scale. Threaded
elements 340(1)-340(4) and slot 335 are shown in FIG. 6C.
[0074] When angiography wire torque apparatus 310 is used, a
practitioner positions wire 305 into slots 325 and 335, and screws
elements 340(1)-340(4) of block 330 into receptacle 350 of block
320 (by rotating block 330 in the direction of arrow C, FIG. 6A).
As elements 340(1)-340(4) progress into receptacle 350 and tapered
region 352, they squeeze together to hold wire 305 in place (i.e.,
in the closed position) so that the practitioner can manipulate
wire 305 by manipulating apparatus 310. Manipulation of apparatus
310 may be easier and more precise than manipulation of wire 305 by
itself. Furthermore, inserting and removing wire 305 through slots
325 and 335 may be easier and faster than threading wire 305
through an end of a torque device, saving the practitioner valuable
time during angiography or other catheterization procedures.
[0075] FIG. 7A is a perspective view of one angiography wire torque
apparatus 410, in accord with an embodiment. FIG. 7A may not be
drawn to scale. Apparatus 410 includes two blocks 420 and 430
forming slots 425 and 435, respectively. Apparatus 410 may be made
of, for example, plastic, metal, or combinations thereof (e.g.,
metal parts with plastic coatings). In apparatus 410, blocks 420
and 430 are hexagonal in cross section; it will be appreciated that
blocks 420 and 430 may have different shapes. FIG. 7A shows blocks
420 and 430 engaged about wire 405 by rotating block 430 in the
direction of arrow D relative to block 420, so that apparatus 410
is in a closed position, as discussed below.
[0076] FIG. 7B is a side view of blocks 420 and 430 of apparatus
410 disengaged from each other (i.e., in an open position). FIG. 7B
may not be drawn to scale. Block 430 includes a threaded element
440 with a tongue 445; a slot 435 extends through element 440 and
to the other end of block 330, as shown. Block 420 includes a
partially threaded receptacle 450 that intersects slot 425, as
shown.
[0077] When angiography wire torque apparatus 410 is used, a
practitioner positions wire 405 into slots 425 and 435, and screws
element 440 of block 430 into receptacle 450 of block 420 (by
rotating block 430 in the direction of arrow D, FIG. 7A). As
element 440 advances into receptacle 450, tongue 445 jams wire 405
against block 420 to hold wire 405 in place (i.e., in a closed
position) so that the practitioner can manipulate wire 405 by
manipulating apparatus 410.
[0078] FIG. 7C, FIG. 7D, and FIG. 7E are cross-sectional views of
block 420 taken at the planes indicated by dashed lines 6C-6C,
6D-6D and 6E-6E, respectively, in FIG. 7B. FIG. 7C, FIG. 7D, and
FIG. 7E may not be drawn to scale. Each of FIG. 7C, FIG. 7D, and
FIG. 7E show a cross-section of wire 405 and tongue 445 (at a plane
E-E shown in FIG. 7B) as tongue 445 advances into block 420. In
FIG. 7C, tongue 445 has just entered a nonthreaded portion 450' of
receptacle 450. In FIG. 7D, as element 440 (see FIG. 7B) screws
into block 420, tongue 445 advances through nonthreaded portion
450' of receptacle 450; FIG. 7D shows tongue 445 blocking wire 405
from slot 425 (e.g., a closed position). In FIG. 7E, as element 440
screws further into block 420, tongue 445 advances past nonthreaded
portion 450' into slot 425 and deforms against block 420 and wire
405.
[0079] Manipulation of apparatus 410 may be easier and more precise
than manipulating wire 405 by itself. Furthermore, inserting and
removing wire 405 through slots 425 and 435 may be easier and
faster than threading wire 405 through an end of a torque device,
saving the practitioner valuable time during angiography or other
catheterization procedures.
[0080] Certain modifications of angiography wire torque apparatus
410 are within the scope of the present disclosure. For example, a
threaded element like element 440 may be cylindrical instead of
cone shaped, and a corresponding threaded receptacle may also be
cylindrical. A wire torque apparatus like apparatus 410 may have
other numbers of tongues besides the single tongue 445 shown in
FIG. 7B, FIG. 7C, FIG. 7D and FIG. 7E; for example, from one to
four of such tongues may be utilized.
[0081] It is contemplated that other existing types of wire torque
apparatus that clamp a wire (such as those illustrated in U.S. Pat.
No. 6,533,772 to Sherts et al.) may be improved by forming a
lengthwise slot through appropriate elements of such devices, so
that the device may clamp at a midpoint of the wire (e.g., without
having to manipulate the device from an end of the wire to the
location being clamped).
[0082] FIG. 8A is a top view of a wire insertion device 510, in
accord with an embodiment. Wire insertion device 510 has a
triangular base 530, side walls 540(1) and 540(2), and an insertion
sleeve 520, as shown. Side walls 540(1) and 540(2) are separated
from each other by a slot 550. Insertion sleeve 520 has a
lengthwise slot 515 that meets slot 550 where sleeve 520 meets base
530, as shown. An end 522 of sleeve 550 is sized for insertion into
a catheter.
[0083] FIG. 8B is a side view of wire insertion device 510, showing
how sidewalls 540(1) and 540(2) may slope near slot 550. FIG. 8C is
an end view of wire insertion device 510, looking from the open
side of base 530 toward sleeve 520.
[0084] FIG. 9A, FIG. 9B and FIG. 9C illustrate use of wire
insertion device 510 with an angiography wire 505. In FIG. 9A, a
proximal end 507 (e.g., a patient end) of wire 505 is inserted into
sleeve 520 through slot 550 in the direction of arrow E. Base 530
and side walls 540(1)-540(2) provide surfaces which a practitioner
may push wire 505 against to urge it into slot 550, which may be
especially helpful when proximal end 507 has bends that make wire
505 resist straightening (e.g., to facilitate insertion of wire 505
into sleeve 520). In FIG. 9B, wire 505 has been pushed into sleeve
520, and sleeve 520 has been inserted into a catheter 560. Sleeve
520 is stiff enough, and slit 515 is small enough, that proximal
end 507 does not poke out of sleeve 520 through slit 515. FIG. 9C
illustrates the removal of wire 505 from wire insertion device 510.
Just prior to removal of wire 505, proximal end 507 (not shown) is
within catheter 560, wire insertion device 510 is withdrawn from
catheter 560, and wire 505 is in the position labeled 505(a). A
practitioner lifts wire 505 upwards (e.g., in the direction of
arrows F) through slot 550 and slit 515 (not visible in this view
of device 510) until wire 505 is in the position labeled 505(b), so
that wire 505 is clear of device 510 yet remains inside catheter
560. Wire insertion device 510 may thus be removed from wire 505
along any section of wire 505. The entire wire 505 need not be
threaded through device 510 for removal of the device at a distal
end of wire 505.
[0085] FIG. 10A is a side view of a wire insertion device 610, in
accord with an embodiment. Wire insertion device 610 has two wire
threading elements 620(1) and 620(2) that mount on handles 640(1)
and 640(2) respectively; between elements 620(1) and 620(2) is a
channel 615. Each of handles 640(1) and 640(2) has a grip element,
650(1) and 650(2), respectively, that may include one or more
gripping features 655. Gripping features 655 are shown as
indentations for fingers; but it will be appreciated that gripping
features 655 may also be other shapes, or may be surface textures
adapted for gripping (e.g., by a gloved hand). Handles 640(1) and
640(2) couple with a crossbar 630, as shown. Crossbar 630 is a
relatively stiff but flexible element that biases handles 640(1)
and 640(2) in a closed position (e.g., with wire threading elements
620(1) and 620(2) touching except for channel 615). It will be
appreciated that device 610 may be made of plastic, metal, or
combinations of plastic and metal (e.g., plastic molded about a
metal spring that is within crossbar 630 and handles 640(1) and
640(2)).
[0086] FIG. 10B is a front view of wire insertion device 610; this
view shows wire threading elements 620(1) and 620(2) tapering to
tips 622(1) and 622(2), respectively, that are sized for insertion
into a catheter. It will be appreciated that a shape and taper of
tips 622 may be different from the shape and taper shown in FIG.
10B; for example, tips that taper to a finer point may be used to
handle narrower wires.
[0087] FIG. 10C is a top view of device 610; handle 640(1),
crossbar 630 and wire threading element 620(1) are hidden in this
view.
[0088] FIG. 10D shows device 610 in an open position that forms
when handles 640(1) and 640(2) are squeezed together; that is, the
handles move in the direction of arrows G. FIG. 10E is an enlarged
detail of wire threading element 620(1) and handle 640(1), as seen
from above (i.e., as seen from wire threading element 620(2) when
device 610 is in the open position), showing a longitudinal groove
617(1) extending through wire grasping element 620(1). An
angiography wire 605 is within groove 617(1). Longitudinal groove
617(1) and corresponding longitudinal groove 617(2) in wire
threading element 620(2) form channel 615 when device 610 is in the
closed position (see FIG. 10A).
[0089] To use wire insertion device 610, a practitioner squeezes
handles 640(1) and 640(2) together, as shown in FIG. 10D, and
places angiography wire 605 within groove 617(1), as shown in FIG.
10E. It will be appreciated that the orientation of device 610 is
arbitrary; for example, device 610 may be turned upside down from
the position shown in FIG. 10D, and wire 605 may be placed within
groove 617(2) instead. The practitioner releases handles 640(1) and
640(2) to close wire 605 in channel 615. The practitioner withdraws
wire 605 by pulling it in the direction opposite of arrow H, shown
in FIG. 10E, to withdraw a proximal tip 607 of wire 605 into
channel 615. If tip 607 is curved, as shown in FIG. 10E, the act of
withdrawing tip 607 into channel 615 straightens tip 607 for
insertion into a catheter. With device 610 still in the closed
position, the practitioner inserts tips 622(1) and 622(2) into a
catheter (not shown) and pushes wire 605 in the direction of arrow
H to insert wire 605 into the catheter. When a sufficient length of
wire 605 is within the catheter, the practitioner withdraws device
610 from the catheter, squeezes handles 640(1) and 640(2) together
to open device 610, and removes device 610 from wire 605. Like wire
insertion device 510, wire insertion device 610 may thus be used
without having to manipulate the device to a distal end of a wire
after use.
[0090] FIG. 11 shows a side view of a wire insertion device 710, in
accord with an embodiment. Wire insertion device 710 has wire
threading elements 720(1) and 720(2) that mount on handles 740(1)
and 740(2), respectively; between elements 720(1) and 720(2) is a
channel 715. Wire threading elements 720(1) and 720(2) are like
wire threading elements 620(1) and 620(2) of wire insertion device
610, except that wire threading element 720(1) has a beveled
surface 722(1) that facilitates alignment of a wire within channel
715. Wire threading element 720(2) has a corresponding beveled
surface 722(2) such that surfaces 722(1) and 722(2) can close
completely about a wire. An axle 730 pivotably joins handles 740(1)
and 740(2). Each of handles 740(1) and 740(2) has a gripping
feature, 755(1) and 755(2), respectively, that is a loop adapted
for use with fingers. Each of handles 740(1) and 740(2) also has a
closure element, 745(1) and 745(2), respectively, that have teeth
743 for latching device 710 closed (e.g., elements 745(1) and
745(2) and teeth 743 act like the closure elements of a hemostat).
Wire threading elements 720(1) and 720(2) are biased towards each
other, into the closed position shown in FIG. 11, by an elastic
element 750 (e.g., a spring, but other devices such as elastic or
rubber bands may also be used). It will be appreciated that wire
insertion device 710 is used much like wire insertion device 610,
except that the action of axle 730 requires spreading of the
gripping elements to open the device. For example, a practitioner
may spread gripping elements 755(1) and 755(2) apart to open device
710. A wire (not shown) is then placed in channel 715 and handles
740(1) and 740(2) are released to close elements 720(1) and 720(2)
about the wire, optionally engaging teeth 743. The wire may be
partially withdrawn so that a proximal tip of the wire is within
channel 715. Tips of elements 720(1) and 720(2) are inserted into a
catheter. The wire is inserted into the catheter. The practitioner
may withdraw elements 720(1) and 720(2) from the catheter and,
alternatively, open device 710 to remove it from the wire, or leave
device 710 closed about the wire (e.g., with teeth 743
engaged).
[0091] FIG. 12A is a side view of a wire insertion device 810, in
accord with an embodiment. Wire insertion device 810 includes two
side elements 840(1) (shown) and 840(2) (hidden behind element
840(1) in this view) that are joined by a hinge element 830 and
that form a channel 815, as shown in FIG. 12B. Device 810 forms a
tip 820 and a tip surface 822 that are adapted for insertion into a
catheter. Device 810 may be made out of metal and/or plastic.
[0092] FIG. 12B shows an enlarged end view of a region I of wire
insertion device 810. Channel 815 forms where side elements 840(1)
and 840(2) connect via hinge element 830. Hinge element 830 may be,
for example, a plastic hinge formed concurrently with side elements
840(1) and 840(2) (e.g., device 810 may be molded as one piece).
Alternatively, tip surface 822 and hinge element 830 may be made of
metal, for example, and side elements 840(1) and 840(2) may be
plastic elements molded about portions of the metal.
[0093] FIG. 12C is a perspective view illustrating device 810
during use. Device 810 is in an open position; that is, side
elements 840(1) and 840(2) are positioned away from each other to
allow access to channel 815. A practitioner places a midsection of
an angiography wire 805 within channel 815, as shown. After wire
805 is within channel 815, the practitioner can (1) close device
810 about wire 805 by pushing side elements 840(1) and 840(2)
together, (2) draw wire 805 back through channel 815 so that any
curves in proximal tip 807 of wire 805 straighten within channel
815, (3) insert tip 820 of device 810 in a catheter, (4) push wire
805 into the catheter to a sufficient length, (5) withdraw device
810 from the catheter, and (6) release side elements 840(1) and
840(2) so that device 810 can be removed from wire 805.
[0094] It will be appreciated that wire insertion devices like
device 810 may take various forms. For example, although device 810
is shown with flat side elements 840(1) and 840(2), side elements
of other wire insertion devices may be thicker or form different
shapes that practitioners may prefer. A closure (e.g., a snap or a
latch) may be provided to keep a wire insertion device loosely
closed over a wire during procedures wherein a practitioner may
anticipate withdrawal and re-insertion of the wire; the closure may
be of a type that is easily removed should the practitioner decide
that a subsequent re-insertion is not required. Gripping surfaces
or features may be provided. Device 810 may include embedded
springs, or hinge element 830 may act as a living hinge, to bias
the device open. Device 810 may have a relatively long, narrow tip
(e.g., region I of FIG. 12A) which may be, for example, a metal
cylinder with an opening that adjoins channel 815, suitable for
threading a micro wire into a catheter to a sufficient distance
that a curved end does not curl up before the walls of the catheter
can constrain it from curling up.
[0095] FIG. 13A shows a wire insertion device 910, in accord with
an embodiment. Wire insertion device 910 has side elements 920(1)
and 920(2) that hingedly couple with handles 940(1) and 940(2),
respectively, at points labeled J in FIG. 13A. Between elements
920(1) and 920(2) is a channel 915. An axle 930 pivotably joins
handles 940(1) and 940(2). Each of handles 940(1) and 940(2) has a
gripping feature, 955(1) and 955(2) respectively, that is a loop
adapted for use with fingers. Side elements 920(1) and 920(2) are
biased towards each other, into the closed position shown in FIG.
13A, by an elastic element 950 (e.g., a spring, but other devices
such as elastic or rubber bands may also be used).
[0096] FIG. 13B is a top view of wire insertion device 910. Side
elements 920(1) and 920(2) are shaped like side elements 820(1) and
820(2) of wire insertion device 810; channel 915 extends between
side elements 920(1) and 920(2) inside hinge element 930.
[0097] FIG. 13C shows wire insertion device 910 in an open
position. The open position forms when gripping elements 955(1) and
955(2) are spread apart from each other, thus spreading handles
940(1) and 940(2), and pulling side elements 920(1) and 920(2) at
points J. It will be appreciated that wire insertion device 910 is
used much like wire insertion devices 710 and 810. For example, a
practitioner may place a midsection of an angiography wire (not
shown) within channel 915 and close device 910 about the wire by
releasing gripping elements 955(1) and 955(2). The practitioner can
draw the wire back through channel 915 so that any curves in a
proximal tip of the wire straighten within channel 915. Tip 920 of
device 910 is then inserted into a catheter and the wire is pushed
into the catheter to a sufficient length. Finally, the practitioner
may withdraw device 910 from the catheter and spread gripping
elements 955(1) and 955(2) so that device 910 can be removed from
the wire.
[0098] FIG. 14A shows an aneurysm clip 980(1). Clip 980 has a
spring 982(1) that biases jaws 986(1) and 986(2) into a closed
position. A practitioner applying clip 980(1) uses an applicator
tool (not shown) to squeeze clip 980(1) at points 984, forcing jaws
986(1) and 986(2) apart so that they may be positioned about a base
of an aneurysm. The applicator tool may be the same tool used to
apply prior art aneurysm clip 80, FIG. 2A and FIG. 2B. In clip
980(1), jaws 986(1) and 986(2) include stubs 988(1) and 988(2) and
non-metallic blades 990(1) and 990(2), respectively. Non-metallic
blades 990(1) and 990(2) may be made of, for example,
polymethylmethacrylate, poly(etheretherketone), or carbon fiber.
Non-metallic blades 990(1) and 990(2) do not introduce "flare" in
angiographic images in the way that an equivalent metal element
does (as demonstrated in FIG. 16A through FIG. 16E). Spring 982(1)
and stubs 988(1) and 988(2) may be made of titanium, for example.
Elements 990(1) and 990(2) mount over stubs 988(1) and 988(2); each
such element 990 may bond to a corresponding stub 988 with an
adhesive (e.g., epoxy glue) or may be press-fitted over stub 988.
FIG. 14B shows a side view of clip 980(1); relative to the view
shown in FIG. 14A, clip 980(1) is rolled towards the viewer so that
jaw 986(1) is in front of, and blocks view of, jaw 986(2).
[0099] Use of non-metallic material for elements of an aneurysm
clip may enable fabrication of complex contours and/or surface
textures that may not be easily fabricated in metallic elements.
Such contours may (a) decrease deflection of an aneurysm clip's
jaws (e.g., jaws 986(1)-986(10), see also FIG. 15A-FIG. 15D) as
compared to jaws of aneurysm clips that are made entirely of metal,
and (b) allow fabrication of curves and angles suitable for
clipping aneurysms of unusual shapes and/or locations. It is
appreciated that non-metallic material may also be used for other
parts of an aneurysm clip; for example, a spring or an entire
aneurysm clip may be made from non-metallic material.
[0100] FIG. 15A through 15C show aneurysm clips 980(2) through
980(4). FIG. 15A shows aneurysm clip 980(2) that has spring 982(2)
which biases jaws 986(3) and 986(4) into a closed position. In clip
980(2), jaws 986(3) and 986(4) include stubs 988(3) and 988(4) and
non-metallic blades 990(3) and 990(4), respectively. Stubs 988(3)
and 988(4) are longer than stubs 988(1) and 988(2) shown in FIG.
14A and FIG. 14B, but are narrower than jaws of aneurysm clips that
do not use non-metallic blades 990(3) and 990(4), such that "flare"
in angiographic images of clip 980(2) is accordingly reduced. FIG.
15B shows aneurysm clip 980(3) that has spring 982(3) which biases
jaws 986(5) and 986(6) into a closed position. In clip 980(3),
non-metallic blades 990(5) and 990(6) attach to spring 982(3) via
non-metallic stubs 994(1) and 994(2) that are attached to cup
fittings 992(1) and 992(2) with adhesive or by press-fitting. FIG.
15C shows aneurysm clip 980(4) that has spring 982(4) that biases
jaws 986(7) and 986(8) into a closed position. In clip 980(4),
non-metallic blades 990(7) and 990(8) attach to spring 982(4) via
metal clamping elements 996(1) and 996(2) and pins 998 that extend
partially through non-metallic blades 990(7) and 990(8).
[0101] FIG. 15D shows an aneurysm clip 980(5) that has spring
982(5) that biases jaws 986(9) and 986(10) into a closed position.
In clip 980(5),jaws 986(9) and 986(10) include stubs 988(5) and
988(6) and non-metallic blades 990(9) and 990(10), respectively.
Non-metallic blades 990(9) and 990(10) are sized and shaped to
reduce deflection, as compared to similarly sized metal elements,
but produce less "flare" in angiographic images of clip 980(5) than
is produced by a metallic aneurysm clip of similar dimensions. FIG.
15E is an enlarged cross-section of non-metallic blades 990(9) and
990(10) of aneurysm clip 980(5), taken along line 15E-15E of FIG.
15D. The use of non-metallic material in blades 990(9) and 990(10)
facilitates fabrication of complex shapes such as those shown in
FIG. 15E, which may provide additional support as compared with
cylindrical blades. FIG. 15F is an enlarged cross-section of
non-metallic blades 990(9)' and 990(10)' that can be used as blades
990(9) and 990(10) of clip 980(5), illustrating another
advantageous shape that may be fabricated of non-metallic
material.
[0102] FIG. 16A through FIG. 16E demonstrate the reduced "flare" in
angiographic images produced by aneurysm clips according to the
present disclosure (e.g., any of clips 980(1) through 980(5)) as
compared to prior art clips. A prior art aneurysm clip and an
aneurysm clip with carbon fiber jaws were attached to a tube filled
with angiographic contrast medium; the tube and the clips were
suspended in a vessel of water for imaging. A stack of images was
taken, each image corresponding to a different depth in the water;
FIG. 16A through FIG. 16E are selected images from the stack of
images. FIG. 16A and FIG. 16B show images with artifacts caused by
the prior art aneurysm clip (e.g., like clip 80, FIG. 2). FIG. 16D
and FIG. 16E show images with reduced artifacts due to the carbon
fiber jaws. More particularly, in FIG. 16A, artifact 1002 is
produced by tips of metallic jaws of the prior art clip, image 1004
is an image of the tube, and artifact 1006 is produced by a
metallic spring. FIG. 16B is taken at a depth where jaws of the
prior art clip clamp the tube; artifact 1008 produced by the prior
art clip obscures the tube entirely. FIG. 16C shows an image 1010
of the tube alone (taken at a depth between the depths where the
images of FIGS. 16A and 16B and the images of FIG. 16C and FIG. 16D
were taken). FIG. 16D shows an image 1012 of the tube and an
artifact 1014 created by a metallic spring of the aneurysm clip,
which corresponds to the maximum flare seen in any image at a depth
corresponding to the aneurysm clip. FIG. 16E shows an image 1016 of
the tube; artifacts 1018(1) and 1018(2) of carbon fiber jaws of the
clip, and an artifact 1020 corresponding to the metallic spring of
the clip. It is seen that FIG. 16D and FIG. 16E show reduction in
the "flare" produced by metallic portions of a prior art clip, as
compared to the images shown in FIG. 16A and FIG. 16B. In
particular, image 1016 (of the tube, analogous to a blood vessel
imaged during angiography) is clearly visible within FIG. 16E, but
a corresponding image in FIG. 16B is obscured by "flare" produced
by the prior art clip.
[0103] FIG. 17 shows a CT image reformatted from the stack of
images from which FIG. 16A through FIG. 16E were selected. A tube
1100 is filled with angiographic contrast medium. Arrow 1110 points
to a location where tube 1100 is pinched by carbon fiber jaws of
the aneurysm clip of the present disclosure (the carbon fiber jaws
are not visible in the CT image). Arrow 1120 points to "flare"
introduced by metal of the prior art aneurysm clip, and arrow 1130
points to reduced "flare" introduced by metal forming the spring of
the aneurysm clip having carbon fiber jaws.
[0104] FIG. 18A and FIG. 18B show an aneurysm clip applicator 1310,
according to an embodiment, in "open" and "closed" positions
respectively. FIG. 18A and FIG. 18B may not be drawn to scale.
Applicator 1310 includes handles 1360(1) and 1360(2) that a
practitioner uses to operate jaws 1340(1) and 1340(2), which in
turn operate an aneurysm clip 1305. An optional spring 1375 may be
configured to bias handles 1360(1) and 1360(2) in an "open"
position; FIG. 18A shows spring 1375 as a flat spring (e.g., formed
from a strip of spring steel), but it is appreciated that another
type of spring may be used as spring 1375. In FIG. 18A, handles
1360(1) and 1360(2) and spring 1375 are not compressed; applicator
1310 is thus in an "open" position, with jaws 1340(1) and 1340(2)
in position to grasp clip 1305 (which is in a "closed" position).
Applicator 1310 includes pivot points 1330 and 1350 that allow
applicator 1310 to transition from the "open" position shown in
FIG. 18A to the "closed" position shown in FIG. 18B.
[0105] Applicator 1310 also includes an electromagnet 1321, a power
supply 1395 and a switch 1390. Wires 1380 connect electromagnet
1321, power supply 1395 and switch 1390. Electromagnet 1321 is
deactivated and disengaged from a counter element 1320 while
applicator 1310 is in the "open" position. An optional damping
mechanism 1365 is also shown in FIG. 18A and is explained
below.
[0106] In FIG. 18B, handles 1360(1) and 1360(2), and spring 1375
have been compressed by the practitioner, placing applicator 1310
into the "closed" position, such that jaws 1340(1) and 1340(2)
force clip 1305 into the "open" position. When applicator 1310 is
in the "closed" position, and the practitioner activates a switch
1390, power supply 1395 connects with electromagnet 1321,
activating electromagnet 1321 so that it attracts counter element
1320, latching applicator 1310 in the "closed" position and clip
1305 in the "open" position.
[0107] Electromagnet 1321, counter element 1320, switch 1390, wires
1380 and power supply 1395 thus form an electromagnetic catch for
applicator 1310. Latching applicator 1310 in the "closed" position
allows the practitioner to manipulate applicator 1310 without the
physical burden of maintaining pressure on handles 1360(1) and
1360(2). Switch 1390 may be advantageously placed on handle 1360(1)
(or handle 1360(2)) where it is easily accessible (e.g., by a
fingertip of the practitioner). Counter element 1320 may be, for
example, a ferrous plate, or it may be a magnet of suitable
polarity so as to be attracted to electromagnet 1321 when the
electromagnet is magnetized.
[0108] When clip 1305 is in a final position for (e.g., in position
for clipping an aneurysm), the practitioner may activate switch
1390 to disconnect power source 1395 from electromagnet 1321.
Deactivation of electromagnet 1321 releases it from counter element
1320 so that applicator 1310 can return to the "open" position,
closing clip 1305. Optional spring 1375 may assist in returning
handles 1360(1) and 1360(2) to the "open" position. The release of
handles 1360(1) and 1360(2) requires no additional motion by the
practitioner, minimizing the risk of misplacing clip 1305. Optional
damping mechanism 1365 may help eliminate any sudden jerk that may
occur when electromagnet 1321 deactivates, and may control the
speed at which handles 1360(1) and 1360(2) return to the "open"
position, further minimizing the risk of misplacing clip 1305. It
is contemplated that damping mechanism 1365 may be a small dashpot,
a magnetic damping device or any other type of damping device known
in the mechanical arts.
[0109] Position of counter element 1320 relative to handle 1360(2),
according to one embodiment, may be adjustable by way of an
optional screw 1370. The position of counter element 1320 relates
to a distance between counter element 1320 and electromagnet 1321
when applicator 1310 is in the "open" state, which in turn relates
to a distance that jaws 1340(1) and 1340(2) will open when
applicator 1310 is in the "closed" state. Positioning counter
element 1320 further away from handle 1360(2) reduces a distance
that jaws 1340(1) and 1340(2) open. Use of screw 1370 to adjust
this distance allows applicator 1310 to fit multiple clips 1305,
and allows fine adjustments in the distance that clip 1305
opens.
[0110] It is appreciated that applicator 1310 may be custom
fabricated to include electromagnet 1321, counter element 1320,
switch 1390, power supply 1395 and, optionally, screw 1370, damping
mechanism 1365 and/or spring 1375. Alternatively, electromagnet
1321, counter element 1320, switch 1390, power supply 1395 and,
optionally, screw 1370, damping mechanism 1365 and/or spring 1375
may form a retrofit kit that can be installed on an existing
applicator to add electromagnetic catch functionality.
[0111] FIG. 19A shows an aneurysm clip applicator 1400, according
to an embodiment, with a distal portion 1410 in an "open" position.
Distal portion 1410 includes jaws 1440(1) and 1440(2) configured to
engage clip 1405, and is manufactured of steel or titanium so that
it is easily sterilized for reuse. An actuator portion 1415
connects to the distal portion 1410 by way of connectors 1420.
Connectors 1420 may include male-female devices as shown, latches,
or other hardware for locking jaws 1440(1) and 1440(2) to actuator
portion 1415. Actuator portion 1415 may be sterilizable and
reusable, or may be manufactured for single use and subsequent
disposal.
[0112] FIG. 19B shows an actuator portion 1415(1), according to an
embodiment, that may be used as actuator portion 1415 of aneurysm
clip applicator 1400. Actuator portion 1415(1) includes connector
elements 1530 (male connector elements are shown), that secure
portion 1415(1) to distal portion 1410 (see FIG. 19A). Actuator
portion 1415(1) includes handles 1560(1) and 1560(2) that a
practitioner compresses to operate jaws to open an aneurysm clip.
Actuator portion 1415(1) also includes an optional spring 1575 and
a damping mechanism 1565.
[0113] Once distal portion 1410 attaches to actuator portion
1415(1) to form applicator 1400, operation is much like operation
of applicator 1310, FIG. 18A and FIG. 18B. Electromagnet 1521 and a
counter element 1520 disengage while applicator 1400 is in the
"open" position. The practitioner may activate a switch 1590 to
connect a power supply 1595 with an electromagnet 1521, magnetizing
electromagnet 1521 so that it attracts counter element 1520,
latching applicator 1400 in the "closed" position with clip 1405 in
an "open" position. The practitioner may then activate switch 1590
to disconnect power source 1595 and electromagnet 1521, releasing
electromagnet 1521 from counter element 1520. Spring 1575 may then
decompress, returning handles 1560(1) and 1560(2), and applicator
1400 to the "open" position so that clip 1405 closes. Optional
damping device 1565 may control the speed at which applicator 1400
returns to the "open" position. Position of counter element 1520
relative to handle 1560(2), according to one embodiment, is
adjustable by way of optional screw 1570.
[0114] FIG. 19C is an exploded diagram illustrating how an actuator
portion 1415(2) and distal portion 1410 may cooperate to form an
aneurysm clip applicator 1400(1), according to an embodiment.
Actuator portion 1415(2) includes connector elements 1630, (male
connector elements are shown), that secure portion 1415(2) to
distal portion 1410 (see FIG. 19A). Actuator portion 1415(2)
includes handles 1660(1) and 1660(2) that a practitioner compresses
to operate jaws to open an aneurysm clip. Actuator portion 1415(2)
also includes an optional spring 1675 (shown as a coil spring) and
a damping mechanism 1665. Once distal portion 1410 attaches to
actuator portion 1415(2) to form applicator 1400, operation is much
like operation of applicator 1310.
[0115] Actuator portion 1415 may, for example, include plastic
components and be considered disposable; alternatively, actuator
portion 1415 may include metal (e.g., steel or titanium) components
that can be sterilized and reused. Thus, for example, an applicator
according to the present disclosure could be created (1) by
retrofitting electromagnetic catch components to an existing
applicator (such as the applicator shown in FIG. 3A and FIG. 3B),
(2) by manufacture of a one-piece applicator, or (3) by manufacture
of distal and Actuator portions as shown in FIG. 19A, FIG. 19B and
FIG. 19C.
[0116] The changes described above, and others, may be made in the
wire torque apparatus, wire insertion devices, aneurysm clips and
aneurysm clip applicators described herein without departing from
the scope hereof. For example, gripping features of torque devices
or wire insertion devices may be protrusions (e.g., like gripping
features 145 of FIG. 4A), facets (e.g., like the hexagonal faces
shown in FIG. 5A, FIG. 5B, FIG. 5C, FIG. 6A and FIG. 6B), finger
indentations (e.g., like gripping features 655 of FIG. 10A, FIG.
10B, FIG. 10C and FIG. 10D), loops (e.g., like gripping elements
755 of FIG. 11), grooves, pits, or raised features. A handle with a
crossbar, like handles 640(1), 640(2) and crossbar 630 may be used
with wire insertion devices like device 810. It should thus be
noted that the matter contained in the above description or shown
in the accompanying drawings should be interpreted as illustrative
and not in a limiting sense. The following claims are intended to
cover all generic and specific features described herein, as well
as all statements of the scope of the present method and system,
which, as a matter of language, might be said to fall there
between.
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