U.S. patent application number 11/981008 was filed with the patent office on 2008-03-06 for implantable medical device having pre-implant exoskeleton.
Invention is credited to Michael S. Williams.
Application Number | 20080058886 11/981008 |
Document ID | / |
Family ID | 34699932 |
Filed Date | 2008-03-06 |
United States Patent
Application |
20080058886 |
Kind Code |
A1 |
Williams; Michael S. |
March 6, 2008 |
Implantable medical device having pre-implant exoskeleton
Abstract
The present application describes a method and apparatus for
implanting a medical device within a living body. The apparatus
includes an elongate sleeve positionable with a living body, such
as within a blood vessel, and a medical device insertable into the
sleeve. During use, the sleeve is retained with the body, and the
medical device is sealed within the sleeve. The sleeve
substantially avoids biological growth onto the medical device, and
thus permits removal of the medical device independently of the
sleeve.
Inventors: |
Williams; Michael S.; (Santa
Rosa, CA) |
Correspondence
Address: |
STALLMAN & POLLOCK LLP
353 SACRAMENTO STREET
SUITE 2200
SAN FRANCISCO
CA
94111
US
|
Family ID: |
34699932 |
Appl. No.: |
11/981008 |
Filed: |
October 31, 2007 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11009649 |
Dec 10, 2004 |
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11981008 |
Oct 31, 2007 |
|
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60529051 |
Dec 12, 2003 |
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Current U.S.
Class: |
607/36 |
Current CPC
Class: |
A61N 1/37516 20170801;
A61N 1/375 20130101; A61N 1/37223 20130101; A61N 1/37512 20170801;
A61M 5/14276 20130101; A61N 1/37205 20130101; A61N 1/37518
20170801 |
Class at
Publication: |
607/036 |
International
Class: |
A61N 1/375 20060101
A61N001/375 |
Claims
1. A method of implanting a medical device within a living body,
the method comprising the steps of: forming an incision in a living
body; introducing a sleeve having a length through the incision;
positioning the entire length of the sleeve within the body;
inserting an implantable medical device into the sleeve and sealing
the medical device within the sleeve.
2. The method of claim 1, wherein the positioning step positions at
least a portion of the sleeve within a blood vessel.
3. The method of claim 1, wherein the inserting step is performed
prior to the introducing step.
4. The method of claim 1, wherein the inserting step is performed
after the introducing step.
5. The method of claim 2, further including the step of anchoring
the sleeve within the blood vessel.
6. The method of claim 5, wherein the sleeve includes an expandable
retention device, and wherein the anchoring step includes the step
expanding the retention device into contact with walls of the
vessel.
7. The method of claim 2, wherein the positioning step positions
the entire length of the sleeve within the blood vessel.
8. The method of claim 1, wherein the medical device is removable
from the sleeve while the sleeve remains within the body.
9. The method of claim 1, wherein the sealing step attaches a
sealing device to the sleeve.
10. The method of claim 9, wherein the sealing step attaches a cap
or plug to the sleeve.
11. The method of claim 9, wherein the sealing step applies a
sealing compound to the sleeve.
12. The method of claim 1, wherein after the sealing step, the
sleeve substantially prevents body fluids surrounding the sleeve
from contacting the medical device.
13. The method of claim 1, wherein after the sealing step, the
sleeve substantially prevents biological growth onto the medical
device.
14. The method of claim 1, wherein the introducing step introduces
a sleeve having an exterior and at least one electrode on the
exterior; the sealing inserting step inserts a medical device
having an interior and pulse generator sealed within the interior;
and the method further includes the step of electrically coupling
the pulse generator to the electrode.
15. The method of claim 14, wherein the sleeve includes a side
branch extending from the sleeve, wherein the method includes
positioning the side branch within the heart.
16. The method of claim 15, wherein at least one electrode is a
branch electrode positioned on the side branch, and wherein the
electrically coupling step couples the branch electrode to the
pulse generator.
17. The method of claim 1, wherein: the introducing step introduces
a sleeve having a fluid delivery port; the inserting step inserts a
medical device having an interior and a fluid reservoir in the
interior; and the method further includes the step of fluidly
coupling the fluid delivery port and the fluid reservoir.
18. The method of claim 1, wherein the method is further for
explanting the medical device, and wherein the method includes the
steps of: withdrawing a portion of the sleeve from the body; and
extracting the medical device from within the sheath.
19. The method of claim 18, further including the step of: after
the extracting step, inserting a second medical device into the
sleeve.
20. The method of claim 1, further include the step of allowing the
incision to heal, leaving the medical device and the sleeve within
the body.
21-40. (canceled)
41. An implantable intravascular medical system kit, including: a
elongate sleeve proportioned for implantation within a blood vessel
of a patient; an implantable medical device positionable within the
sleeve; and instructions for use setting forth implantation methods
for the sleeve and medical device, including the steps of: forming
an incision in a living body; introducing the sleeve through the
incision and into a blood vessel; positioning an entire length of
the sleeve within the body; inserting the medical device into the
sleeve and sealing the medical device within the sleeve.
42-43. (canceled)
Description
PRIORITY CLAIM
[0001] This application claims priority from prior Provisional
Application Ser. No. 60/529,051, filed Dec. 12, 2003, and which is
incorporated herein by reference.
FIELD OF THE INVENTION
[0002] The present invention generally relates to devices or
systems implanted within the body for therapeutic and/or diagnostic
purposes. In particular, the invention provides methods and devices
for facilitating implantation of such systems within the patient's
vasculature.
BACKGROUND OF THE INVENTION
[0003] Pacemakers, defibrillators and implanted cardioverter
defibrillators ("ICDs") have been successfully implanted for years
for treatment of heart rhythm conditions.
[0004] Pacemakers are implanted in patients who have bradycardia
(slow heart rate). The pacemakers detect periods of bradycardia and
deliver electrical stimuli to increase the heartbeat to an
appropriate rate.
[0005] ICDs are implanted in patients who may suffer from episodes
of fast and irregular heart rhythms called tachyarrhythmias. An ICD
can cardiovert the heart by delivering electrical current directly
to the heart to terminate an atrial or ventricular tachyarrhythmia,
other than ventricular fibrillation. An ICD may alternatively
defibrillate the heart in a patient who may suffer ventricular
fibrillation (VF), a fast and irregular heart rhythm in the
ventricles. During a VF episode, the heart quivers and can pump
little or no blood to the body, potentially causing sudden death.
An ICD implanted for correction of ventricular fibrillation will
detect a VF episode and deliver an electrical shock to the heart to
restore the heart's electrical coordination.
[0006] Another type of implantable defibrillation device treats
patients who may suffer from atrial fibrillation (AF), which is a
loss of electrical coordination in the heart's upper chambers
(atria). During AF, blood in the atria may pool and clot, placing
the patient at risk for stroke. An electrophysiological device
implanted for correction of atrial fibrillation will detect an AF
episode and deliver an electrical shock to the atria to restore
electrical coordination.
[0007] Pacemakers and ICDs are routinely implanted in the pectoral
region either under the skin (subcutaneous) or under the pectoral
muscle. The leads are placed at appropriate locations around,
within or on the heart. Because of this complexity, a cardiologist
identifying a heart rhythm condition may be required to refer his
or her patient to sub-specialists or surgeons for implantation of a
pacemaker or ICD--thus delaying implantation of the device in a
patient who urgently needs it. It is thus desirable to simplify
these devices and the procedures for implanting them so as to
permit their implantation by a broader range of physicians.
[0008] U.S. application Ser. Nos. 10/453,971 and 10/454,223 ("the
'971 and '223 applications), filed Jun. 4, 2003, and 10/862,113,
filed Jun. 4, 2004 (the '113 application) describe intravascular
systems that may be used to deliver electrical energy to the heart
such as for defibrillation, pacing, and/or cardioversion of the
heart. Each of these applications is incorporated herein by
reference for all purposes.
[0009] Generally speaking, the systems described in the '971, '113
and '223 applications include at least one housing containing the
necessary circuitry and related components for delivering a charge
to the heart for pacing, and/or defibrillation, etc. The systems
may also include `at least one` electrode lead through which the
electrical energy is delivered to the body. Some or all of these
components are positioned within the vasculature, such as in the
superior vena cava ("SVC"), the inferior vena cava ("IVC"), or the
left or right subclavian, coronary sinus, and/or other vessels of
the venous or arterial systems. For example, the housing containing
electronics, circuitry, batteries, capacitors, etc. may be
positioned in the IVC or SVC, while leads extending from the
housing may extend to the left subclavian vein (LSV), the IVC, the
coronary sinus of the heart, and/or the right ventricle of the
heart. Retention devices may be used to retain some of these
components within the vasculature.
[0010] The present disclosure describes components that facilitate
implantation and later removal of the housing containing
electronics, circuitry, batteries, etc. in an intravascular system.
In particular, the application describes a sleeve or "exoskeleton"
that is implanted in the vasculature. The exoskeleton may be
retained in place using a retention device. Following implantation
of the exoskeleton, the housing is inserted into the exoskeleton.
If at some date it becomes necessary to explant the housing, it may
be withdrawn from the exoskeleton and removed from the body,
leaving the exoskeleton in place.
BRIEF DESCRIPTION OF THE DRAWINGS
[0011] FIG. 1 is a perspective illustration showing human cardiac
anatomy.
[0012] FIG. 2 is a plan view generally showing components of a
first embodiment of intravascular defibrillation and/or pacing
system and associated implantation tools.
[0013] FIG. 3A is a plan view of a distal portion of the
exoskeleton of FIG. 2.
[0014] FIG. 3B is a plan view of the exoskeleton and insert of FIG.
2, showing an alternative arrangement of electrical contacts.
[0015] FIG. 3C is a plan view of an insert positioned within an
exoskeleton, showing a third arrangement of electrical
contacts.
[0016] FIG. 4A is a plan view of an insert.
[0017] FIG. 4B is a plan view of a distal portion of an exoskeleton
assembled with an insert. The exoskeleton is shown in
cross-section.
[0018] FIGS. 5A through 5E are a sequence of schematic views of a
heart and associated vasculature, illustrating an implantation
method using the system of FIG. 2.
[0019] FIG. 5F is a schematic view similar to the FIG. 5A-5E views
illustrating removal of the insert.
[0020] FIG. 6 is an elevation view showing an alternative
embodiment of an exoskeleton and insert.
[0021] FIG. 7 is a side elevation of an alternative insert.
[0022] FIG. 8A is a front elevation view showing an alternative
exoskeleton.
[0023] FIG. 8B is a side elevation view showing an alternative
insert for use with the exoskeleton of FIG. 8A.
[0024] FIG. 8C is a side elevation view showing the components of
FIGS. 8A and 8B in assembled form.
[0025] FIG. 9 is a cross-sectional side view of another embodiment
of an exoskeleton and insert.
[0026] FIGS. 10A and 10B illustrate various electrode and contact
embodiments useful for exoskeletons.
[0027] FIG. 11 illustrates an alternative embodiment of an
exoskeleton and insert which form part of an intravascular drug
delivery system.
DETAILED DESCRIPTION OF THE DRAWINGS
Cardiac Anatomy
[0028] FIG. 1 shows the cardiac anatomy of a human, including the
heart and major vessels. The following anatomic locations are shown
and identified by the listed reference numerals: TABLE-US-00001
Right Subclavian 2a Left Subclavian 2b Superior Vena Cava (SVC) 3a
Inferior Vena Cava (IVC) 3b Right Atrium (RA) 4a Left Atrium (LA)
4b Right Atrial Appendage (RAA) 5 Coronary Sinus Ostium (CS Os) 6
Right Ventricle (RV) 7a Left Ventricle (LV) 7b Aortic Arch 8
Descending Aorta 9
[0029] Exoskeleton configurations will be described in the context
of an intravascular system useful for electrophysiological ("EP")
applications (such as implantable defibrillation systems and
associated components), it should be appreciated that the disclosed
embodiments and methods or variations thereof may be used to
implant other types of intravascular systems, including but not
limited to pacing, defibrillation or cardioversion systems. The
components may find further use in connection with intravascular
systems for delivering other forms of therapy (e.g., pharmaceutical
therapies) to the body. Such systems are described in U.S.
application Ser. No. ______, INTRAVASCULAR DELIVERY SYSTEM FOR
THERAPEUTIC AGENTS, filed Dec. 9, 2004, Attorney Docket No.
NMX-110, the entirety of which is incorporated herein by reference.
Other systems for which the exoskeleton components may be useful
include intravascular diagnostic systems such as those that monitor
blood glucose, blood oxygen, or other parameters. It should also be
mentioned that although this application describes the systems for
use in the vasculature, pre-implant exoskeletons may be implanted
at other sites within the body where medical implants are to be
placed. For example, exoskeletons may function as pre-implant
devices in subcutaneous pockets or in organs or body cavities
throughout the body.
General Discussion
[0030] FIG. 2 generally shows one example of an intravascular
defibrillation system 10 of a type that may utilize components of
the type described herein. The elements of system 10 include a
defibrillation and/or pacing device 12, which is comprised of a
tubular exoskeleton 13a and an insert 13b that is slidably received
within an opening 15a in the exoskeleton. Exoskeleton 13a may
function as a "pre-implant", i.e., a sleeve or shell that is first
anchored within a vessel, whereas insert 13b serves to house the
electronics and associated features for carrying out the system
functions.
[0031] The exoskeleton 13a is proportioned to be passed into the
vasculature and to be anchored within the patient's vasculature
with minimal obstruction to blood flow. Suitable sites for the
exoskeleton may include, but are not limited to the venous system
using access through the right or left femoral vein or the
subclavian or brachiocephalic veins, or the arterial system using
access through one of the femoral arteries. Thus, the exoskeleton
preferably has a streamlined maximum cross sectional diameter which
may be in the range of 3-15 mm or less, with a most preferred
maximum cross-sectional diameter of 3-8 mm or less. The
cross-sectional area of the exoskeleton in the transverse direction
(i.e., transecting the longitudinal axis) should be as small as
possible while still accommodating the required components within
the insert 13b. This area is preferably in the range of
approximately 79 mm.sup.2 or less, and more preferably in the range
of approximately 40 mm.sup.2 or less, or most preferably between
12.5-40 mm.sup.2.
[0032] The exoskeleton preferably forms a fluid-tight barrier
against migration of body fluids into its interior. Avoiding
leakage of blood and body fluids avoids thrombus formation and
endothelial or cellular growth within the exoskeleton and onto the
insert, and thus allows the insert to be removed from the
exoskeleton when necessary for replacement or servicing. Examples
of materials useful for the exoskeleton include PTFE, ePTFE, PFPE,
other fluropolymers, polyurethanes, silicone, polyolefin rubber,
dacron polyester, PET, PMMA, EVA or polypropylene, ceramics,
surface reactive glass ceramics (including bioglasses or
bioceramics), or metals including titanium and its alloys and/or
other biocompatible metals. Exoskeleton 13a may be formed of a
polymeric material having a reinforcing structure (e.g., a metallic
or polymeric braid) over, under or integrated with the polymeric
material. One example of this type of arrangement would be a braid
lined with a Teflon polymer.
[0033] Because the ekoskeleton might remain permanently in the
vasculature, it may be desirable to promote tissue growth (e.g.,
cellular encapsulation, in-growth, endothelialization) onto and/or
into the exoskeleton 13a. Tissue growth onto/into the exoskeleton
can improve the stability of the exoskeleton within the vessel, and
may improve the biocompatibility of the system within the vessel by
improving blood-surface compatibility. Cellular growth may be
encouraged by giving the exoskeleton an in-growth promoting surface
using structural features. For example, all or a portion of the
exterior surface of the exoskeleton may have pores (e.g., from a
porous material), interstices (e.g., in a mesh material), or other
surface modifications into or onto which cellular growth can occur.
In one embodiment, the exoskeleton may have an exterior surface
formed or covered by Dacron or by a form of ePTFE having a node to
fibril length of approximately 15-25 microns. Cellular growth into
or onto the exoskeleton may also be promoted using a substance that
promotes in-growth. For example, the exoskeleton may be coated or
impregnated with a substance such as albumen, growth factors,
synthetic or natural therapeutic molecules, or any other substance
that will promote cellular growth.
[0034] On the other hand, if the option to explant the exoskeleton
is desired, it may be formed of a material or covered by a layer or
coating having anti-proliferative properties so as to minimize
endothelialization or cellular ingrowth, since minimizing growth
into or onto the device will help minimize vascular trauma when the
device is explanted. A form of ePTFE having a note-to-fibril length
of approximately 1-10 microns, and preferably less than
approximately 10 microns, may be used for this purpose.
[0035] In another embodiment, the exoskeleton may be constructed
such that it will degrade over a period of time calculated such
that degradation will occur after the intended useful life of the
insert. Materials suitable for this purpose include LPLA,
polyglycolic acid, polydioxanone, polyanhydrides or other erodable
materials. According to this embodiment, degradation of the
exoskeleton would preferably be timed to occur following removal of
the implant.
[0036] The exoskeleton surface may also be anti-thrombogenic (e.g.,
using materials or coating such as perfluorocarbon coatings applied
using supercritical carbon dioxide), although if cellular ingrowth
is desired some thrombosis may be allowed as a substrate for
endothelial growth. The exoskeleton may also include a surface or
coating, which elutes compositions, such as anti-thrombogenic
compositions (e.g., heparin sulfate) and/or anti-proliferative
compositions and/or immunosuppressive agents.
[0037] Referring to FIG. 2, the most proximal section of the device
may include a transition 17a to a more flexible tail section 17b of
the exoskeleton, which may be coiled and tucked into a subcutaneous
pocket following implantation as will be discussed below.
[0038] In another embodiment, the insert 13b may fit snugly into
the exoskeleton 13a, in which case the exoskeleton may function as
a coating on the insert 13b.
[0039] One or more electrode leads 14 may extend as branches from
the exoskeleton 13a. Leads include electrodes 16 for delivering
electrical energy to the surrounding body tissue. In the FIG. 2
embodiment, the lead 14 may be positionable with in the right
ventricle (RV) of the heart. Additional electrodes may be
positioned on the body of the exoskeleton. For example, the
exoskeleton may include electrodes 18a positionable within the left
subclavian vein (LSV) 2b, and electrodes 18b positionable within
the inferior vena cava (IV C) 3b.
[0040] It should be noted that the term "exoskeleton" is not
intended to mean that the exoskeleton 13a is necessarily hard or
rigid. As discussed, the exoskeleton preferably forms a barrier
against migration of body fluids into contact with the insert, but
it need not be a rigid barrier. In a preferred embodiment the
exoskeleton is sufficiently flexible to be passed through the
vasculature. However, certain sections of the exoskeleton 13a may
include additional features that supplement the strength and
stability of those sections after they have been positioned at
their final location within the vasculature. This may be desirable
during removal of the insert 13b from the exoskeleton 13a to assist
the exoskeleton 13a in resisting axial forces applied against it
during withdrawal of the insert.
[0041] For example, in the FIG. 2 embodiment it may be desirable to
reinforce the lead 14 or the portion of the exoskeleton positioned
distally of lead bifurcation 11. One reinforcement method might
include providing the exoskeleton with pockets of curable or
reactive polymer in a liquid state. These pockets might be
positioned throughout the exoskeleton, or at select regions such as
the lead 14, and/or the bifurcation 11, and points distal to the
bifurcation 11. Once the exoskeleton is positioned or just prior to
extraction of the insert, the polymer would be cured using the
appropriate curing method (e.g., UV exposure, chemical contact,
thermal activation, etc.). The cured material can help the
exoskeleton to retain a desired shape within the vessel, and can
assist with axial stability. Another embodiment of a reinforcement
method might involve inserting reinforcing wires or ribbons through
lumens in the sidewalls of the exoskeleton following implantation
of the exoskeleton or just prior to extraction of the insert.
[0042] Referring to FIG. 3A, the interior surface of the
exoskeleton includes a plurality of electrical contacts 19a, b, c.
Each of the contacts 19a, 19b, 19c is connected to a corresponding
wire 20a, 20b, 20c that extends through the exoskeleton (e.g.,
through the main lumen or though channels in the sidewalls of the
exoskeleton). Each wire is in turn coupled to one of the electrodes
or electrode arrays 16, 18a, 18b. FIG. 3A also illustrates an
alternative form of electrodes that differ from the surface
electrodes shown on the FIG. 2 embodiment. In the FIG. 3A
embodiment, each wire (e.g., wire 20a) extending through the
exoskeleton penetrates the wall of the exoskeleton and is wound on
the surface of the exoskeleton to form the electrode. Sealing
compound is preferably used to seal the exoskeleton at the point of
penetration.
[0043] Referring again to FIG. 2, the insert 13b is a hermetically
sealed housing containing electronics and other features necessary
for the operation of the system. These features may include one or
more pulse generators, including associated batteries, capacitors,
microprocessors, and circuitry for generating defibrillation
pulses. Detection circuitry for detecting arrhythmias or other
abnormal activity of the heart may also be housed within insert
13b. The housing may be made from metals such as titanium or
titanium alloys, polymers, or other suitable materials. Although
the exoskeleton will preferably isolate the insert from body
materials, the insert may be covered by a layer or coating having
anti-proliferative properties so as to minimize endothelialization
or cellular ingrowth onto the insert in the event some fluids
migrate into the exoskeleton.
[0044] One or more electrical contacts 22a, 22b, 22c are positioned
on the exterior surface of the insert 13b. The contacts 22a, 22b,
22c may take the form of conductive elements attached to the
housing of the device insert. Alternatively, if the insert 13b
includes a conductive housing to which an insulating material is to
be applied, the contacts may be formed by selectively applying the
coating or removing portions of the coating to leave one or more
exposed contact regions on the surface of the insert.
[0045] Contacts 22a, 22b, 22c are positioned to electrically couple
to the corresponding contacts 20a, 20b, 20c (FIG. 3A) inside the
exoskeleton when the device 12 is fully assembled. When the
contacts are properly coupled, electrical energy emitted by the
pulse generator within the housing is directed to the appropriate
electrodes 16, 18a, 18b on the exoskeleton. Likewise, any
electrodes are positioned to detect the heart's electrical
activity, are electrically coupled to detection circuitry within
the insert 13b.
[0046] FIG. 3B illustrates alternative positioning of the contacts
19a, b, c and the contacts 22a, 22b, 22c. Rather than positioning
all contacts within a cluster towards the proximal end of the
device 12 as shown in FIG. 3A, the FIG. 3B embodiment positions
contacts 19b, 22b in the region of the LSV electrode 18a, and
contacts 19c, 22c in the region of the IVC electrode 18b. The
contacts 19a, 22a for the RV electrode 16 are positioned near the
bifurcation of the lead 14.
[0047] Returning again to FIG. 3A, it should be noted that if the
contacts 19a, b, c are positioned in a proximal portion of the
exoskeleton 13a, the insert 13b need not be proportioned to extend
to the distal end of the exoskeleton. However, the insert 13b may
be long enough to extend to the distal end even if it not necessary
for making electrical contact.
[0048] Another arrangement of contacts is shown in FIG. 3C, which
illustrates the distal portion of insert 13b disposed within the
distal portion of exoskeleton 13b. The walls of the exoskeleton are
shown in cross-section to allow the insert to be seen. As shown, a
tiered structure is used for the distal portions of the insert and
exoskeleton with conductive rings forming contacts 19e, 22e at each
tier 7. More specifically, at each tier 7 a conductive ring 19e
lines the interior surface of the exoskeleton 13b, and a
corresponding conductive ring 22e lines the exterior surface of the
insert 13a. The tiers may be proportioned such to create an
interference fit between the insert and the exoskeleton.
[0049] The system may include alternative features that engage the
insert 13b within the exoskeleton 13a. The retention forces between
the exoskeleton and insert are preferably sufficient to retain the
insert, but also such that they may be overcome by manually
withdrawing the insert 13b. As one example, the interior surface of
the exoskeleton and/or the exterior surface of the insert may
include raised elements (e.g., rib features, broadened sections
etc.) that cause the two components to engage due to friction
forces between adjacent surfaces. FIG. 4A illustrates raised
elements 23 on the surface of the insert 13b. Alternatively, the
general fit between the components 13a, 13b may be sufficient to
create such friction.
[0050] As another example, one or more of the contacts within the
exoskeleton 13a may take the form of a metallic leaf spring
radially biased towards the central axis of the exoskeleton. This
is illustrated in FIG. 4B. In this embodiment, the contacts 19b are
inwardly biased leaf springs. The electrodes 18a may be strips of
conductive material or sections of conductive tubing electrically
coupled to the contacts 22b using rivets 21 or other conductive
elements passing through the wall of the exoskeleton. As shown,
when the insert is placed within the exoskeleton, leaf spring
contact 19b springs into engagement with a corresponding contact
22b on the insert 13b. To facilitate engagement, the contact 22b
may be positioned within a recess formed in the surface of the
insert 13b as shown. A plurality of similar leaf springs (which may
or may not be conductive) may be used at one or more locations on
the exoskeleton surface to ensure that engagement between the
components is secure.
[0051] Some alternative electrode and contact designs similar to
the FIG. 3A design are shown in FIGS. 10A and 10B. It should be
mentioned that the configurations for the electrodes and associated
contacts described in this application are merely examples and not
given as an all-inclusive list.
[0052] In one embodiment shown in FIG. 10A, an electrode 18d
comprises a wire coil, wherein a first portion of the coil is
positioned within the exoskeleton to form a contact 19d that makes
contact with a corresponding contact on the insert. A second
portion of the coil is wrapped around the exterior surface of the
exoskeleton for contact with tissue.
[0053] In a similar embodiments shown in FIG. 10B, the electrode
18e is formed of a strand wire wound in an undulating pattern. A
portion of the pattern is positioned inside the exoskeleton to
serve as contact 19e, whereas another portion extends through the
exoskeleton wall to form the external electrode. A similar pattern
may be cut into a sheet or tube of metal rather than looped using a
wire. The contact portion 19e of the wire may be biased inwardly in
a manner similar to the leaf springs 19b of FIG. 4B
[0054] Referring again to FIG. 2, one or more retention devices
such as anchor 24 are provided for retaining the exoskeleton within
a blood vessel. Anchor 24 includes structural features that allow
the anchor to self-expand into radial engagement with a vessel
wall. For example, a band, mesh or other framework formed of one or
more shape memory (e.g., nickel titanium alloy, nitinol, thermally
activated shape-memory material, or shape memory polymer) elements
or stainless steel, Elgiloy, or MP35N elements may be used. In this
embodiment the anchor 24 is preferably constructed to promote
tissue ingrowth to as to enhance anchor stability within the
vessel. Structural features such as mesh or other framework
configurations are suitable for this purpose, although compositions
and/or coatings that promote in-growth may also be used.
[0055] During implantation, a retractable sheath 26 may be slidably
positioned over the anchor 24 and the exoskeleton 13a so as to
retain the anchor in its compressed position. (The sheath 26 may
also be used to hold the lead branch 14 streamlined against the
exoskeleton 13a during implantation.) Retraction of the sheath once
the exoskeleton is properly positioned allows the anchor 24 to
expand into contact with the surrounding walls of the vessel,
thereby holding the exoskeleton in the desired location. Once
deployed, the anchor 24 is preferably intimate to the vessel wall,
which is distended slightly, allowing the vessel lumen to remain
approximately continuous despite the presence of the anchor and
thus minimizing turbulence or flow obstruction. Although
self-expansion of the anchor is preferable, mechanical expansion
means (e.g., balloon expanders etc) may be used for active
expansion of the anchor.
[0056] The anchor may also have drug delivery capability via a
coating matrix impregnated with one or more pharmaceutical
agents.
[0057] The anchor 24 may be configured such that the exoskeleton
13a and anchor 24 share a longitudinal axis, or such that the axes
of the exoskeleton 13a and anchor 24 are longitudinally offset.
[0058] An implantation mandrel 28 is attachable to the proximal end
of exoskeleton 13a (e.g., at transition region 17a) for advancing
the exoskeleton into position within the body. The mandrel 28 may
also be used to push the insert into the exoskeleton or a separate
tool can be used for this purpose. The system may additionally be
provided with other components useful for implanting the system,
including guidewires 30a, 30b and an introducer 32. If guidewires
are to be used for implantation of the exoskeleton, the exoskeleton
will preferably include guidewire lumens that permit tracking of
the exoskeleton over the guidewires, or openings formed at the
distal end of the exoskeleton and/or lead 14 for receiving the
guidewires. The distal openings would preferably include seals to
prevent migration of blood or other body fluids into the
exoskeleton. The openings might instead include one-way valves that
allow any body fluids that pass into the exoskeleton to be purged
from the exoskeleton using a fluid (e.g., saline or carbon dioxide
gas) injected into the proximal opening 15.
[0059] FIGS. 5A through 5E illustrate implantation of the system 10
of FIG. 2. In the illustrated method, the exoskeleton is implanted
first, and then the insert is passed into the exoskeleton. However,
in an alternative implantation method the insert may be passed into
the exoskeleton outside the body and the two components introduced
simultaneously.
[0060] A small incision is first formed in the femoral vein and the
introducer sheath 32 is inserted through the incision into the vein
to keep the incision open during the procedure. Next, guidewires
30a, 30b are passed through the sheath 32 and into the inferior
vena cava 3b. Guidewire 30a is steered under fluoroscopy into the
left subclavian vein 2b and guidewire 30b is guided into the right
ventricle 7a of the heart. In an alternative embodiment of the
implantation, only guidewire 30b is used and is advanced into the
right ventricle 7a.
[0061] Next, the lead 14 (FIG. 2) is threaded over guidewire 30b by
extending the guidewire into the exoskeleton and out of the
exoskeleton via an opening in the lead 14. If both guidewires are
used, the distal end of the exoskeleton 3b is threaded over
guidewire 30a. The lead 14 and the distal end of the exoskeleton
13a are then passed through the introducer sheath 32 and into the
IVC 3b. See FIG. 5A. Pushing on the exoskeleton causes the lead 14
to track over guidewire 30b while the exoskeleton advances within
the vasculature (and over guidewire 30b if used).
[0062] The guidewires 30a, 30b are withdrawn. If necessary, a fluid
such as saline or CO2 is directed through exoskeleton as described
above to purge any body fluids from the exoskeleton.
[0063] Next, implantation mandrel 28 is attached to the proximal
portion of the exoskeleton 13a (e.g., at transition region 17a) and
is used to push the exoskeleton further into the vasculature.
Advancement of the mandrel 28 is continued until the distal portion
of the exoskeleton reaches the desired position within the LSV 2b,
and the lead 14 had tracked the guidewire 30b into the right
ventricle 7a as shown in FIG. 5B. At this stage, some of the
flexible tail section 17b of the exoskeleton remains outside the
body.
[0064] The exoskeleton is next anchored in place by releasing the
anchor 24 to its expanded position as shown in FIG. 5C. The anchor
expands into contact with the surrounding vessel wall, thereby
preventing migration of the exoskeleton. If desired, the distal
portion of exoskeleton 13a may be anchored in the LSV 2b using
another suitable anchor. The mandrel 28 is detached from the
exoskeleton and withdrawn from the body.
[0065] Next, the insert 13b is inserted into the exoskeleton as
shown in FIG. 5D. If necessary, the implantation mandrel 28 may be
attached to the insert 13b and used to push the insert 13b into
position. The insert 13b is advanced to a point at which the
contacts on the insert 13b have made electrical contact with the
corresponding contacts of the exoskeleton. Finally, the mandrel 28
is removed and the opening 15a in exoskeleton is sealed using a cap
or plug 15b, or using a sealing compound that will harden to seal
the opening 15a. The flexible tail section 17b of the exoskeleton
is coiled and tucked into the femoral vein or into a subcutaneous
pocket adjacent to the femoral vein and is stored there for future
access. The incision through the patient's skin is preferably
closed and allowed to heal.
[0066] Future access to the insert 13b may be needed for a variety
of reasons. For example, if the battery within the insert 13b
should become depleted, the insert may be removed and replaced with
a new device, or a charging device may be coupled to the insert
13b.
[0067] If the insert is to be replaced, a femoral incision is
formed to gain access to the tail section 17b. A sufficient length
of the tail 17b is removed from the body to permit access to the
opening 15a in the tail 17b. The opening 15a is unsealed such as by
removing its cap, plug 15b or seal. Alternatively, the exoskeleton
may be re-opened by snipping off the proximal portion of the tail
within which the cap, plug or seal is positioned. An extraction
tool such as mandrel 28 may be passed into the exoskeleton and used
to engage the insert. To facilitate this process, an alternative
mandrel may be used that includes a distal coupling comprising a
mouth that is significantly broader than the proximal end of the
device. When the mandrel is advanced through the exoskeleton
towards the insert 13b, the mouth will pass over the proximal end
of the device 10 and will then be actuated to clamp over the
proximal end of the insert, allowing the insert to be withdrawn by
retracting the mandrel from within the tail section 17b. Once the
insert is extracted, a fresh insert may be advanced into the
exoskeleton using techniques described above, and the tail may be
re-sealed and returned to its pocket within the body.
[0068] An alternative extraction method is illustrated in FIG. 5F.
As shown, a syringe 60 may be coupled to the exoskeleton 13a and
used to pump saline, carbon dioxide, or other fluid into the
exoskeleton. As the injected fluid fills the distal portion of the
exoskeleton, fluid pressure forces the insert towards the open end
of the exoskeleton. This step may also be combined with manual
extraction using a mandrel. Once the insert is extracted, a fresh
component may be inserted into the exoskeleton and will displace
any fluid remaining in the exoskeleton will be driven out the
opening 15a by the advancing insert.
[0069] FIG. 6 shows an alternative embodiment of a system 110
utilizing an exoskeleton 113a and an insert 113b insertable into
the exoskeleton. In system 110, leads 14a, 14b extend from the
exoskeleton 113a as shown. Each lead 114a, 114b is electrically
connected to a contact point (not shown) that is exposed in the
hollow interior of the exoskeleton 113a. The contact points are
positioned to make electrical contact with corresponding points 122
on the surface of the interior housing when the exoskeleton 113a
and insert 113b are assembled.
[0070] The exoskeleton and the insert 113a, 113b are preferably
provided with means for securely engaging one another. For example,
as shown in FIG. 6, threaded female and male connectors 40, 42 may
be provided on the exoskeleton and inserts 113a, 113b,
respectively. Following insertion of the insert 13b into the
exoskeleton 13a, the insert 113a is rotated to engage the threads
of the connectors. Additional sealing structures (e.g., o-rings)
may be included on the proximal end of one or both of the
components 113a, 113b to minimize flow of blood into the device. As
an alternative shown in FIG. 7, threads 42a may be formed on the
exterior surface near the distal end of the insert 113b, with
corresponding female threads on the exoskeleton (not shown). In
either case, an implantation tool (which may be similar to mandrel
28 of FIG. 2) would be connectable to the insert 113b and used for
guiding the insert 113b through the vasculature and then rotating
the component 113b to cause the corresponding threads to
engage.
[0071] As yet another alternative, as shown in FIGS. 8A and 8B,
insert 113b (FIG. 8B) may include a spring clip 44, and exoskeleton
113a (FIG. 8A) may include a window 46, such that when the
components are assembled the clip 44 engages with the window as
shown in FIG. 8C. Since clip 44 may be exposed through the window
46, it may be desirable to wire the clip 44 to function as an
electrode on the exterior of the device.
[0072] As discussed, one or more o-ring seals 50 (FIGS. 7, 8A and
8C) may be used to keep fluids out of the exoskeleton. Seals (not
shown) may also be used around the clip 44 to prevent fluid leakage
from entering the device 112 through the window.
[0073] In another alternative embodiment shown in FIG. 9, leads 214
are attached to the insert 213b, and the exoskeleton 214a includes
openings through which the leads may be passed during implantation.
In the FIG. 9 embodiment exoskeleton 213a includes sleeves 52
through which the leads may be passed for this purpose.
Alternatively, the exoskeleton may include holes in the distal end
in place of sleeves 52. Seals (such as o-rings of the type
discussed earlier) may be positioned to prevent migration of fluids
into the exoskeleton via the sleeves 52.
[0074] During implantation of the system 212, leads 214 are fed
through the sleeves 52 and are positioned within the heart and/or
vessels in a manner similar to that described above. Fluid such as
saline or gas such as carbon dioxide may be directed into the open
proximal end of the exoskeleton to prevent inflow of blood or to
displace blood that may have already have entered the exoskeleton
during implantation. Holes or one-way valves (not shown) may also
be formed in the distal region of the exoskeleton to allow any
blood that may have accumulated within the exoskeleton to be
displaced and evacuated as the insert is passed into the
exoskeleton to facilitate retention in the body.
Drug Delivery System
[0075] The exoskeleton configuration may be adapted for use with an
intravascular drug delivery system of the type describe in U.S.
application Ser. No. ______, INTRAVASCULAR DELIVERY SYSTEM FOR
THERAPEUTIC AGENTS, filed Dec. 9, 2004, Attorney Docket No.
NMX-110, which is incorporated herein by reference. Such a system
includes an implantable drug reservoir, together with components
that function to transfer drug from the reservoir into the
bloodstream or into certain organs or tissues. Components used for
this purpose may include pumps, motors and batteries, and/or other
components such as those listed in the NMX-110 application.
[0076] Referring to FIG. 11, a system 310 may include an
exoskeleton 313a and an insert 313b slidably received within the
exoskeleton 313a. Insert 313b includes a drug reservoir 314 and a
refill line 318 coupled to the reservoir. A pump system 316 directs
agent to an exit tube or orifice 320.
[0077] Exoskeleton includes a port 322 that allows fluid released
through the exit orifice 320 to pass into the bloodstream. A seal
324 may be positioned within the exoskeleton to prevent backflow of
drug from exit orifice 320 into the exoskeleton 313a.
[0078] The exoskeleton may include a flexible tail portion 317
that, as described in connection with the FIG. 2 embodiment, may be
tucked into the femoral vein or a subcutaneous pocket following
implantation.
[0079] A subcutaneous portal 326 is fluidly coupled to the refill
line 318 of reservoir, and may also function to seal the tail 317
of the exoskeleton. Portal 326 may include a one-way valve (not
shown) that prevents fluid from entering the exoskeleton, or it may
include a seal formed of a material that will reseal itself
following puncture.
[0080] Implantation of the system 310 and replacement of the insert
313b may be performed using techniques described above. The
reservoir 314 may be refilled by using a refill vessel such as a
recharge syringe 328 filled with the desired drug. The needle tip
of the recharge syringe may be inserted through the skin and into
the subcutaneous portal 326. In this embodiment, drug reservoir
within the insert 313b may be maintained at a negative pressure so
as to draw the agent from the syringe once fluid communication is
established. Thus provides feedback to the user that the syringe
needle has been inserted at the proper location and can thus help
to avoid injection of the agent directly into the patient in the
event the portal 326 is missed by the needle.
[0081] In an alternative refill method, the tail 317 may be
withdrawn from the body through a small incision, and the recharge
syringe 328 or other refill device may be coupled to the portal 326
outside the body. In either case, the drug is then injected from
the syringe into the reservoir via the portal 326 and refill line
318. If the system 310 is provided without a refill line and
portal, the insert may instead be replaced with a new component
containing a fresh supply of drug using methods described
above.
[0082] In another embodiment, the insert 313b may be provided with
a refill port in the insert body 313b rather than a fill line 318
extending from the insert. Such an embodiment might be refilled
using a mandrel having a distal coupling including a mouth that is
significantly broader than the proximal end of the device. To
refill a device according to this embodiment, the mandrel would be
introduced into the exoskeleton and advanced towards the insert
until it passes over the proximal end of the insert. The mandrel is
then clamped over the proximal end of the insert to sealingly
engage the insert and to create a fluid coupling between the
mandrel's fluid lumen and a refill lumen into the insert. Drug is
then introduced into the mandrel for delivery into the reservoir
within the insert.
[0083] Various embodiments of systems, devices and methods have
been described herein. These embodiments are given only by way of
example and are not intended to limit the scope of the present
invention. The examples and alternatives set forth for the
described components are merely examples and should not be
considered to be all-inclusive lists. It should be appreciated,
moreover, that the various features of the embodiments that have
been described might be combined in various ways to produce
numerous additional embodiments. Moreover, while various materials,
dimensions, shapes, implantation locations, etc. have been
described for use with disclosed embodiments, others besides those
disclosed may be utilized without exceeding the scope of the
invention.
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