U.S. patent application number 12/265441 was filed with the patent office on 2010-05-06 for biasing laser catheter: monorail design.
This patent application is currently assigned to Spectranetics. Invention is credited to Melissa Brookshier, Jacob Keeler.
Application Number | 20100114081 12/265441 |
Document ID | / |
Family ID | 42132326 |
Filed Date | 2010-05-06 |
United States Patent
Application |
20100114081 |
Kind Code |
A1 |
Keeler; Jacob ; et
al. |
May 6, 2010 |
BIASING LASER CATHETER: MONORAIL DESIGN
Abstract
In some embodiments, without limitation, the invention comprises
a catheter having an elongated housing with a channel disposed
therein. A laser delivery member is movable and at least partially
disposed within the channel. A ramp is disposed within the housing
at an angle to its central axis and proximate to its distal end.
The ramp is adapted to move the distal end of the laser delivery
member outwardly from the central axis of the housing. A guidewire
biases the distal end of the laser delivery member generally
inwardly toward the central axis of the housing. In some
embodiments, without limitation, the offset of the central axis of
the tip of the laser delivery member from the central axis of the
housing is determined by adjusting the extent to which the laser
delivery member travels on the ramp, and disposition of the laser
delivery member on the guidewire maintains the offset tip
substantially parallel to the central axis of the housing. Thus, in
accordance with the invention, the distal end of the laser delivery
member may be biased in a desired direction or offset, permitting
ablation of an area larger than the area of the distal end of the
catheter.
Inventors: |
Keeler; Jacob; (Colorado
Springs, CO) ; Brookshier; Melissa; (Colorado
Springs, CO) |
Correspondence
Address: |
TOWNSEND AND TOWNSEND AND CREW, LLP
TWO EMBARCADERO CENTER, EIGHTH FLOOR
SAN FRANCISCO
CA
94111-3834
US
|
Assignee: |
Spectranetics
Colorado Springs
CO
|
Family ID: |
42132326 |
Appl. No.: |
12/265441 |
Filed: |
November 5, 2008 |
Current U.S.
Class: |
606/15 ;
604/164.01; 606/14 |
Current CPC
Class: |
A61B 2018/2238 20130101;
A61B 18/245 20130101; A61B 2018/2211 20130101; A61B 2017/22038
20130101 |
Class at
Publication: |
606/15 ; 606/14;
604/164.01 |
International
Class: |
A61B 18/24 20060101
A61B018/24; A61M 5/00 20060101 A61M005/00 |
Claims
1. A catheter comprising: an elongated housing having a central
axis between a first proximal end and a first distal end, the
housing having a channel disposed between the first proximal end
and the first distal end; a laser delivery member having a second
proximal end, a second distal end, and at least one optical fiber,
the laser delivery member being at least partially disposed within
the channel and movable therein; a cavity disposed proximate the
first distal end of the elongated housing and in communication with
the channel; to a ramp disposed at an angle to the central axis and
proximate the first distal end of the elongated housing, the ramp
being in communication with the channel and adapted to move the
second distal end of the laser delivery member outwardly from the
central axis of the elongated member; a guidewire in mechanical
communication with both the laser delivery member and the elongated
housing, the guidewire being adapted to bias the second distal end
of the laser delivery member generally inwardly toward the central
axis; and a slot disposed proximal to the cavity, the slot in
mechanical communication with the channel and the cavity, and
configured to permit a portion of the guidewire to move from within
the channel outwardly from the central axis of the elongated
housing when the second distal end of the laser delivery member
moves outwardly from the central axis of the elongated member when
engaged with the ramp.
2. The catheter according to claim 1, wherein the guidewire is at
least partially eccentrically disposed within the laser delivery
member.
3. The catheter according to claim 1, wherein laser delivery member
further comprises a plurality of fiber optics bundled together
within an outer sheath.
4. The catheter according to claim 1, further comprising a trigger
in mechanical communication with the laser delivery member and the
elongated housing and being configured to actuate the laser
delivery member relative to the elongated housing.
5. The catheter according to claim 4, wherein the trigger actuates
the laser delivery member relative to the elongated housing in
response to trigger actuation.
6. The catheter according to claim 1, further comprising a trigger
in mechanical communication with the laser delivery member and the
elongated housing and being configured to actuate the laser
delivery member from a first position relative to the elongated
housing to a second position relative to the elongated housing.
7. The catheter according to claim 6, wherein the distal end of the
laser delivery member is at least partially disposed within the
cavity in the first position and at least partially disposed
external to the cavity in the second position.
8. A catheter comprising: an elongated housing having a central
axis, a distal end, a proximal end and a housing channel disposed
between the distal end and the proximal end; a light guide having a
distal end and a proximal end; a guidewire at least partially
disposed within the housing channel and in mechanical communication
with the light guide and the elongated housing; and a monorail
having a central axis substantially parallel with the central axis
of the elongated housing, the monorail tip comprising: a monorail
proximal end coupled with the distal end of the elongated housing;
a monorail distal end; a monorail channel in mechanical
communication with the housing channel and extending from the
monorail proximal end to the monorail distal end, the channel; a
window in mechanical communication with the monorail channel; a
ramp disposed between the window and the monorail distal end at an
angle to the central axis of the monorail tip, the ramp being in
mechanical communication with the monorail channel and adapted to
guide the distal end of the light guide outwardly from the central
axis of the monorail tip as the distal end of the light guide is
moved toward the monorail distal end; and a slot disposed between
the monorail distal end and the window, the slot being in
mechanical communication with the monorail channel and the window,
and configured to permit a portion of the guidewire to move from
within the monorail channel outwardly from the central axis of the
monorail tip when the distal end of the light guide moves outwardly
from the central axis of the monorail when engaged with the
ramp.
9. The catheter according to claim 8, wherein monorail channel
further comprises: a distal monorail channel proximate to the
monorail distal end, and sized to allow the guidewire to pass
therethrough; and a proximal monorail channel proximate to the
monorail proximal end, and sized to all the guidewire and the light
guide to pass therethrough.
10. The catheter according to claim 8, wherein the guidewire is
eccentrically disposed within at least a portion of the light
guide.
11. The catheter according to claim 8, wherein the slot width is
greater than the width of the guidewire and less than the width of
the light guide.
12. The catheter according to claim 8, further comprising a marker
band disposed between the monorail distal end and the window.
13. The catheter according to claim 8, wherein the light guide
comprises one or more optical fibers.
14. The catheter according to claim 8, further comprising a trigger
coupled proximate with the elongated housing and the light guide,
the trigger being configured to actuate the light guide from a
first position relative to the elongated housing to a second
position relative to the elongated housing.
15. The catheter according to claim 8, wherein the trigger is
configured to actuate the light guide from the second position to
the first position.
16. A catheter comprising: an elongated housing having a central
axis, a distal end, a proximal end and a housing channel disposed
between the distal end and the proximal end; a fiber optic bundle
having a distal end and a proximal end; a monorail having a
monorail distal end, a monorail proximal end, a central axis
substantially parallel with the central axis of the elongated
housing, and a monorail channel in mechanical communication with
the housing channel extending from the monorail proximal end to the
monorail distal end, the proximal end of the monorail being
mechanically coupled with the distal end of the housing channel; a
guidewire at least partially disposed within the housing channel
and at least partially disposed within the monorail channel, a
portion of the guidewire exiting the monorail through the monorail
channel at the distal end of the of the monorail, and the guidewire
being in mechanical communication with the fiber optic bundle; and
biasing means coupled with the monorail for biasing a portion of
the fiber optic bundle proximal to the distal end of monorail at a
position external to the monorail and substantially parallel with
the central axis of the monorail.
17. The catheter according to claim 16, further comprising means
for allowing the guidewire to extend from the distal end of the
fiber optic bundle and exit the monorail through the monorail
channel at the distal end of the monorail channel.
18. The catheter according to claim 16, further comprising
actuating means for actuating the distal end of the fiber optic
bundle from a position within the monorail channel to a position
external to the monorail in coordination with the biasing
means.
19. The catheter according to claim 18, wherein at least a portion
of the actuating means is coupled with the elongated housing at the
proximal end of the elongated housing.
20. The catheter according to claim 18, wherein the actuating means
moves the fiber optic bundle about 1 cm to about 2 cm.
21. The catheter according to claim 16, wherein the biasing means
includes a window within the monorail with a ramp configured
therein at an angle relative to the central axis of the
monorail.
22. The catheter according to claim 16, wherein the biasing means
includes a slot within the monorail in mechanical communication
with the monorail channel, the slot being configured to allow the
guidewire to pass therethrough as a portion of the fiber optic
bundle is biased with the biasing means.
23. The catheter according to claim 16, wherein the guidewire is
eccentrically disposed within the fiber optic bundle.
24. The catheter according to claim 16 further comprising a marker
band disposed proximal to the distal end of the monorail.
25. A catheter comprising: an elongated housing having a central
axis, a housing distal end, a housing proximal end and a housing
channel disposed between the distal end and the proximal end; a
light guide having a distal end and a proximal end, being disposed
within the housing channel; and a guidewire at least partially
disposed within the housing channel and in mechanical communication
with the light guide and the elongated housing, the elongated
housing further comprising: a window in mechanical communication
with a portion of the housing channel; a ramp disposed within the
window at an angle to the central axis of the elongated housing,
the ramp being in mechanical communication with the housing channel
and adapted to guide the distal end of the light guide outwardly
from the central axis of the housing as the distal end of the light
guide is moved toward the housing distal end; and a slot disposed
between the housing distal end and the window, the slot being in
mechanical communication with the housing channel and the window,
and configured to permit a portion of the guidewire to move from
within the housing channel outwardly from the central axis of the
housing when the distal end of the light guide moves outwardly from
the central axis of the housing when engaged with the ramp.
26. A guidewire introducer comprising: a funnel section including a
proximal end with a proximal opening having a first diameter and a
distal end with a distal opening having a second diameter, a funnel
channel extending between the proximal opening and the distal
opening, the first diameter being greater than the second diameter;
and an elongated tubular section having an interior channel, a
distal end, and a proximal end, the proximal end of the elongated
tubular section being coupled with the distal end of the funnel
section.
27. The guidewire introduce according to claim 26, wherein the
funnel section includes a perforation extending from the proximal
opening to the distal opening.
28. The guidewire introduce according to claim 26, the funnel
section being configured to decouple from the elongated tubular
section.
29. The guidewire introduce according to claim 26, the diameter of
the interior channel being configured to accept a guidewire.
30. The guidewire introduce according to claim 26, further
comprising a tab coupled with the funnel section.
31. A catheter comprising: an elongated housing having a central
axis, a distal end, a proximal end and a housing channel disposed
between the distal end and the proximal end; a light guide having a
distal end and a proximal end; and an actuating mechanism
configured to actuate the light guide from a first position to a
second position relative to the housing, the light guide being in a
substantially fixed position relative to the housing when in the
second position.
32. The catheter according to claim 31, further comprising a
monorail tip.
33. The catheter according to claim 31, wherein the actuating
mechanism includes an elongated arm and a catch block, wherein the
elongated arm and catch block are coupled when the actuating
mechanism is in a second position.
Description
TECHNICAL FIELD
[0001] The embodiments described herein are generally directed to
improved apparatus and methods for the delivery of laser energy,
including without limitation, to a laser delivery catheter.
BACKGROUND OF THE INVENTION
[0002] Arteries are the primary blood vessels that are responsible
for providing blood and oxygen to the heart muscle. Arterial
disease occurs when arteries become narrowed or blocked by a
buildup of plaque (as some examples, atherosclerotic plaque or
other deposits). When the blockage is severe, the flow of blood and
oxygen to the heart muscle is reduced, causing chest pain. Arterial
blockage by clots formed in a human body may be relieved in a
number of traditional ways. Drug therapy, including nitrates,
beta-blockers, and peripheral vasodilatator drugs to dilate the
arteries or thrombolytic drugs to dissolve the clot, can be
effective. If drug treatment fails, angioplasty may be used to
reform or remove the atherosclerotic plaque or other deposits in
the artery.
[0003] Traditional balloon angioplasty is sometimes used to address
the blockage by inserting a narrow, flexible tube having a balloon
into an artery in the arm or leg. The blocked area in the artery
can be stretched apart by passing the balloon to the desired
treatment site and gently inflating it a certain degree. In the
event drug therapy is ineffective or angioplasty is too risky
(often introduction of a balloon in an occluded artery can cause
portions of the atherosclerotic material to become dislodged which
may cause a total blockage at a point downstream of the subject
occlusion thereby requiring emergency procedures), the procedure
known as excimer laser angioplasty may be indicated.
[0004] Excimer laser angioplasty procedure is similar in some
respects to conventional coronary balloon angioplasty. A narrow,
flexible tube, the laser catheter, is inserted into an artery in
the arm or leg. The laser catheter contains one or more optical
fibers, which can transmit laser energy. The laser catheter is then
advanced inside the artery to the targeted obstruction at the
desired treatment site. After the laser catheter has been
positioned, the laser is energized to "remove" the obstruction.
[0005] In many procedures, the lesion is often engaged similar to
conventional balloon angioplasty by crossing the blockage with a
guidewire. The laser catheter's thin, flexible optical fibers
facilitate the desired positioning and alignment of the catheter.
Using the excimer laser, the clinician performs a controlled
blockage removal by sending bursts of ultraviolet light through the
catheter and against the blockage, a process called "ablation." The
catheter is then slowly advanced through the blockage reopening the
artery. If there are multiple blockages, the catheter is advanced
to the next blockage site and the above step is repeated. When the
indicated blockages appear to be cleared, the catheter is
withdrawn.
[0006] However, due to the configuration of the optical fibers in
most prior art laser catheters, the clinician is able to ablate
only material that is typically directly in front of the distal end
of the catheter. Thus, the debulked tissue area is limited to an
area approximately the size of the optical fiber area at the distal
end of the catheter. Typically, follow-up angioplasty is
recommended.
[0007] Thus, it would be desirable to provide an apparatus and
methods that could bias the distal end of the laser catheter in a
desired direction to enable the clinician to ablate an area larger
than the area of the distal end of the catheter. Furthermore,
because plaque may be eccentric in a blood vessel and require
directional control to adequately ablate the target area, it would
be advantageous to provide an apparatus that is sufficiently
flexible to travel and rotate around the target area so that the
clinician may control the area to be ablated.
BRIEF SUMMARY OF THE INVENTION
[0008] In accordance with some embodiments, without limitation, a
catheter is provided having an elongated housing, a laser delivery
member, a cavity disposed within the elongated housing, a ramp
disposed within the cavity, a slot disposed within the elongated
housing, and a guidewire. The elongated housing may have a central
axis between a first proximal end and a first distal end and/or may
have a channel disposed between the first proximal end and the
first distal end. The laser delivery member may have a second
proximal end, a second distal end, and at least one optical fiber.
The laser delivery member may be at least partially disposed within
the channel and movable therein. The cavity may be disposed
proximate the first distal end of the elongated housing and/or may
be in mechanical communication with the channel. The ramp may be
disposed at an angle to the central axis and proximate the first
distal end of the elongated housing. The ramp may be in mechanical
communication with the channel. The ramp may also be adapted to
move the second distal end of the laser delivery member outwardly
from the central axis of the elongated member. The guidewire may be
in mechanical communication with both the laser delivery member and
the elongated housing. The guidewire may be adapted to bias the
second distal end of the laser delivery member generally inwardly
toward the central axis. The slot may disposed proximal to the
cavity and may be in mechanical communication with the channel and
the cavity. The slot may be configured to permit a portion of the
guidewire to move from within the channel outwardly from the
central axis of the elongated housing when the second distal end of
the laser delivery member moves outwardly from the central axis of
the elongated member when engaged with the ramp.
[0009] In some embodiments, the guidewire may be at least partially
eccentrically disposed within the laser delivery member. In other
embodiments, a trigger in mechanical communication with the laser
delivery member and the elongated housing may be include. The
trigger may be configured to actuate the laser delivery member
relative to the elongated housing. The trigger may actuate the
laser delivery member relative to the elongated housing in response
to trigger actuation. For example, the trigger may actuate the
laser delivery member from a first position relative to the
elongated housing to a second position relative to the elongated
housing. In some examples, the laser delivery member may be at
least partially disposed within the cavity in the first position
and may be at least partially disposed external to the cavity in
the second position.
[0010] In accordance with some embodiments, without limitation, a
catheter is provided having an elongated housing, a light guide, a
guidewire, and a monorail. The elongated housing may have a central
axis, a distal end, a proximal end and a housing channel disposed
between the distal end and the proximal end. The light guide may
have a distal end and a proximal end. The guidewire may be at least
partially disposed within the housing channel and in mechanical
communication with the light guide and the elongated housing. The
monorail may be an attachment or may be integrally coupled with the
elongated housing. The monorail may also have a central axis
substantially parallel with the central axis of the elongated
housing. In some embodiments, the monorail may also include: a
monorail proximal end coupled with the distal end of the elongated
housing; a monorail distal end; a monorail channel in mechanical
communication with the housing channel and extending from the
monorail proximal end to the monorail distal end, the channel; a
window in mechanical communication with the monorail channel; a
ramp; and a slot.
[0011] In some embodiments, the ramp may be disposed between the
window and the monorail distal end at an angle to the central axis
of the monorail tip. The ramp may be in mechanical communication
with the monorail channel and/or may be adapted to guide the distal
end of the light guide outwardly from the central axis of the
monorail tip as the distal end of the light guide is moved toward
the monorail distal end. The slot may be disposed between the
monorail distal end and the window. The slot may be in mechanical
communication with the monorail channel and the window. The slot
may be configured to permit a portion of the guidewire to move from
within the monorail channel outwardly from the central axis of the
monorail tip when the distal end of the light guide moves outwardly
from the central axis of the monorail when engaged with the
ramp.
[0012] In some embodiments, the monorail channel may include a
distal monorail channel proximate to the monorail distal end, and
sized to allow the guidewire to pass therethrough, and/or a
proximal monorail channel proximate to the monorail proximal end,
and sized to all the guidewire and the light guide to pass
therethrough. In some embodiments, the guidewire may be
eccentrically disposed within at least a portion of the light
guide. In some embodiments, the slot width may be greater than the
width of the guidewire and/or less than the width of the light
guide. In some embodiments, a marker band may be disposed between
the monorail distal end and the window.
[0013] In yet other embodiments a trigger may be coupled proximate
with the elongated housing and the light guide. The trigger may be
configured to actuate the light guide from a first position
relative to the elongated housing to a second position relative to
the elongated housing. In some embodiments, the trigger may be
configured to actuate the light guide from the second position to
the first position.
[0014] A catheter comprising an elongated housing, a fiber optic
bundle, a monorail, a guidewire, and biasing means is provided
according to another embodiment. The elongated housing may have a
central axis, a distal end, a proximal end and a housing channel
disposed between the distal end and the proximal end. The fiber
optic bundle may include a distal end and a proximal end. The
monorail may have a monorail distal end, a monorail proximal end, a
central axis substantially parallel with the central axis of the
elongated housing, and a monorail channel in mechanical
communication with the housing channel extending from the monorail
proximal end to the monorail distal end. The proximal end of the
monorail may be mechanically coupled with the distal end of the
housing channel. The guidewire may be at least partially disposed
within the housing channel and at least partially disposed within
the monorail channel. In some embodiments, a portion of the
guidewire may exit the monorail through the monorail channel at the
distal end of the of the monorail. In yet other embodiments, the
guidewire may be in mechanical communication with the fiber optic
bundle. The biasing means may be coupled with the monorail for
biasing a portion of the fiber optic bundle proximal to the distal
end of monorail at a position external to the monorail and
substantially parallel with the central axis of the monorail.
[0015] A catheter may also include means for allowing the guidewire
to extend from the distal end of the fiber optic bundle and exit
the monorail through the monorail channel at the distal end of the
monorail channel. The catheter may also include actuating means for
actuating the distal end of the fiber optic bundle from a position
within the monorail channel to a position external to the monorail
in coordination with the biasing means.
[0016] A catheter comprising an elongated housing, a light guide,
and a guidewire is provided according to another embodiment.
According to this embodiment, the elongated housing may have a
central axis, a housing distal end, a housing proximal end and a
housing channel disposed between the distal end and the proximal
end. The light guide may have a distal end and a proximal end and
may be at least partially disposed within the housing channel. The
guidewire may be at least partially disposed within the housing
channel and in mechanical communication with the light guide and
the elongated housing. The elongated housing may further include a
window in communication with a portion of the housing channel. The
elongated housing may also include a ramp disposed within the
window at an angle to the central axis of the elongated housing
that may be in communication with the housing channel and adapted
to guide the distal end of the light guide outwardly from the
central axis of the housing as the distal end of the light guide is
moved toward the housing distal end. The elongated housing may also
include a slot disposed between the housing distal end and the
window. The slot may be in mechanical communication with the
housing channel and the window and/or may be configured to permit a
portion of the guidewire to move from within the housing channel
outwardly from the central axis of the housing when the distal end
of the light guide moves outwardly from the central axis of the
housing when engaged with the ramp.
BRIEF DESCRIPTION OF THE DRAWINGS
[0017] The features and inventive aspects of the present invention
will become more apparent upon reading the following detailed
description, claims, and drawings, of which the following is a
brief description.
[0018] FIG. 1 is perspective elevated view of a catheter according
to one embodiment.
[0019] FIG. 2 is an exploded perspective view of a cavity of FIG.
1.
[0020] FIG. 3 is an exploded perspective view of FIG. 1 showing one
embodiment of a ramp.
[0021] FIG. 4 is an exploded perspective view of FIG. 1 showing a
ramp, a laser delivery member, and a guidewire.
[0022] FIG. 5 is a perspective elevated view of a first embodiment
of a support structure.
[0023] FIG. 6 is a top plan view of FIG. 5.
[0024] FIG. 7 is a side plan view of FIG. 5.
[0025] FIG. 8 is a top plan view of a second embodiment of a
support structure.
[0026] FIG. 9 is a side plan view of FIG. 8.
[0027] FIG. 10 is a perspective elevated view of a third embodiment
of a support structure.
[0028] FIG. 11 is a top plan view of FIG. 10.
[0029] FIG. 12 is a perspective elevated view of a fourth
embodiment of a support structure.
[0030] FIG. 13 is a perspective elevated view of a fifth embodiment
of a support structure.
[0031] FIG. 14 is a perspective elevated view of a sixth embodiment
of a support structure.
[0032] FIG. 15 is a top plan view of a seventh embodiment of a
support structure.
[0033] FIG. 16 is a perspective elevated view of FIG. 15.
[0034] FIGS. 17A and 17B show top and side views of a laser
catheter with a fiber optic bundle disposed within a window
according to some embodiments.
[0035] FIGS. 18A and 18B show top and side views of a laser
catheter with a fiber optic bundle externally biased according to
some embodiments.
[0036] FIG. 19A shows a catheter with a monorail tip and a
guidewire introducer according to another embodiment.
[0037] FIGS. 19B and 19C show different embodiments of a guidewire
introducer according to some embodiments.
[0038] FIG. 20 shows a catheter with an externally biased fiber
optic bundle according to some embodiments.
[0039] FIGS. 21A and 21B show portions of the monorail tip with
cavity and a slot according to some embodiments.
[0040] FIGS. 22A and 22B show examples of a trigger mechanism that
may be employed at the proximal end of a laser catheter to actuate
a fiber optic bundle within an elongated catheter body according to
some embodiments.
[0041] FIG. 23 shows a catheter with a monorail tip coupled with a
trigger mechanism according to one embodiment.
[0042] FIG. 24A-F show two views of a catheter lock-actuation
mechanism in various positions according to some embodiments.
DETAILED DESCRIPTION OF THE INVENTION
[0043] Referring now to the drawings, illustrative embodiments are
shown in detail. Although the drawings represent some embodiments,
the drawings are not necessarily to scale and certain features may
be exaggerated to better illustrate and explain an innovative
aspect of an embodiment. Further, the embodiments described herein
are not intended to be exhaustive or otherwise limit or restrict
the embodiments of the invention to the precise form and
configuration shown in the drawings and disclosed in the following
detailed description.
[0044] Referring now to FIGS. 1-4, a catheter 10 is shown having an
elongated housing 12. The elongated housing 12 includes a central
axis between a first proximal end 14 and a first distal end 16. A
cavity 18 is located proximate to the first distal end 16 of
elongated housing having a ramp 20 at an angle to the central axis
of the housing 12. The angle of the ramp may but need not be the
same over the length of the ramp. In some preferred embodiments,
without limiting the scope of the invention, the housing includes a
tapering end and a guide wire aperture 32 capable of accepting the
guidewire 28. A laser delivery member 22 comprising one or more
optical fibers capable of transmitting light energy is disposed
within a channel 26 of the housing 12 having a second proximal end
(not shown) and a second distal end 24 movable therein. In some
embodiments, without limitation, the laser delivery member 22 may
be in mechanical communication with a guidewire 28 as further
discussed below.
[0045] The guidewire 28 is threaded through a needle (not shown)
into the artery and the needle is removed. The guidewire is
advanced to or near the treatment site and may be inserted at its
distal end into or across the lesion to be treated, as desired. The
guidewire 28 serves as a tracking guide for the housing 12 and
laser delivery member 22 to run on. Guidewires for such uses are
known in the art and may comprise those with diameters between
about 0.010 and 0.06 inches, with 0.014 and 0.018 inches diameter
being typical sizes for artery applications. The guidewires may
have bendable tips of coiled wire or plastic and a more rigid shaft
of tapered ground stainless steel or other suitable material for
push and torque transmission. The housing 12 and laser delivery
member 22 are introduced coaxially, either sequentially or
simultaneously, onto the guidewire 28 and advanced to a target area
as further discussed below.
[0046] In some embodiments, without limitation, the housing 12 is
introduced onto the guidewire 28 that has been inserted into the
patient, and the housing is advanced to or near the treatment site
such that portions of the guidewire 28 are disposed at least
initially within the guide wire aperture 32, tapering end 30, and
channel 26 of the housing. The laser delivery member 22 is then
introduced onto the guidewire 28 so disposed within the catheter
The laser delivery member 22 is then advanced along the guidewire
28 such that the distal end 24 of the laser delivery member 22
becomes supported by the ramp 20 and oriented within the cavity 18
at any angle between 1 degree and 90 degrees in relation to the
central axis of the housing 12, as desired by the user. Laser
energy is then applied to the treatment site according to methods
and protocols known to those of ordinary skill in the art. In some
embodiments, without limiting the scope of the invention, in
conjunction with the application of laser energy, the position of
the laser delivery member 22 may optionally be varied by the user
by moving the member 22 proximally or distally in order to adjust
the angle of disposition of its distal end 24. Optionally, the
offset of the central axis of the tip of the laser delivery member
22 from the central axis of the housing 12 may be varied by
adjusting the distance that the delivery member 22 travels on the
ramp 20 while keeping the central axis of the tip substantially
parallel to the central axis of the housing 12. In addition, the
catheter 10 containing the laser delivery member 22 may optionally
be rotated along its central axis during the laser treatment and
thereby apply laser energy to areas of the treatment site within
the arc of the rotation. Optionally, the guidewire 28 may be
withdrawn before application of laser energy and after the laser
delivery member 22 has been introduced via the guidewire 28 into
the channel 26 of the housing 12.
[0047] In some embodiments, the elongated housing 12 is an
elongated structure having a lumen or channel 26 large enough to
accommodate the laser delivery member 22 and guidewire 28. The
channel 26 extends the entire length of the housing 12 from the
first proximal end 14 to the first distal end 16. Optionally, in
some embodiments, the channel 26 may extend only to the ramp 20.
Various control mechanisms including electrical, optical, and
mechanical control mechanisms may be employed with the housing 12
permitting the catheter to be specifically directed to a target
area (not shown) within the blood vessel. One embodiment of the
housing includes a tapering end 30 and a guide wire aperture 32
capable of accepting the guidewire 28. The housing 12 may be made
from any rigid, semi-flexible, or flexible material including a
combination thereof made from a material including metal, plastic,
rubber, and the like. Round or flat metal ribbon wire may be
embedded within the material, inserted through the cavity 18, or
disposed at the first distal end 16 to add stability to the housing
12 at the first distal end 16. The length of the housing 12 may be
varied as desired. The housing 12 may be one piece or have a
plurality of sections including a support structure section at the
first distal end 16 as discussed further below. The distal end 16
of the housing 12 may include a non-traumatic polymer tip separate
or integrated into the housing 12. This allows the forces seen in
bending to be dissipated throughout the structure, reducing stress
risers that could cause failure. The housing 12 may also include at
least one wire disposed within the channel 26 to add robustness to
the housing 12. The channel 26 is in communication with cavity 18
and wire aperture 32. The channel 26 is open to the exterior of the
housing 12 through the cavity 18.
[0048] The ramp 20 is disposed within cavity 18 and is configured
to project the laser delivery member 22 outwardly at various
determinable angles. Optionally, the ramp 20 is used to determine
the offset of the central axis of the tip of the laser delivery
member 22 from the central axis of the housing 20, while keeping
the axis substantially parallel, by adjusting the extent to which
the laser delivery member 22 travels on the ramp 20. In some
embodiments without limitation, the disposition of the laser
delivery member 22 on the guidewire 28 maintains the offset tip
substantially parallel to the central axis of the housing In some
embodiments, without limitation, the angle of lateral deviation of
the ramp 20 from central axis of the housing 12 will vary in range
as desired from one (I) degree to ninety (90) degrees, more usually
in the range from thirty (30) degrees to sixty-five (65) degrees.
By employing ramp 20 having different exit angles from the
associated channel 26, different angles and/or offsets may be
selected for treating a target area after the catheter 10 has been
located within a patient. In some embodiments, without limitation,
the ramp 20 may be adjustable, as one example only, by inflation of
a balloon, and/or the ramp 20 may be slidable to allow varying
degrees of offset.
[0049] The ramp 20 may be a built-up feature within the channel 26
of the housing 12 and may be located anywhere along the
longitudinal length of the housing 12, but preferably at or within
about 3 cm from the first distal end 16 of the housing 12. The ramp
20 may be formed or fused to the internal wall of the housing 12
and made from metal, plastic, rubber, and the like. In one
embodiment, the ramp length (RL) is generally 1 cm. However, the
ramp length (RL) may also be varied.
[0050] The first distal end 16 of the housing 12 may be formed from
plastic, metal, or any combination thereof. When metal is used,
materials must be selected to provide appropriate flexibility
without producing failure since the cavity 18 tends to reduce the
structural integrity of some portions of the housing 12. Thus, in
some embodiments, the first distal end 16 comprises a shape memory
alloy, as one example only, nickel-titanium alloy. In other
embodiments, without limitation, the first distal end 16 may
comprise a stent-like structure proximal, distal, within, or a
combination of such proximate the cavity 18. The stent-like
structure may be made from at least one of stainless steel,
cobalt-chromium, nickel titanium, and the like.
[0051] An alternative embodiment of the housing 12 comprises having
at least one section at the first distal end 16. A first embodiment
of a support structure is support member 34 as shown in FIGS. 5-7.
The support member 34 may be used to support the first distal end
16 while providing flexibility without producing failure. The first
distal end 16 of the housing may otherwise experience limited
torsional and bending strength of the area around the cavity 18
specifically traversing bends having a radius of about 0.75 inches.
The support member 34 assists in withstanding the torsional and
bending forces when traversing bends of about 0.75 inches, while
maintaining aspects of both integrity and functionality. In some
embodiments, without limitation, support member 34 reinforces the
area around the cavity 18 at the first distal end 16 with struts 36
forming a stent-like pattern 38. Support member 34 is formed from
metal, plastic, or combinations thereof, and is at least partially
axially disposed around the wall of the first distal end 16 of the
housing 12. The housing 12 may be one longitudinal piece or have a
plurality of sections including the support structure as described
above disposed at the first distal end 16 of the housing 12. Other
embodiments of the support structure include a marker band
proximate the first distal end 16 of the housing 12 and radiopaque
markers at various intervals along the ramp 20 to demarcate
acceptable ramp 20 positions for the catheter 10. As one example
only, a user may place a catheter at a first mark on the ramp to
increase the offset for ablation to 1 mm. A second mark might equal
a 1.5 mm offset. This way the support structure may be used
progressively, as one example only, as a progressive atherectomy
tool. Additional embodiments having generally similar benefits may
also be used, as further discussed below.
[0052] Referring to FIGS. 8 and 9, a second embodiment of a support
structure is shown as second support member 40 having a spring-like
geometry 42. The support member 40 may be used to support the first
distal end 16 while providing flexibility without producing
failure. The second support member 40 acts as a backbone for the
first distal end 16 of the housing The spring-like geometry 42
permits flexing without causing failure. The height H of the
spring-like geometry 42 may be of any height but is preferably
below the centerline of the second support member 40. The ramp 20
may be molded over the spring like geometry 42 including having a
top coat (not shown).
[0053] Referring to FIGS. 10 and 11, a third embodiment of a
support structure is shown as a third support member 44. The
support member 44 may be used to support the first distal end 16
while providing flexibility without producing failure. The third
support member 44 provides variable stiffness along the length of
the member 44. Member 44 is the most rigid at rib 46 and most
flexible at rib 48. This flexibility is accomplished by having the
ribs increase in width W and distance D in addition to decreasing
the side of a beam 50 as shown in FIG. Beam 50 tapers from a first
wide beam width BW1 to a narrower beam width BW2. A tip 52 having a
tip length TL disposed at the distal end support member 44
functions to provide support for the first distal end 16 of the
housing 12 while allowing additional flexibility. The ramp 20 may
be molded over the spring-like geometry 42 including having a top
coat (not shown). The support member length L may be varied
depending on user requirements including varying the tip length
TL.
[0054] FIG. 12 shows a fourth embodiment of a support structure as
fourth support member disposed at the first distal end 16 of the
housing 12. The support member 54 may be used to support the first
distal end 16 while providing flexibility without producing
failure. Support member 54 includes a rigid body 56 and a variably
rigid base 58 extending from the body 56. Body 56 includes an
aperture 57 in communication with channel 26. The base 58 may be
elastomeric having the greatest flexibility at distal end 60. The
ramp 20 may be molded over the base 58 including having a top coat
(not shown). The support member base length BL may be varied
according to user requirements.
[0055] FIG. 13 shows a fifth embodiment of a support structure as
fifth-support member 62. The support member 62 includes a rigid
body 64 having a flexible tapered nose portion 66. At least the
nose portion 66 may be comprised of elastomeric material, as one
example only, Rebax 55D available from Arkema. The body 64 is
configured to communicate with the first distal end 16 of the
housing 12. An aperture 68 is disposed within body 64 in
communication with channel 26 of the housing 12 and is configured
to accommodate both the laser delivery member 22 and guidewire 28.
Aperture 68 is also in communication with the nose window 69. The
nose window 69 of the nose portion 66 includes a nose ramp 70
configured to project the laser delivery member 22 outwardly at
various predetermined angles. Optionally, the ramp 20 is used to
determine the offset of the central axis of the tip of the laser
delivery member 22 from the central axis of the housing 20, while
keeping the axes substantially parallel, by adjusting the extent to
which the laser delivery member 22 travels on the ramp 20. In some
embodiments without limitation, the disposition of the laser
delivery member 22 on the guidewire 28 maintains the offset tip
substantially parallel to the central axis of the housing 12.
Usually, the angle of lateral deviation of the ramp 20 from the
housing 12 will vary in range as desired from one (1) degree to
ninety (90) degrees, more usually in the range from thirty (30)
degrees to sixty-five (65) degrees. The nose portion also includes
a nose channel 72 and a nose guidewire aperture 74. The guidewire
28 disposed within and in mechanical communication the laser
delivery member 22 extends outwardly from the second distal end 24
of the laser delivery member 22 and is guided through the nose
channel 72 and extending out the guidewire aperture 74. Both the
nose channel 72 and guidewire aperture 74 provide securement for
the guidewire 28 so that the guidewire 28 may properly bias the
second distal end 24 of the laser delivery member 22 generally
inwardly toward the central axis of the body 64.
[0056] FIG. 14 shows a sixth embodiment of a support structure as
sixth support member 80. The support member 80 may be used to
support the first distal end 16 while providing flexibility without
producing failure. Support member 80 includes a rigid body 82 and
at least two variably rigid legs 84 extending from the body 82.
Body 82 includes an aperture 86 in communication with the channel
26. The body 82 may be elastomeric having the greatest flexibility
at distal end 88. The legs 84 may be of any shape extending from
the body 82. The ramp 20 may be molded over the legs 84 including
having a top coat (not shown). The support member leg length LL may
be varied depending on user requirements.
[0057] FIGS. 15 and 16 show a seventh embodiment of a support
structure as seventh support member 90. The support member 90 may
be used to support the first distal end 16 while providing
flexibility without producing failure. The first distal end 16 of
the housing may otherwise experience limited torsional and bending
strength of the area around the cavity 18 specifically traversing
bends having a radius of about 0.75 inches. The support member 90
assists in withstanding the torsional and bending forces when
traversing bends of about 0.75 inches while maintaining both
integrity and functionality. Support member 90 reinforces the area
around the cavity 18 at the first distal end 16 with a braid 92
forming a stent-like pattern 94. Support member 90 is formed from
metal or plastic and is at least partially axially disposed around
the wall of the first distal end 16 of the housing 12. The housing
12 may be one longitudinal piece or have a plurality of sections
including the support structure as described above disposed at the
first distal end 16 of the housing 12. Support member 90 includes a
rigid body 92 and a variably rigid base 94 forming the stent-like
pattern 94 extending from the body 92. Body 92 includes an aperture
96 in communication with channel 26. The base 94 may be elastomeric
having the greatest flexibility at distal end 98. A tip 100 having
a tip length TL disposed at the distal end support member 90
functions to provide support for the first distal end 16 of the
housing 12 while allowing additional flexibility. The ramp 20 may
be molded over the base 94 including having a top coat (not shown).
The support member stent-like length SL may be varied depending on
user requirements.
[0058] In operation, once the guidewire 28 is in place, or as it is
being positioned, the housing 12 is inserted. This housing 12 has a
central channel 26, which may include the laser delivery member 22
and guidewire 28. The housing 12 and the laser delivery member 22
are advanced through the guidewire into the desired target area.
Therefore, the guidewire 28 is in mechanical communication with
both the laser delivery member 22 and the elongated housing 12.
However, the housing 12 may be advanced prior to inserting the
laser delivery member 22. As the laser delivery member 22
approaches the ramp 20, it is biased in an outwardly direction
through the cavity 18. The further the laser delivery member 22 is
advanced, the more it projects outwardly from the cavity 18 at the
first distal end 16 of the housing 12. In some embodiments, without
limitation, the guidewire 28 disposed within the laser delivery
member 22 biases the second distal end 24 of the laser delivery
member 22 inwardly providing a travel path and forcing the second
distal end 24 to face forward along the guidewire 28 and generally
parallel to the centerline of the housing 12. Otherwise, the second
distal end 24 of the laser delivery member 22 would continue along
the ramp 20 further projecting away from the centerline of the
housing 12 and would not be "attacking" the target area in front of
the catheter 10 as desired.
[0059] FIGS. 17A, 17B, 18A, 18B, 19, 20, 21A, 21B, 22 and 23
provided examples of various other embodiments. Some of these
embodiments may be related to one or more embodiments described
above.
[0060] FIGS. 17A and 17B show top and side views of a catheter with
fiber optic bundle 22 (laser delivery member or light guide)
disposed within cavity 18 according to some embodiments. FIGS. 18A
and 18B show top and side views of a catheter with fiber optic
bundle 22 externally biased. The catheter include an elongated
housing 12 with a fiber optic bundle (laser deliver member or light
guide) 22 within the inner lumen 26 of the catheter. Fiber optic
bundle 22, for example, may include one or more optical fibers
bundled within a sheath for the deliver of laser energy toward the
distal end 24 of the fiber optic bundle. Elongated housing 12 may
include a monorail tip 30 that may be an integral part of the
elongated housing or a detachable tip according to some
embodiments. The monorail tip 30 may include a cavity that exposes
portions of the fiber optic bundle. The monorail tip 30 includes a
monorail channel 164 that directs the guidewire from within the
fiber optic bundle toward an exit aperture 32 of the monorail tip
30. The monorail 30 tip may also in clued a ramp 160 and a slot
162. The ramp 160 may be integral with the monorail tip 30. The
slot 162 may be mechanically connected with the monorail channel
164 and the cavity 18.
[0061] Using an actuator, for example, an actuator like the one
shown in FIG. 22, fiber optic bundle 22 may be moved from the
position shown in FIGS. 17A and 17B to the position shown in FIGS.
18A and 18B. Looking at FIG. 17A, as fiber optic bundle 22 is
linearly actuated within channel 26 of elongated housing 12, the
distal end of fiber optic bundle 24 is engaged by ramp 160. As the
distal end of fiber optic bundle 24 is actuated forward, the distal
end 24 moves up the ramp 160. While distal end 24 moves up ramp
160, a portion of guidewire 28 moves from within channel 164
through slot 162. Ramp 160 may be linear or nonlinear. In some
embodiments, ramp 160 has a steep slop, in other embodiments ramp
160 has a gradual slope. In some embodiments ramp 160 has a gradual
curve in some positions and more steep curve in other portions.
Slot 162 may also pass through ramp 160. Cavity 18 may comprise any
size or shape and may be configured to permit the distal end of the
fiber optic bundle to move from within cavity 18 as shown in FIGS.
17A and 17B up the ramp to the position shown in FIGS. 18A and
18B.
[0062] Monorail tips disclosed throughout this disclosure in
various embodiments may be manufactured from plastic or metallic
materials. Monorail tips may include, for example, one or more
marker bands. For example, a marker band may be located near the
distal end of the monorail tip. A marker band may also be located
near the window or a monorail tip. If more than one marker band is
used, the bands may have different widths or constructed with outer
distinguishing features
[0063] FIGS. 18A and 18B show the fiber optic bundle 22 at a
resting position after actuation. In this position, for example,
guidewire 28 biases distal end 24 toward the central axis of
elongated housing 12. Guidewire 28, in this position, exits fiber
optic bundle 22, passes through slot 162, passes through channel
164 and exits the elongated housing 12 through guide wire aperture
34. Slot 16 allows guidewire 28 to bias fiber optic bundle 22
toward the central axis of housing 12. FIG. 19 shows an example of
an apparatus that may provide both channel 164 and slot 162.
[0064] FIGS. 17A, 17B, 18A and 18B also show examples of guidewire
28 positioned eccentrically within at least a portion of fiber
optic bundle 22. For example, guidewire 28 may exit distal end 24
of the fiber optic bundle 22 from an off axis position. The
eccentricity may decrease any optical dead area behind guidewire
28, which may result in increased light intensity from the fiber
optic bundle 22.
[0065] The catheter tip may also include a separate monorail tip
coupled with the elongated housing and the fiber optic bundle. The
tip may be removable or non-removable. In some embodiments, the tip
includes at least a ramp and a slot as described in regard to FIGS.
17A, 17B, 18A and 18B. In some embodiments, the monorail tip may
include a window (or cavity), a proximal monorail channel for
receiving the fiber optic bundle, and/or a distal monorail channel
through which the guidewire may exit the monorail tip. In some
embodiments, the monorail tip may be integral with the
catheter.
[0066] As described above, the ramp 160 may be a built-up feature
within the channel 26 of the housing 12 and may be located anywhere
along the longitudinal length of the housing 12. For example, the
ramp may be located within about 3 cm from the first distal end 16
of the housing 12. The ramp 20 may be formed or fused to the
internal wall of the housing 12 and made from metal, plastic,
rubber, and the like. In other embodiments, the ramp may be
integrally formed as part of the walls of the housing. In one
embodiment, the ramp length may be about 0.5 cm, 1 cm, 1.25 cm, 1.5
cm, etc. In other embodiments, the ramp may be located about 0.5
cm, 0.75 cm, 1 cm, 1.25 cm, 1.5 cm, 1.57 cm, 2 cm, 2.25 cm, 2.5 cm,
etc from the distal end 16 of the housing 12.
[0067] The first distal end 16 of the housing 12 may be formed from
plastic, metal, or any combination thereof. In some embodiments,
the first distal end 16 of the housing may include a detachable
monorail tip. In other embodiments, the first distal end of the
housing may include an integral monorail tip that is not
detachable. When metal is used, materials must be selected to
provide appropriate flexibility without producing failure since the
cavity tends to reduce the structural integrity of some portions of
the housing 12. Thus, in some embodiments, the first distal end 16
may comprise a shape memory alloy, as one example only,
nickel-titanium alloy.
[0068] FIG. 19 shows a biasing catheter with a guidewire introducer
150 according to some embodiments. Guidewire introducer 150 aids in
introducing the guidewire within the catheter 12. In some
applications, for example, a physician may guide the distal end of
guidewire 28 into position with a patients arteries. Once in place,
the proximal end of guidewire 28 may be thread into the catheter
12. The introducer may simplify the threading process. After used,
the introducer 150 may be removed and possibly discarded. In other
applications, for example, the introducer may be used prior to
introducing the guidewire into the patient's arteries.
[0069] FIG. 19A also shows cavity 18 with ramp 160 disposed
therein. Fiber optic bundle (light guide or laser delivery member)
22 in a first position may rest within cavity 18. After actuation,
fiber optic bundle 22, for example, may move to a second position
such that the distal end of fiber optic bundle 22 is disposed
relative to the top of the ramp or beyond. In the second position,
guidewire 22 biases the distal end of fiber optic bundle 22 back
toward the elongated housing. As seen in FIG. 19, slot 162 is
coupled with ramp 160. Moreover, a portion of slot 162 extends
through ramp 160. At the distal end of ramp 160, the guidewire may
continue through an internal cavity within the catheter and exit
the catheter through the distal aperture and/or through the
guidewire introduce 150. Guidewire introducer 150 may be used to
guide a guidewire into the monorail tip, into the catheter and into
the fiber optic bundle 22.
[0070] FIGS. 19B and 19C show examples of guidewire introducers
according to some embodiments. As shown in FIG. 19B, guidewire
introducer includes a funnel section 1905, a thumb tab 1915, and
elongated cylindrical section 1910. Elongated cylindrical section
1910 is coupled with funnel section 1905 and each have a channel
(not shown) running through the length of the cylindrical section
1910 and the funnel section 1905. The channel is sized to allow a
guidewire to pass there through. The funnel section 1910 may be
used to slide a guidewire through the channel. The larger opening
in the funnel section 1910 allows for simpler feeding of a
guidewire therethrough. Once a guidewire is within the channel, the
funnel section 1910 may be removed. The funnel section 1910 may
include perforations or may be scored along a portion of the funnel
to allow a user to remove the funnel while a guidewire extends
through the channel. In some embodiments, the funnel section 1910
may be ripped, peeled, or pulled from the elongated section and the
guidewire. In some embodiments, the body of the funnel section may
be ripped or peeled such that the channel within the body of the
funnel section may be exposed.
[0071] FIG. 19C shows another example of a guide wire introducer
150. In this embodiment, the thumb tab 1915 is not used. The funnel
includes an extended section 1920 that may be used by a user to
grip the funnel section 1905.
[0072] FIG. 20 shows a fiber optic bundle (light guide or laser
delivery member) 22 in a second position outside the cavity 18 of
the elongated housing 12. As shown, fiber optic bundle 22 is
positioned near the outer surface of the catheter. Fiber optic
bundle 22 may move from the first position shown in FIG. 19 to the
second position shown in FIG. 20 by actuating fiber optic bundle 22
relative to the elongated housing 12. During actuation, fiber optic
bundle 22 is engaged with ramp 160 and may move to an exterior
position as shown in FIG. 20. In the second position, the guidewire
28 enters the channel of the catheter through slot 162. Moreover,
in some embodiments, guidewire 28 may also apply a biasing force to
the fiber optic bundle 22 as it enters the slot and/or channel and
may bias the distal end of the fiber optic bundle toward the
central axis of the elongated housing 12.
[0073] FIG. 21 shows an example of a portion of the distal end of
the catheter or of a monorail tip that may be used to provide a
guidewire cavity and channel. As shown, slot 162 is proximate and
part of channel 164. Various sizes of slot 162 and/or channel 164
may be used as long as a guidewire may pass through each. Moreover,
slot 162 may have diameter smaller than the diameter of the fiber
optic bundle used with the catheter to restrict entry through the
slot only to the guidewire.
[0074] FIGS. 22A and 22B show examples of trigger mechanisms 174
according to some embodiments. Trigger mechanism 174 may be used to
actuate a fiber optic bundle relative to an elongated housing. Such
actuation may linearly advance the distal end of a fiber optic
bundle from the first a position, for example, as shown in FIG. 19,
to a second position, for example as shown in FIG. 20. The distal
end of the trigger 176 may be coupled with an elongated catheter
housing and a fiber optic bundle. The trigger, in some embodiments,
may also provide a positive stop mechanism and/or a retraction
mechanism. The trigger mechanism, for example, may linearly move
the fiber optic bundle 1-2 cm relative to the elongated housing. In
other embodiments, the trigger mechanism, for example may linearly
move the fiber optic bundle 0.5 cm, 0.75 cm, 1 cm, 1.25 cm, 1.5 cm,
1.75 cm, 2 cm, 2.25 cm, 2.5 cm, 2.75 cm, 3 cm, and/or 3.25 cm,
etc.
[0075] In some embodiments, trigger mechanism 174 linearly actuates
the fiber optic bundle a fixed distance. Such a mechanism removes
any guess work or subjectivity from manually actuating the fiber
optic bundle without a trigger mechanism 174. In other embodiments,
trigger mechanism 174 may have multiple stops. That is, the trigger
mechanism may actuate the fiber optic bundle from a rest position
to a first position. The trigger mechanism may then actuate the
fiber optic bundle from the first position to a second position.
From the second position the trigger mechanism may actuate the
fiber optic bundle back to the rest position. In some embodiments,
three, four, five, or more positions may be used. The trigger
mechanism may require sequentially moving from one position to the
next position. In another embodiment, the trigger mechanism may
permit actuation from any position to any other position.
[0076] Trigger mechanism 174, may include one or more levers,
buttons, and/or mechanical devices that may be used by a physician
to actuate the fiber optic bundle. As shown in FIG. 22A, trigger
mechanism 174 may include two handles 178 that may be gripped by
the fingers. As handles 178 are moved upward relative to the rest
of the trigger mechanism, the trigger mechanism 174 linearly
actuates the fiber optic bundle. A second movement of handles 178,
actuates the fiber optic bundle in an opposite direction causing
the fiber optic bundle to return to the previous position. Trigger
mechanism 174, in some embodiments, may employ springs that aide in
returning the fiber optic bundle from the second position back to
the first position. Moreover, various stop mechanisms may be
employed. While a mechanical trigger mechanism is shown in the
figures and described above, any other type of mechanism may be
used. For example, a motor and/or pressure actuated trigger
mechanism may be employed. In such examples, computer or electronic
control may be used to control the trigger mechanism. FIG. 22B
employs a disk that may be gripped by the fingers, rather than the
handles shown in FIG. 22A.
[0077] As shown in FIG. 22, the fiber optic bundle 176 may pass
directly through the trigger mechanism 174 and extend through the
catheter.
[0078] FIG. 23 shows a trigger mechanism coupled with a catheter 12
that includes a monorail tip 180 according to one embodiment.
[0079] FIGS. 24A and 24B show a side and top view of an example of
an internal trigger mechanism according to one embodiment. Various
portions of a trigger mechanism are not shown in these figures
solely for descriptive convenience. For example, finger grips are
not shown. Plunger 210 is coupled with mechanism body 215. Plunger
210 extends into a portion of mechanism body 215 and is coupled
with spring 205. A fiber optic cable and/or catheter may extend
from the proximal end 222 of plunger 210 through mechanism 215 and
exit through distal end 220 of mechanism body 215. Such a fiber
optic bundle or catheter may be coupled with plunger 210 and/or
slide through mechanism 215. An engagement arm 225 with tip 226 is
located within mechanism 215. A catch block 230 is coupled with
part of plunger 210. Catch block 230 includes a front end 242 and a
back end 240. Engagement arm 225 and catch block 230 work in
harmony to provide stop actuation to a fiber optic and/or catheter
coupled with plunger 210.
[0080] As plunger 210 is pressed toward mechanism body 215 by a
user, engagement arm 225 contacts the front end 242 of catch block
230. Engagement arm 225 becomes biased and locks with catch block
230 as shown in FIGS. 24C and 24D. Once in this position, plunger
210 may rest at this actuated position. When plunger 210 is pressed
again, engagement arm 225 moves passed catch block 230 as shown in
FIGS. 24E and 24F. Once past catch block 230, when pressure on
plunger 210 is released by the user, spring 205 pushes the plunger
back out. Engagement arm 225 slides over the top of catch block
230. The internal trigger mechanism may then return to the position
shown in FIGS. 24A and 24B.
[0081] Various other trigger mechanisms may also be used. For
example, the engagement arm may be coupled with the plunger and the
catch block may be coupled with the mechanism body. A similar
action may lock and/or actuate the plunger relative to the
mechanism body. Various other engagement arms and catch blocks may
be employed.
[0082] The lock-actuation mechanism described above and shown in
FIGS. 24A-24F may be used to actuate a fiber optic bundle through a
catheter body. The plunger, for example, may be coupled with the
fiber optic bundle and the mechanism body may be coupled with the
catheter body. Thus, the actuation and/or locking discussed above,
may actuate and/or lock a fiber optic bundle relative to the
catheter body.
[0083] The preceding description has been presented only to
illustrate and describe exemplary embodiments of the methods and
systems of the present invention. It is not intended to be
exhaustive or to limit the invention to any precise form disclosed.
It will be understood by those skilled in the art that various
changes may be made and equivalents may be substituted for elements
thereof without departing from the scope of the invention. In
addition, many modifications may be made to adapt a particular
situation or material to the teachings of the invention without
departing from the essential scope. Therefore, it is intended that
the invention not be limited to the particular embodiment disclosed
as the best mode contemplated for carrying out this invention, but
that the invention will include all embodiments falling within the
scope of the claims. The invention may be practiced otherwise than
is specifically explained and illustrated without departing from
its spirit or scope.
* * * * *