CA2365889C

CA2365889C - Percutaneous material removal device and method

Info

Publication number: CA2365889C
Application number: CA002365889A
Authority: CA
Inventors: Thomas R. Findlay, Iii; James R. Madonia
Original assignee: Edwards Lifesciences Corp
Current assignee: Edwards Lifesciences Corp
Priority date: 1999-04-30
Filing date: 1999-11-11
Publication date: 2010-01-05
Anticipated expiration: 2019-11-11
Also published as: DE69927719T2; US6238405B1; WO2000066010A1; AU1477800A; AU767363B2; EP1176915B1; US6623495B2; ATE306216T1; EP1176915A1; DE69927719D1; US20010005909A1; JP4079595B2; JP2002542874A; CA2365889A1

Abstract

A catheter-based material removal device includes an elongated tube having a distal material removal tip thereon. The material removal tip includes a one- or two-piece housing affixed to the tube, and a rotating member therein. The rotating member includes a screw thread for coarsely chopping material received within the housing and an outwardly projecting flange for finely chopping the material. The housing includes at least one shearing member located axially adjacent t he outwardly projecting flange. The shearing member has a relatively small circumferential size and a shearing edge that removes any material build-up on the axially-facing surface of the flange. Two shearing members may be provided, one each on both the proximal and dist al sides of the flange. There may be three flanges restrained within a groove formed with the housing. The shearing members are located adjacent to the groove and may have the shape of teeth, with arcuate inner faces spanning an included angle through the center of the housing of about 25 degrees. The shearing member on the housing extends inward from a lumen wall and the shearing edge thereon has a radiall y oriented portion and a curvilinear portion blending into tangency with the lumen wall.

Description

PERCUTANEOUS MATERIAL REMOVAL
DEVICE AND METHOD
Background of the Invention The Field of the Invention The present invention is related to methods and apparatus for clearing blocked natural and synthetic vessels, and more specifically, to methods and apparatus for percutaneously clearing material from vessels with a rotating device and suction.
Description of the Related Art A variety of techniques and instruments have been developed for use in the removal or repair of obstructive material in vessels and other body passageways. Such material may include atheromas, thrombi, or emboli. An atheroma is a mass of plaque of degenerated, thickened arterial intima occurring in atherosclerosis. A thrombus is an aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. An embolus is a clot or other plug brought by the blood from another vessel and forced into a smaller one, thus obstructing the circulation.
Many catheter-mounted devices are presently available for removing material from vessels. Some of these devices include rotatable abrasive members on the distal tip of a flexible catheter, which tend to remove hardened atherosclerotic materials without damaging the normal elastic soft tissue of the vessel wall.
Another material removal device is seen in the U.S. Patent No.
5,423,799 to Shiu, and includes a tubular housing mounted on the distal end of a catheter within which a helical screw member rotates. The screw includes a sharp edge which, in cooperation with housing, cuts the tissue and draws it into the housing for later removal.
Despite advances made in catheter-mounted material removal devices, many of them remain limited in their operational capacity, and tend to clog up fairly quickly. This necessitates the surgeon advancing very slowly through the material blockage, and greatly increases the length of surgery. In the worst-case, the device becomes irreversibly clogged, and must be removed and another device procured and substituted. Therefore, there remains a need for a more efficient catheter-mounted material removal device that can rapidly cut through a mass of blocking material without clogging.
Summary of the Invention In one embodiment, the present invention provides a device for removing material from a body lumen including an elongate, flexible tube having distal and proximal ends and a passageway therethrough. The device has a material removal tip on the distal end including an outer housing rotationally fixed with respect to the tube and a rotating member within the housing. The housing includes a lumen extending from a distal open mouth to the tube passageway. The rotating member includes distal and proximal ends, a central body, and a plurality of circumferentially spaced flanges extending radially outward from the body. At least one shearing member is formed within the lumen of the housing and axially adjacent to the flange to cooperate with the flange and shear material received in the housing mouth. The shearing member may be located distally or proximal with respect to the flanges, or shearing members on both sides of the flanges may be provided. The housing desirably includes proximal and distal sections, each including lumens, and an annular groove larger than either the distal or proximal sections and formed therebetween for axially restraining the flanges on the rotating member. The shearing member is preferably located adjacent to the groove. The housing may be fonmed in one piece or two separate pieces.

In a preferred embodiment, the rotating member has a central body and a helical screw thread thereon and is driven by a drive shaft that extends through a catheter attached to the housing. The shearing member has a radial dimension that brings it into close proximity with an associated rotating member. That is, a distal shearing member is sized to come into close proximity with the central body of the rotating member, while a proximal shearing member is sized to come into close proximity with a drive shaft.
In another aspect, the present invention provides a material removal tip for use in a catheter-mounted material removal device, comprising a rotatable member having an outwardly projecting shearing member, and a generally tubular housing sized to receive the rotatable member. The housing includes a stationary shearing member located axially adjacent to the rotating shearing member. The stationary and rotating shearing members cooperate to chop material received within the housing, reducing the clogging propensity of the material. There is preferably a plurality of rotating shearing members axially restrained within a groove formed on the inner surface of the housing. The stationary shearing member is desirably located adjacent to groove, either proximally, distally, or both in the case of two stationary shearing members.
In accordance with a particular aspect the present invention provides a percutaneous device for removing material from a body lumen comprising a material removal tip for a catheter-mounted device that comprises a rotatable member having a body and a distal first shearing member in the form of a screw thread and a generally tubular housing sized to receive the rotatable member for rotation therein, wherein the rotatable member chops material and draws material into the housing; characterized in that the device further includes a second shearing member mounted on the housing axially adjacent one or more shearing flanges mounted on the proximal end of the rotatable member, the second shearing member cooperating with the one or more shearing flanges to further chop the material.
The present invention further provides a method of material removal, including advancing through a body lumen a catheter-mounted material removal device having distal material removal tip including a hollow housing and a rotatable member therewithin. The rotatable member is rotated to engage the material, which is then sheared in the housing between relatively rotating shearing members to 3a reduce the clogging propensity of material. Subsequently, the sheared material is removed from within the housing as the device is further advanced through the body lumen.

Brief Description of the Drawings Figure 1 is a schematic view of a hand-held material removal system within which the material removal device of the present invention is incorporated;
Figure 2a is a longitudinal sectional view through one embodiment of a material removal tip of the present invention having a two-piece housing;
Figure 2b is an end elevational view of the material removal tip having a two-piece housing, taken along line 2b-2b of Figure 2a;
Figure 2c is a sectional view of a stationary shearing member of the proximal housing section in operation, taken along line 2c-2c of Figure 2b;
Figure 2d is a sectional view of a stationary shearing member of the distal housing section in operation, taken along line 2d-2d of Figure 2b;
Figure 3a is a longitudinal sectional view through a proximal housing section of the material removal tip of Figure 2a;
Figure 3b is an end elevational view of the proximal housing section, taken along line 3b-3b of Figure 3a;
Figure 4a is a longitudinal sectional view through a distal housing section of the material removal tip of Figure 2a;
Figure 4b is an end elevational view of the distal housing section, taken along line 4b-4b of Figure 4a;
Figure 5a is a longitudinal sectional view through a second embodiment of a material removal tip of the present invention having a one-piece housing;
Figure 5b is an end elevational view of the material removal tip having a one-piece housing, taken along line 5b-5b of Figure 5a;
Figure 6a is a longitudinal sectional view through the one-piece housing of the material removal tip of Figure 5a;
Figure 6b is an end elevational view of the one-piece housing, taken along line 6b-6b of Figure 6a;
Figure 7a is a longitudinal sectional view through an alternative one-piece housing in accordance with the present invention;

Figure 7b is an end elevational view of the alternative one-piece housing, taken along line 7b-7b of Figure 7a.

Description of the Preferred Embodiments 5 With reference to Figure 1, a material removal system 10 suitable for use with the present invention comprises an elongate flexible tube 12 having a proximal end 14 and a distal end 16. A hand-held control 18 attached to the proximal end 14 of the tube 12 permits manipulation of the system. The control 18 carries electronic circuitry, controls, and indicators. A source of vacuum communicates with the hand-held control 18 which in turn includes passages for creating a negative pressure in the interior of the tube 12. In addition, a drive motor (not shown) is mounted within the hand-held control 18 for supplying rotational motion to a flexible drive shaft 22 (Figure 2a) extending through the elongated tube 12. A tubular removal passageway 24 is thus defined in the space outside of the drive shaft 22 and within the flexible tube 12. The drive shaft 22 is preferably hollow to permit passage therethrough of a guidewire 28.
The present invention provides an improved distal material removal tip 30, which is shown in detail in Figures 2, 3 and 4. The removal tip 30 comprises an outer housing 32 and a member 34 received therewithin for rotation about an axis 37. The outer housing 32 has a substantially hollow tubular shape and comprises a distal section 36 and a proximal section 38, through which a continuous lumen 40 extends. The lumen 40 is defined by a distal lumen 42 within the distal section 36, a proximal lumen 44 within the proximal section 38, and an annular groove 461ocated intermediate the distal and proximal sections, all being axially aligned. In the illustrated embodiment, the groove 46 has a larger diameter than the distal lumen 42, which in turn has a larger diameter than the proximal lumen 44. The rotatable member 34 is received within the distal housing section 36, with a portion within the groove 46, as will be described below.

The aforementioned flexible tube 12 is seen in phantom coaxially received over a tubular body 50 on the proximal housing section 38. Likewise, the drive shaft 22 is seen in phantom extending through the flexible tube 12 and through the proximal lumen 44 into engagement with the rotatable member 34.
In this manner, the drive shaft 22 and member 34 rotate together within the housing 32. A number of different drive shaft configurations may be utilized with the present invention, none of which should be construed as limiting.
Both the elongated tube 12 and drive shaft 22 are seen in phantom in Figure 2a, and thus are not seen in the end view of Figure 2b.
As mentioned, the rotatable member 34 is partly received within the groove 46. More particular, the rotatable member 34 comprises a generally cylindrical or tubular body 56 from which a continuous helical screw thread 58 radially outwardly extends. The screw thread 58 begins at a distal face 60 of the member 34 and continues around the body 56 for approximately two-thirds of its length. A plurality of cantilevered fingers 62 defined by longitudinal slots 64 are provided on the proximal end of the member 34. Each of the fingers 62 carries an outwardly extending cutter or flange 66, each of which in axial projection has a generally truncated triangular shape as seen in Figure 2b.
There are preferably three such flanges 66 evenly circumferentially spaced and fonning somewhat of a propeller configuration about the rotatable member 34.
The flanges 66 terminate in outer tips that together define a circle having a diameter greater than the diameter of the distal lumen 42, but less than the diameter of the groove 46.
With reference to Figures 3a and 3b, the proximal housing section 38 includes the tubular body 50 terminating on its distal end in a radially outwardly extending annular shoulder 70 having a diameter that is reduced at a step 72 to a cylindrical land 74 ending at a distal face 76.
And seen in Figure 4a and 4b, the distal housing section 36 also includes a tubular body 80 extending from a distal mouth 82 to a proximal end 84. The lumen 42 extends proximally from the mouth 82 until a step 86 increases the diameter to that of a stepped bore 88.
The land 74 of the proximal housing section 38 has a diameter that is approximately equal to the diameter of the bore 88. Consequently, the distal end of the proximal housing section 38 is closely received within the bore 88 until the proximal end 84 contacts the step 72. By cooperation between the distal and proximal sections 36, 38, the groove 46 is defined on its outer side by the bore 88, and on respective axial sides by the distal face 76 of the proximal housing section 38 and the step 86 of the distal housing section 36. The rotatable member 34 is captured in the location of Figure 2a by cooperation between the outwardly projecting flanges 66 and the groove 46. The cantilevered fingers 62 enable inward deflection of the flanges 66 so that they can pass through the distal lumen 42 of the housing 32 and snap outward into the groove 46. The spacing between the flanges 66 and the groove 46 are slightly exaggerated in the drawings, and in a working model of the device the axial dimension of the flanges 66 will be slightly smaller than the spacing between the step 86 and the distal face 76. In this manner, the flanges 66 are constrained in the groove 46 from even slight axial movement.
The present invention provides at least one shearing member that is axially adjacent the flanges 66. In the embodiment of Figures 2-4, there are two such shearing members, a distal member 100 and a proximal member 102. The distal shearing member 100 projects radially inwardly with respect to the distal lumen 42 of the distal housing section 36. Likewise, proximal shearing member 102 projects radially inwardly with respect to the proximal lumen 44 of the proximal housing section 38. As seen best in Figure 4a, the distal shearing member 100 has a proximal face 104 which is co-extensive with the step 86.
The proximal face 104 is thus positioned on the edge of the groove 46 closely adjacent to the rotating flanges 66. In like manner, as seen in Figure 3a, the proximal shearing member 102 has a distal face 106 which is co-extensive with the distal face 76 of the proximal housing section 38. The distal face 106 is thus positioned on the edge of the groove 46 closely adjacent to the rotating flanges 66.
With reference to the detailed views of Figures 3-4, the shearing members 100, 102 in a preferred embodiment resemble teeth. More specifically, the distal shearing member 100 includes an arcuate inner face I

having a relatively small included angle 112 and transition surfaces 114 on either side joining the inner face to the distal lumen 42. The proximal shearing member 102 includes an arcuate inner face 120 having an included angle 122 and transition surfaces 124 on either side joining the inner face to the proximal lumen 44. The small included angles 112, 122 and generally radially oriented transition surfaces 114, 124 define shearing members 100, 102 of relatively small angular size. The angular size must of course be sufficient to provide shearing strength in operation, as will be described, but should be kept to a minimum to reduce the obstruction to flow of material through the housing 32.
As seen in Figure 2a, each of the shearing members 100, 102 has a radial dimension sufficient to bring its respective inner face 110, 120 into close proximity with an adjacent rotating element. That is, the inner face 110 of the distal shearing member 100 is spaced across a gap 130 from the body 56 of the rotatable member 34. Similarly, the inner face 120 of the proximal shearing member 102 is spaced across a gap 132 from the drive shaft 22. The gaps 130 and 132 are preferably minimized without risking contact between the respective rotating element and shearing member. More specifically, the gaps 130 and 132 are each desirably greater than zero but less than 0.0508 mm (0.002 inches). More preferably, the gaps 130 and 132 are each less than 0.0254 mm (0.001 inches), and most preferably the gaps are each less than 0.0127 mm (0.0005 inches).
Each of the inner faces 110, 120 of the shearing members 100, 102 preferably has an arcuate surface concentric with the axis of rotation of the adjacent rotating element. In addition, the inner faces 110, 120 preferably have a radius of curvature that corresponds to the adjacent rotating elements.

Namely, the distal shearing member 100 has an inner face 110 that is the same radius of curvature as the body 56 of the rotatable member 34, and the inner face 120 of the proximal shearing member 102 has a curvature that is the same as the external diameter of the drive shaft 22. In one embodiment, the radius of curvature of the inner face 110 is about 1.194 mm (0.047 inches), and the radius of curvature of the inner face 120 is about 0.991 mm (0.039 inches).
As illustrated in Figure 2b, the distal shearing member 100 is oriented 180 degrees about the housing 32 with respect to the proximal shearing member 102. In practice, the relative orientation of the shearing members 100, 102 about the housing 32 is not considered especially significant. Therefore, the shearing members 100, 102 may be axially aligned, or offset with respect to one another around the circumference of the housing 32 at any relative orientation.
The axial and circumferential dimensions of each of the shearing members 100, 102 must be sufficient to provide adequate strength without inordinately blocking the lumen 40 through the housing 32. In one embodiment, the distal lumen 42 has a diameter of approximately 1.75 mm (0.069 inches), and the distal shearing member 100 has an axial dimension of approximately 0.279 mm (0.011 inches) and an included angle of approximately degrees. In the same embodiment, the proximal lumen 44 has a diameter of 20 approximately 1.42 mm (0.056 inches), and the proximal shearing member 102 has an axial dimension of approximately 0.318 mm (0.0125 inches) and an included angle about of 25 degrees.
In use, the material removal tip 30 is inserted into a body vessel or other cavity using the aforementioned guidewire 28 and conventional catheter 25 introduction techniques not described further herein. The distal tip 30 is manipulated into close proximity with the target blockage or material deposit, the drive shaft 22 rotated, and the vacuum source 20 actuated. As the distal tip is advanced toward the material to be removed, the suction created at the mouth 82 tends to pull material into contact with the rotatable member 34 and 30 screw thread 58. The combination of suction and "Archimedes Screw" action of the screw thread 58 draws material into the distal housing section 36, and ultimately into contact with the rotating flanges 66. As the material is drawn through the distal housing section 36, the screw thread 58 performs a coarse chopping, reducing the largest material agglomerations in size. Subsequently, 5 the rotating flanges 66 more finely chop the material to reduce clogging of the tubular passageway between the drive shaft 22 and first the proximal lumen 44 and then the inner surface of the elongated tube 12.
It has been found that without a shearing member, such as provided by the distal and proximal members 100, 102, material tends to build up on the 10 axially-facing surfaces of the flanges 66. Eventually, buildup of material occludes the circumferential spaces between the flanges 66, greatly diminishing the capacity of material removal, and in some instances irreversibly clogging the device. Consequently, the present invention provides one or more shearing members to cut or otherwise knock material from the axially facing surfaces of the rotating flanges 66. Because of the relative movement between the flanges 66 and shearing members 100, 102, the discontinuous circumferential projection of the shearing members, and the close axial spacing between these relatively moving surfaces, material is effectively sheared from the axially facing surfaces of the flanges 66. Any material sheared from the flanges 66 is then exhausted in a proximal direction through the annular passageway 24 within the elongated tube 12. The flanges 66 are thus maintained clear of material, and their corners thus remain unobstructed and effective in finely chopping the material that reaches them.

With reference to Figures 3 and 4, the proximal face 104 of the distal shearing member 100 and the distal face 106 of the proximal shearing member 102 are preferably oriented normal to the axis of rotation 37 of the member 34.
In addition, the transition surfaces 114, 124 are preferably axially oriented.
As seen in Figures 2c and 2d, therefore, the cross-sections (taken circumferentially) of the shearing members 100, 102 are rectangular, and shearing edges 116, 126 are defined by perpendicular corners that face the leading edges of the oncoming flanges 66. The leading edges of each of the flanges 66 are likewise defined by perpendicular corners 68 so that the passage of the flanges 66 past the shearing members 100, 102 creates a scissor-like action, serving not only to clear material from the axial surfaces of the flanges 66 but also to sever fibrous matter present in any material caught therebetween. Alternatively, one or both of the cooperating edges on the flanges 66 and shearing members 100, 102 may be sharpened to knife edges to further facilitate the severing action, although there may be a limit to such sharpening dictated by strength considerations.
Figure 2c shows one flange 66 having material adhered thereto and approaching the proximal shearing member 102, while Figure 2d shows another flange 66 having just passed the distal shearing member 100 and been cleared of material.
To further facilitate the two functions of the shearing members 100, 102 (i.e., clearing material from the axial surfaces of the flanges 66 and also severing fibrous matter), the transition surfaces 114, 124 each have a radial portion that gradually transitions to blend into the base lumen wall, as seen in Figures 3b and 4b. That is, the transition surface 114 gradually curves into tangency with the wall of the distal lumen 42, and the transition surface 124 gradually curves into tangency with the wall of the proximal lumen 44. The curvilinear transition surfaces 114, 124 thus provide a radial shear component between the respective shearing edges 116, 126 and leading edges 68 of the rotating flanges 66. It will be clear, therefore, that the shearing action is scissor-like (as opposed to uni-directional shear) as the oncoming leading edge 68 of each flange 66 first reaches the radially outermost portion of each shearing edge 116 or 126, and then gradually reaches the rest of the shearing edge. This is preferred over a situation where the flange leading edge 68 reaches the entire shearing edge at once, which would be the case if the surfaces 114, 124 were entirely radially disposed. Of course, the latter arrangement is not precluded while still obtaining most of the benefits of the present invention.
As mentioned above, various other configurations of the material removal tip 30 are contemplated. For example, Figures 5-6 illustrate a material removal tip 150 having a one-piece housing 152 and a single shearing member 154. As before, the housing 152 includes a distal section 160, a proximal section 162, a distal lumen 164, a proximal lumen 166, and an intermediate groove 168. Likewise, the rotating member 170, identical to the member 34 previously described, includes outwardly projecting flanges 172 that are axially restrained within the groove 168. The elongated tube and drive shaft are not shown in Figure 5a for clarity.
As seen best in Figures 6a and 6b, the shearing member 154 is located just proximal to the groove 168, and thus corresponds to the proximal shearing member 102 described for the first embodiment. There is no distal shearing member in this embodiment. It all other aspects, the shearing member 154 is identical to the proximal shearing member 102 described above, and includes an arcuate inner face 174 spanning an included angle 176, transition surfaces 178, and a distal face 180 coincident with the proximal boundary of the groove 168.
The distal face 180 is thus axially adjacent the rotating flanges 172 and serves to knock material from the proximal faces of the flanges.
Although only one shearing member is shown located either distally or proximally with respect to the groove, those skilled in the art will recognize that two or more shearing members on either side can also be provided. It has been found that a single shearing member is sufficient to knock material from the axially facing surfaces of the flanges, and is preferred because it minimizes the obstruction to flow of material from the distal to the proximal sections of the housing. Likewise, as mentioned above, a shearing member provided of only one side of the rotating flanges is believed to significantly improve performance of the device. Thus, as seen in Figures 5-6, a single shearing member 154 is provided proximal to the rotating flanges 172, and another alternative not illustrated is a single shearing member located distally with respect to the flanges.
A still further embodiment of the present invention is seen in Figures 7a and 7b. In these views, an alternative one-piece housing 200 is shown for use with a rotating member, such as the members 34 or 170 described previously.
Again, the housing 200 includes a distal section 202, a proximal section 204, a distal lumen 206, a proximal lumen 208, and an intermediate groove 210. A
distal shearing member 220 and a proximal shearing member 222 are located on opposite sides and adjacent to the groove 210. The shearing members 220 and 222 are aligned circumferentially, as seen in the end view of Figure 7b.
The choice of using a one- or two-piece housing depends upon the manufacturing choices available. A one-piece housing is preferred if tooling for forming the shearing members 220, 222 on the inner surface thereof is really available. On the other hand, forming the inner shearing members on the mating ends of each section of a two-piece housing is somewhat easier, and the two sections can then be joined and welded or otherwise fastened together.
A number of different materials are suitable for the material removal device, including stainless-steel, titanium, acrylic or other suitable biocompatible and rigid materials. The selection of material may be dictated by the particular manufacturing process used. In a preferred embodiment, the material removal device housing is formed in two sections of stainless-steel and includes a single shearing member on each side of the rotating flanges. The two sections are preferably laser welded together.
The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive.
The scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes that come within the meaning and range of equivalency of the claims are to be embraced within their scope.

Claims

CLAIMS:

1. A percutaneous device for removing material from a body lumen comprising a material removal tip for a catheter-mounted device that comprises a rotatable member (34) having a body (56) and a distal first shearing member in the form of a screw thread (58) and a generally tubular housing (32) sized to receive the rotatable member (34) for rotation therein, wherein the rotatable member chops material and draws material into the housing; characterized in that the device further includes a second shearing member (100) mounted on the housing axially adjacent one or more shearing flanges (66) mounted on the proximal end of the rotatable member (34), the second shearing member (100) cooperating with the one or more shearing flanges (66) to further chop the material.

2. The device of Claim 1, wherein the second shearing member (100) extends radially inward from the housing (32) in close proximity of the body (56) of the member (34).

3. The device of Claim 2, wherein the second shearing member (100) is integral with the housing (32).

4. The device of any one of claims 1 to 3, wherein the shearing flanges (66) extend radially outward from the body (56) of the member (34).

5. The device of Claim 4, wherein the gap between a radially inwardly facing shearing surface (110) of the shearing member (100) and the body (56) of the member (34) is less than about 0.0508 mm.

6. The device of any one of claims 1 to 5, further comprising a third shearing member (102) which also cooperates with the shearing flanges (66).