Abstract: An intravascular device and methods for forming multiple percutaneous myocardial revascularization (PMR) holes in a heart chamber wall simultaneously. One device includes a basket formed of flexible arms carrying cutting probes over their length. The basket arms are outwardly arcuately biased so as to assume an outwardly bowed, arcuate shape when unconstrained. The device includes an inner shaft distally secured to a proximal portion of the basket and slidably disposed within an outer shaft. The inner shaft and collapsed basket can be retracted within the outer shaft, delivered intravascularly to the left ventricle, and distally advanced, forcing the basket to assume the bowed shape. Radio frequency current supplied to the electrical cutting probes burn holes into the ventricle wall and myocardium. One embodiment has high pressure fluid jet cutting means. Another embodiment uses a basket as an anchor to position a steerable cutting probe.

Abstract: A modified medical device for delivery of a pharmaceutically active material is described. The present inventors have found that many conventional medical devices contain a metallic component that comes into contact with a pharmaceutically active material during use, and that the contact substantially reduce the pharmaceutical effectiveness of the pharmaceutically active material. The invention described herein concerns numerous modifications to the metallic component that are effective to prevent such a substantial reduction in pharmaceutical effectiveness.

Abstract: Devices and methods for creating a series of percutaneous myocardial revascularization (PMR) channels in the heart. One method includes forming a pattern of channels in the myocardium leading from healthy tissue to hibernating tissue. Suitable channel patterns include lines and arrays. One method includes anchoring a radiopaque marker to a position in the ventricle wall, then using fluoroscopy repeatedly to guide positioning of a cutting tip in the formation of multiple channels. Another method uses radiopaque material injected into each channel formed, as a marker. Yet another method utilizes an anchorable, rotatable cutting probe for channel formation about an anchor member, where the cutting probe can vary in radial distance from the anchor. Still another method utilizes a multiple wire radio frequency burning probe, for formation of multiple channels simultaneously. Still another method utilizes liquid nitrogen to cause localized tissue death.

Abstract: Devices and methods for creating a series of percutaneous myocardial revascularization (PMR) channels in the heart. One method includes forming a pattern of channels in the myocardium leading from healthy tissue to hibernating tissue. Suitable channel patterns include lines and arrays. One method includes anchoring a radiopaque marker to a position in the ventricle wall, then using fluoroscopy repeatedly to guide positioning of a cutting tip in the formation of multiple channels. Another method uses radiopaque material injected into each channel formed, as a marker. Yet another method utilizes an anchorable, rotatable cutting probe for channel formation about an anchor member, where the cutting probe can vary in radial distance from the anchor. Still another method utilizes a multiple wire radio frequency burning probe, for formation of multiple channels simultaneously. Still another method utilizes liquid nitrogen to cause localized tissue death.

Abstract: A catheter having an elongate shaft including a proximal and a distal end. The shaft includes a conductor. An electrode is disposed at the distal end of the shaft and is connected to the conductor. The electrode has a generally annular, cross-sectional shape. The annular shape defines an opening within the electrode. An insulator surrounds the conductor. In accordance with the method of the present invention, a crater wound can be formed through the endocardium and into the myocardium of a patient's heart. Collateral damage to the myocardium can be made by infusing pressurized fluid into the crater wound.

Abstract: A filter retrieval device having an actuatable dilator tip for retrieval of an intravascular filter from a body lumen is disclosed. An outer shaft coupled to a distal sheath is advanced along a filter wire to desired point within the vasculature. An intravascular filter such as a distal protection filter can be advanced along the filter wire to a point distal a lesion to collect debris dislodged during a medical procedure. Disposable in part within the distal sheath is an actuatable dilator tip adapted to retrieve the filter at least in part within the distal sheath. Actuation of the dilator tip may be accomplished by any number of means, including a resilient member such as a spring coil, or by a reduced inner diameter portion disposed on the distal sheath adapted to engage a plurality of recessed surfaces disposed on the dilator tip.

Abstract: A catheter having an elongate shaft including a proximal and a distal end. The shaft includes a conductor. An electrode is disposed at the distal end of the shaft and is connected to the conductor. The electrode has a generally annular, cross-sectional shape. The annular shape defines an opening within the electrode. An insulator surrounds the conductor. In accordance with the method of the present invention, a crater wound can be formed through the endocardium and into the myocardium of a patient's heart. Collateral damage to the myocardium can be made by infusing pressurized fluid into the crater wound.

Abstract: A PMR catheter including an elongate shaft having a proximal end and a distal end, and a conductor extending therethrough. An insulator disposed around the conductor. At least one conductive loop disposed at the distal end of the shaft. The conductive loop having an electrode disposed at its distal end.

Abstract: A catheter system includes a catheter having a proximal end, a distal end, and a lumen extending therein. An administering portion is disposed at the distal end of the catheter and is configured to administer a bolus of liquid in response to positive pressure in a distal portion of the lumen. The catheter system of the present invention has a dead space of less 0.32 cc and preferably less than 0.15 cc in which residual therapeutic agents remain after delivery. The present invention also includes a method of administering a liquid to a treatment site. The distal end of the catheter is transluminally positioned proximate the treatment site. The catheter is charged by placing a bolus of the liquid in the lumen A positive pressure is created to drive the bolus to the administering tip to express the bolus from the distal end of the catheter.

Abstract: A transmyocardial revascularization catheter which includes an elongate drive shaft having a proximal end, a distal end and a longitudinal axis. The TMR catheter also includes a cutting tip disposed at the distal end of the shaft. The tip has a distally disposed cutting edge and a longitudinally extending lumen therethrough. A motor is coupled to the drive shaft for rotation of the cutting tip. The shaft defines a longitudinally extending lumen in fluid communication with the tip lumen.

Abstract: Devices and methods for increasing blood perfusion within the myocardium of the heart by wounding the myocardium and applying growth factors to promote vascularization. One method includes driving spikes into the myocardium from within the heart, with the spikes being formed of biodegradable material, containing releasable growth factors, and having lumens and side holes. An alternative method utilizes non-biodegradable spikes with lumens and side holes. Another method promotes vascularization by injecting angiogenic material into holes bored into the myocardium, leaving a patent hole. Another method includes injecting angiogenic material into the myocardium without boring, leaving no patent hole. The angiogenic material can be carried in a biodegradable adhesive. Revascularization of the myocardium is promoted in one method by externally wounding the heart and applying a patch including growth factors.

Abstract: A PMR catheter including an elongate shaft having a proximal end and a distal end, and a conductor extending therethrough. An insulator disposed around the conductor. At least one conductive loop disposed at the distal end of the shaft. The conductive loop having an electrode disposed at its distal end.

Abstract: A catheter assembly including a guide wire having a proximal end, a distal end, and a balloon catheter. The balloon catheter includes a tubular member having a balloon proximate the distal end, and a guide wire tube having a lumen therethrough for slidably receiving the guide wire. The guide wire tube extends longitudinally along the exterior surface of the balloon from a point proximate the distal end of the balloon past the proximal end of the balloon. The guide wire tube is elastic and collapses radially when pressed against a vessel wall during inflation of the balloon. In a preferred method of use, the guide wire is placed in a first position across a treatment area followed by threading the balloon catheter over the guide wire so that balloon is also across the treatment area. The guide wire is then pulled in a proximal direction to a second retracted position, wherein the distal end of the guide wire is proximal of the proximal end of the balloon, yet within the guide wire tube.

Abstract: An intravascular device and methods for forming multiple percutaneous myocardial revascularization (PMR) holes in a heart chamber wall simultaneously. One device includes a basket formed of flexible arms carrying cutting probes over their length. The basket arms are outwardly arcuately biased so as to assume an outwardly bowed, arcuate shape when unconstrained. The device includes an inner shaft distally secured to a proximal portion of the basket and slidably disposed within an outer shaft. The inner shaft and collapsed basket can be retracted within the outer shaft, delivered intravascularly to the left ventricle, and distally advanced, forcing the basket to assume the bowed shape. Radio frequency current supplied to the electrical cutting probes burn holes into the ventricle wall and myocardium. One embodiment has high pressure fluid jet cutting means. Another embodiment uses a basket as an anchor to position a steerable cutting probe.

Abstract: Devices and methods for creating a series of percutaneous myocardial revascularization (PMR) channels in the heart. One method includes forming a pattern of channels in the myocardium leading from healthy tissue to hibernating tissue. Suitable channel patterns include lines and arrays. One method includes anchoring a radiopaque marker to a position in the ventricle wall, then using fluoroscopy repeatedly to guide positioning of a cutting tip in the formation of multiple channels. Another method uses radiopaque material injected into each channel formed, as a marker. Yet another method utilizes an anchorable, rotatable cutting probe for channel formation about an anchor member, where the cutting probe can vary in radial distance from the anchor. Still another method utilizes a multiple wire radio frequency burning probe, for formation of multiple channels simultaneously. Still another method utilizes liquid nitrogen to cause localized tissue death.

Abstract: Devices and methods for increasing blood perfusion within the myocardium of the heart by wounding the myocardium and applying growth factors to promote vascularization. One method includes driving spikes into the myocardium from within the heart, with the spikes being formed of biodegradable material, containing releasable growth factors, and having lumens and side holes. An alternative method utilizes non-biodegradable spikes with lumens and side holes. Another method promotes vascularization by injecting angiogenic material into holes bored into the myocardium, leaving a patent hole. Another method includes injecting angiogenic material into the myocardium without boring, leaving no patent hole. The angiogenic material can be carried in a biodegradable adhesive. Revascularization of the myocardium is promoted in one method by externally wounding the heart and applying a patch including growth factors.

Abstract: A transmyocardial revascularization catheter which includes an elongate drive shaft having a proximal end, a distal end and a longitudinal axis. The TMR catheter also includes a cutting tip disposed at the distal end of the shaft. The tip has a distally disposed cutting edge and a longitudinally extending lumen therethrough. A motor is coupled to the drive shaft for rotation of the cutting tip. The shaft defines a longitudinally extending lumen in fluid communication with the tip lumen.

Abstract: A catheter system having a changeable distal member. The catheter system includes a proximal member, including a shaft having a proximal end, a distal end and a lumen extending therethrough. A distal member is included having a distal portion which may be passed through the lumen of the proximal member and releasably sealed to the proximal member at a desired location during a catheter procedure. The distal member may further include a push member operably coupled to the distal portion. The distal member may include a fluid-tight releasable seal for releasably sealing the distal member to the proximal member.

Abstract: An RF TMR catheter having an elongate shaft and a metallic cutting tip disposed at the distal end of the shaft. A hood is disposed proximate the distal end of the shaft for limiting the depth of penetration of the metallic cutting tip.

Abstract: A catheter assembly including a guide wire having a proximal end, a distal end, and a balloon catheter. The balloon catheter includes a tubular member having a balloon proximate the distal end, and a guide wire tube having a lumen therethrough for slidably receiving the guide wire. The guide wire tube extends longitudinally along the exterior surface of the balloon from a point proximate the distal end of the balloon past the proximal end of the balloon. The guide wire tube is elastic and collapses radially when pressed against a vessel wall during inflation of the balloon. In a preferred method of use, the guide wire is placed in a first position across a treatment area followed by threading the balloon catheter over the guide wire so that balloon is also across the treatment area. The guide wire is then pulled in a proximal direction to a second retracted position, wherein the distal end of the guide wire is proximal of the proximal end of the balloon, yet within the guide wire tube.