Abstract: A viewing system and method for enhancing objects of interest represented on a moving background in a sequence of noisy images and for displaying the sequence of enhanced images, comprising extracting means (11) for extracting features related to an object of interest in images of the sequence; registering means (12) for registering the features related to the object of interest with respect to the image referential, yielding registered images (13); similarity detection means for determining the resemblance of the representations of a registered object of interest in succeeding images and weighing means for modulating the intensities of the pixels of said object of interest over the images of the sequence; temporal integrating means (14, 33b) for integrating the object of interest and the background over a number, or at least two, registered images (13) of the sequence; and display means (54) for displaying the processed images (15, 45) of the enhanced registered object of interest on faded background.

Abstract: The present invention provides improved light delivery catheters for use in therapeutic methods, such as PDT, that require illumination of target tissue within a blood vessel or other hollow body organ. An improved catheter includes an optical fiber that transmits light from a light source at the proximal end of the catheter shaft to a light treatment zone. An occlusion balloon on the distal end of the catheter shaft adjacent to the light treatment zone receives fluid via an inflation lumen in the catheter shaft. An infusion lumen connects with a plurality of infusion ports at the light treatment zone to deliver infusion fluid to the hollow body organ so that blood can be flushed from the region between the light treatment zone and target tissue.

Abstract: An endovascular tissue removal system including an expandable mechanism introduceable to the ventricular side of a valve to support the leaflets of the valve in a closed position and a tissue removal device advanceable to the leaflets and configured to resect the leaflets as they are supported by the expandable mechanism.

Abstract: Devices (i.e., catheters and guidewires) for, and methods of, ultrasonic imaging and ablation. In one embodiment, a device includes: (1) a fiber-optic bundle configured to carry laser light for ultrasonic imaging, each fiber of the fiber-optic bundle having a reflective layer oriented at an acute angle with respect thereto at a distal end thereof, (2) an elongated member associated with the fiber-optic bundle and configured to carry energy for ablation, the energy for ablation projecting past the distal end and (3) a photoacoustic layer associated with the each fiber of the fiber-optic bundle and configured to receive at least some of the laser light for the ultrasonic imaging and generate ultrasonic pressure waves in response thereto.

Abstract: Methods and apparatus are disclosed for forming annular lesions in tissue. The methods include introduction of an optical apparatus proximate to a tissue site, via, for example, a catheter. The optical apparatus includes a pattern-forming optical wave guide in communication with a light transmitting optical fiber. Energy is transmitted through the optical fiber, such that radiation is propagated through the optical fiber and the wave guide projects an annular light pattern, e.g., a circle or a halo.

Abstract: An optic fiber probe system for treating thrombus of a patient comprising at least one optic fiber with at least one confined liquid-fillable void space and a light source for causing a laser-induced liquid/bubble jet that ejects from an opening of the confined void space to breakup the thrombus.

Abstract: Expandable laser catheters for utilizing laser energy to remove obstructions from body passages are described. In one embodiment, the laser catheter includes a shaftway having a distal end including a flexible portion configured in a series of radial folds. Multiple optical fibers, configured to transmit laser energy, extend along the shaftway and are attached to the flexible portion. An inflatable, ring-shaped balloon is attached to the catheter within the flexible portion. In use, the catheter is inserted into a body passage such as an artery, and advanced until the distal end is adjacent to an obstruction. The balloon is inflated to expand the flexible portion and to bring the optical fibers nearer the inner wall of the body passage. Laser energy is directed by the optical fibers toward targeted regions of the obstruction. As the catheter is advanced and the process repeated, a core is formed from the obstruction and contained within the flexible portion.

Abstract: An endovascular laser treatment device designed to be used with an optical fiber to treat venous diseases such as varicose veins is provided. The device includes a spacer that positions the distal end of the optical fiber away from the inner wall of the blood vessel during delivery of laser energy to provide an even distribution of thermal energy around the vessel, thereby avoiding vessel perforation and incomplete vessel collapse.

Abstract: A method and apparatus for treating atrial tissue include positioning a lesion formation tool against the atrial surface. An optical fiber of the tool is energized at a wavelength is selected to form a volume of necrosed tissue through the thickness of the atrial tissue. A guide member is attached to the tip of the fiber. The guide member is slidable along the surface of the atrial tissue in atraumatic sliding engagement.

Abstract: A method of transluminal laser revascularization of cerebral blood vessels having atherosclerotic lesions by introducing into the affected lumen a microcatheter device composed of a plurality of coaxial microcatheters moveably inserted one into the other and guiding through the catheters a laser-powered lightguide optical fiber, the end face of which is positioned at an optimal distance from the occlusive tissues which are then deteriorated by laser radiation at a relatively high laser power from 20 to 35 W.

Abstract: A method and apparatus for treating a body tissue in situ (e.g., an atrial tissue of a heart to treat atrial fibrillation) include a lesion formation tool is positioned against the heart surface. The apparatus includes a guide member having a tissue-opposing surface for placement against a heart surface. The guide member also has interior surfaces and a longitudinal axis. A guide carriage is sized to be received with the guide member and moveable therein along the longitudinal axis. An optical fiber is positioned within the guide carriage with the carriage retaining the fiber. The carriage receives the fiber with an axis substantially parallel to the longitudinal axis and bends the fiber to a distal tip with an axis of said fiber at said distal tip at least 45 degrees to the longitudinal axis and aligned for discharge of laser energy through the tissue opposing surface.

Abstract: A method and apparatus for forming a lesion in tissue along a desired ablation path with treating a body tissue in situ (e.g., an atrial tissue of a heart to treat) atrial fibrillation include a lesion formation tool including is positioned against the heart surface. The lesion formation tool includes a guide member having a tissue-opposing surface for placement against a heart surface. An ablation member is coupled to the guide member to move in a longitudinal path relative to the guide member. The guide member includes a track. A carriage is slidably received with the track. The ablation member is secured to the carriage for movement therewith. The guide member includes a visualization component.

Abstract: Device for performing laser angioplasty, in which laser light is beamed via a laser radiation device in the area of a catheter tip, with simultaneous OCT monitoring, for the ablation of plaque. The feed lines for the laser radiation device and the rotating OCT signal lines are disposed in a common catheter sheath, said feed lines leading to an OCT sensor disposed within a ring-shaped window running around the circumference of the catheter sheath, said OCT sensor being disposed at a distance from the laser radiation device.

Abstract: A method and apparatus for treating an atherosclerotic target region of a coronary vessel in a patient are disclosed. The method includes delivering to the patient, a photoatherolytic compound, to cause accumulation of the compound in the target region, accessing the target region intraluminally with a guidewire, and advancing over the guidewire, a catheter having (i) a proximal main-body sleeve, (ii) a flexible, non-inflatable, translucent distal-end sleeve joined to the main-body sleeve at a catheter juncture, and (iii) an inner lumen extending through the two sleeves, said advancing being effective to position the catheter's distal-end sleeve within the target region. The guidewire is then removed and replaced by a fiber-optic bundle having a light-diffusing tip, until said tip is positioned adjacent the catheter juncture.

Abstract: Methods and apparatus are disclosed for forming annular lesions in tissue. The methods include introduction of an optical apparatus proximate to a tissue site, via, for example, a catheter. The optical apparatus includes a pattern-forming optical wave guide in communication with a light transmitting optical fiber. Energy is transmitted through the optical fiber, such that radiation is propagated through the optical fiber and the wave guide projects an annular light pattern, e.g., a circle or a halo.

Abstract: An apparatus for treating a biological tissue of a patient in situ includes an optical fiber for guiding a coherent waveform of a selected wavelength to a fiber tip. The wavelength is selected to have a low absorption in water. The fiber tip is contained within a guide member having a discharge bore to define an unobstructed light pathway. The guide member is adapted to be slidable along a tissue surface in atraumatic sliding engagement with the discharge bore opposing the surface. The guide member is carried on an elongated flexible member.

Abstract: A catheter device for treating a vascular disease is provided. The catheter device includes an energy delivery device such as an optical fiber for delivering laser energy and a catheter. The catheter lumen receives the optical fiber and a fluid such as an anesthetic agent or vasoconstricting agent. According to the invention, a plurality of exits are formed in the sidewall of the catheter. The exits are in communication with the catheter lumen and administer the fluid into the blood vessel. By administering the fluid from within the catheter lumen, the present catheter device eliminates the need to make numerous external punctures to deliver fluid injections.

Abstract: A method and apparatus for treating atrial tissue include positioning a lesion formation tool against the atrial surface. An optical fiber of the tool is energized at a wavelength is selected to have a low absorption in water.

Abstract: A blood vessel occlusion system and method includes a handheld probe including a power source, the probe being adapted to transmit energy from the power source through a body surface and into a target blood vessel, for example a varicose vein. Further included is a manual or automatic switch mechanism adapted to enable and disable the power source in response to a predetermined level of compression applied, by means of the probe against the target blood vessel. When the blood vessel is compressed sufficiently to collapse and substantially slow or substantially prevent a flow of blood therethrough, the power source is activated and the vessel is cauterized, leaving the blood vessel in a condition that is resistant to recanalization.

Abstract: The apparatus and method are designed to compute the optimal spatial and temporal characteristics for combating tumor growth within a body on the basis of cytological (as provided by biopsies, etc.) and anatomical data (as provided by CT, MRI, PET, etc.), as well as the electric properties of the different elements. On the basis of this computation, the apparatus applies the fields that have maximal effect on the tumor and minimal effect on all other tissues by adjusting both the field generator output characteristics and by optimal positioning of the insulated electrodes or isolects on the patient's body.

Abstract: An apparatus for forming a lesion in cardiac tissue includes an optical fiber for guiding a coherent waveform of a selected wavelength to a fiber tip. The wavelength is selected to have a low absorption in water. The fiber tip is contained within a guide member having a discharge bore for a direction of energy discharge to define an unobstructed light pathway from the fiber tip through a discharge end of the discharge bore. A fluid pathway is in fluid flow communication with the guide member to admit a bio-compatible flushing fluid to the discharge bore.

Abstract: A method for closed-chest cardiac surgical intervention relies on viewing the cardiac region through a thoracoscope or other viewing scope and endovascularly partitioning the patient's arterial system at a location within the ascending aorta The cardiopulmonary bypass and cardioplegia can be induced, and a variety of surgical procedures performed on the stopped heart using percutaneously introduced tools. The method of the present invention will be particularly suitable for forming coronary artery bypass grafts, where an arterial blood source is created using least invasive surgical techniques, and the arterial source is connected to a target location within a coronary artery while the patient is under cardiopulmonary bypass and cardioplegia.

Abstract: A fiber optic laser catheter assembly for use in removing, or largely debulking, obstructions or occlusions from a lumen in a living body. The catheter assembly includes an outer tubular sheath, an optical fiber extending through the sheath, and a fiber guide for holding the fiber within the sheath. In all of the disclosed embodiments, the obstructions are removed by controllably positioning an optical fiber's distal tip in a succession of selected radial and circumferential positions so as to sculpt away the obstruction without substantial risk of mechanically or thermally damaging the vessel. Several of the embodiments are configured such that the portion of the occlusion that can be reliably sculpted away has a radius greater even than the radius of the catheter assembly itself.

Abstract: The present invention relates to methods and apparatuses for use in revascularization of damaged areas of myocardium through application of one or more radiation type treatment modalities.

Abstract: A method and apparatus for treating gum disease includes a light producing dental appliance that is accessible exteriorly of the body for placement within the mouth of the patient to expose the mouth to light radiation of a selected wavelength and in an amount that is effective for killing or debilitating pathogenic microorganisms and especially Porphyromona gingivalis within the mouth of the patient such that the bacterial load carried to the heart is diminished thereby reducing or eliminating the symptoms of coronary artery disease, atherosclerosis vascular inflammation and plaque formation.

Abstract: An apparatus for applying light to a site to be treated on a wall of a vessel in the human or animal body, in particular for laser welding of two vessels to one another, has a light-feeding instrument that guides light generated by an extracorporeal light source to the site and radiates it onto the latter. The light-feeding instrument has an elongated optical conductor that can be inserted into the lumen of the vessel and can be displaced therein in the longitudinal direction of the vessel, and has light-deflecting means that direct the light fed through the optical conductor in a substantially radial fashion onto the site to be treated.

Abstract: A biological optical measuring instrument comprising a measuring probe (101) for collecting light from a plurality of portions of a subject (214) transmitted through the subject (214) by means of an optical fiber (108) by guiding light emitted from a light source (102) by an optical fiber (107), and irradiating the light to the subject (214) so as to create a living body transmitted light intensity image of the subject (214) from the transmitted and collected light. The measuring probe (101) further comprises optical fiber fixing members (201, 210, 211) for fixing the optical fibers (107, 108) at a predetermined interval and support members (202, 204, 205) for rockably supporting the optical fiber fixing members. Thus, it is possible to provide a technique of performing living body optical measurement while the living body lies in lateral decubitus.

Abstract: An endovascular laser treatment device preferably includes a catheter having a hub at its proximal end, an optical fiber for insertion into the catheter, a fiber connector attached to the optical fiber at a selected distance from the distal end of the optical fiber, and a temporary stop removably mounted around the optical fiber. The treatment device has two positions: a protective position and an operating position. As the fiber is inserted through the catheter, the temporary stop rests against the hub and places the fiber tip in the protective position where the distal end of the optical fiber is positioned near the distal end of the catheter, but is still disposed inside the catheter. When the temporary stop is removed and the fiber connector is coupled with the catheter hub, the fiber tip is in the operating position where the distal end of the optical fiber extends past the distal end of the catheter by a predetermined distance to expose the fiber tip.

Abstract: A method for closed-chest cardiac surgical intervention relies on viewing the cardiac region through a thoracoscope or other viewing scope and endovascularly partitioning the patient's arterial system at a location within the ascending aorta. The cardiopulmonary bypass and cardioplegia can be induced, and a variety of surgical procedures performed on the stopped heart using percutaneously introduced tools. The method of the present invention will be particularly suitable for forming coronary artery bypass grafts, where an arterial blood source is created using least invasive surgical techniques, and the arterial source is connected to a target location within a coronary artery while the patient is under cardiopulmonary bypass and cardioplegia.

Abstract: A catheter introduction apparatus provides an optical assembly for emission of laser light energy. In one application, the catheter and the optical assembly are introduced percutaneously, and transseptally advanced to the ostium of a pulmonary vein. An anchoring balloon is expanded to position a mirror near the ostium of the pulmonary vein, such that light energy is reflected and directed circumferentially around the ostium of the pulmonary vein when a laser light source is energized. A circumferential ablation lesion is thereby produced, which effectively blocks electrical propagation between the pulmonary vein and the left atrium.

Abstract: A system for performing minimally invasive cardiac procedures. The system includes a pair of surgical instruments that are coupled to a pair of robotic arms. The instruments have end effectors that can be manipulated to hold and suture tissue. The robotic arms are coupled to a pair of master handles by a controller. The handles can be moved by the surgeon to produce a corresponding movement of the end effectors. The movement of the handles is scaled so that the end effectors have a corresponding movement that is different, typically smaller, than the movement performed by the hands of the surgeon. The scale factor is adjustable so that the surgeon can control the resolution of the end effector movement. The scale factor of the end effector can be set to zero to prevent movement of the end effector. An input button may also be provided so that the end effector only moves when the input button is depressed by the surgeon.

Abstract: A method of endovenous laser treatment in disclosed. An introducer sheath 40 is introduced into a vein and an optical fiber 12 is introduced through the introducer sheath until a first marking 45 on the optical fiber 12 indicates that the distal end of the optical fiber 12 is substantially in alignment with the distal end of the introducer sheath 40. The introducer sheath 40 is then withdrawn relative to the optical fiber 12 until a second marking 46 on the optical fiber 12 indicates that the distal end of the optical fiber 12 extends a predetermined distance beyond the distal end of said introducer sheath 40. Laser radiation is passed down the optical fiber 12 so that laser radiation is delivered to the inner wall of the vein and the introducer sheath 40 together with the optical fiber 12 are withdrawn a certain distance along the vein.

Abstract: A novel device and method for preventing restenosis and streamlining the angioplasty procedure. The device and method provide a fiberoptic guidewire, or, alternatively, a light-conducting catheter, to decrease the size of the angioplasty device, decrease the overall time of the procedure, and increase the safety of the procedure. The present invention delivers radiation to a sclerotized area after balloon angioplasty treatment to prevent restenosis Radiation delivered via the catheter or fiberoptic guidewire discourages the cell proliferation and cell growth after angioplasty, thereby improving the chances of avoiding restenosis.

Abstract: A medical laser device is disclosed comprising an optical fiber 12 having markings 45, 46 which enable the optical fiber 12 to be accurately positioned relative to an introducer sheath 40. The introducer sheath 40 may also have graduated markings to enable the sheath 40 to be withdrawn at a controlled rate. A pulsed or continuous laser source may be provided.

Abstract: A method for performing a bypass procedure utilizes the patient's vascular system for accessing or reaching a desired location within the patient's body. The method may also provide a direct flow path from a heart chamber to a coronary vessel via a septal passageway.

Abstract: A mechanism and method for steering a surgical instrument inserted into an endoscope such as a ureteroscope, nephroscope, or cystoscope, and/or for steering the endoscope, utilizes a shape memory structure secured to the surgical instrument or to the endoscope, the shape memory structure having a transformation temperature slightly greater than that of the human body so that bending of the shape memory structure, and therefore of the surgical instrument or endoscope, may be carried out by raising a temperature of irrigation fluid in the working channel. The steering mechanism may be used as a supplement to a tensioned-wire steering mechanism, reducing stress on the endoscope shaft and extending the service life and repair interval of the endoscope. In addition, when the surgical instrument is a glass optical fiber, the steering mechanism may be used to ensure that a tip of the optical fiber is within the field-of-view of fiber optics incorporated into the endoscope.

Abstract: The method of vascular treatment for restenosis or vulnerable plaque after an invasive procedure, such as for example angioplasty, stenting with or without drug coating, or drug delivery, comprises: inserting a catheter or hollow guide wire to the treatment location; delivering light through the catheter in the wavelength range of about 700–2500 nm; and moving the light to treat the affected region.

Abstract: An artery blockage removal system including a hollow plastic tube with IR optical fibers extending longitudinally between its inner and outer walls, the end of the tube having a metal clad tip ring preferably of gold abutting against the end of the IR optical fibers, and the outer surface of the hollow plastic tube having curved arterial guards molded into its outer circumference to hold the inner walls of the artery away from the hollow plastic tube and metal clad tip ring to avoid physical and thermal damage to the inner artery walls, whereby arterial blockage is removed through application of the metal clad tip ring heated by the IR optical fibers and a vacuum applied through the center of the hollow tubing.

Abstract: Methods and apparatus are disclosed for forming annular lesions in tissue. The methods include introduction of an optical apparatus proximate to a tissue site, via, for example, a catheter. The optical apparatus includes a pattern-forming optical wave guide in communication with a light transmitting optical fiber. Energy is transmitted through the optical fiber, such that radiation is propagated through the optical fiber and the wave guide projects an annular light pattern, e.g., a circle or a halo.

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: An apparatus and method for phototherapy are described in which laser light or other radiation is projected from within a catheter, through a balloon member, and toward the surface of tissue. The light reflected from body fluids or the tissue surface is captured by a collecting device located within the catheter, e.g., within the balloon member, and the intensity of the reflected light is ascertained. The apparatus and method provides for accurately positioning the apparatus against the tissue treatment site.

Abstract: A tip of a needle is inserted into large vein of a patient. The needle is mounted in a butterfly device axially engaged to a generally cylindrical housing containing a Y-connector. A pharmaceutically acceptable solution is fed to the needle through the Y-connector to the housing. A quartz optic fiber is fed through the housing and needle to the tip of the needle in the patient's venous system. A source of UV and visible light directs both UV and visible light alternatively through the optic fiber to the patient's venous system to kill pathogens in the venous system.

Abstract: A system and method of marking percutaneous myocardial revascularization channels in a human heart and introducing into the channels a therapeutic or diagnostic agent by inserting a catheter system into the left ventricle of a heart, applying tissue ablative energy through the catheter to create a channel into the heart wall, introducing an imaging medium to the heart wall proximate the channel for marking the position of that channel for imaging, and introducing in or proximate the channel a therapeutic or diagnostic agent.

Abstract: A method and apparatus for reducing the thickness of arterial walls is disclosed. Ablation of the exterior layer of the arterial walls is performed using mechanical or laser ablation techniques. Surveying is preferably carried out during the procedure to ensure optimal ablation. The ablation reduces the effective thickness of the arterial walls and increases flexibility so that the walls distend under normal blood pressure, thereby improving blood flow. Advantageously, the procedure is carried out without invasion of the blood vessel lumen and without damage to the inner layer of the artery wall.

Abstract: An improved articulating device for use with a medical insertion instrument comprising in part a first tube having a plurality of ribs defining a plurality of bending segments, a second tube axially disposed within the first tube, and means for transmitting an axial deflecting pull load. Such device has improved controlled for positioning an end of the device at a selected position within the body. The articulating device has a generally constant moment of inertia and a polar moment of inertia that generally decreases from its proximal to distal end.

Abstract: An ultrasonic angioscope system which uses an imaging technique of sending ultrasonic waves to a portion ahead of a stricture of a blood vessel and visualizing a portion in the forward direction of the angioscope, and which uses a laser breakdown is provided.

Abstract: A guiding catheter system for delivering an elongated therapeutic or diagnostic device into a patient's left ventricle which includes a first guiding catheter with a shaped distal extremity configured to be aligned with or parallel to a longitudinal axis or long dimension of the patient's left ventricle and a second guiding catheter slidably and rotatably disposed within an inner lumen of the first guiding catheter which has a shaped distal shaft section and an inner lumen configured to slidably receive an elongated therapeutic or diagnostic device such as a tissue ablation device, e.g. an optical fiber connected to a laser source, an ultrasonic energy emitting device or a radio frequency energy emitting device. The shaped distal section of the first guiding catheter is shaped or is shapable within the patient's heart chamber.

Abstract: A method for inhibiting or suppressing stenosis associated with an arteriovenous access. A dosage of photosensitive compound is introduced into the artery or vein. An anastomotic area of the artery or vein is then exposed to a source of light having a wavelength suitable for photoactivating the photosensitive compound for a period of time sufficient to provide a therapeutic effect. A method is also described for the delivery of drugs into the anastomotic site of an AV access to inhibit the formation of stenotic lesions at those sites.

Abstract: A device and method for excimer laser ablation is provided wherein fibers in a catheter tip are arranged in an eccentric bundle. The optical fibers are cut and polished at an angle with respect to the end face of the catheter. The guidewire lumen lumen is preferably offset from the center of the tip.

Abstract: Method and apparatus for treatment and post-treatment of the stenosed region of an artery after reduction of the region by angioplasty or other means by applying a radioactive dose to said reduced region of the artery by positioning a radioactive dose to the reduced region is disclosed.