Abstract: A vulnerable plaque treatment catheter arrangement for the analysis and treatment of the lipid pool of a vulnerable plaque in a coronary artery is disclosed. The arrangement comprises a flexible, elongated, hollow sheath having a proximal end and a distal end, the sheath being arranged for insertion into a coronary artery. A first energy emitter and receiver device is arranged in an annular array in the distal end of the sheath. An energy generator source and an energy control unit is arranged in communication with the first device to provide both diagnosis and treatment to vulnerable plaque within a coronary artery.

Abstract: A medical device for fragmenting objects and aspirating remaining debris enables a physician or other medical personnel quickly and easily remove objects, such as kidney stones, from a patient. The medical device can include a dual-lumen elongated member and a handle coupled to the elongated member. A first one of the lumens provides a suction passageway, and a second one of the lumens receives a laser fiber for delivering laser energy to an object, such as a kidney stone, within the patient. The handle can include a positioning mechanism to enable the physician by manual manipulation to move and hold in place the laser fiber longitudinally within the second lumen.

Abstract: A method and apparatus is described for eliminating atherosclerotic vascular disease by exposing the interior of an artery or vein to visible or ultraviolet light of a selected spectrum to thereby sterilize the artery, eradicating infectious pathogens and reverse the pathogenesis of atherosclerotic artery disease. The light energy can be supplied through a fiber optic bundle positioned via an intra-arterial catheter that is connected to an appropriate light radiation source located outside of the body during treatment. In another form of the invention, the light energy is produced by means of a light energy source located at the distal tip of the instrument shaft positioned centrally within the atherosclerotic plaque formation during treatment.

Abstract: A method for selective heating of subsurface structures in material such as tissue includes a cooling device for thermally quenching or removing heat from the top surface of tissue during or just after delivering pulsed energy to target or subsurface structures or tissue, a preferred embodiment of the invention using dynamic cooling, to quench the thermal energy conducted from the targeted structure into surrounding tissue.

Abstract: The present invention provides improved devices for pharmaceutical delivery and fluid removal using laser ablation or alteration. These devices have marking means for marking the ablation or alteration site, the area around the site, or the site and the area around the site. In a preferred embodiment, the mark created by the devices is a physical mark which remains detectable after the marking means is inactivated or redirected away from the site.

Abstract: An endarterectomy surgical instrument and procedure for removing plaque from a selected length of an artery and surgical instruments for cutting plaque build-ups. The endarterectomy surgical instrument has means for developing an image of the surgical site so that probing of the artery can be observed without requiring opening the artery along the selected length over which the plaque is removed.

Abstract: A method and apparatus of providing endovascular therapy. The steps include arranging optical fibers within a catheter, the catheter having a tip whose length is at least 1 cm and whose diameter of less than 1 millimeter, connecting an excimer laser to the optical fibers; and delivering laser energy from the excimer laser in excess of 60 fluence at 40 Hertz through the optical fibers. The delivering of the laser energy may be to non-calcified or calcified deposits of an atherosclerotic lesion to ablate the same. The method also includes the step of inserting the catheter through an artery by pushing the same until the tip is in within laser energy striking distance of the atherosclerotic lesion.

Abstract: The invention encompasses methods and flexible apparatus for delivering radiation energy to a radiation-absorbing fluid within the apparatus to generate a series of expanding and collapsing bubbles therein, and thereby generate flow in a fluid surrounding the apparatus. Effective fluid flow is obtained via at least one optical fiber, disposed within the apparatus near a distal opening therein, that, when fired, tends to pump fluid with respect to the apparatus, and at least one other optical fiber, disposed within the apparatus in the vicinity of a side opening thereof, that, when fired, tends to agitate fluid near its distal end. These pumping and agitative actions cause a net fluid motion that is particularly effective in disrupting a partial or total occlusion in a body passage, such as a blood vessel, within which the apparatus is operated.

Abstract: Partial or total occlusions of fluid passages within the human body are removed by positioning an array of optical fibers in the passage and directing treatment radiation pulses along the fibers, one at a time, to generate a shock wave and hydrodynamics flows that strike and emulsify the occlusions. A preferred application is the removal of blood clots (thrombin and embolic) from small cerebral vessels to reverse the effects of an ischemic stroke. The operating parameters and techniques are chosen to minimize the amount of heating of the fragile cerebral vessel walls occurring during this photo acoustic treatment. One such technique is the optical monitoring of the existence of hydrodynamics flow generating vapor bubbles when they are expected to occur and stopping the heat generating pulses propagated along an optical fiber that is not generating such bubbles.

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: A light stint implant device adapted to be surgically implanted in a major blood vessel for assisting in the treatment of long term viral infection, alone or in combination with anti-viral drugs, is disclosed. The implant device is programmed for set periods of illumination and set periods of dormancy through a remote power supply and timing device accessible through a sub-dermal implant adapted to be surgically placed in a location under the skin. The device, after being implanted within such blood vessel will eliminate viruses located within the blood through exposure to light given off by the light stint implant device during the periods of illumination.

Abstract: A method is disclosed for treating blood vessels using endovascular techniques to deliver laser energy. Percutaneous access into the vein lumen will be obtained using an angiocatheter through which a fiber optic line will be introduced. The vein will be emptied of blood using elevation of the limb, patient positioning, compression, or other means. Laser energy will be delivered into the vein lumen using wavelengths from about 532 nanometers to about 1064 nanometers. Sufficient power and duration will be used to damage the entire thickness of the vein wall, ultimately causing fibrosis of the treated blood vessel. Fibrosis of the treated blood vessel causes the blood vessel to decrease in diameter or collapse.

Abstract: A method of selecting laser parameters for performing laser-assisted myocardial revascularization to avoid inducing undesired cardiac arrhythmia without synchronization of delivery of laser energy and the patient's cardiac cycle, the method comprising the steps of minimizing the power level of laser energy used, thereby decreasing the overall trauma to the heart, selecting a pulse frequency as great as possible while avoiding adverse summation effects, selecting a pulse width as wide as possible to prevent excessively high peak powers per pulse and not so wide as to cause undesired thermal damage, selecting an energy flux rate, shaping the front end of each pulse of laser energy to provide efficient, non-explosive TMR channeling, and correcting the selected power level, pulse width, pulse frequency and energy flux rate for mechanical events, including method of access to the heart, position of selected portions of myocardium in the heart, temporal duration of the procedure, natural movement of the heart,

Abstract: This invention is a catheter-based device for generating an ultrasound excitation in biological tissue. Pulsed laser light is guided through an optical fiber to provide the energy for producing the acoustic vibrations. The optical energy is deposited in a water-based absorbing fluid, e.g. saline, thrombolytic agent, blood or thrombus, and generates an acoustic impulse in the fluid through thermoelastic and/or thermodynamic mechanisms. By pulsing the laser at a repetition rate (which may vary from 10 Hz to 100 kHz) an ultrasonic radiation field can be established locally in the medium. This method of producing ultrasonic vibrations can be used in vivo for the treatment of stroke-related conditions in humans, particularly for dissolving thrombus or treating vasospasm.

Abstract: A laser catheter is disclosed wherein optical fibers carrying laser light are mounted in a catheter for insertion into an artery to provide controlled delivery of a laser beam for percutaneous intravascular laser treatment of atherosclerotic disease. A transparent protective shield is provided at the distal end of the catheter for mechanically diplacing intravascular blood and protecting the fibers from the intravascular contents, as well as protecting the patient in the event of failure of the fiber optics. Multiple optical fibers allow the selection of tissue that is to be removed. A computer controlled system automatically aligns fibers with the laser and controls exposure time. Spectroscopic diagnostics determine what tissue is to be removed.

Abstract: A device for use in laser ophthalmic surgery includes a laser system, a disposable contact lens and an adjustable retainer ring for mounting the contact lens on the laser system. In order to properly align the disposable contact lens to the laser system, reference marks on the contact lens are brought into coincidence with predetermined focal points along the laser beam paths. To this end, the laser system successively directs a laser beam along at least three predetermined paths to respective predetermined focal points, and the contact lens is positioned across these predetermined paths. Along each predetermined path, the laser beam is activated to establish a series of laser marks on the contact lens. If the laser marks, predetermined focal points and reference marks are all coincident, then the contact lens is properly aligned with the laser system.

Abstract: Fiber delivered laser pulses emulsify thrombus by mechanical stresses that include a combination of pressure, tension and shear stress. Laser radiation is delivered to the locality of a thrombus and the radiation is absorbed by blood, blood dot, or other present materials. The combination of a leading pressure wave and subsequent vapor bubble cause efficient, emulsification of thrombus. Operating the laser in a low average power mode alleviates potential thermal complications. The laser is operated in a high repetition rate mode to take advantage of ultrasound frequency effects of thrombus dissolution as well as to decrease the total procedure time. Specific parameter ranges for operation are described. The device includes optical fibers surrounding a lumen intended for flow of a cooling agent. The fibers may be arranged concentrically around the lumen to deliver radiation and heat over as large an area as possible.

Abstract: A cardiovascular treatment method utilizes an elongate flexible surgical instrument (e.g., catheter) having a distal end. A distal end portion of the instrument is inserted into a vascular system of a patient. A surgical head at the distal end of the instrument is positioned so that the head is disposed adjacent to myocardium tissue of the patient. The head is operated to form a recess in the myocardium tissue. Prior to operating the head to form the recess, a thickness of the myocardium tissue is measured, the recess formed during the operation having a length determined in accordance with the measured thickness of the myocardium tissue. The thickness measurement partially determines the length of the recess. The angle of entry of the recess with respect to the heart wall also partially determines the length of the recess: the greater the angle, the longer the recess can be for a given myocardium thickness.

Abstract: A method of identifying vasculature comprising the steps of introducing an indicator in a peripheral vessel, and advancing a portion of the indicator into an internal vessel to identify said vessel. A catheter for identifying vasculature is also disclosed. The catheter is adapted to be introduced into a peripheral vessel and a portion thereof advanced into an internal vessel. The catheter comprises a light delivery portion at a distal end thereof and an expandable member located proximal to the light delivery portion.

Abstract: Apparatus and methods are provided for thermally and/or mechanically treating tissue, such as valvular structures, to reconfigure or shrink the tissue in a controlled manner. The apparatus comprises a catheter in communication with an end effector which induces a temperature rise in an annulus of tissue surrounding the leaflets of a valve or in the chordae tendineae sufficient to cause shrinkage, thereby causing the valves to close more tightly. Mechanical clips can also be implanted over the valve either alone or after the thermal treatment. The clips are delivered by a catheter and may be configured to traverse directly over the valve itself or to lie partially over the periphery of the valve to prevent obstruction of the valve channel. The clips can be coated with drugs or a radiopaque coating. The catheter can also incorporate sensors or energy delivery devices, e.g., transducers, on its distal end.

Abstract: An endarterectomy surgical instrument and procedure for removing plaque from a selected length of an artery and surgical instruments for cutting plaque build-ups. The endarterectomy surgical instrument has means for developing an image of the surgical site so that probing of the artery can be observed without requiring opening the artery along the selected length over which the plaque is removed.

Abstract: A myocardial revascularization system that includes a laser energy source (e.g., a semiconductor laser), an outer guide member providing access to a patient's heart, and an optical fiber. The optical fiber is coupled to receive laser energy pulses from the source, is slidably located within the guide member, and is extendible from the distal end of the guide member. A drive motor is connected to the fiber to automatically move the distal end of the optical fiber with respect to the distal end of the guide member. A controller controls the drive motor to automatically move the fiber in synchronism with firing of the laser energy, and automatically calibrates the position of the distal end of the fiber with respect to the distal end of the catheter. The fiber has, at its tip, an enlargened portion with a front surface coated with a heat absorbing material that is nonmetallic and is partially transparent to the pulses. The outer guide member is 7 French or smaller and has a deflectable distal end.

Abstract: The variable stiffness optical fiber shaft includes an optical fiber and a reinforcing tube with apertures formed around the surface of the reinforcing tube, and at least one coaxial outer layer of a polymer, metal, or both for providing desired variations in stiffness along at least a portion of the length of the shaft. The apertures can be formed as axial or helical slits in the surface of the reinforcing tube, and the reinforcing tube can also be formed to be tapered at the point where the apertures are formed in the reinforcing tube to provide an optical fiber shaft that is torqueable and pushable at the proximal end, yet soft and flexible at the distal end.

Abstract: The invention encompasses methods and apparatus for pumping fluid from one location to another through the repetitive expansion and collapse of bubbles generated as a result of the absorption of repetitive pulses of radiation in a fluid. This pumping phenomenon can be used to aid removal of a total or partial occlusion in a body passage by emulsifying the occlusion with acoustic shock and pressure waves or by causing mechanically disrupting the occlusive material.

Abstract: A long pulse alexandrite laser for treating dermatological specimens is disclosed. The use of alexandrite allows operation in the near-infrared, specifically in a 50 nm range surrounding 755. Infrared in this range allows good penetration while still achieving an acceptable ratio of hemoglobin to melanin absorption. In operation, the laser generates pulses having a durations between 5 and 100 msec and fluences between 10 and 50 J/cm2. A light delivery system is provided that transmits the laser light output pulse to dermatological targets of a patient. The invention is also directed to a hair removal system. Here, it is desirable to use an index-matching application on the skin sections to be treated, and a visual indicator is thermo- or photo-responsive or otherwise responsive to the laser light pulse to generate a visible change. Also, the invention is directed to a combined sclerotherapy and light treatment method and kit for unwanted veins.

Abstract: An apparatus for performing transmyocardial revascularization provides a closed-chest formation of a channel in a wall of a heart. An articulating scope in one embodiment includes a flexible distal portion which provides for a coupling of a surface of the heart to the distal portion. The articulating distal portion is coupled to a control member to provide articulation. Movement of the control member causes deflection, including articulation, of the generally flexible working end of the scope. The coupler may be a two way valve to provide both vacuum and flushing solutions. The articulating scope can be supported by a scope holder that is table mounted or mounted to the patient. An access port provides for the introduction of tools and instruments. An adaptor couples the access port with a handle. The handle provides a working channel for the introduction of an energy delivery device.

Abstract: Systems and methods are provided for selectively applying electrical energy to a target location on an external body surface, such as skin tissue removal and/or collagen shrinkage in the epidermis or dermis, e.g., the removal of pigmentations, vascular lesions (e.g., leg veins), scars, tattoos, etc., and for other surgical procedures on the skin, such as tissue rejuvenation, cosmetic surgery, wrinkle removal, hair removal and/or transplant procedures. The present invention applies high frequency (RF) electrical energy to one or more electrode terminals adjacent an external body surface, such as the outer surface of the skin, to remove and/or modify the structure of tissue structures within the skin. Depending on the specific cosmetic procedure, the present invention may be used to: (1) volumetrically remove tissue or hair (i.e.

Abstract: The present invention relates to a system for irradiating a living body with laser light. The system is excellent in treatment effect by enhancing the absorption efficiency of laser light at a target area of the living tissue. The system comprises a target means located on the surface or in the inside of a living tissue to be treated including a material which absorbs the laser light to generate heat; and means for irradiating said target with the laser light to generate heat.

Abstract: A cryoplasty catheter and method for preventing or slowing reclosure of a lesion following angioplasty. The cryoplasty catheter includes a shaft having proximal and distal ends and a dilatation balloon disposed at the distal end. An intake lumen and exhaust lumen are defined by the shaft to deliver coolant to the balloon and to exhaust or drain coolant from the balloon. The method in accordance with the present invention includes cooling a lesion to aid in remodeling the lesion through dilatation and/or freezing a portion of the lesion adjacent the dilatation balloon to kill cells within the lesion to prevent or retard restenosis.

Abstract: An energy delivery system for performing myocardial revascularization on a heart of a patient including an energy pulse source that produces energy pulses sufficient to create channels in a wall of a heart, and an energy pulse delivery system connected to receive the energy pulses and deliver the energy pulses to desired locations for channels in the wall of the heart. Also disclosed are a sensor that senses a cyclical event related to the contraction and expansion of the beating heart; a controller responsive to the sensor for automatically firing the energy pulse system to provide energy to strike the beating heart only within a safe time period during a heart beat cycle; RF electrical or laser energy pulses; a temperature sensor to avoid damage caused by overheating adjacent heart tissue; a thermal conductivity cooling system; and programmably adjusting duty cycle, duration and amplitude of energy pulses.

Abstract: An apparatus and method for accurately and reproducibly locating a planar array of optical fibers in space are disclosed. A single acousto-optic modulator is used to accurately and substantially-simultaneously deflect multiple beams of different-wavelength radiation energy to each of said accurately-positioned optical fibers. Both aspects of the invention can be used in an apparatus and method for removing occlusions from vessels, as previously disclosed.

Abstract: A controlled advancement laser ablation device is provided for precise ablation of body matter. The laser ablation device includes a laser energy transmission mechanism such as, e.g. a fiber optic fiber mounted for controlled translational longitudinal movement relative to a housing structure. A laser energy generator is optically connected to the laser energy transmission mechanism. A controlled advancement mechanism is provided in engagement with the laser energy transmission mechanism for advancing the mechanism through the housing structure at a controlled rated coordinated with the laser energy generator output to ablate body tissue. Controlled advancement mechanisms include constant and/or variable rate springs, motors, and other mechanisms which can be coordinated with the laser energy generator to advance the laser energy transmission mechanism as the targeted substance is ablated. The device is particularly suitable for use in transmyocardial revascularization (TMR) and angioplasty procedures.

Abstract: A laser application set, which is an interventional application set for minimum invasive, laser-induced thermotherapy of soft-tissue tumors is disclosed. The laser application set is designed in such a manner that an introductor tube (6) with a stylet (12) is provided and accommodates a tunneled catheter (17) with an internal stylet (20).

Abstract: A controlled advancement laser ablation device is provided for precise ablation of body matter. The laser ablation device includes a laser energy transmission mechanism such as, e.g., a fiber optic fiber mounted for controlled translational longitudinal movement relative to a housing structure. A laser energy generator is optically connected to the laser energy transmission mechanism. A controlled advancement mechanism is provided in engagement with the laser energy transmission mechanism for advancing the mechanism through the housing structure at a controlled rated coordinated with the laser energy generator output to ablate body tissue. Controlled advancement mechanisms include constant and/or variable rate springs, motors, and other mechanisms which can be coordinated with the laser energy generator to advance the laser energy transmission mechanism as the targeted substance is ablated. The device is particularly suitable for use in transmyocardial revascularization (TMR) and angioplasty procedures.

Abstract: An optical transmissive, light-diffusing, fiber tip assembly having a radiation-scattering particles incorporated therein and a reflective end surface is disclosed for use in phototherapy. As radiation propagates through the fiber tip, a portion of the radiation is scattered in a cylindrical (or partially cylindrical) pattern along the length of the fiber tip. Radiation which is not scattered during this initial pass through the tip is reflected by at least one surface of the assembly and returned through the tip. During this second pass, the remaining radiation (or at least a major portion of this returning radiation) again encounters the scatterers which provide further radial diffusion of the radiation. Preferably, the scattering medium and the reflective end cap interact to provide a substantially uniform axial distribution of laser radiation over the length of the tip apparatus.

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 surgical device is provided for forming a channel through or partially through vascular tissue, including vascular tissue, utilizing both mechanical and laser energy, and, if desired, depositing a therapeutic agent therein. The device includes an optical fiber for transmission of laser energy, a housing, and a hollow guide attached to the housing through which the optical fiber extends. A needle is attached to the distal end of the optical fiber in fluid communication with a catheter surrounding the optical fiber. Additionally, an actuator is included operably connected to the optical fiber for selectively extending the needle and/or fiber from the hollow guide. Finally, a laser control device is contemplated operably connected to the optical fiber, transmitting laser energy from the distal end of the fiber after the needle has penetrated a layer of selected distance into the tissue.

Abstract: Systems and methods for determining an effective amount of light energy to deliver to fluids, particularly fluids having target and non-target materials. The systems and methods specifically relate to phototherapy and photopheresis systems where an effective amount of light energy is desired to be delivered to targets in biological fluids.

Abstract: Apparatus for pumping fluid from one location to another via generation of bubbles in fluid, and expansion and callapse thereof, are described. These apparatus deliver repetitive pulses of radiation to a fluid to form bubbles therein. The expansion and collapse of the bubbles cause fluid motion or pumping. This pumping can be used to facilitate removal of a total or partial occlusion in a body passage by a variety of mechanisms. The apparatus are flexible to facilitate use within a body passage.

Abstract: A device and method for the removal of subcutaneous adipose layers with a laser source, optical fiber for conveying the laser ben emitted by the first source and a hollow needle f or guiding the fiber. The fiber ends in the vicinity of the end of the needle. The laser beam is generated with an intensity and a wavelength for liquefying, and maintaining liquid, the adipose cells. The laser beam from the optical fiber irradiates adipose cells in the adipose layer to transform the adipose cells into, and maintain the adipose cells as, a liquid substance.

Abstract: A method for treating in-stent restenosis using radiation having a wavelength sufficient to kill or promote cellular death (e.g., through programmed cell death), or otherwise remove smooth muscle cells which have proliferated, or which might otherwise proliferate, in the proximity of (i.e., within, around or adjacent to) a stent within a body lumen, causing (or potentially causing) at least partial blockage of the lumen. The treatment method includes irradiating smooth muscle cells in the region of the stenosis with non-ablative, cytotoxic radiation, such as UV radiation. A cytotoxic, photoactivatable chromophore may also be delivered to the treatment site prior to irradiation. The method can be used prophylactically or to treat in-stent restenosis after blockage has occurred without further damage to surrounding tissue.

Abstract: An endoscopic instrument for the therapy of the heart muscle forming channels in the heart muscle tissue by way of laser energy and including a shank tube and at least one instrumentation channel for a laser fiber disposed in axial direction within the shank tube as well as central optics parallel to the laser fiber for observing the locus of treatment. The distal end of the shank tube may be connected to a vacuum source and is designed such that the heart muscle can be restrained by partially suctioning the same against the shank end.

Abstract: A viewing and treatment apparatus for performing minimally invasive surgery through an opening in a patient's chest, the apparatus includes a visualization scope with an elongated portion and a distal end, and a working device such as a tissue ablation energy delivery device. The working device is encompassed within a working channel that communicates with the distal end of the scope. In one embodiment, a bronchoscope is used whose catheter shafting includes an introducer sleeve at the distal section of the scope for providing stability during introduction to a patient's chest while stabilizing the treatment and visualization distal ends of the scope at a treatment site. This embodiment can include a needle piercing assembly that cooperatively works with the work device such as for drug delivery.

Abstract: Phototherapeutic instruments are disclosed having a light transmitting optical fiber with a flexible portion that facilitates passage of the instrument through a tortuous lumen within a patient and an outer support sheath slidably mounted about the fiber. In one preferred embodiment, the instrument includes a rigid light-emitting tip. The support sheath is configured to protect the more delicate optical fiber and provide support for the flexible portion of the optical fiber during penetration of the light-emitting tip into a patient's tissue. During insertion of the instrument into a tortuous lumen, the optical fiber is covered by the support sheath, allowing the light-emitting tip to deflect with ease as it travels along the tortuous lumen.

Abstract: Laser energy produced by a laser operating in the mid-infrared region (approximately 2 micrometers) is delivered by an optical fiber in a catheter to a surgical site for biological tissue removal and repair. Disclosed laser sources which have an output wavelength in this region include: Holmium-doped Yttrium Aluminum Garnet (Ho:YAG), Holmium-doped Yttrium Lithium Fluoride (Ho:YLF), Erbium-doped YAG, Erbium-doped YLF and Thulium-doped YAG. For tissue removal, the lasers are operated with relatively long pulses at energy levels of approximately 1 joule per pulse. For tissue repair, the lasers are operated in a continuous wave mode at low power. Laser output energy is applied to a silica-based optical fiber which has been specially purified to reduce the hydroxyl-ion concentration to a low level. The catheter may be comprised of a single optical fiber or a plurality of optical fibers arranged to give overlapping output patterns for large area coverage.

Abstract: A method for treating myocardium using at least one mechanical or electromagnetic energy functional device for forming a network of branched, interconnecting passages in a boundary between endocardium and myocardium, thereby enhancing blood flow into the treated zone, and a device for selectively treating ischemic myocardium tissue comprising a tube having proximal end and distal end, and at least one hollow lumen and defining an axis, at least two mechanical or electromagnetic energy functional devices disposed within the tube, the at least two mechanical or electromagnetic energy functional devices each having a distal end disposed adjacent the distal end of the central tube, and a deflecting member adjacent the distal portion of the central tube for deflecting the distal end of each of the at least two mechanical or electromagnetic energy functional devices away from the axis, for enabling treatment of selective areas of ischemic or hibernating myocardium tissue.

Abstract: The apparatus for combined mechanical/laser myocardial revascularization of a human heart includes: inserting a mechanical piercing device and an elongated flexible lasing apparatus into the chest cavity of a patient; mechanically auto-piercing, micro-tearing or spreading the epicardium of the heart; and then lasing from beneath the epicardium through the myocardium.

Abstract: The invention encompasses methods and apparatus for pumping fluid from one location to another through the repetitive expansion and collapse of bubbles generated as a result of the absorption of repetitive pulses of radiation in a fluid. This pumping phenomenon can be used to aid removal of a total or partial occlusion in a body passage by emulsifying the occlusion with acoustic shock and pressure waves or by mechanically disrupting the occlusive material.

Abstract: A controlled advancement laser ablation device is provided for precise ablation of body matter. The laser ablation device includes a handle portion having proximal and distal openings and a fiber advancing device having a stationary member and a movable member. The movable member is movable towards and away from the stationary member. A fiber casing is included having proximal and distal ends. The distal end is secured to the proximal end of the handle portion and the proximal end is secured to the stationary member. At least one optical fiber is included having proximal and distal ends. The distal end is extendible through the handle portion and a portion of the fiber, defined between the proximal and distal ends, is secured to the movable member. A laser energy generator is optically connected to the proximal end of the optical fiber. The handle portion includes a self-biasing advancing mechanism.

Abstract: A method and catheter system for irradiating a body lumen wall which comprises providing an elongated, flexible radiation transmission member having an emitting portion at its distal end, advancing the emitting portion to an area adjacent the wall defining the patient's body lumen to be treated by irradiation, and directing radiation through the transmission member while moving the transmission member to cause the emitting portion to irradiate a length of the wall of the body lumen. The transmission member may be rotated independently or in conjunction with longitudinal movement to achieve either selective or uniform irradiation of the wall defining the body lumen. In one embodiment, this invention comprises an elongated flexible shaft, having an inflatable member disposed at the distal end. A radiation transmission member having an emitting portion on its distal end is slidably disposed within the elongated shaft so that the emitting portion resides within the inflatable member.