Atherectomy system adapted to allow retrograde ablation

Abstract

The atherectomy system is adapted for both antegrade and retrograde ablation and includes a drive coil and an atherectomy tool coupled to the drive coil. The atherectomy tool includes a distal region adapted for antegrade ablation and a proximal region adapted for retrograde ablation. The proximal handle includes an actuation member. The actuation member is adapted to be movable in a first direction to urge the atherectomy tool in an antegrade ablation direction and adapted to be movable in a second direction to urge the atherectomy tool in a retrograde ablation direction. The atherectomy system is adapted such that the actuation member provides similar feedback to the user regardless of whether the atherectomy tool is ablating in the antegrade ablation direction or the retrograde ablation direction.

Description

[Technical field]

[0001] The present disclosure relates to medical devices and methods of making and using the medical devices. More particularly, the present disclosure is directed to devices and methods for removing occlusive material from a body lumen. Additionally, the present disclosure is directed to an atherectomy device for creating a passageway through an occlusion in a body lumen, such as a blood vessel. [Background technology]

[0002] In medical applications, a wide variety of medical devices have been developed, for example, for use in accessing body cavities and interacting with fluids and structures therein. Some of these devices may include guidewires, catheters, pumps, motors, controllers, filters, grinders, needles, valves, as well as delivery devices and / or systems used to deliver such devices. These devices may be manufactured by any one of a variety of different manufacturing methods and used according to any one of a variety of methods. Each of the known medical devices and methods has certain advantages and disadvantages. Summary of the Invention

[0003] The present disclosure provides design, material, manufacturing, and use alternatives for medical devices. In one example, an atherectomy system is adapted for both antegrade and retrograde ablation. The atherectomy system includes a drive coil and an atherectomy tool coupled to the drive coil. The atherectomy tool includes a distal region adapted for antegrade ablation and a proximal region adapted for retrograde ablation. The proximal handle includes an actuation member. The actuation member is adapted to be movable in a first direction to urge the atherectomy tool in an antegrade ablation direction and is adapted to be movable in a second direction to urge the atherectomy tool in a retrograde ablation direction. The atherectomy system is adapted such that the actuation member provides similar feedback to the user regardless of whether the atherectomy tool is ablating in an antegrade ablation direction or a retrograde ablation direction.

[0004] Alternatively or additionally, the drive coil may be adapted such that the actuation member provides similar feedback to the user regardless of whether the atherectomy tool is ablating in an antegrade or retrograde ablation direction.

[0005] Alternatively or additionally, the drive coil may have an axial force-torque ratio of less than 50 gf / mNm (490.3325 N / Nm) and greater than -50 gf / mNm (-490.3325 N / Nm).

[0006] Alternatively or additionally, the drive coil may have a tensile stiffness in the range of 0-5 N / mm (0-5000 N / m) (gauge length 100 mm) and a compressive stiffness in the range of 0-10 N / mm (0-10000 N / m) (gauge length 10 mm).

[0007] Alternatively or additionally, the drive coil may have a torque of 0 to 0.05 mNm / degree (0 to about 2.865×10 -3 The torsional stiffness may be in the range of 200 mm (gauge length). Alternatively or additionally, the drive coil may have a bending stiffness of less than 0.5 N / mm (5000 N / m) (23 mm span).

[0008] Alternatively or additionally, the drive coil may have a break torque value of greater than 1 mNm (0.001 Nm). Alternatively or additionally, the drive coil may include a single layer coil, a two layer coil, a three layer coil, or a four layer coil.

[0009] Alternatively or additionally, the atherectomy system may further include a drive motor operably coupled to the drive coil. As another example, an atherectomy system is adapted to enable bidirectional ablation. The atherectomy system includes a proximal handle including an actuating member. The actuating member is adapted to be movable in a first direction to perform antegrade ablation and in a second direction to perform retrograde ablation. The atherectomy tool includes a distal region adapted for antegrade ablation and a proximal region adapted for retrograde ablation. A drive coil extends between the proximal handle and the atherectomy tool and is adapted to provide predictable feedback via the actuating member regardless of whether the atherectomy tool is performing retrograde ablation or antegrade ablation.

[0010] Alternatively or additionally, the drive coil may have an axial force-torque ratio of less than 10 gf / mNm (approximately 98.07 N / Nm) and greater than -10 gf / mNm (approximately -98.07 N / Nm).

[0011] Alternatively or additionally, the drive coil may have a tensile stiffness in the range of 0.5-2 N / mm (500-2000 N / m) (gauge length 100 mm). Alternatively or additionally, the drive coil may have a compressive stiffness in the range of 3.5 to 5 N / mm (3500 N / m to 5000 N / m) (gauge length 10 mm).

[0012] Alternatively or additionally, the drive coil has a torque of 0.0004 to 0.002 mNm / degree (2.292×10 -5 ~1.146×10 -4 The torsional stiffness may be in the range of 200 mm (gauge length).

[0013] Alternatively or additionally, the drive coil may have a bending stiffness of less than 0.1 N / mm (100 N / m) (23 mm span). Alternatively or additionally, the drive coil may have a break torque value of greater than 4mNm (0.004Nm).

[0014] As another example, an atherectomy system is adapted to enable bidirectional ablation. The atherectomy system includes a proximal handle including an actuation member adapted to be movable in a first direction to move an atherectomy burr in an antegrade ablation direction and adapted to be movable in a second direction to move the atherectomy burr in a retrograde ablation direction. The atherectomy tool includes a distal region adapted for antegrade ablation and a proximal region adapted for retrograde ablation. The drive coil extends between the proximal handle and the atherectomy tool and is adapted to provide a force-torque ratio of -10 gf / mNm (approximately -98.07 N / Nm) to 10 gf / mNm (approximately 98.07 N / Nm), a tensile stiffness in the range of 0.5 to 2 N / mm (500 to 2000 N / m) (gauge length 100 mm), and a compressive stiffness in the range of 3.5 to 5 N / mm (3500 N / m to 5000 N / m) (gauge length 10 mm).

[0015] Alternatively or additionally, the drive coil has a torque of 0.0004 to 0.002 mNm / degree (2.292×10 -5 ~1.146×10 -4 The torsional stiffness may be in the range of 200 mm (gauge length).

[0016] Alternatively or additionally, the drive coil may have a bending stiffness of less than 0.1 N / mm (100 N / m) (23 mm span). Alternatively or additionally, the drive coil may have a break torque value of greater than 4mNm (0.004Nm).

[0017] The above summary of some embodiments is not intended to describe each disclosed embodiment or every implementation of the present disclosure. The following figures and detailed description more particularly exemplify these embodiments.

[0018] The present invention may be more fully understood from the following detailed description of various embodiments of the invention in conjunction with the accompanying drawings, in which: [Brief description of the drawings]

[0019] [Figure 1] 1 is a schematic block diagram of an exemplary atherectomy system. [Diagram 2] 2 is a cross-sectional view of an exemplary atherectomy tool that can be used with the exemplary atherectomy system of FIG. 1. [Figure 3A] Schematic diagram of an exemplary single layer drive coil. [Figure 3B] Schematic diagram of an exemplary two-layer drive coil. [Figure 3C] 2 is a schematic cross-sectional view of an exemplary three-layer drive coil. [Figure 3D] 2 is a schematic cross-sectional view of an exemplary four-layer drive coil. [Figure 4] Graph showing experimental data. [Diagram 5] Graph showing experimental data. [Figure 6] Graph showing experimental data. [Figure 7] Graph showing experimental data. [Figure 8] Graph showing experimental data. [Figure 9] Graph showing experimental data. [Figure 10] Graph showing experimental data. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0020] While the present disclosure is amenable to various modifications and alternative forms, details thereof have been shown by way of example in the drawings and will be described in detail. It is to be understood, however, that the intention is not to limit the disclosure to the particular embodiments described. On the contrary, the invention is intended to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the present disclosure.

[0021] For the following defined terms, these definitions shall be applied, unless a different definition is given in the claims or elsewhere in this specification. In this specification, all numerical values, whether expressly stated or not, are assumed to be modified by the term "about." The term "about" generally refers to a range of numerical values ​​that one of ordinary skill in the art would consider equivalent to the recited value (i.e., having the same function or result). In many instances, the term "about" can include numbers that are rounded to the nearest significant figure.

[0022] The recitation of numerical ranges by endpoints includes all numbers within that range (e.g., 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.80, 4, and 5). As used in this specification and the appended claims, the singular forms "a," "an," and "the" include plural referents unless the content clearly dictates otherwise. As used in this specification and the appended claims, the term "or" is generally used in its sense including "and / or" unless the content clearly dictates otherwise.

[0023] The following detailed description should be read with reference to the drawings, in which like elements in different drawings are numbered the same. The drawings, which are not necessarily to scale, depict illustrative embodiments and are not intended to limit the scope of the invention.

[0024] Cardiovascular disease and peripheral arterial disease can result from the accumulation of atheromatous material on the inner walls of blood vessel lumens, resulting in a condition known as atherosclerosis. Atheromatous and other vascular deposits can restrict blood flow and cause ischemia in a patient's heart, the vasculature of a patient's legs, the patient's carotid arteries, etc. Such ischemia can result in pain, swelling, non-healing wounds, amputations, strokes, myocardial infarctions, and / or other conditions.

[0025] Atherosclerotic deposits may have a wide variety of characteristics, some being relatively soft, others fibrous and / or calcified. In the latter case, the deposits may be referred to as plaques. Atherosclerosis occurs naturally as a result of aging, but may also be exacerbated by factors such as diet, high blood pressure, genetics, and vascular injury. Atherosclerosis may be treated in a variety of ways, including drugs, bypass surgery, and / or various catheter-based approaches that may rely on intravascular dilation or removal of atheromatous or other material obstructing blood vessels. Atherectomy is a catheter-based intervention that may be used to treat atherosclerosis.

[0026] Atherectomy is an interventional medical procedure performed to restore blood flow through a portion of a patient's vascular system that has been blocked by plaque or other material (e.g., blocked by an occlusion). In an atherectomy procedure, a device on the end of a drive shaft is used to engage and / or remove (e.g., abrade, crush, cut, scrape, etc.) plaque or other material from the patient's blood vessel (e.g., artery or vein). In some cases, the device on the end of the drive shaft may be abrasive and / or otherwise configured to remove plaque from the vessel wall or other obstructions within the vessel when the device is rotating and engages the plaque or other obstruction. In some cases, atherectomy involves using an abrasive atherectomy burr that is rotated at high speeds of over 100,000 revolutions per minute (RPM) to abrade plaque and other hardened material from within the patient's blood vessel. The atherectomy burr can be rotated at speeds of over 140,000 RPM, over 180,000 RPM, and even as fast as 220,000 RPM. Atherectomy can include orbital rotational atherectomy in addition to rotational atherectomy.

[0027] 1 is a schematic block diagram of an exemplary atherectomy system 10. The exemplary atherectomy system 10 includes a proximal handle 12 that can be held in a user's hand when operating the atherectomy system 10. In some cases, the proximal handle 12 can instead be adapted to be fixed in space, such as, for example, fixed to a table. The atherectomy system 10 includes an actuation member 14 that is slidably coupled to the proximal handle 12 such that the actuation member 14 can be moved in a first direction relative to the proximal handle 12 indicated by arrow 16 and in a second direction relative to the proximal handle 12 indicated by arrow 18.

[0028] A drive coil 20 extends distally from the proximal handle 12. An atherectomy tool 22 is secured to a distal end 24 of the drive shaft 20. Although not shown, the drive shaft 20 includes a lumen that allows the drive shaft 20 to be advanced over and rotated relative to a guidewire to reach a treatment site. It will be understood that the drive shaft 20 shown diagrammatically may include additional components. For example, the drive shaft 20 may include an outer sheath (not shown). In some cases, the outer sheath may be adapted to allow the drive shaft 20 to rotate within the outer sheath. In some cases, the outer sheath may be fixed such that the drive coil 20 can translate relative to the outer sheath. In some cases, the outer sheath may be fixed such that the outer sheath translates axially as the drive coil 20 translates axially.

[0029] In some cases, moving the actuating member 14 in a first direction indicated by arrow 16 may cause the drive coil 20 and the atherectomy tool 22 to also move in the direction indicated by arrow 16. In some cases, moving the actuating member 14 in the first direction indicated by arrow 16 may cause the atherectomy tool 22 to move in an antegrade ablation direction. In some cases, moving the actuating member 14 in a second direction indicated by arrow 18 may cause the drive coil 20 and the atherectomy tool 22 to also move in the direction indicated by arrow 18. In some cases, moving the actuating member 14 in the second direction indicated by arrow 18 may cause the atherectomy tool to move in a retrograde ablation direction.

[0030] The actuation member 14 can take any of a variety of forms. For example, in some cases, the actuation member 14 can simply be a knob extending from a proximal handle such that a user can grasp the knob and move it left and right (in the orientation shown) in the directions indicated by arrows 16 and 18. The actuation member 14 can include a knob that slides back and forth, and in some cases, a knob that rotates. The actuation member 14 can include, for example, a lever that can be moved to indicate a forward or reverse direction.

[0031] In some cases, particularly when the atherectomy system 10 is configured as a fly-by-wire system without a direct mechanical connection between the actuating member 14 and the drive coil 20, the actuating member 14 may take the form of a joystick or other game controller. In some cases, the actuating member 14 may be a knob that is easily grasped by an operator to operate the atherectomy system 10. In some cases, the actuating member 14 may include a touch-sensitive controller or even a touch screen. Moving the actuating member 14 back and forth in the directions indicated by arrows 16 and 18 may cause the actuating member 14 to output a demand signal and move the drive coil 20 accordingly. Further details regarding atherectomy systems using fly-by-wire to facilitate ablation generally, and retrograde ablation specifically, may be found in U.S. Patent Application No. 63 / 257,681, filed October 20, 2021, entitled "FLY BY WIRE CONTROL FOR ATHERECTOMY," which is incorporated herein by reference.

[0032] In some cases, the proximal handle 12 may include a motor 26, such as an electric drive motor, a pneumatic drive motor, a hydraulic drive motor, or even a take-up drive motor. The motor 26 may be located within the proximal handle 12, as shown in phantom. In some cases, the motor 26 may not be located within the proximal handle 12, but instead may be located remotely within a console 28, with a flexible drive cable 30 extending from the motor 26 to the proximal handle 12.

[0033] In some cases, the drive motor and other components, such as, but not limited to, a controller adapted to regulate operation of the drive motor, may be disposed in a reusable assembly. This reusable assembly may be left outside the sterile field during use. It may be bagged or otherwise sealed for use within the sterile field. In some cases, the reusable assembly may be adapted to be sterilized multiple times and thus may be used on more than one patient. In some cases, it may be assumed that at least some of the proximal handle 12, drive shaft 20, and atherectomy tool 22 are part of a single-use assembly that can be sterilized for use on one patient and then discarded. In some cases, it may be assumed that the entire atherectomy system 10 is adapted for single use. In some cases, it may be assumed that the entire atherectomy system 10 is adapted for multiple use.

[0034] To perform retrograde ablation, as seen, for example, in FIG. 2, the atherectomy tool 22 may be adapted to perform both antegrade and retrograde ablation. The atherectomy tool 22 may be viewed as having an ovoid body 30 including a distal tapered portion 32 and a proximal tapered portion 34. The atherectomy tool 22 includes a lumen 36 aligned with a corresponding lumen 38 extending through the drive shaft 20 for accommodating a guidewire (not shown). The atherectomy tool 22 includes a cavity 40 adapted to accommodate the drive shaft 20 and secure the atherectomy tool 22 relative to the drive shaft 20. The atherectomy tool 22 may be secured in place, for example, with an adhesive, or may be welded or soldered.

[0035] The distal tapered portion 32 may be considered to be adapted to perform antegrade ablation, while the proximal tapered portion 34 may be considered to be adapted to perform retrograde ablation. In some cases, one or both of the distal tapered portion 32 and the proximal tapered portion 34 may include a sharp cutting surface. In some cases, as shown, an abrasive material 42, such as, but not limited to, diamond, may be disposed over the distal tapered portion 32. An abrasive material 44, such as, but not limited to, diamond, may be disposed over the proximal tapered portion 34. Thus, the atherectomy tool 22 may be considered to be adapted for both antegrade and retrograde ablation.

[0036] In some cases, the drive shaft 20 is a coil spring. It will be appreciated that the coil spring may have a first set of characteristics when under compression, such as when the drive shaft 20 is advanced distally and the atherectomy tool 22 reaches an obstacle. It will be appreciated that the coil spring may have a second set of characteristics different from the first set of characteristics when under tension, such as when the drive shaft 20 is retracted proximally and the atherectomy tool 22 reaches an obstacle. In some cases, the drive shaft 20 is intended to rotate in a particular rotational direction when used to drive the atherectomy tool 22, but the generation of excessive torque may cause the atherectomy system 10 to behave differently. For example, a controller regulating the operation of the proximal handle 12 may stop the drive shaft 20 and reverse its rotational direction for a short period of time. It will be appreciated that this may cause the drive shaft 20 to alternately wind when driven in its primary direction and unwind when driven in a rotational direction opposite its primary direction or unwind on itself. It will be appreciated that the feel of the atherectomy system 10, which manifests itself as the force felt by the user when attempting to adjust the actuating member 14, may not be consistent depending on what the drive shaft 20 is doing.

[0037] In some cases, the atherectomy system 10 may provide a certain feedback to the user when the user is using the atherectomy system 10 to ablate in an antegrade direction, i.e., when the atherectomy tool 22 is advancing distally into the lesion to be removed or reduced. In some cases, the feedback provided to the user during antegrade ablation provides predictability, i.e., the user learns to recognize how the feedback the user is receiving via the force the user is applying to the actuating member 14 translates into the movement of the drive shaft 20. The user learns that applying a certain force via the actuating member 14 means, for example, that the atherectomy tool 22 will move a certain distance at a certain force at the lesion. The feedback when ablating in the antegrade direction may be considered approximately linear, intuitive, and predictable.

[0038] However, in some cases, it may be desirable to also be able to ablate in a retrograde direction, i.e., while moving the atherectomy tool 22 in a proximal direction. This can occur when the user applies too much force and the atherectomy tool 22 penetrates the lesion and reaches too far distal to the lesion. This is referred to as "watermelon seeding" the atherectomy tool 22. Alternatively or additionally, if the lesion is removed or reduced while ablating in the antegrade direction, the atherectomy tool 22 can be translated distal to the lesion so that upon translation in the proximal direction, the atherectomy tool 22 can ablate in a retrograde direction. This is known as "polishing" the lesion. Ablation in both the antegrade and retrograde directions may be advantageous compared to polishing in the antegrade direction only. In some cases, ablation in the retrograde direction may provide the user with less predictable and less "linear" feedback. Thus, there is a risk of introducing excessive force, which may potentially cause tissue damage or even jam the atherectomy tool 22, potentially occluding blood flow.

[0039] In some cases, the proximal handle 12 may be adapted to customize the feedback provided to the user to make the feedback more consistent whether ablating in an antegrade or retrograde ablation direction. The feedback may be envisioned to include any of a variety of different feedbacks. It may include one or more of audible feedback, tactile feedback. In some cases, the feedback may include mechanical feedback. In some cases, the feedback may include vibration feedback. These are merely examples and are not intended to be limiting. Further details regarding atherectomy systems using customizable feedback when performing ablation generally, and retrograde ablation specifically, may be found in U.S. Patent Application No. 63 / 237679, entitled “ATHERECTOMY SYSTEM WITH ANTEROGRADE AND RETROGRADE ABLATION,” filed August 27, 2021, which is incorporated herein by reference.

[0040] In some cases, the drive coil 20 itself may be adapted to work well during both antegrade and retrograde ablation. The drive coil 20 may be formed, for example, as a single layer coil, a double layer coil, a triple layer coil, or even a quadruple layer coil. FIG. 3A is a schematic diagram of a single layer drive coil 20a with one or more threads 50 wound in a helical direction. FIG. 3B is a schematic diagram of a double layer drive coil 20b including one or more threads 52 wound to form an outer layer 54 and one or more threads 56 wound to form an inner layer 58. In some cases, the one or more threads 52 forming the outer layer 54 may be wound in a first helical direction and the one or more threads 56 forming the inner layer 58 may be wound in a second helical direction. The second helical direction may be the same as the first helical direction or may be opposite to the first helical direction.

[0041] Figure 3C is a schematic cross-sectional view of a three-layer drive coil 20c including a first layer 60, a second layer 62, and a third layer 64. Figure 3D is a schematic cross-sectional view of a four-layer drive coil 20d including a first layer 60, a second layer 62, a third layer 64, and adding a fourth layer 66. First layer 60 defines a lumen 68 extending through drive coil 20c and drive coil 20d.

[0042] It will be appreciated that the atherectomy system can be provided in a variety of different sizes, using a variety of different sized sheaths, a variety of different sized guidewires, and the like. The designs tested herein can be thought of as having certain outer diameter requirements, including an outer diameter (OD) of 0.60 mm to 1.2 mm. Each of these drive coils can pass through a guidewire having a nominal diameter of 0.229 mm to 0.356 mm, depending on the OD. The drive coils can be formed from a variety of different materials, but in some cases, the drive coils are formed from 304V stainless steel. In some cases, the drive coils are formed from a shape memory alloy of nickel and titanium.

[0043] It will be appreciated that the number of thread lines per layer in each of the drive coils 20a, 20b, 20c, and 20d may be different to provide predictable user feedback. The winding direction of each layer may be the same or different. For example, some of the thread lines may be wound in a clockwise direction while other thread lines may be wound in a counterclockwise direction. Some of the thread lines may have a round cross-sectional shape. Some of the thread lines may have a flat or oval cross-sectional shape. Some of the thread lines may have a square or rectangular cross-sectional shape. Some of the thread lines may have, for example, a three-sided shape, or a five-sided shape, or a six- or more-sided shape.

[0044] The individual layers may be bare. The individual layers may have intermediate layers separating them to tailor predictable user feedback while maintaining a safety profile. In some cases, the intermediate layers (if present) may provide lubrication between adjacent layers, allowing relative movement between them. In some cases, the intermediate layers (if present) may actually increase friction between adjacent layers, thereby limiting relative movement between them.

[0045] Each layer may be wound at a certain pitch. In some cases, each layer may be swaged before the subsequent layer. In some examples, the final layer may be swaged to customize the characteristics of the drive coil 20.

[0046] Through experimentation, it has been found that a particular combination of performance parameters provides a drive coil 20 that operates well during both antegrade and retrograde ablation, and that provides consistent or predictable feedback to the user during both antegrade and retrograde ablation.

[0047] The property of interest is the axial or longitudinal force-torque ratio, which can be defined as the axial force divided by the torque. In other words, the axial force-torque ratio can be considered as the slope of the torque vs. axial force line. The axial force-torque ratio can be measured, for example, using an Instron model 5944. One end of the test coil is held steady and the other end of the test coil is rotated. The resulting torque and axial force values ​​are measured. During testing, the test coil was supported by a 0.04 inch (1.016 mm) ID (inner diameter) tube, although other sizes are also contemplated. A positive value is tension, meaning that the coil will shorten when subjected to torque, while a negative value is compression, meaning that the coil will lengthen when subjected to torque. The shortening and lengthening of the coil creates an axial force. In some cases, the desired axial force-torque ratio is less than 50 gf / mNm (grams per milliNewton meter) (about 490.33 N / Nm) and greater than -50 gf / mNm (about -490.33 N / Nm). In some cases, the desired axial force-torque ratio is less than 25 gf / mNm (about 245.17 N / Nm) and greater than -25 gf / mNm (about -245.17 N / Nm). In some cases, the desired axial force-torque ratio is less than 10 gf / mNm (about 98.07 N / Nm) and greater than -10 gf / mNm (about -98.07 N / Nm).

[0048] In some cases, it may be beneficial to consider the axial force-torque ratio in combination with the compressive stiffness and the tensile stiffness. The compressive stiffness is a parameter associated with antegrade ablation, where the atherectomy tool 22 is pushed into contact with the lesion. The tensile stiffness is a parameter associated with retrograde ablation, where the atherectomy tool 22 is pulled back into contact with the lesion. In some cases, the force applied to the atherectomy tool 22 is the sum of the axial force-torque, the compressive stiffness, and / or the tensile stiffness. Since the primary parameter involved in providing a predictable indication of the applied force to the user during antegrade ablation is the compressive stiffness, when combined with a positive axial force-torque ratio, the user continues to feel a predictable indication of the applied force. The magnitude of the positive axial force-torque ratio in combination with the compressive stiffness determines the sensitivity, or "springiness," that the user feels to the atherectomy tool 22 through the actuating member 14 during antegrade ablation. A negative axial force-torque ratio provides the user with a non-intuitive and unpredictable indication of the applied force during antegrade ablation.

[0049] During retrograde ablation, the sum of the tensile stiffness and the axial force-torque provides an indication of the applied force. The magnitude and direction of the axial force-torque ratio, combined with the tensile stiffness, can dramatically change the force felt at the lesion by the atherectomy tool 22 relative to the force applied by the actuating member 14 when treating the lesion retrograde compared to treating the lesion antegrade. A large positive axial force-torque ratio provides the user with a non-intuitive and unpredictable indication of the applied force, such that the lesion feels a significantly larger force than the user is applying to the actuating member 14 when ablating retrograde. A negative axial force-torque provides the user with a predictable indication of the applied force in retrograde ablation at the expense of a predictable sensation in the antegrade ablation direction. To provide the user with a predictable and intuitive indication of the applied force in both antegrade and retrograde ablation, the magnitude and direction of the axial force-torque ratio must be balanced with the sum of the compressive stiffness and / or tensile stiffness when treating antegrade and retrograde.

[0050] In some cases, the desired compressive stiffness is in the range of 0-10 N / mm (Newtons per millimeter) (0-10,000 N / m), measured at a gauge length of 10 mm. In some cases, the desired compressive stiffness is in the range of 3.5-5 N / mm (3,500 N / m-5,000 N / m), measured at a gauge length of 10 mm. In some cases, the desired tensile stiffness is in the range of 0-5 N / mm (0-5,000 N / m), measured at a gauge length of 100 mm. In some cases, the desired tensile stiffness is in the range of 0.5-2 N / mm (500-2,000 N / m), measured at a gauge length of 100 mm. These values ​​are optimized for antegrade ablation, as this is the primary treatment direction until the lesion has been sufficiently reduced so that the atherectomy tool 22 has passed the lesion and "polishing" of the lesion can occur.

[0051] Torsional stiffness is an important property that affects the dynamic torque transmission between the motor 26 and the atherectomy tool 22 and must remain within a controlled range to protect the integrity of the system and prevent excessive torque from being transmitted to the vessel. Torsional stiffness can also be measured using an Instron model 5944. In some cases, the desired range of torsional stiffness is 0-0.05 mNm / degree (milliNewton meters per degree) (0-2.865 x 10) at a gauge length of 200 mm. -3 In some cases, the desired range of torsional stiffness is 0.0004 to 0.002 mNm / degree (2.292 x 10) at a gauge length of 200 mm. -5 ~1.146×10 -4 Nm / rad).

[0052] Bending stiffness is an important property, but may in some cases be less noticeable with the guidewire used in combination with the drive coil 20 and any sheath extending over the drive coil 20, because the guidewire and sheath may generally have a bending stiffness much higher than that of the drive coil 20. For example, the sheath may have a bending stiffness 10, 20, or more times that of the drive coil 20. The large diameter portion of the guidewire may have a bending stiffness 5 or 6 times that of the drive coil 20. Nevertheless, it is desirable for the drive coil 20 to have a bending stiffness (measured in a 3-point bending test with a strain rate of 0.1 mm / (mm×min) over a 23 mm span) of less than 0.5 N / mm (0-5000 N / m). In some cases, the drive coil 20 may have a bending stiffness of less than 0.1 N / mm (100 N / m), measured over a 23 mm span.

[0053] The break torque is an important characteristic in ascertaining the stability of the drive coil 20 against breakage during use, particularly when the atherectomy tool 22 dynamically stops within a lesion during ablation so that the drive coil remains intact for subsequent treatment. In some cases, the drive coil 20 has a break torque of greater than 1 mNm (milliNewton meter). In some cases, the drive coil 20 may have a break torque of greater than 4 mNm (0.004 Nm).

[0054] [experiment] Several drive coils were fabricated and tested, and Table 1 below provides a list of each drive coil and details regarding the construction of each drive coil.

[0055] [Table 1]

[0056] Table 2 below provides experimental results for the drive coils referenced in Table 1.

[0057] [Table 2]

[0058] Retrograde ablation was tested by placing a drive coil containing an atherectomy bur at its distal end between the two halves of a clamshell lesion surrogate. The user attempted to ablate the clamshell lesion in a retrograde direction. The user could move the drive coil back and forth to move the atherectomy bur repeatedly in and out of contact with the clamshell lesion. The result is a pass if the user is able to perform the ablation without the system stalling.

[0059] FIG. 4 is a graph of torque versus rotation angle, with torque (in millinewton meters) plotted on the Y-axis and rotation angle (in degrees) plotted on the X-axis, measured at a gauge length of 200 mm. As shown, a control representing an available drive coil is represented as graph line 70. Several of the drive coils tested were substantially stiffer than the control represented by graph line 70. Two of the drive coils tested were less stiff than the control represented by graph line 70. Specifically, drive coil designs 12 and 13 had lower torque values ​​for a given rotation angle as compared to the control represented by graph line 70.

[0060] FIG. 5 is a graph showing the torsional stiffness data for each of the tested coil designs, measured at a gauge length of 200 mm. The data was normalized by comparing to a control. As shown, the control (far right of the graph) has a torsional stiffness set equal to x. Thus, the other tested coil designs are compared to x. Coil design 13, for example, has a torsional stiffness that is 0.3 times that of the control. Coil design 9, for example, has a torsional stiffness that is 18 times that of the control. Coil design 6, for example, has a torsional stiffness that is 91 times that of the control.

[0061] 6 is a graph showing axial force plotted on the Y-axis and torque plotted on the X-axis. Graph line 72 represents a control. As shown, some coil designs, such as design 10, represented by graph line 74, and design 11, represented by graph line 76, have force-torque curves that are much higher than the control represented by graph line 72. All other coil designs have force-torque curves that are lower than the control represented by graph line 72. These force-torque curves are mostly positive and show shortening, but some may briefly go negative and show lengthening.

[0062] Figure 7 is a graph showing force-torque data representing the linear slope average of the data shown in Figure 6. As in Figure 5, the data has been normalized to the control coil design. In this case, two of the coil designs, Design 10 and Design 11, have higher force-torque values ​​than the control, while the remaining coil designs all have lower force-torque values ​​than the control.

[0063] Figure 8 is a graph showing the tensile stiffness plotted for each of the coil designs tested, measured at a gauge length of 100 mm. Tensile stiffness, which measures the response to pulling on the coil, is a relevant parameter for assessing retrograde ablation. The designs tested thus far can be seen to have tensile stiffness (measured at a gauge length of 100 mm) ranging from 0.4 to 4.5 times that of the control, which can be seen at the far right of the graph.

[0064] FIG. 9 is a graph showing the compression stiffness plotted for several of the coil designs tested. Compression stiffness, which measures the response to pushing on the coil, is a relevant parameter for assessing antegrade ablation. Compression stiffness was tested using a gauge length of 10 mm and a displacement rate of 2.5 mm / min.

[0065] FIG. 10 is a graph showing the bending stiffness plotted for each of the coil designs tested, measured at a gauge length of 23 mm. As noted above, the sheath can have a bending stiffness significantly higher than the coil itself. This is demonstrated on the right side of the graph, where the bending stiffness of the control sheath (far right) is significantly higher than the bending stiffness of the control coil (second from the right). FIG. 10 also shows that for the coils tested, the bending stiffness of the coil is less than the bending stiffness of the guidewire plotted on the left side of the graph.

[0066] Reviewing the experimental data, it can be seen that coil designs 6, 7, 8, and 13 passed the retrograde ablation test. This is believed to be due to the relatively low values ​​of axial force-torque ratio for these designs. Designs 6, 7, and 8 had torsional stiffness values ​​that were too high. Design 13 had a break torque value that was too low.

[0067] It will be understood that the present disclosure is in many respects merely illustrative. Changes may be made in details, particularly in matters of shape, size, and arrangement of steps, without exceeding the scope of the present disclosure. This may include, to the extent appropriate, using any of the features of one exemplary embodiment in other embodiments. The scope of the invention is, of course, defined in the language in which the appended claims are expressed.

Claims

1. 1. An atherectomy system adapted for both antegrade and retrograde ablation, comprising: A drive coil is provided. an atherectomy tool coupled to the drive coil, the atherectomy tool including a distal region adapted for antegrade ablation and a proximal region adapted for retrograde ablation; a proximal handle including an actuation member adapted to be movable in a first direction to urge the atherectomy tool in an antegrade ablation direction and adapted to be movable in a second direction to urge the atherectomy tool in a retrograde ablation direction; The atherectomy system, wherein the actuation member is adapted to provide similar feedback to a user regardless of whether the atherectomy tool is ablating in the antegrade ablation direction or the retrograde ablation direction.

2. The atherectomy system of claim 1 , wherein the drive coil is adapted such that the actuation member provides similar feedback to a user regardless of whether the atherectomy tool is ablating in the antegrade ablation direction or the retrograde ablation direction.

3. 3. The atherectomy system of claim 2, wherein the drive coil has an axial force-torque ratio of less than 50 gf / mNm (490.3325 N / Nm) and greater than -50 gf / mNm (-490.3325 N / Nm).

4. 4. The atherectomy system of claim 2 or 3, wherein the drive coil has a tensile stiffness in the range of 0-5 N / mm (0-5000 N / m) (gauge length 100 mm) and a compressive stiffness in the range of 0-10 N / mm (0-10000 N / m) (gauge length 10 mm).

5. The driving coil has a temperature of 0 to 0.05 mNm / degree (0 to about 2.865×10 －３ The atherectomy system according to any one of claims 2 to 4, having a torsional stiffness in the range of 100 mm / rad (gauge length 200 mm).

6. The atherectomy system of any one of claims 2 to 5, wherein the drive coil has a break torque value of greater than 1 mNm (0.001 Nm).

7. 1. An atherectomy system adapted to enable bidirectional ablation, comprising: a proximal handle including an actuation member adapted to be movable in a first direction to perform antegrade ablation and adapted to be movable in a second direction to perform retrograde ablation; an atherectomy tool including a distal region adapted for antegrade ablation and a proximal region adapted for retrograde ablation; a drive coil extending between the proximal handle and the atherectomy tool, the drive coil adapted to provide predictable feedback via the actuation member regardless of whether the atherectomy tool is performing retrograde or antegrade ablation. Atherectomy system.

8. The atherectomy system of claim 7, wherein the drive coil has an axial force-torque ratio of less than 10 gf / mNm (approximately 98.07 N / Nm) and greater than -10 gf / mNm (approximately -98.07 N / Nm).

9. 9. The atherectomy system of claim 7 or 8, wherein the drive coil has a tensile stiffness in the range of 0.5 to 2 N / mm (500 to 2000 N / m) (gauge length 100 mm).

10. 10. The atherectomy system of claim 7, wherein the drive coil has a compressive stiffness in the range of 3.5 to 5 N / mm (3500 N / m to 5000 N / m) (gauge length 10 mm).

11. The driving coil has a resistance of 0.0004 to 0.002 mNm / degree (2.292×10 －５ ~1.146 x 10 －４ The atherectomy system according to any one of claims 7 to 10, having a torsional stiffness in the range of 100 mm / rad (gauge length 200 mm).

12. The atherectomy system of any one of claims 7 to 11, wherein the drive coil has a break torque value of greater than 4 mNm (0.004 Nm).

13. 1. An atherectomy system adapted to enable bidirectional ablation, comprising: a proximal handle including an actuation member adapted to be movable in a first direction to move the atherectomy bar in an antegrade ablation direction and adapted to be movable in a second direction to move the atherectomy bar in a retrograde ablation direction; an atherectomy tool including a distal region adapted for antegrade ablation and a proximal region adapted for retrograde ablation; a drive coil extending between the proximal handle and the atherectomy tool, the drive coil comprising: A force-torque ratio between -10 gf / mNm (approximately -98.07 N / Nm) and 10 gf / mNm (approximately 98.07 N / Nm); Tensile stiffness in the range of 0.5 to 2 N / mm (500 to 2000 N / m) (gauge length 100 mm); and adapted to provide a compression stiffness in the range of 3.5-5 N / mm (3500 N / m-5000 N / m) (10 mm gauge length); Atherectomy system.

14. The driving coil has a resistance of 0.0004 to 0.002 mNm / degree (2.292×10 －５ ~1.146 x 10 －４ 14. The atherectomy system of claim 13, having a torsional stiffness in the range of 1 / 2 Nm / rad (gauge length 200 mm).

15. 15. The atherectomy system of claim 13 or 14, wherein the drive coil has a break torque value of greater than 4 mNm (0.004 Nm).

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