Method and apparatus for angioplasty

Claims

What is claimed is:

1. A method for preventing abrupt reclosure and restenosis in percutaneous transluminal coronary angioplasty comprising the steps of:

providing a balloon in the coronary artery at the region of coronary narrowing;

inflating the balloon with fluid; and

providing heat at the region surrounding the inflated balloon at a level sufficient to fuse together segments of tissue in said region and to coagulate blood trapped within dissection planes of tissue and within fissures created by wall fracture in said regions, said level being below the vaporization threshold of the tissues; and

deflating and removing said balloon thereby to provide a smooth cylindrically-shaped channel which prevents collapse of material into the coronary artery.

2. The method of claim 1 wherein said heat is provided by monochromatic radiation injected into the interior of said balloon.

3. The method of claim 2 wherein said monochromatic radiation heats material within the balloon, with the heat thus generated being transferred to the region surrounding the balloon.

4. The method of claim 2 wherein said balloon and fluid utilized to inflate said balloon is transparent to radiation of a predetermined wavelength and wherein said heat is provided at said region by radiation which passes through the balloon wall and is absorbed by blood and other arterial tissue in the region surrounding the balloon.

5. The method of claim 1 wherein the surface of said balloon is provided with wires, said wires being heated by passage of electric current therethrough.

6. The method of claim 1 wherein resistance heating means are provided in the balloon and wherein said region is heated by the passage of electrical current through the resistance heating means within the balloon.

7. The method of claim 1 wherein the heat delivered to the region adjacent the balloon is provided by transmitting energy to a region within the balloon via fiber optics having a light disseminating termination, with said fiber optics including means within the balloon for causing energy transmitted down the fiber optics to be emitted radially and homogeneously along the long axis of the light disseminating termination of the optical fiber within the inflated balloon.

8. The method of claim 1 wherein said steps are utilized after conventional percutaneous transluminal coronary angioplasty.

9. The method of claim 1 wherein said steps are utilized in lieu of conventional percutaneous transluminal coronary angioplasty.

10. The method of claim 1 wherein the liquid within the balloon is heated by a chemical exothermic reaction.

11. The method of claim 10 wherein said chemical exothermic reaction includes the dissolution of magnesium sulfate powder.

12. The method of claim 10 wherein said chemical exothermic reaction includes the interaction of silver chloride and sodium hydroxide solutions.

13. The method of claim 1 wherein said balloon is filled with a biocompatible gas, with the energy inserted into the balloon being absorbed only by the balloon material, or other absorbing surface provided within the body of the balloon.

14. The method of claim 1 wherein the plaque, the normal arterial wall, blood within the arterial wall or any or all of these tissues are heated directly without first heating either the fluid within the balloon or the balloon material.

15. A method of preventing abrupt reclosure and restenosis comprising the step of providing a smooth enlarged lumen composed of fused tissue elements of the arterial wall in the region of a coronary narrowing, the smooth enlarged lumen being formed due to the utilization of an inflated balloon inserted through the artery and positioned at the narrowed portion thereof and via energy transmitted from the balloon surface to the immediately adjacent region at a level sufficient to achieve tissue fusion, said level being below the vaporization threshold of the tissues, whereby the incidence of restenosis is reduced because of more favorable flow patterns produced by the smooth lumen and because the fused tissue elements of the arterial wall are incapable of proliferation, wherein a balloon is utilized at the coronary narrowing and wherein the balloon is filled with transparent fluid and wherein the balloon is transparent to radiation of a predetermined wavelength, said fused material being provided through the utilization of an optical fiber with a portion positioned at the balloon, the fiber having a light disseminating termination at the interior of the balloon structure, the method further including the injection of laser light into end of the fiber which laser light is transmitted through the liquid and balloon to the surrounding tissue which contains blood.

16. The method of claim 15 wherein said predetermined wavelength is 1.06 microns.

17. The method of claim 15 wherein said predetermined wavelength includes the several wavelengths produced by an argon-ion laser.

18. The method of claim 15 wherein the balloon is filled with a fluid which absorbs a specific laser wavelength.

19. The method of claim 15 wherein biocompatible pigments including Evan's Blue, methylene blue and Congo red are utilized in the balloon inflation.

20. The method of claim 15 wherein the fluid utilized in the balloon is water.

21. The method of claim 20 wherein 10.6 micron radiation is injected into the water.

22. A process for remodeling a tissue material comprising the steps of:

altering a tissue material configuration to provide a reconfigured tissue material shape wherein said altering step includes the step of expanding a plaque restricted vessel; and

thermally fusing the reconfigured tissue material to cause retention of the reconfigured tissue material shape, said thermal fusing accomplished by transmitting heat to the reconfigured tissue at a level sufficient to fuse said tissue, said level being below the vaporization threshold of the tissue.

23. The process of claim 22 wherein said altering step further includes the step of pressing the plaque into surrounding vessel tissue.

24. The process of claim 23 wherein the fusing step includes the step of fusing the plaque in the surrounding vessel tissue.

25. The process of claim 22 wherein said altering step includes the step of pressing a tissue anonomally into a surrounding tissue area to define said reconfigured tissue shape.

26. The process of claim 22 wherein said tissue material is collagen containing tissue material.

27. A system for remodeling a tissue material comprising:

means for altering a tissue material configuration to provide a reconfigured tissue material shape wherein said means for altering includes means for expanding a plaque restricted vessel; and

means for transmitting energy to the reconfigured tissue material to cause retention of the reconfigured tissue material shape, said energy transmitted at a level sufficient to fuse the reconfigured tissue, said level being below the vaporization threshold of the tissue material.

28. The system of claim 27 wherein said means for altering further includes means for pressing the plaque into surrounding vessel tissue.

29. The system of claim 28 wherein the means for fusing includes means for fusing the plaque in the surrounding vessel tissue.

30. The system of claim 27 wherein said means for altering includes means for pressing a tissue anonomally into a surrounding tissue area to define said reconfigured tissue shape.

31. The system of claim 27 wherein said tissue material is collagen containing tissue material.

32. A method for treating a stenosis in a bodily passage comprising:

positioning within the passage an expandable device with external surface of the expandable device facing the inner surface of the passage at the region of the stenosis;

expanding the expandable device to cause the external surface to apply pressure on the inner surface of the passage to enlarge the inner diameter of the passage at the region of the stenosis;

while pressure is being applied and the diameter is enlarged, providing heat via the external surface of the expandable device to cause reformation of the tissue in the region of the stenosis to form a channel of larger diameter, said heat provided at a level sufficient to fuse the tissue, said level being below the vaporization threshold of the tissue; and

contracting the expandable device.

33. The method of claim 32 wherein said heat is provided by monochromatic radiation injected into the interior of the expandable device.

34. The method of claim 33 wherein the monochromatic radiation heats material within said expandable device, with the heat thus generated being transferred via the external surface of the expandable device to the region surrounding the expandable device.

35. The method of claim 33 wherein the expandable device is transparent to radiation of a predetermined wavelength, the expandable device is inflated by a fluid which is transparent to radiation of a predetermined wavelength and wherein the heat is provided at the region by radiation which passes through the surface of the expandable device and is absorbed by blood and other arterial tissue in the region surrounding the expandable device.

36. The method of claim 32 wherein the surface of the expandable device is provided with wires, said wires being heated by passage of electric current therethrough.

37. The method of claim 32 wherein resistance heating means are provided in the expandable device and wherein the region is heated by the passage of electrical current through the resistance heating means within the expandable device.

38. The method of claim 32 wherein the heat delivered to the region adjacent to the expandable device is provided by transmitting energy to a region within the expandable device via fiber optics having a light disseminating termination, with said fiber optics including means within the expandable device for causing energy transmitted down the fiber optics to be emitted radially and homogenously along the long axis of the light disseminating termination of the optical fiber within the inflated expandable member.

39. The method of claim 32 wherein said steps are utilized after conventional percutaneous transluminal coronary angioplasty.

40. The method of claim 32 wherein said steps are utilized in lieu of conventional percutaneous transluminal coronary angioplasty.

41. The method of claim 32 wherein heat is provided by a chemical exothermic reaction within the expandable device.

42. The method of claim 41 wherein said chemical exotheric reaction includes the dissolution of magnesium sulfate powder.

43. The method of claim 41 wherein said chemical exothermic reaction includes the interaction of silver chloride and sodium hydroxide solution.

44. The method of claim 32 wherein said expandable device is filled with a biocompatible gas, with the energy inserted into the device being absorbed only by the device material, or other absorbing surface provided within the body of the expandable device.

45. The method of claim 32 wherein the plaque, the normal arterial wall, blood within the arterial wall or any or all of these tissues are heated directly without first heating either the fluid within the expandable device or the device material.

46. An angioplasty device comprising a catheter suitable for insertion into an artery and having:

a tube defining a lumen;

an inflatable balloon secured to said tube for inflation from a remote source of fluid, said balloon being configured so that said tube may be navigated through the artery when deflated and allow blood flow while said tube is being navigated with the balloon in a deflated state, said balloon configured to withstand the heat necessary to fuse and reform tissue;

means for inflating said balloon with fluid when said balloon is in an area of stenosis of the artery to apply pressure to the area of stenosis of said artery to widen the inner diameter of the artery at that area; and

means for applying heat at the artery region surrounding the balloon at a level sufficient to fuse together segments of tissue in said artery region and to coagulate blood in said region so that a smooth cylindrically shaped inner wall of the artery is formed, said level being below the vaporization threshold of the tissue;

said device being specifically adapted to apply pressure to the area of stenosis in the artery and to simultaneously deliver heat to that area to enable fusion of the plaque fragments and the plaque-artery separations so that upon subsequent deflation and removal of the balloon, a smooth, cylindrically-shaped channel is produced, said smooth channel producing more favorable flow patterns, preventing the proliferation of the fused elements of the arterial wall and preventing the collapse of material into the artery.

47. The angioplasty device of claim 46 wherein said means for applying heat comprises means for heating a liquid within said balloon, said liquid diffusing energy to heat the balloon and the balloon heating the surrounding artery.

48. The angioplasty device of claim 47 wherein said means for heating a liquid within said balloon comprises one or more electrically heated wires in said tube.

49. The angioplasty device of claim 47 wherein said means for heating a liquid within said balloon comprises laser wavelength produced by one or more optical fibers within said tube.

50. The angioplasty device of claim 49 wherein said liquid further comprises a biocompatable component that absorbes the specific laser wavelength used so that the liquid heats rapidly.

51. The angioplasty device of claim 47 wherein said means for heating a liquid comprises an optical fiber and one or more metallic elements within the balloon;

said optical fiber heating the one or more metallic elements within the balloon, said heat produced being transferred to the liquid within said balloon, said heated liquid transferring heat to the region of the artery.

52. The angioplasty device of claim 46 wherein said means for applying heat comprises a chemical exothermic reaction.

53. The angioplasty device of claim 52 wherein said chemical exothermic reaction includes the dissolution of magnesium sulfate powder.

54. The angioplasty device of claim 52 wherein said chemical exothermic reaction includes the interaction of silver chloride and sodium hydroxide solution.

55. The angioplasty device of claim 46 wherein said means for applying heat comprises means for heating the balloon surface directly, said balloon then heating the surrounding artery.

56. The angioplasty device of claim 55 wherein said means for heating the balloon surface directly comprises a thermal conductive material within the membrane of the balloon.

57. The angioplasty device of claim 56 wherein said thermal conductive material is a fine wire meshwork that can be heated electrically.

58. The angioplasty device of claim 56 wherein said thermal conductive material is a meshwork of optical fibers that diffuse light along their entire length, said fibers coupled to the output of a laser and further comprising one or more components within the balloon that absorbs the wavelength of the specific laser used to heat the balloon material.

59. The angioplasty device of claim 56 wherein said thermal conductive material comprises a wire meshwork within the balloon material that can be heated by the output of a laser.

60. The angioplasty device of claim 55 wherein said means for heating the balloon surface directly comprises a biocompatible gas in the interior of said balloon, wherein energy is delivered to the interior of the balloon and absorbed by the balloon material or by another absorbing surface provided within the body of the balloon.

61. The angioplasty device of claim 46 wherein said means for applying heat comprises:

a laser; and

a dye, said dye being capable of absorbing the specific wavelength of said laser used;

said dye being applied to the plaque and any injured portion of the arterial wall,

said laser and said dye heating the tissue directly without first heating either the fluid within the balloon or the balloon material.

62. The angioplasty device of claim 46 wherein said means for applying heat at the artery region comprises:

an optical fiber, part of said optical fiber positioned within said balloon, said optical fiber including a light disseminating termination at the interior of the balloon structure;

means for injecting laser light of a specific wavelength into one end of said fiber; and

a transparent fluid within said balloon;

wherein said balloon is transparent to radiation of the wavelength utilized.

63. The angioplasty device of claim 62 wherein said wavelength utilized is 1.06 microns.

64. The antioplasty device of claim 62 wherein said transparent fluid further comprises biocompatible pigments that absorb the specific laser wavelength used.

65. The angioplasty device of claim 62 wherein said transparent fluid is water.

FIELD OF INVENTION

This invention relates to angioplasty and, more particularly, a method and apparatus for preventing abrupt reclosure and restenosis after treatment.

BACKGROUND OF THE INVENTION

The mortality and morbidity from ischemic heart disease results primarily from atheromatous narrowings of the coronary arteries. Although various medical and surgical therapies may improve the quality of lifestyle of most patients with symptomatic coronary atherosclerosis, these therapies do not favorably change the underlying anatomy responsible for the coronary luminal narrowings and therefore do not prevent the occurrence of future cardiac events such as occurrence of worsening of signs and symptoms of myocardial ischemia, myocardial infarction and sudden death.

Percutaneous transluminal coronary angioplasty (PTCA) has recently been developed as an alternative method of treatment of coronary atherosclerosis. During cardiac catheritization an inflatable balloon is inserted in a coronary artery at the region of a coronary narrowing. Inflation of the balloon for 15-60 seconds results in expansion of the narrowed lumen or passageway. Because residual narrowing is usually present after the first balloon inflation, multiple inflations are routinely performed in an attempt to reduce the severity of the residual stenosis or tube narrowing. Despite these multiple inflations, a mild to moderately severe residual stenosis usually is present after successful PTCA.

One of the major problems with such treatment is that a flap of material occasionally is formed during the treatment which, after withdrawal of the instrumentation, falls back into theartery causing abrupt reclosure. This necessitates emergency coronary artery bypass surgery and thus PTCA is potentially dangerous and often provides only a temporary treatment of symptoms of obstructive coronary arterial atherosclerosis. The reason that the flap is formed is that upon balloon inflation the surrounding material is broken or fragmented which causes blood to enter the arterial wall between planes of dissection. This causes the arterial wall to swell acutely and either reduces the size of the channel or completely obliterates the channel resulting in a five percent incidence of abrupt reclosure.

Moreover with present PTCA procedures, postmortem pathologic studies show that disruption of the arterial wall and atheromatous plaque occurs following balloon inflation, including fracture of the plaque and separation of tissue layers, e.g., dissection. Angiographically a shaggy or hazy appearance of the coronary lumen is often seen and evidence for overt dissection is often apparent following successful PTCA. Disruption of the arterial wall temporarily increases the size of the coronary channel but predisposes to deposition of platelets and microthrombi which very likely contribute to the greater than 25% incidence of restenosis within three to six months following successful PTCA.

By way of further background, recent studies have been reported using lasers to perform vascular anastomoses so that end-to-end and end-to-side arterial and vein grafting can be achieved without sutures. The basic principle simply involves placing the free edges of a vessel and the graft in close proximity and heating these tissues with either an argon-ion, neodymium:YAG, or CO.sub.2 laser. Cross linking of collagen and other tissue proteins occurs and a coagulation is observed pathologically following the treatment. The tissue integrity is maintained, however, and the tensile strength of the "sutureless" anastomosis rivals that of anastomoses performed with sutures used in a conventional manner. Moreover, short and long term tissue healing appears to be better with the laser thermal fusion of tissues than with the suture technique.

SUMMARY OF THE INVENTION

The subject technique reduces the disruption of the arterial wall and therfore the complications associated with PTCA. During balloon inflation the disrupted tissues of the plaque and the arterial wall are heated in order to fuse together fragmented segments of tissue and to coagulate blood trapped within dissected planes of tissue and within fissures created by wall fracture. Upon subsequent balloon deflation, a smooth, cylindrically-shaped channel results. The thermal energy is applied either during the first balloon inflation or during a balloon inflation subsequent to PTCA performed in a routine manner.

It has been found that by using the subject technique thermal fusion of fragmented segments of the arterial wall following PTCA is possible. Moreover, it has been found that a better "set" of the vessel wall occurs. Elastic recoil of portions of the arterial wall, which often occurs following conventional PTCA is reduced with the subject thermal treatment. The smooth luminal surface results in normal patterns of blood flow such that local turbulence and regions of flow separation and stagnation, which favor platelet deposition, thrombus formation, and plaque growth, are reduced. Abrupt reclosure following the thermal treatment during PTCA does not occur since upon balloon deflation blood is unable to enter dissected planes within the arterial wall. The incidence of restenosis is reduced because of more favorable flow patterns produced by the smooth lumen and because the fused necrotic elements of the arterial wall are incapable of proliferation in response to the initial injury sustained during balloon inflation. Moreover, while it has been suggested that the smooth muscle cell, the principal cell type within the plaque and normal arterial wall, proliferates in response to any form of injury and contributes to plaque progression, thermal destruction of the smooth muscle cell provided by the subject technique prevents this response.

Thus one aspect of the present invention is the application of thermal energy to the arterial wall during PTCA. This energy is applied principally to either the atheromatous plaque, the normal arterial wall, blood within the arterial wall or to all three tissues simultaneously.

The present invention relates to a method of balloon angioplasty which is based on the following novel combination of observations: First, thermal energy can be used to fuse together disrupted tissue elements of the arterial wall following conventional balloon angioplasty; secondly, that blood is an effective absorber of many wavelengths of light, including the 1.06 micron radiation of the neodymium:YAG laser and that the presence of blood within arterial wall fissures created by a conventional balloon angioplasty will facilitate laser fusion of disrupted plaque and other arterial wall elements; thirdly, that application of tissue pressure during application of thermal energy facilitates fusion of disrupted tissue elements, and, therefore, that balloon inflation during application of thermal energy is useful and necessary for compression of the disrupted tissue layers; fourthly, that balloon inflation during application of thermal energy will prevent constriction of the lumen cross section from tissue shrinkage; fifthly, that application of thermal energy to the arterial wall during balloon inflation is acutely and chronically well tolerated by arterial wall tissue; and, sixthly, that thermal energy can be applied to the arterial wall during balloon inflation without damaging the balloon or causing the formation of intraluminal clots.

Although the most important application of this novel technique is to improve PTCA of coronary arteries, this technique can also be applied to atherosclerotic arteries located elsewhere, such as the renal, iliac, femoral and popliteal arteries.

In addition, this technique may be applied to carotid arteries, unlike conventional angioplasty, because thermal fusion of the disrupted arterial tissues prevents embolization of tissue fragments to the brain.

In a preferred embodiment, the balloon is filled with transparent liquid and the balloon itself is transparent. An optical fiber is utilized within the catheter which has a light disseminating termination within the balloon structure. Laser light is injected into one end of the fiber and is disseminated by the disseminating means at the end of the fiber within the balloon such that the light travels virtually unaffected through the liquid in the balloon and through the balloon itself to the surrounding tissue which contains a certain amount of blood. When utilizing a neodymium:YAG laser at 1.06 microns, it has been found that this radiation while weakly absorbed by the surrounding tissue is strongly absorbed by the blood which causes the required fusion.

In studies of fresh postmortem human atherosclerotic arteries, filled with heparinized blood, it was found that fusion of plaque fragments and plaque-media separations could be easily achieved with this technique without vaporizing any portion of the plaque or normal arterial wall. Histologic examination of formalin-fixed arterial specimens subjected to this treatment showed a coagulum at the junction between layers or fragments of tissue, while no overt evidence of damage to the normal arterial wall was found. Moreover, no tissue adhesion to the balloon material occurred, and no damage occured to the balloon itself, which could be made from one of a variety of high temperature plastic materials, such as a silicon polymer (Silastic), Reynolds oven cooking bags and plastic sheets of autoclave packaging material.

The thermal fusion of disrupted arterial tissues appeared to be facilitated not only by preferential absorption of the neodymium:YAG radiation by blood between separated tissue layers, but also by the increase in tissue pressure produced first by balloon inflation and second by tissue shrinking from heating, the latter effect very likely representing initial protein cross linking. When arterial tissue is heated to temperatures greater than 70 degrees C, tissue shrinkage will ordinarily occur as a result of cross linking of proteins. However, in the present invention, the fixed volume of fluid within the balloon prevents the lumen cross section from decreasing in size during thermal fusion of tissues. Since the balloon is deflated after completion of thermal fusion, the lumen cross section following balloon deflation is not significantly smaller than the inflated balloon.

The following list describes alternative techniques which can be used to heat the tissues.

The first technique is the heating of the liquid within the balloon of the angioplasty catheter. Any biocompatible liquid used within the balloon, typically a normal saline/radiographic contrast medium mixture, can be heated with one or more electrically heated wires. Alternatively, the liquid can be heated by laser energy delivered from one or more optical fibers. In the latter embodiment a biocompatible component of the liquid absorbs the specific laser wavelength used. For example, hemoglobin dissolved or suspended in the liquid strongly absorbs the energy of an argon-ion laser. As a result the liquid heats rapidly. Other examples of biocompatible pigments, which can be used in a similar manner, include Evan's Blue, methylene blue and Congo red. If water is used as the absorber, no visible pigments are required. Many different lasers, such as the CO.sub.2 laser operating at the 10.6 micron wavelength, can be used to heat water efficiently.

In another embodiment, laser energy transmitted by an optical fiber is use to heat one or more metallic elements, such as wires, within or near the balloon.

In another embodiment, the liquid is heated by a chemical exothermic reaction. Both the reactants and the products are biocompatible. Examples include the dissolution of magnesium sulfate powder or the interaction of silver chloride and sodium hydroxide solutions. The individual components required for the exothermic reaction are injected into the balloon cavity either simultaneously or sequentially.

In another embodiment the balloon is heated directly. As an example, thermal conductive material within the membrane of the balloon is heated directly. In one embodiment, a fine wire meshwork within the substance of the balloon is heated electrically. Alternatively, a meshwork of optical fibers, each of which is "lossy," i.e., each fiber diffuses light along its length, is coupled to the output of a laser. One or more components of the material within the balloon absorb the wavelength of the specific laser used and results in heating the balloon material. In another embodiment, laser energy is used to heat a wire meshwork within the balloon material. In yet another embodiment, the laser energy is delivered to the cavity of the balloon, with the balloon filled with a biocompatible gas such as CO.sub.2, the energy being absorbed only by the balloon material, or other absorber(s) provided within the interior of the balloon.

In a still further embodiment, the tissues are heated directly. The plaque, the normal arterial wall, blood within the arterial wall, or any or all of these tissues are heated directly without first heating the liquid within the balloon or the balloon material. For example, the plaque and any injured portion of the arterial wall, when routine PTCA is performed prior to application of thermal energy during subsequent balloon inflation, may be stained with a dye, such as Evan's blue or methylene blue. The energy of a Krypton or an argon-ion laser, among other lasers, is absorbed by the pigmented tissue and not by a translucent liquid or gas-filled balloon. Hemoglobin within blood, which has entered the arterial wall or spaces created by fractures from PTCA performed in a routine manner, acts as a natural pigment and is selectively heated by the output of any of a variety of lasers, such as an argon-ion laser.

An additional and optional element of the subject invention is the use of a sound transducer in conjunction with the laser irradiation to sense intra-arterial sound produced by the laser irradiation heating of the tissue. In one embodiment, a catheter sound transducer similar to a high fidelity end-tipped manometer used to measure intravascular blood pressure is positioned within the outer catheter guide sheath near the balloon.

In ano