Tissue slitting methods and systems
Methods and systems for separating an object, such as a lead, from formed tissue are provided. Specifically, a tissue slitting device is configured to engage patient formed tissue at a slitting engagement point. While the object is subjected to a first traction force, the tissue slitting device is caused to move further into the engaged tissue and slit the tissue past the point of engagement. The slitting device causes the tissue to separate along an axial direction of the length of the formed tissue and releases at least some of the force containing the object. The methods and systems are well suited for use in cardiac pacing or defibrillator lead explant procedures.
1. A tissue-slitting apparatus comprising:
a shaft, wherein the shaft is flexible, wherein the shaft includes a proximal end, a distal end, and a shaft wall surrounding an inner lumen running from the proximal end to the distal end, wherein the inner lumen is configured to receive a lead implanted within tissue growth on a vessel wall of a patient; and
a plurality of optical fibers configured to carry ablative energy and disposed within the shaft wall,
wherein the distal end of the shaft comprises:
distal ends of the plurality of optical fibers; and
a wedge shape extending radially outward from the shaft wall and terminating at a blade,
wherein the distal ends of the plurality of optical fibers and the wedge shape are located at only a portion of a perimeter of the distal end of the shaft such that the distal ends of the plurality of optical fibers and the wedge shape are proximate to one another, and
wherein at least one of the ablative energy or the blade is configured to separate the tissue growth from the lead to thereby permit the lead to be removed from the patient.
2. The tissue-slitting apparatus of claim 1 , wherein of the portion of the perimeter is not circular and a remaining portion of the perimeter is circular.
3. The tissue-slitting apparatus of claim 2 , wherein the portion of the perimeter that is not circular comprises a left sloped section of the wedge shape and a right sloped section of the wedge shape, wherein the left sloped section of the wedge shape and the right sloped section of the wedge shape are angled relative to one another.
4. The tissue-slitting apparatus of claim 3 , wherein the left sloped section of the wedge shape and the right sloped section of the wedge shape meet at a first mid-line of the wedge shape that is centered laterally relative to the shaft and oriented along a radius of the inner lumen.
5. The tissue-slitting apparatus of claim 4 , wherein the distal end of the shaft comprises a cutting edge different than the blade, wherein the cutting edge extends along the first mid-line such that the cutting edge is oriented along the radius of the inner lumen.
6. The tissue-slitting apparatus of claim 5 , wherein a point of the cutting edge and a point of the blade are coincident.
7. The tissue slitting apparatus of claim 5 , wherein the cutting edge is disposed at a distalmost portion of the tissue slitting apparatus.
8. The tissue slitting apparatus of claim 5 , wherein the wedge shape is configured to peel the tissue growth away from the cutting edge or to cause a parting of the tissue growth.
9. The tissue-slitting apparatus of claim 4 , wherein the blade comprises a left blade portion extending radially outward from the left sloped section of the wedge shape and a right blade portion extending radially outward from the right sloped section of the wedge shape.
10. The tissue-slitting apparatus of claim 9 , wherein the left blade portion and the right blade portion meet at a second mid-line that is centered laterally relative to the shaft and oriented along a radius of the inner lumen such that the first mid-line and the second mid-line are continuous.
11. The tissue-slitting apparatus of claim 10 , wherein the blade is oriented laterally from a left side of the shaft to an opposite, right side of the shaft.
12. The tissue-slitting apparatus of claim 11 , wherein the left blade portion tapers from the second mid-line to the left side of the shaft and the right blade portion tapers from the second mid-line to the right side of the shaft.
13. The tissue-slitting apparatus of claim 1 , wherein the distal ends of the plurality of optical fibers are disposed radially inward relative to the blade.
14. The tissue slitting apparatus of claim 1 ,
wherein the tissue growth forms a substantially cylindrical tube enclosing the lead, and
wherein the blade is angled away from the distal end of the shaft such that the blade is configured to cut a slit from an interior of the cylindrical tube to an exterior of the cylindrical tube.
15. The tissue slitting apparatus of claim 1 , wherein the shaft is configured to be indexed along the lead via the inner lumen.
16. The tissue slitting apparatus of claim 1 , wherein the inner lumen is further configured to receive a mechanical traction device configured to engage the lead.
17. The tissue slitting apparatus of claim 1 , wherein a remaining portion of the perimeter comprises a non-traumatic edge.