Methods and systems for restoring patency
A method for maintaining patency in a duct or hollow vessel located within the body of a patient is described wherein the duct includes one or more obstructions. The method comprises the steps of introducing a device into the duct, the device comprising a catheter having a distal and a proximal end, wherein the distal end includes a distal tip portion and wherein the distal tip portion comprises at least one energy delivery member; locating the device within the duct at a position proximal to the obstruction; delivering energy to the duct and any surrounding tissue via the at least one energy delivery member for a specified time period, so that the obstruction is removed from the duct; and withdrawing the device from the duct. It is optional to subsequently place a device such as a stent at the therapy site in order to further maintain long term patency of the duct. It is also optional to apply a dilation force to the duct or hollow vessel after the energy delivery phase. Systems are also described for performing the methods of the disclosure.
1. A method for treating a duct of a patient, comprising:
directly visualizing an obstruction within the duct;
positioning a guidewire within the duct adjacent to, through or alongside the obstruction;
positioning a catheter within the duct adjacent to, through or alongside the obstruction, the catheter comprising:
a proximal end;
a distal end, wherein the distal end includes a distal tip portion; and
a pair of bipolar electrodes arranged longitudinally about the distal tip portion;
activating the pair of bipolar electrodes for a time and at a power sufficient to form a substantially cylindrical ablation volume along the pair of bipolar electrodes and reduce the extent of the obstruction;
wherein the time is about 90 seconds and the power is about 10 watts.
2. The method of claim 1 , wherein the activating the bipolar electrodes step further comprises reestablishing normal patency of the duct.
3. The method of claim 1 , wherein the obstruction is a complete blockage of the duct.
4. The method of claim 1 , wherein the positioning a guidewire step positions the guidewire through the obstruction.
5. The method of claim 1 , further comprising translating the catheter proximally to a second position along the obstruction after the activating step and re-activating the bipolar electrodes at the second position.
6. The method of claim 1 , further comprising at least partially dilating the duct with an expanding member along the obstruction.
7. The method of claim 1 , wherein the directly visualizing step is performed both before and after the activating step.
8. The method of claim 1 , wherein a distal electrode of the pair of bipolar electrodes is positioned a distance from the distal tip portion of the catheter.
9. The method of claim 8 , wherein the distance is about 5 millimeters.
10. The method of claim 1 , further comprising:
inserting a balloon within the duct prior to or after the activating step; and
expanding the balloon sufficiently to at least partially dilate the duct at the obstruction.
11. The method of claim 1 , wherein the duct is selected from the group consisting of a biliary duct, a pancreatic duct, and a urinary duct.
12. A method for treating a duct of a patient comprising:
positioning a catheter adjacent to, through or alongside an obstruction within the duct, the catheter comprising:
a proximal end;
a distal end, wherein the distal end includes a distal tip portion;
a pair of bipolar electrodes arranged longitudinally about the distal tip portion, wherein a longitudinal length of each electrode of the pair of bipolar electrodes is at least as great as a longitudinal spacing between the electrodes of the pair of bipolar electrodes; and
activating the pair of bipolar electrodes for a time and at a power sufficient to reduce the extent of the obstruction;
wherein the time is about 90 seconds and the power is about 10 watts.
13. The method of claim 12 , further comprising directly visualizing the obstruction.
14. The method of claim 12 , further comprising dilating the duct prior to or after the activating step.
15. The method of claim 12 , wherein the duct is selected from the group consisting of a biliary duct, a pancreatic duct, and a urinary duct.
16. A method for treating an at least partially obstructed stent comprising:
positioning a catheter within a biliary duct and within at least a portion of the stent, and adjacent to, through or alongside the obstruction, the catheter comprising:
a proximal end;
a distal end, wherein the distal end includes a distal tip portion;
a pair of bipolar electrodes arranged longitudinally about the distal tip portion; and
activating the pair of bipolar electrodes for a time and at a power sufficient to reduce the extent of the obstruction;
wherein the time is about 90 seconds and the power is about 10 watts.
17. The method of claim 16 , further comprising directly visualizing the obstruction.
18. The method of claim 16 , further comprising cannulating the portion of the stent.