Atherectomy devices and methods
This document describes rotational atherectomy devices and systems for removing or reducing stenotic lesions in blood vessels by rotating an abrasive element within the vessel to partially or completely remove the stenotic lesion material.
1. A method for performing rotational atherectomy to remove stenotic lesion material from a blood vessel of a patient, the method comprising:
delivering a rotational atherectomy device into the blood vessel, wherein the rotational atherectomy device comprises:
an elongate flexible drive shaft defining a longitudinal axis, the drive shaft configured for rotation about the longitudinal axis;
an array of at least three spherical abrasive elements positioned along the drive shaft, the spherical abrasive elements fixed to the drive shaft such that a center of mass of each spherical abrasive element is offset from the longitudinal axis, each spherical abrasive element being spaced apart from an adjacent spherical abrasive element;
a metallic stability element that is fixed to the drive shaft and that has a center of mass aligned with the longitudinal axis, the metallic stability element distally spaced apart from a distal-most abrasive element of the spherical abrasive elements, wherein the drive shaft includes a distal extension portion extending distally beyond a distal end of the metallic stability element; a coating on an exterior of the metallic stability element; and
causing a rotary actuator coupled to the drive shaft to rotate the drive shaft about the longitudinal axis, said causing the rotary actuator to rotate the drive shaft about the longitudinal axis causes a portion of the drive shaft extending between the spherical abrasive elements to trace a generally bicone shape.
2. The method of claim 1 , further comprising:
delivering an elongate flush tube into the blood vessel, the flush tube defining a lumen, at least a portion of the drive shaft being disposed within the lumen during the rotating the drive shaft.
3. The method of claim 1 , wherein the distal extension portion of the drive shaft defines a central lumen that slidably receives a guidewire to facilitate the delivering the rotational atherectomy device into the blood vessel.
4. The method of claim 1 , wherein the at least three spherical abrasive elements comprises five spherical abrasive elements.
5. The method of claim 1 , wherein, during the rotating the drive shaft, a portion of the drive shaft proximal of the spherical abrasive elements is supported by a support means.
6. The method of claim 1 , wherein the drive shaft comprises an enhanced column strength means to facilitate pushing the drive shaft through stenotic lesions.
7. The method of claim 1 , further comprising aspirating particulate during the rotating the drive shaft.
8. The method of claim 1 , further comprising conveying a flush fluid during the rotating the drive shaft.
9. The method of claim 1 , wherein the delivering the rotational atherectomy device into the blood vessel comprises passing at least a portion of the distal extension portion through the lesion.
10. The method of claim 9 , wherein the delivering the rotational atherectomy device into the blood vessel comprises passing an entirety of the distal extension portion through the lesion.
11. The method of claim 1 , wherein the delivering the rotational atherectomy device into the blood vessel comprises passing the metallic stability element through the lesion.
12. The method of claim 11 , further comprising rotating the drive shaft to facilitate the metallic stability element to bore through and past the lesion.
13. The method of claim 1 , wherein during rotation of the drive shaft, the spherical abrasive elements each have an orbital path about an axis of rotation, wherein each of the orbital paths has a substantially greater diameter than a travel path of the metallic stability element.
14. The method of claim 13 , further comprising translating the drive shaft proximally and distally during the rotating the drive shaft.
15. The method of claim 14 , wherein rotation of the drive shaft causes the spherical abrasive elements to remove the stenotic lesion material from a wall of the blood vessel.
16. The method of claim 1 , further comprising navigating a guidewire within the patient's vasculature to a target location within the blood vessel.
17. The method of claim 16 , wherein a distal end portion of the guidewire is navigated past a lesion comprising the stenotic lesion material.
18. The method of claim 17 , wherein the delivering the rotational atherectomy device into the blood vessel comprises inserting the drive shaft over the guidewire.
19. The method of claim 18 , wherein at least a portion of the drive shaft remains over the guidewire during the rotating.
20. A method for performing rotational atherectomy to remove stenotic lesion material from a blood vessel of a patient the method
comprising:
delivering a rotational atherectomy device into the blood vessel, wherein the rotational atherectomy device comprises:
an elongate flexible drive shaft defining a longitudinal axis, the drive shaft configured for rotation about the longitudinal axis:
an array of five spherical abrasive elements positioned along the drive shaft, the spherical abrasive elements fixed to the drive shaft such that a center of mass of each spherical abrasive element is offset from the longitudinal axis, each spherical abrasive element being spaced apart from an adjacent spherical abrasive element;
a metallic stability element that is fixed to the drive shaft and that has a center of mass aligned with the longitudinal axis, the metallic stability element distally spaced apart from a distal-most abrasive element of the spherical abrasive elements, wherein the drive shaft includes a distal extension portion extending distally beyond a distal end of the metallic stability element; a coating on an exterior of the metallic stability element; and
rotating the drive shaft about the longitudinal axis, said rotating the drive shaft causes a portion of the drive shaft extending between the spherical abrasive elements to trace a generally bicone shape,
wherein the five abrasive elements include: (i) a proximal-most abrasive element, (ii) the distal-most abrasive element, and (iii) three middle abrasive elements located between the proximal-most and distal most abrasive elements,
wherein the three middle abrasive element have larger outer diameters than the proximal-most and distal-most abrasive elements.
21. The method of claim 20 , wherein during rotation of the drive shaft, the spherical abrasive elements each have an orbital path about an axis of rotation, wherein each of the orbital paths has a substantially greater diameter than a travel path of the metallic stability element.
22. The method of claim 20 , further comprising translating the drive shaft proximally and distally during the rotating the drive shaft.
23. The method of claim 22 , wherein rotation of the drive shaft causes the spherical abrasive elements to remove the stenotic lesion material from a wall of the blood vessel.
24. The method of claim 23 , wherein the delivering the rotational atherectomy device into the blood vessel comprises inserting the drive shaft over a guidewire.
25. The method of claim 24 , wherein during rotation of the drive shaft, at least a portion of the drive shaft remains over the guidewire while the guidewire is rotationally stationary.