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:
navigating a rotational atherectomy device within the blood vessel, the rotational atherectomy device comprising an elongate flexible drive shaft defining a longitudinal axis and including helically wound metallic filars that form a coil having an outer diameter;
advancing a distal tip portion of the drive shaft past stenotic lesion material within the blood vessel;
after advancing the distal tip portion past the stenotic lesion material, advancing a concentric metallic stability element affixed to the coil of the drive shaft past the stenotic lesion material, the concentric metallic stability element having a center of mass aligned with the longitudinal axis;
after advancing the concentric metallic stability element past the stenotic lesion material, advancing a distal-most eccentric abrasive element of an array of at least three eccentric abrasive elements past the stenotic lesion material while causing a rotary actuator coupled to the drive shaft to rotate the drive shaft about the longitudinal axis, the eccentric abrasive elements affixed to the drive shaft such that a center of mass of each eccentric abrasive element is offset from the longitudinal axis, each eccentric abrasive element being spaced apart from an adjacent eccentric abrasive element, wherein said causing the rotary actuator to rotate the drive shaft about the longitudinal axis causes the distal-most eccentric abrasive element to move in an orbital path to abrade the stenotic lesion material.
2. The method of claim 1 , further comprising:
delivering an elongate guide tube into the blood vessel, the guide tube defining a lumen, at least a portion of the drive shaft being disposed within the lumen during said rotating the drive shaft about the longitudinal axis.
3. The method of claim 1 , wherein the distal tip portion of the drive shaft defines a central lumen that slidably receives a guidewire to facilitate the delivering the rotational atherectomy device through the blood vessel.
4. The method of claim 1 , further comprising means for supporting a portion of the drive shaft proximal of the eccentric abrasive elements during the rotating the drive shaft.
5. The method of claim 1 , wherein the drive shaft comprises a means for enhancing column strength to facilitate pushing the drive shaft through the stenotic lesion material.
6. The method of claim 1 , further comprising aspirating particulate abraded from the stenotic lesion material during the rotating the drive shaft.
7. The method of claim 1 , further comprising conveying a flush fluid during the rotating the drive shaft.
8. The method of claim 1 , wherein the concentric metallic stability element includes cylindrical structure having a coating on an exterior thereof.
9. The method of claim 8 , further comprising rotating the drive shaft to facilitate the concentric metallic stability element to bore through and past the stenotic lesion material.
10. The method of claim 1 , wherein during the rotating, each eccentric abrasive element in said array of at least three eccentric abrasive elements has a respective orbital path about an axis of rotation, wherein each of the respective orbital paths has a substantially greater diameter than a travel path of the concentric metallic stability element.
11. The method of claim 10 , further comprising translating the drive shaft proximally and distally while rotating the drive shaft so that said array of at least three eccentric abrasive elements abrades the stenotic lesion material.
12. The method of claim 11 , further comprising, after the advancing the concentric metallic stability element past the stenotic lesion material and prior to the advancing the distal-most eccentric abrasive element past the stenotic lesion material, advancing a second portion of the drive shaft past the stenotic lesion material.
13. The method of claim 1 , further comprising, prior to the advancing the distal tip portion of the drive shaft past the stenotic lesion material, navigating a guidewire within the patient's vasculature to a target location within the blood vessel.
14. The method of claim 13 , wherein a distal end portion of the guidewire is navigated past the stenotic lesion material.
15. The method of claim 14 , wherein the navigating the rotational atherectomy device within the blood vessel comprises advancing the drive shaft over the guidewire.
16. The method of claim 15 , wherein at least a portion of the drive shaft remains over the guidewire during said rotating the drive shaft about the longitudinal axis.
17. The method of claim 1 , wherein said array of at least three eccentric abrasive elements comprises five spherical eccentric abrasive elements.
18. The method of claim 17 , wherein the five spherical eccentric abrasive elements include: (i) a proximal-most spherical eccentric abrasive element, (ii) the distal-most spherical eccentric abrasive element, and (iii) three middle spherical eccentric abrasive elements located between the proximal-most and distal most spherical eccentric abrasive elements.
19. The method of claim 18 , wherein the five spherical eccentric abrasive elements all have equal outer diameters.
20. A method for performing rotational atherectomy to remove stenotic lesion material from a blood vessel of a patient the method comprising;
navigating a rotational atherectomy device within the blood vessel, the rotational atherectomy device comprising an elongate flexible drive shaft defining a longitudinal axis and including helically wound metallic filars that form a coil having an outer diameter;
advancing a distal tip portion of the drive shaft past stenotic lesion material within the blood vessel;
after advancing the distal tip portion past the stenotic lesion material, advancing a concentric metallic stability element affixed to the coil of the drive shaft past the stenotic lesion material, the concentric metallic stability element having a center of mass aligned with the longitudinal axis;
after advancing the concentric metallic stability element past the stenotic lesion material, advancing a distal-most eccentric abrasive element of an array of five eccentric abrasive elements past the stenotic lesion material while rotating the drive shaft about the longitudinal axis, the eccentric abrasive elements affixed to the drive shaft such that a center of mass of each eccentric abrasive element is offset from the longitudinal axis, each eccentric abrasive element being spaced apart from an adjacent eccentric abrasive element, wherein said rotating the drive shaft about the longitudinal axis causes the distal-most eccentric abrasive element to move in an orbital path to abrade the stenotic lesion material,
wherein the five spherical eccentric abrasive elements include: (i) a proximal-most spherical eccentric abrasive element (ii) the distal-most spherical eccentric abrasive element and (iii) three middle spherical eccentric abrasive elements located between the proximal-most and distal most spherical eccentric abrasive elements, and
wherein the three middle spherical eccentric abrasive element have larger outer diameters than the proximal-most and distal-most spherical eccentric abrasive elements.
21. The method of claim 20 , wherein during rotation of the drive shaft, each eccentric abrasive element in said array of five eccentric abrasive elements has a respective orbital path about an axis of rotation, wherein each of the respective orbital paths has a substantially greater diameter than a travel path of the concentric metallic stability element.
22. The method of claim 20 , further comprising translating the drive shaft proximally and distally during rotation of the drive shaft.
23. The method of claim 20 , further comprising, after the advancing the concentric metallic stability element past the stenotic lesion material and prior to the advancing the distal-most eccentric abrasive element past the stenotic lesion material, advancing a second portion of the drive shaft past the stenotic lesion material.
24. The method of claim 20 , further comprising, prior to the advancing the distal tip portion of the drive shaft past the stenotic lesion material, navigating a guidewire within the patient's vasculature to a target location within the blood vessel.
25. The method of claim 24 , wherein a distal end portion of the guidewire is navigated past the stenotic lesion material.
26. The method of claim 24 , wherein the navigating the rotational atherectomy device within the blood vessel comprises advancing the drive shaft over the guidewire.
27. The method of claim 26 , wherein at least a portion of the drive shaft remains over the guidewire during said rotating the drive shaft about the longitudinal axis.