CN104066368A - 用于使经消融组织可视化的***和方法 - Google Patents
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Abstract
公开了用于将经消融组织可视化的***和方法。在一些实施方案中,用于使组织成像的***包含:导管(1601),其具有远端和近端;可膨胀球囊(1603),其安置在导管(1601)的远端附近;以及光学壳体(1803),其从导管(1601)的远端延伸到球囊(1603)中,所述光学壳体(1803)配置成使用于照射所述球囊(1603)外部之组织的光源(1805)和用于使经照射组织成像的照相机(1804)位于所述球囊(1603)内部。
Description
相关申请
本申请要求2012年9月22日提交的美国申请No.13/624,902的权益和优先权,其是2012年9月22日提交的美国申请No.13/624,899的部分继续申请,并要求2011年9月22日提交的美国临时申请No.61/537,798的权益和优先权,并且这些申请的整体通过引用在此并入本文。
政府支持的声明
本发明是在国家卫生研究院授予的批准/合同号R01HL095828下由政府支持完成的。政府享有本发明的某些权益。
技术领域
本文公开的实施方案涉及用于使组织消融(ablation)和可视化的方法和***。
背景技术
示例性实施方案涉及在治疗心房颤动(Atrial Fibrillation,AF)期间使用的技术。心房颤动是最常见的持续性心律失常,其目前影响两百万美国人。心房颤动与死亡率、发病率增加以及生活质量受损有关,并且是卒中的独立危险因素。发生心房颤动的高度终生风险突出了该疾病的公共健康负担,其单在美国每年治疗费用就多达70亿美元以上。
已知患有心房颤动的患者中85%的发作是由起源于延伸入肺静脉(PV)之肌袖(muscle sleeve)内的病灶电活动触发的。心房颤动也可以通过上腔静脉或其他心房结构内的病灶活动触发。这些病灶触发可导致由折返电活动(reentrant electrical activity)和回旋(rotor)驱动的心动过速,其然后可碎裂成心房颤动所特有的众多电微波(electrical wavelet)。延长的心房颤动可引起膜离子通道的功能变化以及离子通道表达的变化。这些改变进一步使心房颤动持续。
射频(RF)消融是用于治疗心房和心室节律紊乱的有效疗法。在美国每年进行近10万例射频消融手术以治疗心律失常。RF消融靶向折返途径和/或异常异位基因座(abnormal ectopic loci)的关键要素而不显著破坏邻近的健康心肌和冠状血管的量。消融还用冷冻消融和激光引导的消融***进行。
为了进行RF消融手术,将导管穿入心脏并将尖端引导到心房中。进行经中隔穿刺以允许从右心房跨越进入左心房,左心房是进行消融的关键(crux)。然后导管发射高能RF电脉冲,其破坏心房组织并形成阻断异常信号的疤痕组织。心房颤动的最常见RF消融治疗由以下组成:各肺静脉口周围以圆形方式引入消融损伤(lesion)。损伤使肺静脉电隔离以阻断病灶触发进入左心房。RF损伤也可在微创或心脏直视手术(open heartsurgery)期间经心外膜引入。
RF消融损伤的程度并不简单地为所递送RF能量的函数,而是取决于许多因素,包括导管尖端与组织之间的接触、心肌的厚度、血液流动的程度以及脂肪的存在。目前我们使用称作3D标测(mapping)***(CARTO和NAVEX)的替代物(surrogate)来确定解剖构造(anatomy),替代物可以深入(be off)1或2厘米。目前的电解剖(electro-anatomical)标测***主要绘出导管尖端的物理位置,但没有绘出由消融引起的细胞损害的程度。因此,迄今为止,RF消融损伤在没有关于受影响组织之生理状况的信息下建立。考虑到消融损伤之间的可激发组织的间隙与心律不齐复发直接相关,这是成问题的。实时监测由消融产生的组织损害仍然是目前消融方法的主要限制。
为了解决不完全损伤的问题,已经提出了两种主要策略。第一种是改进消融装置,其包括发展多极和线性导管、使用激光和高强度聚焦超声的基于球囊(balloon)的技术、以及装备RF导管的压力传感器。
第二种策略是在消融手术期间使RF消融损伤可视化。这样的可视化可基于受损组织的化学和/或物理性质的急剧改变。具体地,目前的可视化方案需要使用染料并且包括磁共振成像(MRI)、相干断层扫描(coherence tomography,CT)和光谱。
所有这些策略使用替代物来预测间隙的区域并且没有一个具有如我们所设计的实时直接可视化技术。尽管有所有的现有技术,可是第一次手术后94%的患者发生肺静脉重新连接(reconnection)。消融手术后心房颤动复发80-90%的次数是由于间隙部位的肺静脉重新连接。
发明概述
本文公开了用于使经消融的组织可视化的***和方法。
根据本文举例说明的一些方面,提供了用于使组织成像的***,其包含:导管,其具有远端和近端;可膨胀球囊(inflatable balloon),其安置在该导管的远端附近;以及光学壳体(optical housing),其从该导管的远端延伸到球囊中;该光学壳体配置成使用于照射所述球囊外部之组织的光源和用于使经照射组织成像的照相机位于所述球囊内部。
根据本文举例说明的一些方面,提供了用于使组织成像的***,其包含:导管,其具有远端和近端;可膨胀球囊,其安置在该导管的远端附近;以及光学壳体,其从该导管之远端延伸到球囊中;球囊内部的光源,该光源被光学壳体支持并配置成激发组织中的烟酰胺腺嘌呤二核苷酸的天然还原形式,或者说烟酰胺腺嘌呤二核苷酸氢(NADH);以及球囊内部的照相机,该照相机被光学壳体支持并配置成使被光源照射的组织成像。
根据本文举例说明的一些方面,提供了用于使组织成像的***,其包含:导管,其具有远端和近端;冲洗端口(irrigation port),其用于在该导管的远端附近用流体置换血液;以及光学壳体,其从该导管的远端延伸,该光学壳体被配置成支持用于照射组织的发光二极管光源和可视化装置,所述可视化装置包含将光学图像转化为电子信号(electronic signal)以使被照射组织成像的多个图像传感器。
根据本文举例说明的一些方面,提供了用于使组织成像的***,其包含:套管(sheath),其用于输注能够置换血液并且透过光的流体;安置在套管内的导管,该导管具有远端和近端;光学壳体,其从该导管的远端延伸,该光学壳体被配置成支持用于照射组织的发光二极管光源和可视化装置,所述可视化装置包含将光学图像转化为电子信号以使被照射组织成像的多个图像传感器。
根据本文举例说明的一些方面,提供了用于使组织成像的方法,其包括:将导管推进到组织,所述导管包含安置在导管之远端附近的可膨胀球囊和光学壳体,所述光学壳体从该导管之远端延伸到所述球囊中以使光源和照相机位于球囊内;消融组织;用光源照射包含被消融处理之组织和周围组织的组织区域以激发在该组织区域中的NADH;用成像装置使该组织区域成像以检测所述组织区域的NADH荧光;以及产生经成像、经照射之组织的显像(display),所述显像举例说明了经消融的组织与未经消融的组织相比具有较少的荧光。
附图说明
将参考附图进一步解释本文公开的实施方案,其中在若干视角中通过相同的数字指示相同的结构。所示的附图不一定是按比例的,而重点在于一般性地说明本文所公开的实施方案的原理。
图1A是根据本公开内容之示例性***的框图(block diagram);
图1B举例说明了用于根据本公开内容示例性***之导管的实施方案;
图1C举例说明了用于根据本公开内容示例性***之导管的实施方案的远端;
图1D举例说明了用于根据本公开内容示例性***之导管的实施方案的近端;
图2A是根据本公开内容之示例性***的框图;
图2B举例说明了用于与图2A中所示之示例性***相连接的滤光器盒实施方案;
图3是根据本公开内容之示例性方法的流程图;
图4A举例说明了RF消融探针处于向心外膜表面递送损伤的位置;
图4B举例说明了在无血大鼠心脏中进行标准RF消融方案后典型损伤的视觉外观;
图4C举例说明在无血心脏中两个独立RF消融损伤的外观,如由fNADH成像所揭示的;
图4D举例说明了在用活体(vital)TTC染料进行TTC染色后相同的两个RF消融损伤的外观(白色组织-坏死,红色-存活);
图4E举例说明了经TTC染色的心脏横截切片示出使用两种不同的能量设置在相反的心外膜表面引入的两处损伤的深度;
图5A举例说明了如在fNADH-敏感性通道上看到的损伤随时间的稳定性;
图5B举例说明了如在fNADH-敏感性通道上看到的在生存手术后2个月剥离之大鼠心脏心外膜表面上的射频消融损伤的图像;
图6A、图6B和图6C举例说明如在fNADH-敏感性通道上看到的RF损伤的尺寸与在TTC染色后之间的比较;
图7A、图7B和图7C举例说明了两处RF损伤之间折返(reentry)的发生,其基于来自使用电压敏感性染料和fNADH之心外膜电活动的双重成像的数据。由于电波(electrical wave)通过两处RF损伤之间的狭窄峡部(isthmus),所以发生折返形成;
图8A、图8B、图8C和图8D举例说明了跨越两处RF损伤之间之峡部的fNADH和电活动的谱(profile);
图9A、图9B、图9C和图9D举例说明了消融区域内的RH237滞留(retention);
图10A、图10B、图11C和图11D举例说明了当与NADH荧光比较时,RF消融手术后RH237的滞留。10B和10C示出在大鼠心脏中完成的RF消融,10D-在兔心脏中;
图11A-11D举例说明在经血液输注的开胸动物中RF消融损伤的可视化。如在图11D中示出的,通过荧光缺乏(赋予组织暗色外观)鉴别经消融的损伤(图的中心部分),而缺血或受损的组织变得更亮,如通过光晕型(halo type)外观举例说明的;
图12是肺静脉附近经血液输注之犬左心房组织的心内膜表面上消融损伤的图像。
图13是冷冻消融后无血大鼠心脏心外膜表面上的消融损伤的图像。
图14举例说明了在已经使用射频消融急剧消融的大鼠经血液输注之肝脏中的fNADH损伤;以及
图15是标准导管右侧的2D图像并且重建为整合入3D标测***之3D。可使用计算机***和程序将所获得的NADH荧光2D图像转化为叠加在所显示的心房解剖构造上的3D图像。
图16是本公开内容球囊导管组件的实施方案的视图。
图17是本公开内容具有隐藏球囊之球囊导管组件的实施方案的视图。
图18是***到本公开内容之实施方案导管中的实施方案光学壳体的视图。
图19、图20和图21举例说明了本公开内容之光学壳体的多种非限制性实施方案。
虽然以上限定的附图阐述了本文公开的实施方案,但是还考虑如在讨论中指出的其他实施方案。本公开内容通过代表性的而不是限制性的方式举例说明实施方案。本领域的技术人员可以想到多种其他修改或实施方案,其落入本文公开之实施方案的原理的范围和精神内。
发明详述
本公开内容的示例性实施方案涉及在消融手术期间使RF消融损伤可视化的***和方法。还提供了用于治疗心房颤动(AF)的***和方法。
提供了用于治疗心房颤动(AF)的***、导管和方法。使用球囊引导的导管对心脏组织中内源NADH的荧光(fNADH)成像以鉴别经消融和未经消融的区域,所述导管装备了用以检测NADH荧光的UV照射源和UV能纤维(UV capable fiber)、荧光能照相机(fluorescence capablecamera)或成像束以及光学带通滤光器(optical band pass filter)。可以使用fNADH成像鉴别经消融区域之间的间隙,并且随后可以将所述间隙消融。成像可在消融手术期间进行并且不需要另外的化学品(例如对比剂、示踪剂(tracer)或染料)。
在一些实施方案中,本公开内容的***可用于使用紫外光照射组织并且可使内源NADH荧光(fNADH)成像以鉴别经消融和未经消融的区域。可使用例如位于导管尖端的双重UV激发/发射光纤波导来实现紫外光的提供和组织之fNADH的成像。本公开内容的方法和***不需要添加染料和染色剂(stain)。此外,本公开内容的方法和***允许在消融手术期间成像,使得初次手术之后无需另外的侵入消融手术。使用本公开内容的方法和***导致在完全消融的部位因缺乏荧光而具有完全暗色的区域,这可通过提供对于健康组织的经标记的对比剂以及在经消融组织和健康组织之间之边界区处甚至更多的对比剂来增强检测经消融区域的能力。该边界区域是水肿组织和缺血组织,其中NADH荧光在成像后变成亮白色。边界区围绕经消融的中心组织建立光晕外观。
根据本公开内容的示例性实施方案,使用低强度紫外光照射,使用内源NADH荧光(fNADH)对经消融组织和所述经消融组织周围的组织成像。NADH是在完整细胞内存在的辅酶并且在心脏肌肉细胞中特别丰富。当NADH从受损细胞的线粒体释放和/或转化为其氧化的NAD+形式时,心肌细胞fNADH显著下降。这揭示了消融诱导的肌肉损害,从而突出了指示不完全心外膜损伤的间隙。
目前的消融在没有关于经消融组织之生理学的有意义的实时信息的情况下进行。病灶源的电隔离是消融功效的唯一指标(indicator)。该方法存在两点主要限制。第一点是在手术期间不能测量损伤的程度。第二点是不能确定电隔离的具体原因。例如,电隔离可以由心脏肌肉损坏导致,但也可由可逆受损细胞的功能改变导致,以及由临时水肿导致。在水肿的情况下,它可以在几周后消退,潜在地恢复异常电传导。在没有对比剂、示踪剂或染料的情况下,本公开内容的fNADH成像揭示不可逆心脏肌肉损害。递送RF能量后立即看到经fNADH成像检测的损伤并且它们保持稳定数小时。因此,可视化可与消融协调地完成或在引入多处损伤后完成。
在本公开内容中使用的缺血损害期间NADH荧光的增加和与之相反的由于以下原因导致的热损坏后的降低之间没有矛盾。约30%的心肌细胞体积由含有大量NADH的线粒体构成。因此,可以相对容易地测量来自肌细胞的fNADH之水平的改变。当肌纤维膜和线粒体膜被加热瓦解时,NADH丢失并且fNADH水平立即下降。在低氧和/或缺血期间,细胞完整性被保留但氧可利用性降低。氧在线粒体电子链中充当最终电子受体并且它的减少导致NADH积累。因此,缺血导致fNADH以时间依赖的方式增加。例如,如果冠状动脉输注在消融期间暂时中断,消融后,可以在邻近更暗色的圆形fNADH损伤处观察到具有升高之fNADH水平的缺血或受损组织的斑点(patch),这可在图4C中看出。
可以在没有另外的示踪剂或对比剂的情况下完成监测内源性fNADH。由于荧光的改变反映急剧的生物化学改变,所以损伤几乎立刻被看到。虽然成像模式(例如MRI、C-臂CT和对比剂超声波心动描记法(contrast echocardiography))是检测由加热诱导之生理改变导致的参数的优秀工具,但是需要对比剂以实时使改变可视化。另外,虽然MRI和C-臂CT提供高空间分辨率,但可能消耗至多30分钟来使细胞坏死可视化。超声波心动描记法更快,但空间分辨率低且视野受限。还已经探讨了基于物理组织改变的其他模式,所述物理组织改变包括组织弹性、阻抗或吸收中的变化。虽然这样的策略提供了实时反馈并且可以预测损伤尺寸和深度,但是它们也需要大量的数据处理并且不提供经消融区域的直接可视化。然而,应当注意,这些公知的成像方法可以与本公开内容的方法联合使用。
目前,多数消融手术是心内膜的,但是大约10%至20%可以施加到心外膜。频繁观察心外膜基底的VT,包括>20%的梗死后VT,以及>30%的来自非缺血性心肌病(特别是查加斯病(Chagas disease))的VT。这些心外膜基底的消融可以使用经皮方法,其包括将套管剑突下(subxiphoid)放置进入完整的、封闭的心包腔(pericardial space)。fNADH成像特别地用于这些过程。装备有UV-兼容光学器件(optic)以及光敏图像捕获装置的传统内窥镜将适用于该目的。为了消融部位的适当可视化,可使用通过内窥镜的空气吹入扩张心包腔。在临床设置中,用二氧化碳而不是空气的吹入将可能降低空气栓塞的风险。如果在内窥镜前面使用可膨胀球囊来置换血液,那么fNADH成像也可以用于心内膜手术。
本公开内容的***和方法让使用者能够在进行消融的同时监测心肌损害。这样一来,临床心脏电生理学家可能能够缩短时间并提高消融的效率,尽可能降低可以引起消融后并发症的不必要的组织损伤,并且降低消融后的心律失常复发和对后续消融的需要。fNADH成像还可以用于靠近消融部位之组织损伤的机理研究并且用于评估可改变损伤间隙之间电传播的药物。
在无血或经血输注的大鼠和兔心脏二者中,fNADH成像的使用允许使消融损伤和损伤之间的间隙可视化。可使光学动作电位和NADH的内源性荧光成像以研究消融损伤周围的电活动和组织活力的改变。可在消融手术期间使用位于导管尖端的双重UV激发/发射光纤波导来实现fNADH成像。这样的波导***可以与3D标测***相连接以提供导管附近心脏肌肉活力的详细绘图。
图1A是根据本公开内容的示例性***的框图。该***包含与外部设备125连接的可膨胀球囊导管105。在一些实施方案中,导管105包含消融装置110、照射装置115以及成像装置120。在一些实施方案中,照射装置115和成像装置120可利用光纤波导来传递往返于经处理组织的光。
在一些实施方案中,本公开内容的方法和***可以与消融手术结合使用,从而实时监测何时实现所期望之组织的完全消融。消融是使用能量,加热或极端的冷(冷冻)来破坏或损害组织(消融)的过程。例如,RF消融依赖于由高频交流电产生的热来消融组织。冷冻消融用于多种临床应用,使用冷却的、热传导的流体通过其循环的中空管或针(冷冻探针)来通过冷冻该组织破坏该组织。可以结合多种类型的组织消融来使用本公开内容的***和方法,所述组织消融包括但不限于RF消融、冷冻消融、声能消融、电磁能消融、微波能量消融、超声消融、化学消融、激光消融、热消融、电消融或其他类型的热或非热能消融。为此,在一些实施方案中,消融装置110可以被推进到需要消融的组织以消融该组织。在一些实施方案中,消融装置110具有选自以下的能量源:射频能量、微波能量、电能、电磁能、冷冻能量(cryoenergy)、激光能量、超声能量、声能、化学能和热能。
外部设备125包含向照射装置115提供紫外光的光源130、照相机135和显示器140。在一些实施方案中,照相机135可为CCD照相机,其对于对应NADH荧光的波长具有高量子效率(即,在460nm有80%量子效率),例如Andor Ixon DV860照相机。在一些实施方案中,照相机135可以配备有460/25nm滤光器135(即,通过紫外光同时阻挡紫外光谱以外之光的滤光器)。
参照图1B,在一些实施方案中,导管105是具有近端220和远端221的多腔导管。导管105包含安置在导管105之远端221附近的球囊222。球囊222可以由UV透明材料(例如UV透明含氟聚合物)制成。在一些实施方案中,球囊222可以具有50μm的厚度、1.31的折射率。球囊222可以是顺应性球囊(complaint balloon)或非顺应性球囊(non-complaintballoon)。
球囊222可以是圆形、扁平形、圆筒形、椭圆形、矩形或取决于待使用导管105处理之解剖构造的其他形状。球囊222可以在荧光成像的部位置换血液以提供光学整洁视图(optically uncluttered view)。因为血液具有荧光性质主要是因为血红蛋白,所以通过该介质成像将使发射途径饱和。球囊可以用气体或液体膨胀。例如,具有约1.00045之低折射率的二氧化碳可用于使该球囊膨胀。另外,在球囊在体内破裂的情况下,由于氮气的高分压,短时期内CO2暴露不会引起任何即时的致命危险。合适的流体包括但不限于水、盐水、血液或其他类似流体。导管105可包含用于使球囊222膨胀和收缩的膨胀/收缩腔225。为了使球囊222膨胀和收缩,在一些实施方案中可以提供两个单独的腔。
除了膨胀/收缩腔225,导管105还可以包含用于推进消融装置110的消融腔223、用于推进成像装置120的成像腔224、以及用于推进照射装置115的照射腔226。应当理解,导管105可以包含另外的腔或者一些腔可以提供多种功能。例如,在一些实施方案中,可以采用单个光纤束使来自光源130的光传递至组织以照射该组织,并且使由该组织反射的光传递至照相机135。
参照图1C,举例说明了无球囊222之导管105的远尖端221的实施方案。为了消融期望组织,消融腔223允许消融装置110通过或超过导管105的远端221。膨胀/收缩腔225让使用者能够将球囊222膨胀或收缩以有助于荧光成像。成像腔224允许成像装置120被推进到球囊中以使经消融组织成像,可以通过经照射腔226推进的照射装置105照射所述经消融组织。应当理解,多个腔223-226相对于彼此的位置可以以期望的程度变化。
参照图1D,举例说明了近尖端220的实施方案。在一些实施方案中,为了将消融装置110引入到导管105,可以提供与消融腔223连通的消融端口233。为了操作球囊222,可以提供与膨胀腔225a和收缩腔225b连通的另一个端口235。在一些实施方案中,近端220包含与成像腔224和照射腔226连通的出口237,以将成像装置120和照射装置110引入到导管105中。为了将导管105与一个或更多个外部设备125相连接,还可以向导管105提供连接器240。
再次参照图1A,外部设备125可以包含照相机135。在一些实施方案中,照相机135可以是CCD(charge-coupled device,电荷耦合装置)照相机。在一些实施方案中,可以选择照相机135使得它能够收集尽可能多的光子,并且这对图像带来最小的噪音。通常对于活细胞的荧光成像,CCD照相机应当在约460nm下具有至少50-70%的量子效率,表明30-50%的光子将被忽略。在一些实施方案中,照相机135在460下具有约90%的量子效率。照相机135可以具有80kHz的采样率。在一些实施方案中,照相机135可以具有8e-(电子)或更小的读出噪音(readoutnoise)。在一些实施方案中,照相机135的最小读出噪音为3e-。
外部设备125还可以包含光源130,例如UV LED发射器。该光源用于经成像装置120照射组织,所述成像装置120可以包含光纤光导(fiberoptic light guide)并且可以通过成像腔224推进到导管105的远尖端221以捕获组织图像。在一些实施方案中,为了照射待可视化的组织,光纤光导可以充当照射装置115以使来自光源130的光以激发波长传递至该组织。光纤光导还可以发挥将由该组织反射的光传递返回至相机135的作用。在一些实施方案中,独立的光纤网络可以用于照射和成像,也就是说,在一些实施方案中,照射装置115可以独立于成像装置120。在一些实施方案中,纤维镜(fiberscope)可以用作成像装置、照射装置或二者。
当经照射组织的图像被CCD捕获时,这些图像可以被发送到显示器140以实时地向使用者显示。可通过使用软件分析图像以获得实时的细节(例如,在图像特定部位的强度或辐射能量),从而帮助使用者确定进一步的干预是否是必要的或期望的。
参照图2A,在一些实施方案中,本公开内容的***可以包含位于导管***105和外部设备125(例如照相机135和光源130)之间的滤光器盒145。滤光器盒145可以包含二色镜146,其用于反射来自光源130的待被照射装置115传播的光。二色镜146可以对光呈45°入射角放置,以建立反射光的阻带(stop band)和透射光的通带(pass band)。来自光源130的光以样本的90°方向被反射。同时,在相同朝向上,由样本传出的光通过该镜。在一些实施方案中,可以使用具有425nm之截止(50%)波长的长传(longpass)二色镜,这是因为它具有在355nm和410nm之间大于80%的近似反射带和在440nm和700nm之间大于90%的透射带。应当理解,可以使用其他光学装置以传递往返于待可视化组织的光。
滤光器盒145还可以包含发射滤光器147以滤除可以带来某种噪音或不期望特征的光。在一些实施方案中,基于NADH荧光,滤光器147可以是460nm的中心波长,具有50nm带宽(即460±25mm)。滤光器盒145还可以包含激发滤光器,其用于选择来自光源130之光的激发波长。
参照图2B,实施方案滤光器盒145包含照相机端口400,其带有容纳于位于照相机端口400前面的滤光器容纳器(filter holder)402中的发射滤光器401。滤光器盒145还包含容纳在滤光器容纳器404中的激发滤光器403,其可以位于光源端口或导管端口。激发滤光器403位于导管端口405。二色镜405被***镜槽406并且相对于端口约45度角定位以将光源130连接至滤光器盒145。
参照图3,举例说明了本公开内容之***的操作。首先,将导管105***到受心房颤动影响的区域,例如肺静脉/左心房交界处(left atrialjunction)(步骤150)。从视野中移除血液。对于心房颤动消融,将使用光纤波导周围的透明球囊置换在肺静脉/左心房交界处的血液。受影响的区域被来自源130和照射装置115的紫外光照射(步骤155)并且使用消融装置110消融照射区域中的组织(步骤160)。使用本公开内容的***可以采用点对点RF消融或冷冻消融或激光或其他已知消融过程。通过使尖端穿过导管的中央腔来进行消融。在该过程之后,可以缩回消融尖端。
通过成像装置120和照相机135的组合来使照射区域成像(步骤165)。本公开内容的方法依赖于NADH之荧光发射的成像,NADH是烟酰胺腺嘌呤二核苷酸(NAD+)的还原形式。NAD+是在所有活细胞的有氧代谢氧化还原反应中发挥重要作用的辅酶。它通过接受来自柠檬酸循环(三羧酸循环)的电子来充当氧化剂,所述柠檬酸循环发生在线粒体中。通过该过程,NAD+由此还原成NADH。NADH和NAD+在细胞的呼吸单元(线粒体)中最丰富,但也存在于胞质中。NADH是线粒体中的电子和质子供体以调节细胞代谢并参与包括DNA修复和转录在内的多个生物学过程。
通过测量组织的UV诱导荧光,能够了解组织的生物化学状态。已经研究了NADH荧光在监测细胞代谢活动和细胞死亡中的用途。体外和体内的一些研究调查了使用NADH荧光强度作为细胞死亡(凋亡或坏死)监测的内在生物标志物的潜力。一旦NADH从受损细胞的线粒体释放或转化为其氧化形式(NAD+),其荧光就显著下降,从而使得其在受损组织与健康组织的区分中非常有用。在氧气不可得时的缺血状态期间,NADH可在细胞中积累,这增加了荧光强度。然而,在死细胞的情况下,NADH的存在全部消失。下表总结了因NADH荧光而不同的相对强度状态:
虽然NAD+和NADH二者都相当容易地吸收UV光,但是NADH响应UV激发而自发荧光,而NAD+则不如此。NADH具有约350-360nm的UV激发峰和约460nm的发射峰。在一些实施方案中,本公开内容的方法可以使用约335nm至约380nm的激发波长。使用恰当的仪器,从而可能将发射波长成像为目的区域内缺氧以及坏死组织的实时测量。此外,用与NADH荧光成比例显示的灰度可以实现相对度量。
在缺氧条件下,氧水平降低。随后的fNADH发射信号的强度可以增加,这表明线粒体NADH的过量。如果不对缺氧加以控制,由于受影响的细胞连同其线粒体死亡,所以最终会发生信号的完全衰减。NADH水平的高对比度可以用来鉴别最终受损的经消融组织的周界。
为了开始荧光成像,操作者可以布置球囊,所述球囊围绕导管的远端部分安置。接下来,NADH被来自光源130的UV光激发。在具有滤光器盒的一些实施方案中,来自光源的第一激发光击中位于滤光器盒145内的二色镜(或二向色分束器)。然后,激发光被二色镜反射经光纤朝向样品。在一些实施方案中,该镜可以相对激发光成45°角定位并且激发光可以被反射90°。在一些实施方案中,本公开内容的方法可以采用约335nm至约380nm的激发波长。
组织样品中的NADH吸收激发波长的光并且发射更长波长的光。发射光可以通过二色镜146来收集并传回。因此,该镜146可以被设计成反射激发波长但透过发射波长。激发波长的反射不是100%,所以少量的这种光穿过二色镜146。同样地,具有不同波长的另外的光可以穿过,因此发射滤光器可以与照相机135结合使用。可以对于荧光团(例如NADH)期望的光的发射波长来选择发射滤光器。
一旦光被滤波,该光就可以被照相机135收集,并且在显示器140上产生经成像的照射区域的显像(步骤170),这用于使用NADH荧光鉴别经成像区域中经消融和未经消融的组织(步骤175)。如果有必要消融另外的组织,则通过返回至消融步骤重复该过程。应当意识到虽然图3举例说明了顺次进行的步骤,但是很多步骤将同时或接近同时进行。因此,例如消融、成像和显示可同时发生,并且可在消融该组织的同时发生经消融和未经消融的组织的鉴别。
本文公开的方法、***和装置可用于多种治疗过程。可在其中使用本文公开的方法、***和装置的示例性过程包括但不限于,用于在心脏中诊断和治疗的过程、用于治疗心律失常(例如室上性心律失常和室性心律失常)、用于治疗心房颤动和肺静脉标测和消融。经消融组织可以是心脏肌肉,但本文公开的方法应当对富含NADH之线粒体显著存在的骨骼肌、肝、肾和其他组织具有同样的作用。
参照图16,与本公开内容的***和方法结合使用的导管1601包含贯穿其延伸的一个或更多个腔和在导管1601的远端附近安置的可膨胀球囊1603。在一些实施方案中,可以将球囊1603之近尖端1604与导管1601之主体的远端相连接并且将其远尖端1605与导管尖端1606相连接,所述导管尖端1606可以通过以下描述的管或腔连接到导管1601。球囊1603可以由光学透明材料制成并且可以用于在荧光成像期间将血液从光学组件的通路中移除。球囊1603可由最符合多种解剖结构的许多不同材料和形状制成。球囊可以由柔软材料(例如硅酮)构成,并且顺应解剖构造。或者,球囊可以由更强的材料(例如聚氨酯)构成并具有较低的顺应性。如在图16中举例说明的,球囊1603可以具有设计用于***到肺静脉口的圆锥形。更具圆形性质的其他形状可以更适于使用于消融治疗的其他心脏解剖构造视野可视化,所述其他心脏解剖构造视野包括(通过非限制性实例)附加通路(accessory pathway)、心室壁部位、心房壁视野或房室结(atrio-ventricular nodal)视野。
导管1601可以用于组织消融,包括但不限于RF消融、冷冻消融、声能消融、电磁能消融、微波能量消融、超声消融、化学消融、激光消融、热消融、电消融或其他类型的热或非热能消融。为此,在一些实施方案中,导管1601可以推进至需要消融的组织并且能够进行一种或更多种消融方法的消融部件可穿过导管1601以消融组织。在一些实施方案中,消融部件具有选自以下的能量源:射频能量、微波能量、电能、电磁能、冷冻能量、激光能量、超声能量、声能、化学能和热能。
在一些实施方案中,导管尖端1606可以配置成充当电极,或用于诊断目的(例如电图传感(electrogram sensing))或用于治疗目的(例如用于发射消融能量)。在一些实施方案中,其中消融能量需要导管,导管1601的尖端1606可以作为消融电极或消融元件。在实施RF能量的实施方案中,将尖端耦接到RF能量源(导管的外部)的接线(wiring)可通过导管1601的腔。尖端1606可包含与导管1601之一个或更多个腔相连通的端口1607。以这种方式,导丝或其他手术设备(例如RF电极)可以经尖端1606推进到导管1601之外。尖端1606可以由任何生物相容性材料制成。在一些实施例中,如果该尖端配置成充当电极,则尖端1606可以由金属制成,所述金属包括但不限于铂、镀铂的铱、不锈钢或钛。尖端1606还可以由生物相容性塑料制成,所述生物相容性塑料包括但不限于硅酮、聚醚醚酮(peek)、聚氨酯。
参照图17,在一些实施方案中,导管尖端1606可以通过延伸超过导管1601之主体远尖端的导丝管1700与导管1601的主体相连接。导丝管1700可以包含与导管1601之一个或更多个腔相连通的一个或更多个腔,以推进导丝、消融部件或其他手术设备超过导管1601的远尖端。导丝管1700的内腔还可以与导管尖端1606的端口1607相连通,以推进手术设备通过导丝管1700或超过导管尖端1606。
在一些实施方案中,导丝管1700可以发挥向球囊1603提供结构支持的作用,尤其是在推进导管1601到治疗部位的过程中当球囊1603处于收缩状态时。在一些实施方案中,导丝管1700可以是半刚性的,以向球囊1603提供结构支持。在一些实施方案中,导丝管1700可以是导管1601的整个腔。在一些实施方案中,导丝管1700独立于导管1601并且可以可移动地***到导管1601的远尖端。在一些实施方案中,导丝管1700可以可滑动地安置在导管1601内,使得导丝管1700可相对于导管1601移动以调节球囊1603的形状,从而有利于导管1601前进或从患者身体退出。例如,可以推进导丝管1700以伸展折叠的球囊,从而更容易地从患者身体退出。在这样的状态下,球囊会表现得更好,更不太可能在移除时卡在导引器套管上。该导丝管可以由任何材料制成。在一些实施方案中,导丝管1700可以由形状记忆材料(如镍钛诺(Nitinol))制成。
参照图17结合图16,导管1601可以包含颈下表面1701,其中球囊1603的近端1604可以与导管1601连接而不增加结合装置的外径。
参照图18,光学壳体1803可以安置在导管1601的远端,以使光学元件(例如照相机1804和光源1805)位于球囊1603内。光学壳体1803能够使照相机1804和光源1805位于球囊内,从而消除对外部光源的需要。此外,通过将光源放在球囊内,可以比使用纤维束时实现更广的照射角度。如在图18中所示,光学壳体1803可以从导管延伸到球囊中,使得光源和照相机完全被容纳在球囊内,从而确保导管不干扰光源或照相机的视野。如在图18中所示,光源和照相机在球囊内部并且不延伸到球囊以外。在一些实施方案中,壳体1803使光学元件相互之间定位成固定的关系。在一些实施方案中,照相机1804和光源1805彼此齐平,使得各组件不会“阻挡”另一个组件的功能。保持齐平确保了照相机1804不会阻挡照射,光源1805也将不会出现在照相机图像中。在一些实施方案中,可以改变组件的位置以避免光学组件相互之间的干扰。
照相机1804可以是能将光学图像转化为电子信号的任意图像传感器。在一些实施方案中,照相机是微型CMOS图像传感器,其具有透镜并且具有或不具有滤光器,所述滤光器用于选择特定的波长或波长组以记录。在一些实施方案中,照相机是能将光学图像转化为电子信号的CCD照相机或其他图像传感器。照相机可以经导线将其信号传输到外部图像处理器和视频终端从而使医生看到。在一些实施方案中,照相机可以具有用于与外部装置通讯的无线通信能力。光源1805可以是具有合适波长的发光二极管(LED)。在一些实施方案中,LED将具有UV范围的波长以引起NADH荧光。在一些实施方案中,通过选择适当波长的LED使包括白光在内的不同波长用于多色照射成为可能。通过非限制性实例,用于UV应用的合适LED将包括具有300nm至400nm波长的那些,而用于可见光或白光应用的合适LED将包括具有色温范围为2000K至8000K的那些。
如在图18中所示,壳体1803可以***到导管1601的远端。在一些实施方案中,壳体1803的外径可以比导管1601的内径小,使得可以在导管1601的内壁和壳体1803之间形成间隙1802。在一些实施方案中,球囊1603可以通过间隙1802膨胀或收缩。当然,应当理解,可以提供用于操作球囊1603的单独的腔。
在一些实施方案中,因为光学壳体1803的外径比导管1601的内径小,壳体1803可以是可相对于导管1601移动的。在一些实施方案中,壳体1803可以相对于导管1601并因而相对于球囊1603自由旋转。在一些实施方案中,该光学壳体1803可相对于球囊导管1601纵向平移,以获得期望的照相机之视角或光源之照射位置。可以提供锁以将光学壳体1803锁定在期望的位置。
图19是导管1601外部的壳体1803的视图,示出照相机1804的线束1901和用于光源1805的线束1902。这些线束可以沿导管的整个长度运行返回到把手(handle)(未示出),在所述把手处它们可以与成像***的其余部分(例如电源或显示器)进行电连接。但是应当注意,在一些实施方案中,照相机可以具有与外部装置无线通讯的无线通讯能力。
壳体1803还包含用于接受导丝管1700的通道1904,以促进导丝管1700和导管1601之间的通讯。
本公开内容的导管可用于微创过程以及常规的手术过程(即开放式过程)。在一些实施方案中,本公开内容的导管可以配置用于血管内途径。在一些实施方案中,本公开内容的导管可以配置用于非血管内途径。在一些实施方案中,本公开内容的***可以是用于手术过程的手术***或装置,所述手术过程通过开放的切口或经皮而不是通过血管内途径引入到组织中。在一些实施方案中,本公开内容的***和装置可以是手持的或机器人控制***的一部分。在一些实施方案中,本公开内容的***或装置可以配置成用于通过机器人***来操作。
在一些实施方案中,组件的尺寸可以根据特定过程变化。在一些实施方案中,本公开内容之导管的刚性可以根据过程的类型、待治疗的解剖构造或二者来变化。在一些实施方案中,可以通过选择用于导管1601、导丝管1700或二者的更具刚性的构件来改变刚性。
参照图20,在一些实施方案中,如果需要更高的刚性,则光学壳体2002可包含用于容纳多根导丝管的多个通道2003、2004。应当注意的是在多个实施例中,一些或全部导丝管可以包含与导管1601的内腔以及导管尖端1606的端口1607相连通的内腔,以使手术设备通过这样的导丝管。在一些实施方案中,一些或全部导丝管可以简单地发挥提供结构支持的作用,因此可能不包含内腔。
图21举例说明了光学壳体2100配置成支持可以发射具有不同波长之光的多光源2101和2102的实施方案。具有不同波长的源允许在单个导管或设备内的不同功能。在一些实施方案中,可以选择光源21011来发射用于荧光成像的UV光,而可以选择光源2102来发射白光以允许使用者看到并引导解剖学标志(anatomical landmark)。捆绑在一起,使用者可以使用同一导管用于引导至消融部位以消融组织和之后使经消融组织可视化二者。在一些实施方案中,可以使用相同波长的多个源。在一些实施方案中,光学壳体2100可配置成支持两个、三个、四个或更多个光源。
应当注意,虽然举例说明了光学壳体1803并且描述为支持光源和照相机,但是在一些实施方案中,壳体可以配置成支持与外部照相机和外部光源相连通的一个或更多个光纤束。
本文公开的方法、***和装置可用于多种治疗过程。可在其中使用本文公开之方法、***和装置的示例性过程包括但不限于,用于心脏中的诊断和治疗过程、用于治疗心律失常(例如室上性心律失常和室性心律失常)、用于治疗心房颤动以及肺静脉标测和消融。
本文公开的方法可以使用二维(2D)至三维(3D)标测方案。多个2D图像可以被叠加到组织或器官(包括心脏)的3D重建图像上。许多心律失常过程包括在过程期间使用患者之特定解剖构造的重建三维图像。使用多种成像模式,包括计算机断层扫描(CT)、磁共振成像(MRI)、超声和电子解剖标测(electroanatomical mapping)使用***(例如NAVX和CARTO)。在所有情况下,三维解剖图像或表面呈现患者的具体解剖构造以帮助靶向待处理的组织区域。在所有情况下,使损伤形成的精确位置和无损伤的精确位置(例如损伤组中的“间隙”或断裂)可视化的能力将指导过程以优化治疗效果。2D图像至3D图像标测允许该***在三维可旋转的交互式虚拟环境中将组织的单个或多个图像(可表明损伤的存在或缺失)与患者的具体解剖构造相叠加、空间记录和/或纹理映射(texturemap)。
在一些实施方案中,本公开内容的***和方法允许将由该***产生的图像记录和/或覆盖到如使用其他成像模式(例如MRI成像、计算机断层扫描(CT)成像、超声成像及其三维重建)所看到的患者之具体解剖构造上。在一些实施方案中,本公开内容的***和方法还可以包括将由该***产生的图像记录和/或覆盖到如使用其他电子解剖标测、解剖重建(anatomical reconstruction)和导航***(navigational system)(例如NAVX和CARTO)看到的患者之具体解剖构造上。记录和覆盖可以在过程期间实时进行。纹理标测NADH图像到重建的心内膜表面允许治疗部位的可视化。例如,损伤的多个NADH快照可以建立整个肺静脉开口或多条肺静脉的完整全景图像。在导管尖端上定位传感器可以提供信息,所述信息将允许NADH图像结合在一起以产生3D重建图像。
虽然结合球囊导管描述了本公开内容的方法和***,但是本公开内容的方法和***还可以使用没有球囊的导管。在荧光成像过程中可以使用置换血液的其他手段。例如,可以向本公开内容的导管提供冲洗端口,通过所述冲洗端口可以将流体递送到导管远尖端以将血液从正被成像的组织置换走。在一些实施方案中,可以通过套管引入该导管,所述套管可以注入能够置换血液并透过光的透明流体。当然,应当理解,在一些实施方案中,用于置换血液的手段可以组合。因此,例如,可以向如上所述的球囊导管提供另外的冲洗端口以有助于通过球囊的血液置换。
以下提供了使用本公开内容的***和方法的实施例。这些实施例仅是代表性的并且不应被用来限制本公开内容的范围。存在本文所公开之方法和装置的多种替代设计。因此,经选择的实施例主要用于说明本文所公开的装置和方法的原理。
实施例
实验过程
使用动物心脏进行了实验以将使用本公开内容NADH记录的成像的有效性与氯化三苯基四氮唑(TTC)染色相比较。如以下将更详细描述的,使用NADH记录的成像与TTC染色表现得一样好。重要的是,其是在活组织中完成的,不需要任何另外的处理时间或者使用染料来实现相同的性能。
动物过程
使用大鼠(200-300g Sprague-Dawley,n=8)和兔(2.5-3.5Kg NewZealand White,n=3)的经剥离无血心脏进行离体实验。对动物进行肝素化并使用标准过程麻醉。然后剥离心脏,主动脉插管并在恒定压力(50mmHg)用氧化的经缓冲Tyrode溶液在室温下Langendorff输注。将心脏放置在接地垫(grounding pad)的顶部并在消融期间浸没在37℃Tyrode溶液中。
使用麻醉的开胸大鼠(200-300g Sprague-Dawley)进行原位实验(n=3)。IP注射Telazol(40mg/kg)后,剃掉胸部和背部的毛发,将动物固定在加热的平台上,并且将消融垫放置在动物的下方。打开胸腔后,随着使暴露的心外膜表面成像,立即进行消融。所有的麻醉和安乐死过程均符合动物使用和管理委员会(institutional Animal Care and Use committee)批准的方案。
消融方案和NADH记录
使用具有4mm尖端的非冷却外套(blazer)导管(EP Technologies,Boston Scientific Corporation)递送射频能量。尖端温度范围为50至70℃。将导管垂直于心外膜表面放置。消融持续时间从15秒到60秒变化,最大功率为50W。使用100瓦特汞灯(Zeiss HBO100W/2)用UV光(350/25nm)照射心外膜表面。为了记录NADH的心外膜荧光,过滤发射光(460/25nm)并使用CCD照相机(Andor Ixon DV860)成像,所述CCD照相机具有相应于NADH荧光之波长的高量子效率(在460nm处80%QE)。
光学标测实验
用电位染料RH237(Molecular Probes,10μM溶液)染色心脏并将Blebbistatin添加到输注液(10μM终浓度)以减少运动伪影(motionartifact)。由两个装有双端口适配器(Andor CSU Adapter Dual Cam)和二色镜(610nm)的CCD照相机(Andor IXON DV860)构成的双重光学标测***被用于使来自同一视野的RH237(250-500fps)和NADH(2fps)之心外膜荧光成像。为记录光学动作电位,使用两个发光二极管(LumiLED,530/35nm)照射心外膜。将所得RH237的荧光在680nm下长通过滤。用如上所述的其他CCD照相机记录NADH荧光。
处理RH237的荧光以从各个图像和信号中减去背景荧光,从而归一化每个像素。使用中值时间滤光器(median temporal filter)来平滑RH237荧光信号(3个样品宽度)。产生激活时间的等时线图以示出波阵面(wavefront)传播。计算在每个像素处光学动作电位的平均振幅来揭示电活跃组织之量的空间变化。
TTC染色
氯化三苯基四氮唑(TTC)活体染色是用于评估急性坏死的标准过程。完成成像过程后,立即通过冠状动脉用含1.0%TTC的Tyrode溶液逆行输注该组织。然后将心脏浸没到TTC溶液中再维持8分钟。代谢活跃的组织呈深红色。坏死组织呈白色。
实验结果
图4A、图4B、图4C、图4D和图4E举例说明了在经剥离的无血大鼠心脏中的RF消融损伤。第一组实验是在来自任一性别之健康大鼠的经剥离心脏中进行的。心脏用Tyrode溶液逆行输注。8个心脏的心外膜被消融并成像。在4个心脏上放置彼此相邻的2处消融损伤。图4A举例说明了RF消融探针处于将损伤递送到心外膜表面上之位置的实例,并且图4B举例说明了在标准的RFA消融方案之后的典型损伤的视觉外观。如在图4B中举例说明的,消融引起心外膜表面之视觉外观立即变为不同(distinct)的苍白组织区域。所述苍白对应于肌红蛋白在60℃以上的温度下变性。然后将心脏置于恒压输注***上并使用单一或双重CCD照相机***成像。图4C举例说明了两种不同的RF消融损伤的外观,如通过fNADH成像所揭示的,其中部分缺血组织呈现白色斑点。如在图4C中举例说明的,fNADH图像揭示,当与周围未经消融的心肌相比时消融的区域呈现显著的暗色。
成像后,将心脏用活体染料TTC染色,其在图4D中举例说明,并且透壁切片以检查消融损伤,其在图4E中举例说明。如在图4D中举例说明的,TTC染色后,代谢活跃的组织呈现红色,不可逆损害的组织呈现白色。图4E举例说明了贯穿心脏的横截切片以显示使用两种不同能量设置的位于相反心外膜表面上之两处损伤的深度。
RF消融损伤的空间范围和时间稳定性
图5A和图5B举例说明了随时间的损伤稳定性。具体地,顶列示出RF消融后在不同时间点(2-120分钟)的fNADH快照。左上角图像上的白色方框表示在三个较下方快照中使用的特写区域,其举例说明了损伤边界在3个中间时间点(5、10和30分钟)中的特写。
如在图5A和图5B中所示,经消融组织中的fNADH水平没有回到其消融前的值并且损伤的尺寸在实验的进程(大约2小时)中没有显著地变化。如通过图5A中的三个较下方特写快照和图5B举例说明的,fNADH图像中对应于损伤的区域随时间变成均匀暗色。
如在图6A、图6B和图6C中举例说明的,从fNADH图像中测量的损伤的尺寸与TTC染色阴性之区域的尺寸相等。具体地,图6A和6B举例说明了如在fNADH敏感性通道上和TTC染色后看到的RF损伤的尺寸。在图6A中,兔心脏表面上的三处损伤的快照分别举例说明了原始NADH图像、经反转的NADH图像(即原始fNADH图像的LUT度标(scale)被反转以将损伤显示成白色)、原始TTC图像以及黑色和白色TTC图像(即灰度标)。图6B的三幅图分别对应于通过在图6A的快照中鉴别的各处损伤a、b和c的强度谱。如通过图6C的柱状图举例说明的,当使用fNADH和TTC染色检查时,损伤的宽度没有显著差异。
TTC染色是测定组织活力的常用方法。它依赖于脱氢酶和NADH与四唑盐反应形成甲(formazan)色素的能力。由于两种方法都依赖于活性NADH的存在,所以这两种方法的损伤尺寸的测量是相似的。因此,如在图6B中的图举例说明的,NADH荧光的实时(live)成像提供了具有高于95%准确度的TTC阳性组织区域的评估。从临床角度看,如在fNADH图像中看到的RF消融损伤的稳定性表明,由于损伤外观保持稳定数小时,所以可以在已经进行多次RF消融后获得基于UV的NADH成像。
鉴别RF消融损伤之间的功能间隙
图7A、图7B和图7C举例说明了通过两处RF损伤之间的狭窄峡部传播的心外膜电活动和fNADH的双重成像。如以上讨论的,如果不完整的损伤充当折返的解剖路径,那么它们甚至可以更加危险,并且损伤之间小至1mm的峡部可以导致复发性传导。为研究通过损伤之间峡部的传播,分析了两处紧密位置的RF损伤之间活动的波阵面。将双极起搏电极(pacing electrode)置于损伤之上的心外膜上,并且以两倍舒张期阈值(2.5mA)施加电流。当存在功能峡部时,有节奏的波(paced wave)引起损伤周围的自发折返环路(reentrant circuit)。在图7C的顺次快照中举例说明了该活动的实例。图7A中的三个快照分别举例说明了具有两处损伤之组织的fNADH图像:使用电压敏感性染料RH237记录的折返环路之一的电活动之等时线图,以及等时线图在FNADH图像上的重叠。图7B举例说明了通过对来自单个的帧中所有像素的光学动作电位进行平均来重建伪ECG迹线,其对应于图7C中示出的顺序。图7C举例说明经处理的RH237顺序的顺次快照,其举例说明了损伤周围有节奏之搏动和折返的传播。
为了建立等时线图并揭示传播波阵面(如在图7A、图7B和图7C中举例说明的),使光学动作电位归一化以全或无的形式示出传播波阵面。这可用于举例说明传播,但它可能引起误解,这是因为它掩盖了真正的光学动作电位振幅。为了更好地表示真正的光学动作电位振幅,在每个像素的RH237信号被调整为对于所有像素的最大光学动作电位振幅的百分比。
图8A、图8B、图8C和图8D举例说明了跨越两处RF损伤之间峡部的fNADH和电活动。具体地,图8A举例说明了相邻RH237图像中沿着黑线的5个连续动作电位之振幅的x-t表示。在图8A中,x轴是两处损伤之间的距离,y轴表示时间,在右侧通过星号表示动作电位。图8B举例说明了用动作电位振幅的谱叠加到损伤之间fNADH的强度谱上的图。两个谱的相关系数r=0.95,P<0.05。在图8C中,光学动作电位振幅的损伤之间谱被举例说明为6个连续搏动的x-t曲线图,x轴为两处损伤中心之间的距离。在图8D中,通过赋予间隙明亮外观的fNADH来鉴别间隙,而通过赋予组织暗色外观的荧光缺乏来鉴别经消融的损伤。然后将动作电位振幅的损伤之间谱与fNADH强度的损伤之间谱进行比较。这两者高度相关(f=0.95)。这些发现表明,fNADH损失可作为靠近消融部位之组织的功能状态降低的直接标志物。
缺乏fNADH表明肌肉损害并且未损害主要的冠状动脉血管
含有NADH的大量线粒体使心脏心肌细胞特别适合于fNADH成像。在RF消融损伤的部位减少的fNADH表明心肌细胞膜完整性的丧失,这是因为细胞和线粒体膜通过热压力被迅速地损害。值得注意的是,消融部位内的心肌细胞坏死并不一定意味着所有下面结构(如冠状血管)的完整性被破坏。在实验中,没有观察到主要冠状动脉血管结构的瓦解。这是因为,如果血管被瓦解,那么受损血管的下游组织将变得缺血,引起fNADH增加。但是,如在图6A中举例说明的,靠近损伤的fNADH水平在消融之前和之后没有显著的改变。RF消融事件之前出现在消融部位附近偶尔看到的更白组织的斑块,这可能是由短暂引起局部缺血之瞬时低输注所致。完整冠状动脉结构的另外的证据是消融后TTC染色的均匀性:任何主要血管损害将已表示为RF消融损伤之外部的未染色组织区域。然而,实验期间制造的并用TTC鉴别的所有13处RF消融损伤都严格地位于RF损伤部位。最后,如在图4B中举例说明的,在心外膜表面上观察到完整血管说明在消融部位没有对主要血管的严重损害。
传导相对于直接电阻性加热
图9A、图9B、图9C和图9D举例说明了RH237滞留在消融区域内。具体地,图9A-9C举例说明用RH237大量(bolus)染色的大鼠心脏的三个顺次快照。如在图9A-9C中举例说明的,RH237荧光随时间降低,突出了损伤作为保留染料的区域。图9D举例说明了从在图9A中鉴别的4个目的区域(region of interest,ROI)获得的RH237染色的强度。随时间趋向于下行的实心点对应于未经消融区域中的ROI,随时间保持稳定的空心点对应于损伤区域中的ROI。
如在图10A、图10B、图10C和图108D中举例说明的,在光学标测期间,消融损伤内的RH237的清除率(washout rate)比在正常组织中的低,这导致在原始RH237图像中损伤和正常组织之间的高度对比。图10A、图10B、图10C和图108D举例说明RF消融手术后RH237的滞留与NADH荧光的比较,以及心外膜的视觉外观。图10A是通过RF导管形成损伤的图示。图10B和10C举例说明了在fNADH图像(左手边图像)和对应的RH237图像(右手边图像)中示出损伤的两个不同的大鼠心脏。这些图像之下的比例尺相当于5mm。图10D举例说明了具有三处RF消融的兔心脏,其出现在fNADH、RH237图像和TTC染色图像内,这些图像之下的比例尺相当于5mm。应当注意的是,白色TTC通道内的棕色边缘与RH237滞留区域一致。重要的是,如通过比较图10B和图10C中的fNADH和RH237图像可看出的,RH237的亮区域(对应于损伤)的直径显著小于由fNADH指示的损伤区域。RH237图像中的损伤尺寸对应于经常在fNADH和TTC图像二者上看到的内部环样结构,例如在图6A中举例说明的那些。
亮RH237区域的最合理的解释是对心外膜毛细血管的急性损害,其发生在RF电极直接下方的直接电阻性加热的部位。然后这减少了RH237染料的清除,如在图10B和图10C中可以看出的。RF电流通过与消融电极直接接触之组织的狭窄边缘的电阻性加热来加热组织。更深的组织加热是从该小的环形体积被动热传导的结果。对于不可逆的心肌损伤需要50℃以上的温度;在100℃以上的温度下,在电极组织接触处发生沸腾,形成凝结物(coagulum)(即,图6A中的棕色环)。使损伤成像的两种方式(fNADH和RH237)之间的直接比较可以允许将直接电阻性加热与转移到更深组织层的传导性加热区分开。
经血液输注的大鼠心脏中的RF损伤
图11A、图11b、图11C和图11举例说明了在经血液输注的开胸动物中RF消融损伤的可视化。具体地,图11A是具有心外膜RF消融损伤之大鼠心脏的开腔明场图像,图11b举例说明了如使用fNADH观察的同一心脏。如在图11C中举例说明的,将以上的经消融心脏浸没在外部添加的血液中完全地掩盖了fNADH信号。血液在可见光带内是光密介质,其干扰组织性质的光谱评估。因此,关键的问题是要示出在经血液输注之动物中基于fNADH成像的可行性。这通过在打开动物的胸腔后立即将损伤引入到心外膜上并以与剥离之心脏实验相同的方式获得fNADH图像来完成。如在图11b中举例说明的,在这些图像中主要的血管呈现暗色印迹,但清楚地显示了RF消融损伤,这表明富含线粒体的心肌提供足以显示周围未经消融组织的fNADH。如在图11C中举例说明的,当同一心脏的心外膜表面被浸没在血液中时整个视域变成暗色。如在图11D中举例说明的,当使用一层透明的聚偏二氯乙烯(polyvinylidene chloride)将血液从心外膜表面置换时,fNADH图像内显示了RF消融损伤。
图12举例说明了在心脏直视手术时从犬的左心房组织获得的消融损伤。该组织位于心房颤动肺静脉隔离手术的区域附近。左心房被手术打开并且从视野中移除血液。同时动物以旁路(bypass)允许心房组织的正常输注。
图13是冷冻消融后大鼠心脏之心外膜表面上消融损伤的图像。该图像是从无血液的经剥离大鼠心脏获得的。使用在金属尖端导管的尖端上的液氮完成冷冻消融。
图14举例说明肝脏经输注大鼠组织,其已经使用射频消融急剧地消融。这样做是为了举例说明消融损伤在其他器官表面看起来如何。
图15是标准导管右边的2D图像并且重建为3D整合到3D标测***中。可使用计算机***和程序将所获得的NDAH荧光2D图像转化为叠加在如所显示的心房解剖构造上的3D图像。
在一些实施方案中,提供了用于在肺静脉和左心房交界处获得经消融心内膜心脏肌肉组织和未经消融之间隙的实时图像的方法,其包括:用透明流体使可膨胀的顺应性球囊膨胀以置换周围血液,从而允许NADH荧光可视化;用紫外光照射以使用UV能纤维激活肺静脉和左心房组织的线粒体NADH;使用光学成像束检测来自经照射肺静脉和左心房组织的NADH荧光;通过用460nm带通滤光器过滤所检测的NADH荧光,以用荧光照相机建立荧光图像;其中所检测的荧光图像示出以下的生理学:由于缺乏荧光而具有暗色外观的经消融的损伤,由于正常荧光而具有明亮外观的间隙,以及经消融损伤周围具有较亮光晕型外观的任意的缺血或受损组织。
在一些实施方案中,提供了用于在肺静脉和左心房交界处获得经消融心内膜心脏肌肉组织和未经消融之间隙的实时图像的方法,其包括:用透明流体使可膨胀的顺应性球囊膨胀以置换周围血液,从而允许NADH荧光可视化;用紫外光照射以使用UV能纤维激活肺静脉和左心房组织的线粒体NADH;使用CMOS照相机检测来自经照射肺静脉和左心房组织的NADH荧光;通过用460nm带通滤光器过滤所检测的NADH荧光,以用荧光照相机建立荧光成像;其中所检测的荧光图像示出以下的生理学:由于缺乏荧光而具有暗色外观的经消融的损伤,由于正常荧光而具有明亮外观的间隙,以及经消融损伤周围具有较亮光晕型外观的任意的缺血或受损组织。
在一些实施方案中,提供了在肺静脉区域中产生经消融损伤之可视化并提供关于生理学之另外信息的方法,该方法包括以下步骤:使用紫外光源照射包括经消融组织和该经消融组织周围之未经消融组织的组织;使经照射的组织成像;以及产生经成像的经照射组织的显像,其中该显像举例说明与经消融组织周围的未经消融区域相比,经消融组织为具有更少荧光。在一些实施方案中,该显像可以举例说明被较低荧光或缺乏荧光之区域包围的高荧光之区域。在一些实施方案中,举例说明的被较低荧光之区域包围的高荧光之区域表明高荧光之区域是未消融的。在一些实施方案中,荧光是由经照射组织中NADH引起的。在一些实施方案中,进行照射、成像和产生,同时使用射频、冷冻消融或激光导管来消融该组织。在一些实施方案中,使用与腔导管之尖端连接的光纤波导来进行照射和成像,损伤光纤波导将来自紫外光源的紫外光递送到经照射组织。在一些实施方案中,该组织是心脏组织。在一些实施方案中,进行经照射组织的成像而不向经照射组织添加化学品。
在一些实施方案中,提供了治疗心房颤动(AF)的方法,该方法包括以下步骤:消融一部分心房组织;使用紫外光源照射组织;使用荧光照相机和滤光器使经照射组织成像,以允许荧光的可视化;产生经成像的经照射组织的显像;基于经成像的经照射组织的显像鉴别经消融组织之间的间隙;其中通过给予该组织暗色外观的荧光缺乏来鉴别经消融组织,并且其中通过给予它们明亮外观的荧光来鉴别构成未经消融组织的间隙,以及消融经鉴别的经消融组织之间的未经消融组织间隙。在一些实施方案中,该显像举例说明了经消融组织具有比间隙更少的荧光。
在一些实施方案中,用于使组织成像的***包含:导管,其具有远端和近端;可膨胀球囊,其安置在该导管的远端附近;以及光学壳体,其从该导管的远端延伸到球囊中,该光学壳体配置成使用于照射球囊外部之组织的光源和用于使经照射组织成像的照相机位于球囊内部。
在一些实施方案中,用于使组织成像的***包含:导管,其具有远端和近端;可膨胀球囊,其安置在该导管的远端附近;以及光学壳体,其从该导管的远端延伸到球囊中;球囊内部的光源,该光源被光学壳体支持并且配置成激发组织中的烟酰胺腺嘌呤二核苷酸的天然还原形式,或者说烟酰胺腺嘌呤二核苷酸氢(NADH);以及球囊内部的照相机,该照相机被光学壳体支持并且配置成使被光源照射的组织成像。
在一些实施方案中,用于使组织成像的***包含:导管,其具有远端和近端;冲洗端口,其用于在该导管的远端附近用流体置换血液;以及光学壳体,其从该导管的远端延伸,该光学壳体被配置成支持用于照射组织的发光二极管光源和可视化装置,所述可视化装置包含将光学图像转化为电子信号以使所述被照射组织成像的多个图像传感器。
在一些实施方案中,用于使组织成像的***包含:套管,其用于输注能够置换血液并透过光的流体;安置在套管内的导管,该导管具有远端和近端;光学壳体,其从该导管的远端延伸,该光学壳体被配置成支持用于照射组织的发光二极管光源和可视化装置,所述可视化装置包含将光学图像转化为电子信号以使所述被照射组织成像的多个图像传感器。
在一些实施方案中,用于使组织成像的方法包括:将导管推进到组织,所述导管包含安置在导管之远端附近的可膨胀球囊和光学壳体,所述光学壳体从该导管之远端延伸到所述球囊中以使光源和照相机位于球囊内;消融组织;用光源照射包含被消融处理之组织和周围组织的组织区域以激发该组织区域中的NADH;用成像装置使该组织区域成像以检测所述组织区域的NADH荧光;以及产生经成像、经照射组织的显像,所述显像举例说明了经消融的组织与未经消融的组织相比具有更少的荧光。
已提出的上述公开内容仅仅是为了举例说明本公开内容的多种非限制性实施方案并且不旨在进行限制。因为本领域技术人员可以进行包含在本公开内容的精神和实质内的所公开实施方案的修改,所有本文公开的实施方案应当被解释为包括在所附权利要求及其等同物的范围之内的所有内容。
Claims (33)
1.用于使组织成像的***,其包含:
导管,其具有远端和近端;
可膨胀球囊,其安置在所述导管的所述远端附近;以及
光学壳体,其从所述导管的所述远端延伸到所述球囊中;所述光学壳体配置成使用于照射所述球囊外部之组织的光源和用于使经照射组织成像的照相机位于所述球囊内部。
2.根据权利要求1所述的***,其还包含具有能量源的消融部件,所述能量源选自射频能量、微波能量、电能、电磁能、冷冻能量、激光能量、超声能量、声能、化学能和热能。
3.根据权利要求1所述的***,其中所述光源是UV发光二极管(LED)。
4.根据权利要求1所述的***,其中所述照相机包含将光学图像转化为电子信号的图像传感器。
5.根据权利要求1所述的***,其中所述***是机器人控制的。
6.根据权利要求1所述的***,其中调整所述光学壳体的尺寸以在所述光学壳体的外表面和所述导管的内壁之间形成间隙。
7.根据权利要求6所述的***,其中所述间隙与所述导管和所述球囊流体连通以操作所述球囊。
8.根据权利要求1所述的***,其中所述光学壳体相对于所述球囊旋转。
9.根据权利要求1所述的***,其还包含支持管,所述支持管延伸超过所述导管的远尖端,以向所述球囊提供结构支持。
10.根据权利要求9所述的***,其还包含围绕所述支持管之远端的尖端,所述尖端被配置成充当消融元件。
11.根据权利要求9所述的***,其中所述支持管包含与所述导管之内腔连通的内腔,其用于使消融部件通过所述球囊的远端。
12.根据权利要求1所述的***,其中所述导管被配置成用于血管内接近所述组织。
13.根据权利要求1所述的***,其中所述导管被配置成用于经开放切口引入组织或经皮引入组织。
14.根据权利要求1所述的***,其中所述光源被配置成激发组织中的烟酰胺腺嘌呤二核苷酸的天然还原形式(NADH)。
15.根据权利要求1所述的***,其还包含第一光源和第二光源,所述第二光源与所述第一光源相比能够产生不同波长的光。
16.根据权利要求1所述的***,其还包含与所述照相机连接的显示***,用于基于所检测的NADH荧光产生经照射组织的图像。
17.根据权利要求14所述的***,其中所述照相机和所述显示***处于无线通讯中。
18.根据权利要求1所述的***,其中所述***在用于心律失常、室上性心律失常、室性心律失常、心房颤动、肺静脉标测和消融的诊断和治疗过程期间在心脏中使用。
19.用于使组织成像的***,其包含:
导管,其具有远端和近端;
可膨胀球囊,其安置在所述导管的所述远端附近;以及
光学壳体,其从所述导管的所述远端延伸到所述球囊中;
所述球囊内部的光源,所述光源被所述光学壳体支持并且配置成激发组织中的NADH;以及
所述球囊内部的照相机,所述照相机被所述光学壳体支持并且配置成使被所述光源照射的所述组织成像。
20.根据权利要求19所述的***,其中所述光学壳体配置成使所述照相机和所述光源相对于所述球囊旋转。
21.根据权利要求19所述的***,其中所述照相机配置成检测被所述光源照射之所述组织的NADH荧光。
22.根据权利要求19所述的***,其包含用于提供白光的第二光源。
23.用于使组织成像的***,其包含:
导管,其具有远端和近端;
冲洗端口,其用于在所述导管的所述远端附近用流体置换血液;和
光学壳体,其从所述导管的所述远端延伸,所述光学壳体被配置成支持用于照射组织的发光二极管光源和可视化装置,所述可视化装置包含将光学图像转化为电子信号以使所述被照射组织成像的多个图像传感器。
24.用于使组织成像的***,其包含:
套管,其用于输注能够置换血液并透过光的流体;
安置在所述套管内的导管,所述导管具有远端和近端;
光学壳体,其从所述导管的远端延伸,所述光学壳体被配置成支持用于照射组织的发光二极管光源和可视化装置,所述可视化装置包含将光学图像转化为电子信号以使所述被照射组织成像的多个图像传感器。
25.用于使组织成像的方法,其包括:
将导管推进到组织,所述导管包含安置在所述导管之远端附近的可膨胀球囊和光学壳体,所述光学壳体从所述导管之远端延伸到所述球囊中以使光源和照相机位于所述球囊内部;
消融所述组织;
用所述光源照射包含经消融处理之组织和周围组织的组织区域以激发所述组织区域中的NADH;
用成像装置使所述组织区域成像以检测所述组织区域的NADH荧光;以及
产生经成像、经照射之组织的显像,所述显像表明经消融的组织与未经消融的组织相比具有较少的荧光。
26.根据权利要求25所述的方法,其中所述组织是心脏肌肉组织。
27.根据权利要求25所述的方法,其还包括区分具有暗色外观的经消融组织和具有较亮外观的受损组织。
28.根据权利要求25所述的方法,其还包括消融另外的受损组织,所述另外的受损组织通过基于荧光的量区分经消融组织和受损组织来鉴别。
29.根据权利要求25所述的方法,其还包括区分不再导电的组织和保持导电的组织。
30.根据权利要求25所述的方法,其还包括区分经消融组织、水肿组织和未经消融组织。
31.根据权利要求25所述的方法,其还包括对通过所述***产生的图像进行记录并重叠到如使用成像模式所看到的患者的解剖构造上,所述成像模式例如MRI成像、计算机断层扫描(CT)成像、超声成像及其三维重建。
32.根据权利要求25所述的方法,其还包括对通过所述***产生的图像进行记录并与患者的解剖构造相重叠,所述解剖构造如使用电子解剖标测、解剖重建和导航***所看到的。
33.根据权利要求31所述的方法,其还包括在所述过程期间进行所述记录和重叠。
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Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
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EP2983581B1 (en) * | 2013-04-08 | 2023-11-15 | Sunnybrook Research Institute | Method for imaging biomarkers indicative of cardiac thermal ablation lesions |
US10349824B2 (en) | 2013-04-08 | 2019-07-16 | Apama Medical, Inc. | Tissue mapping and visualization systems |
CA2908517A1 (en) * | 2013-04-08 | 2014-10-16 | Apama Medical, Inc. | Cardiac ablation catheters and methods of use thereof |
US9636032B2 (en) | 2013-05-06 | 2017-05-02 | Boston Scientific Scimed Inc. | Persistent display of nearest beat characteristics during real-time or play-back electrophysiology data visualization |
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CA2913346A1 (en) | 2013-06-05 | 2014-12-11 | Metavention, Inc. | Modulation of targeted nerve fibers |
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EP3068288A4 (en) * | 2013-11-14 | 2017-07-26 | The George Washington University | Systems and methods for determining lesion depth using fluorescence imaging |
WO2015077474A1 (en) * | 2013-11-20 | 2015-05-28 | The George Washington University | Systems and methods for hyperspectral analysis of cardiac tissue |
TWI533834B (zh) * | 2013-12-10 | 2016-05-21 | Ying-Jie Su | Magnetic manipulation of the surgical lighting device and a hand with a lighting function Assisted system |
US20150254419A1 (en) * | 2014-03-06 | 2015-09-10 | Boston Scientific Scimed, Inc. | Medical devices for mapping cardiac tissue and methods for displaying mapping data |
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WO2015164437A1 (en) * | 2014-04-21 | 2015-10-29 | Clph, Llc | Imaging apparatus and systems and methods for using them |
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US9726647B2 (en) | 2015-03-17 | 2017-08-08 | Hemosonics, Llc | Determining mechanical properties via ultrasound-induced resonance |
US20180064342A1 (en) * | 2015-03-18 | 2018-03-08 | Imricor Medical Systems, Inc. | System and method for enhanced magnetic resonance imaging of tissue |
CN104825118B (zh) * | 2015-05-08 | 2017-04-26 | 南京微创医学科技股份有限公司 | 应用于oct内窥扫描成像的球囊导管、使用方法及oct成像*** |
US10542961B2 (en) | 2015-06-15 | 2020-01-28 | The Research Foundation For The State University Of New York | System and method for infrasonic cardiac monitoring |
US10779904B2 (en) | 2015-07-19 | 2020-09-22 | 460Medical, Inc. | Systems and methods for lesion formation and assessment |
JP6833310B2 (ja) * | 2015-07-27 | 2021-02-24 | オリンパス株式会社 | 内視鏡システム |
WO2017053927A1 (en) | 2015-09-26 | 2017-03-30 | Boston Scientific Scimed Inc. | Systems and methods for anatomical shell editing |
US10405766B2 (en) | 2015-09-26 | 2019-09-10 | Boston Scientific Scimed, Inc. | Method of exploring or mapping internal cardiac structures |
US10271757B2 (en) | 2015-09-26 | 2019-04-30 | Boston Scientific Scimed Inc. | Multiple rhythm template monitoring |
EP4302713A3 (en) | 2015-11-16 | 2024-03-13 | Boston Scientific Scimed, Inc. | Energy delivery devices |
EP3797719A1 (en) | 2016-05-02 | 2021-03-31 | Affera, Inc. | Catheter with ablation electrode |
EP3478182A4 (en) * | 2016-05-25 | 2020-02-26 | Carson, Benjamin | METHOD, SYSTEM, SOFTWARE AND DEVICE FOR IMAGING AND MINIATURIZED THREE-DIMENSIONAL ANALYSIS REMOTELY OF HUMAN LESION CLINICAL APPLICATIONS AND RESEARCH THEREOF |
US10524859B2 (en) | 2016-06-07 | 2020-01-07 | Metavention, Inc. | Therapeutic tissue modulation devices and methods |
WO2018044919A1 (en) * | 2016-09-01 | 2018-03-08 | The George Washington University | Enzyme-dependent fluorescence recovery of nadh after photobleaching to assess dehydrogenase activity of living tissues |
WO2018129094A1 (en) | 2017-01-06 | 2018-07-12 | Intuitive Surgical Operations, Inc. | System and method for registration and coordinated manipulation of augmented reality image components |
US20180242821A1 (en) * | 2017-02-28 | 2018-08-30 | Biosense Webster (Israel) Ltd. | Lens in balloon catheter |
EP3710110A1 (en) | 2017-11-16 | 2020-09-23 | Ebamed SA | Heart arrhythmia non-invasive treatment device and method |
US11617492B2 (en) * | 2017-11-27 | 2023-04-04 | Optecks, Llc | Medical three-dimensional (3D) scanning and mapping system |
USD856514S1 (en) * | 2017-12-06 | 2019-08-13 | U.S. Patent Innovations, LLC | Electrosurgical probe ceramic tip |
USD887550S1 (en) * | 2017-12-06 | 2020-06-16 | Us Patent Innovations, Llc | Electrosurgical probe ceramic tip |
US20190230339A1 (en) * | 2018-01-22 | 2019-07-25 | Kuan-Yu Lu | Image sensor capable of enhancing image recognition and application of the same |
WO2019157285A1 (en) * | 2018-02-09 | 2019-08-15 | Presidio Medical, Inc. | Systems and methods for cardiac conduction block |
WO2019232432A1 (en) | 2018-06-01 | 2019-12-05 | Santa Anna Tech Llc | Multi-stage vapor-based ablation treatment methods and vapor generation and delivery systems |
AU2019339486A1 (en) * | 2018-09-14 | 2021-05-20 | Neuralink Corp. | Computer vision techniques |
AU2019338462A1 (en) | 2018-09-14 | 2021-04-29 | Neuralink Corp. | Device implantation using a cartridge |
US10610280B1 (en) | 2019-02-02 | 2020-04-07 | Ayad K. M. Agha | Surgical method and apparatus for destruction and removal of intraperitoneal, visceral, and subcutaneous fat |
DE102019102841A1 (de) | 2019-02-05 | 2020-08-06 | Olympus Winter & Ibe Gmbh | Lösbarer Isoliereinsatz zur Verwendung in einem Resektoskop |
DE102019102839A1 (de) | 2019-02-05 | 2020-08-06 | Olympus Winter & Ibe Gmbh | Spülflüssigkeit für die Resektion |
CN113423354A (zh) * | 2019-02-28 | 2021-09-21 | 奥林巴斯株式会社 | 医疗用*** |
JPWO2020202742A1 (zh) * | 2019-03-29 | 2020-10-08 | ||
CA3140843A1 (en) * | 2019-06-07 | 2020-12-10 | Vivid Medical, Inc. | Deployable balloon illumination for endoscopy |
US11012599B2 (en) * | 2019-06-20 | 2021-05-18 | Ethicon Llc | Hyperspectral imaging in a light deficient environment |
US11758256B2 (en) | 2019-06-20 | 2023-09-12 | Cilag Gmbh International | Fluorescence imaging in a light deficient environment |
JP2022540450A (ja) * | 2019-07-08 | 2022-09-15 | ストライカー コーポレイション | 目標スペクトル照明のためのシステムおよび方法 |
US20210059746A1 (en) * | 2019-08-30 | 2021-03-04 | Biosense Webster (Israel) Ltd. | Ent guidewire |
KR102095794B1 (ko) * | 2019-10-28 | 2020-04-02 | 오리오스메디칼 주식회사 | 혈관을 스캐닝하는 방법 및 장치 |
US11918360B1 (en) | 2020-04-17 | 2024-03-05 | The Brigham And Women's Hospital, Inc. | Systems and methods for examining hollow organs |
US20210353225A1 (en) * | 2020-05-18 | 2021-11-18 | Chemimage Corporation | Systems and methods for detecting oral cancer using molecular chemical imaging |
WO2021243061A1 (en) * | 2020-05-27 | 2021-12-02 | The George Washington University | Lesion visualization using dual wavelength approach |
EP4225180A1 (en) * | 2020-10-08 | 2023-08-16 | Santa Anna Tech LLC | Visualization-enabled ablation catheters, systems, and methods |
USD1014762S1 (en) | 2021-06-16 | 2024-02-13 | Affera, Inc. | Catheter tip with electrode panel(s) |
KR20240084810A (ko) | 2022-12-07 | 2024-06-14 | 주식회사 클레오 | 의료용 미세입자 |
Citations (8)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN1289239A (zh) * | 1998-01-26 | 2001-03-28 | 麻省理工学院 | 荧光成象内窥镜 |
US20050119523A1 (en) * | 2003-09-03 | 2005-06-02 | Guided Delivery Systems, Inc. | Cardiac visualization devices and methods |
CN1764419A (zh) * | 2003-02-20 | 2006-04-26 | 普罗里森姆股份有限公司 | 心脏消融装置 |
US20070083217A1 (en) * | 2002-05-30 | 2007-04-12 | Eversull Christian S | Apparatus and Methods for Placing Leads Using Direct Visualization |
CN101199410A (zh) * | 2006-11-17 | 2008-06-18 | 韦伯斯特生物官能公司 | 带具有单独光路的全方向光学尖端的改进型导管 |
US20090012367A1 (en) * | 2003-12-17 | 2009-01-08 | Boston Scientific Scimed, Inc. | Medical device with oled illumination light source |
WO2011025640A1 (en) * | 2009-08-27 | 2011-03-03 | New Jersey Institute Of Technology | Integrated fiber optic raman spectroscopy and radio frequency ablation |
CN102099671A (zh) * | 2008-05-20 | 2011-06-15 | 大学健康网络 | 用于基于荧光的成像和监测的装置和方法 |
Family Cites Families (355)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3387305A (en) | 1966-02-09 | 1968-06-11 | Rocky Mountain Sports | Knee protector |
US3831467A (en) | 1973-03-16 | 1974-08-27 | R Moore | Knee brace |
US4024873A (en) | 1976-05-24 | 1977-05-24 | Becton, Dickinson And Company | Balloon catheter assembly |
US4619247A (en) | 1983-03-31 | 1986-10-28 | Sumitomo Electric Industries, Ltd. | Catheter |
JPS60182928A (ja) | 1984-03-01 | 1985-09-18 | オリンパス光学工業株式会社 | 固体撮像素子内蔵の内視鏡 |
JPS63318955A (ja) * | 1987-06-22 | 1988-12-27 | Okamoto Kk | 内視鏡用バル−ンの製造方法 |
JPS63262613A (ja) | 1987-04-20 | 1988-10-28 | Olympus Optical Co Ltd | 立体視内視鏡装置 |
JPH0213423A (ja) * | 1988-06-30 | 1990-01-17 | Okamoto Ind Inc | カテーテル用バルーン及びその製造方法 |
ATE133545T1 (de) | 1988-12-21 | 1996-02-15 | Massachusetts Inst Technology | Verfahren für laserinduzierte fluoreszenz von gewebe |
US5421337A (en) | 1989-04-14 | 1995-06-06 | Massachusetts Institute Of Technology | Spectral diagnosis of diseased tissue |
US5584799A (en) | 1989-09-11 | 1996-12-17 | Gray; James C. | Splint/therapeutic device |
US5074306A (en) | 1990-02-22 | 1991-12-24 | The General Hospital Corporation | Measurement of burn depth in skin |
JP3164609B2 (ja) * | 1990-10-31 | 2001-05-08 | オリンパス光学工業株式会社 | 内視鏡装置 |
US6134003A (en) * | 1991-04-29 | 2000-10-17 | Massachusetts Institute Of Technology | Method and apparatus for performing optical measurements using a fiber optic imaging guidewire, catheter or endoscope |
CA2042075C (en) | 1991-05-08 | 2001-01-23 | Branko Palcic | Endoscopic imaging system |
US5540681A (en) | 1992-04-10 | 1996-07-30 | Medtronic Cardiorhythm | Method and system for radiofrequency ablation of tissue |
US5350375A (en) | 1993-03-15 | 1994-09-27 | Yale University | Methods for laser induced fluorescence intensity feedback control during laser angioplasty |
AU7404994A (en) | 1993-07-30 | 1995-02-28 | Regents Of The University Of California, The | Endocardial infusion catheter |
US5749830A (en) * | 1993-12-03 | 1998-05-12 | Olympus Optical Co., Ltd. | Fluorescent endoscope apparatus |
US5590660A (en) | 1994-03-28 | 1997-01-07 | Xillix Technologies Corp. | Apparatus and method for imaging diseased tissue using integrated autofluorescence |
WO1995029737A1 (en) | 1994-05-03 | 1995-11-09 | Board Of Regents, The University Of Texas System | Apparatus and method for noninvasive doppler ultrasound-guided real-time control of tissue damage in thermal therapy |
US20080154257A1 (en) | 2006-12-22 | 2008-06-26 | Shiva Sharareh | Real-time optoacoustic monitoring with electophysiologic catheters |
US5810802A (en) | 1994-08-08 | 1998-09-22 | E.P. Technologies, Inc. | Systems and methods for controlling tissue ablation using multiple temperature sensing elements |
US8025661B2 (en) | 1994-09-09 | 2011-09-27 | Cardiofocus, Inc. | Coaxial catheter instruments for ablation with radiant energy |
US6423055B1 (en) | 1999-07-14 | 2002-07-23 | Cardiofocus, Inc. | Phototherapeutic wave guide apparatus |
US6572609B1 (en) | 1999-07-14 | 2003-06-03 | Cardiofocus, Inc. | Phototherapeutic waveguide apparatus |
US5954665A (en) | 1995-06-07 | 1999-09-21 | Biosense, Inc. | Cardiac ablation catheter using correlation measure |
US5713364A (en) | 1995-08-01 | 1998-02-03 | Medispectra, Inc. | Spectral volume microprobe analysis of materials |
US6309352B1 (en) | 1996-01-31 | 2001-10-30 | Board Of Regents, The University Of Texas System | Real time optoacoustic monitoring of changes in tissue properties |
US5885258A (en) | 1996-02-23 | 1999-03-23 | Memory Medical Systems, Inc. | Medical instrument with slotted memory metal tube |
WO1997037622A1 (en) | 1996-04-08 | 1997-10-16 | The University Of Southern California | Method and apparatus for using laser-induced fluorescence during photoretractive keratectomy |
US5904651A (en) | 1996-10-28 | 1999-05-18 | Ep Technologies, Inc. | Systems and methods for visualizing tissue during diagnostic or therapeutic procedures |
JP3003597B2 (ja) | 1996-11-18 | 2000-01-31 | 日本電気株式会社 | 固体撮像素子 |
US5833688A (en) | 1997-02-24 | 1998-11-10 | Boston Scientific Corporation | Sensing temperature with plurality of catheter sensors |
US6208886B1 (en) | 1997-04-04 | 2001-03-27 | The Research Foundation Of City College Of New York | Non-linear optical tomography of turbid media |
US6124597A (en) | 1997-07-07 | 2000-09-26 | Cedars-Sinai Medical Center | Method and devices for laser induced fluorescence attenuation spectroscopy |
WO1999013934A1 (fr) | 1997-09-12 | 1999-03-25 | Nippon Zeon Co., Ltd. | Catheter a ballonnet |
US6238389B1 (en) * | 1997-09-30 | 2001-05-29 | Boston Scientific Corporation | Deflectable interstitial ablation device |
US6289236B1 (en) | 1997-10-10 | 2001-09-11 | The General Hospital Corporation | Methods and apparatus for distinguishing inflamed and tumorous bladder tissue |
US6937885B1 (en) | 1997-10-30 | 2005-08-30 | Hypermed, Inc. | Multispectral/hyperspectral medical instrument |
US6174291B1 (en) | 1998-03-09 | 2001-01-16 | Spectrascience, Inc. | Optical biopsy system and methods for tissue diagnosis |
US6251107B1 (en) | 1998-06-25 | 2001-06-26 | Cardima, Inc. | Ep catheter |
US6112123A (en) | 1998-07-28 | 2000-08-29 | Endonetics, Inc. | Device and method for ablation of tissue |
US8024027B2 (en) | 1998-09-03 | 2011-09-20 | Hyperspectral Imaging, Inc. | Infrared endoscopic balloon probes |
CA2343401C (en) | 1998-09-11 | 2009-01-27 | Spectrx, Inc. | Multi-modal optical tissue diagnostic system |
US6178346B1 (en) * | 1998-10-23 | 2001-01-23 | David C. Amundson | Infrared endoscopic imaging in a liquid with suspended particles: method and apparatus |
US6701176B1 (en) | 1998-11-04 | 2004-03-02 | Johns Hopkins University School Of Medicine | Magnetic-resonance-guided imaging, electrophysiology, and ablation |
US6210406B1 (en) | 1998-12-03 | 2001-04-03 | Cordis Webster, Inc. | Split tip electrode catheter and signal processing RF ablation system |
US6423057B1 (en) | 1999-01-25 | 2002-07-23 | The Arizona Board Of Regents On Behalf Of The University Of Arizona | Method and apparatus for monitoring and controlling tissue temperature and lesion formation in radio-frequency ablation procedures |
AU5783900A (en) | 1999-07-02 | 2001-01-22 | Hypermed, Inc. | Integrated imaging apparatus |
JP2001017379A (ja) | 1999-07-09 | 2001-01-23 | Fuji Photo Film Co Ltd | 蛍光診断装置 |
US6219566B1 (en) | 1999-07-13 | 2001-04-17 | Photonics Research Ontario | Method of measuring concentration of luminescent materials in turbid media |
US8540704B2 (en) | 1999-07-14 | 2013-09-24 | Cardiofocus, Inc. | Guided cardiac ablation catheters |
US8900219B2 (en) | 1999-07-14 | 2014-12-02 | Cardiofocus, Inc. | System and method for visualizing tissue during ablation procedures |
US9033961B2 (en) | 1999-07-14 | 2015-05-19 | Cardiofocus, Inc. | Cardiac ablation catheters for forming overlapping lesions |
AU775394B2 (en) | 1999-07-19 | 2004-07-29 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Apparatus and method for ablating tissue |
US6343228B1 (en) | 1999-10-19 | 2002-01-29 | The Hong Kong University Of Science And Technology | Method and apparatus for fluorescence imaging of tissue |
US6542767B1 (en) | 1999-11-09 | 2003-04-01 | Biotex, Inc. | Method and system for controlling heat delivery to a target |
US8221402B2 (en) | 2000-01-19 | 2012-07-17 | Medtronic, Inc. | Method for guiding a medical device |
US6663622B1 (en) | 2000-02-11 | 2003-12-16 | Iotek, Inc. | Surgical devices and methods for use in tissue ablation procedures |
GR1004180B (el) | 2000-03-28 | 2003-03-11 | ����������� ����� ��������� (����) | Μεθοδος και συστημα χαρακτηρισμου και χαρτογραφησης αλλοιωσεων των ιστων |
US20020107514A1 (en) | 2000-04-27 | 2002-08-08 | Hooven Michael D. | Transmural ablation device with parallel jaws |
AU2001249874A1 (en) | 2000-04-27 | 2001-11-12 | Medtronic, Inc. | System and method for assessing transmurality of ablation lesions |
JP2003533267A (ja) | 2000-05-12 | 2003-11-11 | カーディマ・インコーポレイテッド | 凝塊を低減できるマルチチャネルrfエネルギーの伝達システム |
US7252664B2 (en) | 2000-05-12 | 2007-08-07 | Cardima, Inc. | System and method for multi-channel RF energy delivery with coagulum reduction |
US6975898B2 (en) | 2000-06-19 | 2005-12-13 | University Of Washington | Medical imaging, diagnosis, and therapy using a scanning single optical fiber system |
IL138683A0 (en) | 2000-09-25 | 2001-10-31 | Vital Medical Ltd | Apparatus and method for monitoring tissue vitality parameters |
US6663561B2 (en) | 2000-10-05 | 2003-12-16 | Pentax Corporation | Video endoscope system |
US6450971B1 (en) * | 2000-10-05 | 2002-09-17 | Scimed Life Systems, Inc. | Temperature measuring balloon |
US7047068B2 (en) | 2000-12-11 | 2006-05-16 | C.R. Bard, Inc. | Microelectrode catheter for mapping and ablation |
JP2002253500A (ja) * | 2001-03-05 | 2002-09-10 | Olympus Optical Co Ltd | 内視鏡用光源装置 |
US6743225B2 (en) | 2001-03-27 | 2004-06-01 | Uab Research Foundation | Electrophysiologic measure of endpoints for ablation lesions created in fibrillating substrates |
US7250048B2 (en) | 2001-04-26 | 2007-07-31 | Medtronic, Inc. | Ablation system and method of use |
US6989010B2 (en) | 2001-04-26 | 2006-01-24 | Medtronic, Inc. | Ablation system and method of use |
US6648883B2 (en) | 2001-04-26 | 2003-11-18 | Medtronic, Inc. | Ablation system and method of use |
US6663627B2 (en) | 2001-04-26 | 2003-12-16 | Medtronic, Inc. | Ablation system and method of use |
US7959626B2 (en) | 2001-04-26 | 2011-06-14 | Medtronic, Inc. | Transmural ablation systems and methods |
US7255695B2 (en) | 2001-04-27 | 2007-08-14 | C.R. Bard, Inc. | Systems and methods for three-dimensional mapping of electrical activity |
WO2002087456A1 (en) | 2001-05-01 | 2002-11-07 | C.R. Bard, Inc. | Method and apparatus for altering conduction properties in the heart and in adjacent vessels |
US7727229B2 (en) | 2001-05-01 | 2010-06-01 | C.R. Bard, Inc. | Method and apparatus for altering conduction properties in the heart and in adjacent vessels |
US20030208252A1 (en) | 2001-05-14 | 2003-11-06 | O' Boyle Gary S. | Mri ablation catheter |
US7992573B2 (en) | 2001-06-19 | 2011-08-09 | The Trustees Of The University Of Pennsylvania | Optically guided system for precise placement of a medical catheter in a patient |
US8078268B2 (en) | 2001-06-28 | 2011-12-13 | Chemimage Corporation | System and method of chemical imaging using pulsed laser excitation and time-gated detection to determine tissue margins during surgery |
US7596404B2 (en) | 2001-06-28 | 2009-09-29 | Chemimage Corporation | Method of chemical imaging to determine tissue margins during surgery |
US6761716B2 (en) | 2001-09-18 | 2004-07-13 | Cardiac Pacemakers, Inc. | System and method for assessing electrode-tissue contact and lesion quality during RF ablation by measurement of conduction time |
WO2003028571A2 (en) | 2001-09-28 | 2003-04-10 | Institut De Cardiologie De Montreal | Method for identification and visualization of atrial tissue |
EP1455648A4 (en) | 2001-11-09 | 2009-03-11 | Olympus Corp | KORONARSINUS ACCESSORY CATHETER WITH FORWARD IMAGE DISPLAY |
US20030120144A1 (en) | 2001-11-16 | 2003-06-26 | Grabek James R. | Intrapericardial temperature measurement device and method |
US20090281541A1 (en) | 2008-05-09 | 2009-11-12 | Estech, Inc. | Conduction block systems and methods |
US7749157B2 (en) | 2001-12-04 | 2010-07-06 | Estech, Inc. (Endoscopic Technologies, Inc.) | Methods and devices for minimally invasive cardiac surgery for atrial fibrillation |
US20040092806A1 (en) | 2001-12-11 | 2004-05-13 | Sagon Stephen W | Microelectrode catheter for mapping and ablation |
US6825928B2 (en) | 2001-12-19 | 2004-11-30 | Wisconsin Alumni Research Foundation | Depth-resolved fluorescence instrument |
US20040215310A1 (en) | 2002-01-17 | 2004-10-28 | Omar Amirana | Stent and delivery method for applying RF energy to a pulmonary vein and the atrial wall around its ostium to eliminate atrial fibrillation while preventing stenosis of the pulmonary vein thereafter |
US7967816B2 (en) | 2002-01-25 | 2011-06-28 | Medtronic, Inc. | Fluid-assisted electrosurgical instrument with shapeable electrode |
US7192427B2 (en) | 2002-02-19 | 2007-03-20 | Afx, Inc. | Apparatus and method for assessing transmurality of a tissue ablation |
US20050075629A1 (en) | 2002-02-19 | 2005-04-07 | Afx, Inc. | Apparatus and method for assessing tissue ablation transmurality |
US7846157B2 (en) | 2002-03-15 | 2010-12-07 | C.R. Bard, Inc. | Method and apparatus for control of ablation energy and electrogram acquisition through multiple common electrodes in an electrophysiology catheter |
US6746401B2 (en) | 2002-05-06 | 2004-06-08 | Scimed Life Systems, Inc. | Tissue ablation visualization |
CA2484875C (en) | 2002-05-06 | 2013-04-23 | Sherwood Services Ag | Method and system for optically detecting blood and controlling a generator during electrosurgery |
WO2003101287A2 (en) | 2002-05-30 | 2003-12-11 | The Board Of Trustees Of The Leland Stanford Junior University | Apparatus and method for coronary sinus access |
AU2003238656A1 (en) | 2002-06-25 | 2004-01-06 | Glucon Inc. | Method and apparatus for performing myocardial revascularization |
AU2003279097A1 (en) | 2002-09-30 | 2004-04-19 | Vanderbilt University | Optical apparatus for guided liver tumor treatment and methods |
US7001383B2 (en) | 2002-10-21 | 2006-02-21 | Biosense, Inc. | Real-time monitoring and mapping of ablation lesion formation in the heart |
US7306593B2 (en) | 2002-10-21 | 2007-12-11 | Biosense, Inc. | Prediction and assessment of ablation of cardiac tissue |
WO2004095359A2 (en) | 2003-04-18 | 2004-11-04 | Medispectra, Inc. | Systems for identifying, displaying, marking, and treating suspect regions of tissue |
US7539530B2 (en) | 2003-08-22 | 2009-05-26 | Infraredx, Inc. | Method and system for spectral examination of vascular walls through blood during cardiac motion |
US20060009755A1 (en) | 2003-09-04 | 2006-01-12 | Sra Jasbir S | Method and system for ablation of atrial fibrillation and other cardiac arrhythmias |
JP4700001B2 (ja) | 2003-09-19 | 2011-06-15 | ザ ジェネラル ホスピタル コーポレイション | 蛍光偏極撮像方法 |
US7395118B2 (en) | 2003-09-25 | 2008-07-01 | Advanced Neuromodulation Systems, Inc. | System and method for implantable stimulation lead employing optical fibers |
US8172747B2 (en) | 2003-09-25 | 2012-05-08 | Hansen Medical, Inc. | Balloon visualization for traversing a tissue wall |
WO2005032342A2 (en) | 2003-09-30 | 2005-04-14 | Vanderbilt University | Methods and apparatus for optical spectroscopic detection of cell and tissue death |
CA2543070A1 (en) | 2003-10-20 | 2005-05-12 | Johns Hopkins University | Catheter and method for ablation of atrial tissue |
EP1680039A1 (en) | 2003-10-30 | 2006-07-19 | Medical Cv, Inc. | Apparatus and method for laser treatment |
US7232437B2 (en) | 2003-10-30 | 2007-06-19 | Medical Cv, Inc. | Assessment of lesion transmurality |
US7587236B2 (en) | 2004-01-08 | 2009-09-08 | Lawrence Livermore National Security, Llc | Optical spectroscopy for the detection of ischemic tissue injury |
US20050215899A1 (en) | 2004-01-15 | 2005-09-29 | Trahey Gregg E | Methods, systems, and computer program products for acoustic radiation force impulse (ARFI) imaging of ablated tissue |
US20050228452A1 (en) | 2004-02-11 | 2005-10-13 | Mourlas Nicholas J | Steerable catheters and methods for using them |
US20050197623A1 (en) | 2004-02-17 | 2005-09-08 | Leeflang Stephen A. | Variable steerable catheters and methods for using them |
JP2007537011A (ja) | 2004-05-14 | 2007-12-20 | メドトロニック・インコーポレーテッド | 質量を減少させることにより心房細動を治療する方法及び装置 |
US7640046B2 (en) | 2004-06-18 | 2009-12-29 | Cardiac Pacemakers, Inc. | Methods and apparatuses for localizing myocardial infarction during catheterization |
US7527625B2 (en) | 2004-08-04 | 2009-05-05 | Olympus Corporation | Transparent electrode for the radiofrequency ablation of tissue |
US20060089637A1 (en) | 2004-10-14 | 2006-04-27 | Werneth Randell L | Ablation catheter |
US20060089636A1 (en) | 2004-10-27 | 2006-04-27 | Christopherson Mark A | Ultrasound visualization for transurethral needle ablation |
US20060229515A1 (en) | 2004-11-17 | 2006-10-12 | The Regents Of The University Of California | Fiber optic evaluation of tissue modification |
JP2008520364A (ja) | 2004-11-17 | 2008-06-19 | バイオセンス・ウェブスター・インコーポレイテッド | 組織焼灼のリアルタイム評価装置 |
US10413188B2 (en) | 2004-11-17 | 2019-09-17 | Lawrence Livermore National Security, Llc | Assessment of tissue or lesion depth using temporally resolved light scattering spectroscopy |
US8548570B2 (en) | 2004-11-29 | 2013-10-01 | Hypermed Imaging, Inc. | Hyperspectral imaging of angiogenesis |
JP4656924B2 (ja) | 2004-12-03 | 2011-03-23 | 株式会社トプコン | 分光眼底画像データ測定装置 |
US7367944B2 (en) | 2004-12-13 | 2008-05-06 | Tel Hashomer Medical Research Infrastructure And Services Ltd. | Method and system for monitoring ablation of tissues |
US8858495B2 (en) | 2004-12-28 | 2014-10-14 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Five degree of freedom ultrasound catheter and catheter control handle |
US7776033B2 (en) | 2005-01-08 | 2010-08-17 | Boston Scientific Scimed, Inc. | Wettable structures including conductive fibers and apparatus including the same |
US7727231B2 (en) | 2005-01-08 | 2010-06-01 | Boston Scientific Scimed, Inc. | Apparatus and methods for forming lesions in tissue and applying stimulation energy to tissue in which lesions are formed |
US7862561B2 (en) | 2005-01-08 | 2011-01-04 | Boston Scientific Scimed, Inc. | Clamp based lesion formation apparatus with variable spacing structures |
US7729750B2 (en) | 2005-01-20 | 2010-06-01 | The Regents Of The University Of California | Method and apparatus for high resolution spatially modulated fluorescence imaging and tomography |
US20080015569A1 (en) | 2005-02-02 | 2008-01-17 | Voyage Medical, Inc. | Methods and apparatus for treatment of atrial fibrillation |
US7930016B1 (en) | 2005-02-02 | 2011-04-19 | Voyage Medical, Inc. | Tissue closure system |
US7860556B2 (en) | 2005-02-02 | 2010-12-28 | Voyage Medical, Inc. | Tissue imaging and extraction systems |
US8078266B2 (en) | 2005-10-25 | 2011-12-13 | Voyage Medical, Inc. | Flow reduction hood systems |
US8137333B2 (en) | 2005-10-25 | 2012-03-20 | Voyage Medical, Inc. | Delivery of biological compounds to ischemic and/or infarcted tissue |
US7918787B2 (en) | 2005-02-02 | 2011-04-05 | Voyage Medical, Inc. | Tissue visualization and manipulation systems |
US10064540B2 (en) | 2005-02-02 | 2018-09-04 | Intuitive Surgical Operations, Inc. | Visualization apparatus for transseptal access |
US8050746B2 (en) | 2005-02-02 | 2011-11-01 | Voyage Medical, Inc. | Tissue visualization device and method variations |
US7860555B2 (en) | 2005-02-02 | 2010-12-28 | Voyage Medical, Inc. | Tissue visualization and manipulation system |
US20080009747A1 (en) | 2005-02-02 | 2008-01-10 | Voyage Medical, Inc. | Transmural subsurface interrogation and ablation |
US20060200121A1 (en) * | 2005-03-03 | 2006-09-07 | Mowery Thomas M | Navigable, multi-positional and variable tissue ablation apparatus and methods |
WO2006107947A2 (en) | 2005-04-04 | 2006-10-12 | Hypermed, Inc. | Hyperspectral imaging in diabetes and peripheral vascular disease |
WO2006122061A1 (en) | 2005-05-06 | 2006-11-16 | Acumen Medical, Inc. | Complexly shaped steerable catheters and methods for making and using them |
DE102005021205B4 (de) | 2005-05-07 | 2007-08-16 | Mfd Diagnostics Gmbh | Verfahren und Anordnung zur lokalen Erfassung der Vitalität von lebenden Zellen in Zellkulturen oder im Gewebe |
US20070038126A1 (en) | 2005-06-23 | 2007-02-15 | Pyle Jason L | System and method for monitoring of end organ oxygenation by measurement of in vivo cellular energy status |
US8556851B2 (en) | 2005-07-05 | 2013-10-15 | Angioslide Ltd. | Balloon catheter |
DE102005032755B4 (de) | 2005-07-13 | 2014-09-04 | Siemens Aktiengesellschaft | System zur Durchführung und Überwachung minimal-invasiver Eingriffe |
EP3028645B1 (en) | 2005-08-01 | 2019-09-18 | St. Jude Medical International Holding S.à r.l. | Medical apparatus system having optical fiber load sensing capability |
US7681579B2 (en) | 2005-08-02 | 2010-03-23 | Biosense Webster, Inc. | Guided procedures for treating atrial fibrillation |
US7877128B2 (en) | 2005-08-02 | 2011-01-25 | Biosense Webster, Inc. | Simulation of invasive procedures |
US8583220B2 (en) | 2005-08-02 | 2013-11-12 | Biosense Webster, Inc. | Standardization of catheter-based treatment for atrial fibrillation |
US7740584B2 (en) | 2005-08-16 | 2010-06-22 | The General Electric Company | Method and system for mapping physiology information onto ultrasound-based anatomic structure |
JP4681981B2 (ja) | 2005-08-18 | 2011-05-11 | Hoya株式会社 | 電子内視鏡装置 |
US7824397B2 (en) | 2005-08-19 | 2010-11-02 | Boston Scientific Scimed, Inc. | Occlusion apparatus |
CN101247766B (zh) | 2005-08-25 | 2011-03-02 | 皇家飞利浦电子股份有限公司 | 用于电生理学恢复支持以继续线和环消融的*** |
WO2007041542A2 (en) | 2005-09-30 | 2007-04-12 | Cornova, Inc. | Systems and methods for analysis and treatment of a body lumen |
US20070270717A1 (en) | 2005-09-30 | 2007-11-22 | Cornova, Inc. | Multi-faceted optical reflector |
US8929973B1 (en) | 2005-10-24 | 2015-01-06 | Lockheed Martin Corporation | Apparatus and method for characterizing optical sources used with human and animal tissues |
US8221310B2 (en) | 2005-10-25 | 2012-07-17 | Voyage Medical, Inc. | Tissue visualization device and method variations |
WO2007070361A2 (en) | 2005-12-06 | 2007-06-21 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Assessment of electrode coupling for tissue ablation |
US8403925B2 (en) | 2006-12-06 | 2013-03-26 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for assessing lesions in tissue |
US9492226B2 (en) | 2005-12-06 | 2016-11-15 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Graphical user interface for real-time RF lesion depth display |
WO2007067941A2 (en) | 2005-12-06 | 2007-06-14 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Assessment of electrode coupling for tissue ablation |
US9254163B2 (en) | 2005-12-06 | 2016-02-09 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Assessment of electrode coupling for tissue ablation |
US8603084B2 (en) | 2005-12-06 | 2013-12-10 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for assessing the formation of a lesion in tissue |
US8406866B2 (en) | 2005-12-06 | 2013-03-26 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for assessing coupling between an electrode and tissue |
US8317783B2 (en) | 2005-12-06 | 2012-11-27 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Assessment of electrode coupling for tissue ablation |
BRPI0621229A2 (pt) | 2006-01-13 | 2011-12-06 | Smm Medical Ab | dispositivo e sistema para tratamento por compressão de uma parte do corpo |
US20070185479A1 (en) | 2006-02-06 | 2007-08-09 | Liming Lau | Methods and devices for performing ablation and assessing efficacy thereof |
US7918850B2 (en) | 2006-02-17 | 2011-04-05 | Biosense Wabster, Inc. | Lesion assessment by pacing |
JP4828633B2 (ja) | 2006-03-17 | 2011-11-30 | ボエッジ メディカル, インコーポレイテッド | 組織可視化および操作システム |
US20070225697A1 (en) | 2006-03-23 | 2007-09-27 | Ketan Shroff | Apparatus and methods for cardiac ablation |
US20080058786A1 (en) * | 2006-04-12 | 2008-03-06 | Searete Llc, A Limited Liability Corporation Of The State Of Delaware | Autofluorescent imaging and target ablation |
US8145295B2 (en) | 2006-04-12 | 2012-03-27 | The Invention Science Fund I, Llc | Methods and systems for untethered autofluorescent imaging, target ablation, and movement of untethered device in a lumen |
US8129105B2 (en) | 2006-04-13 | 2012-03-06 | Ralph Zuckerman | Method and apparatus for the non-invasive measurement of tissue function and metabolism by determination of steady-state fluorescence anisotropy |
US8628520B2 (en) | 2006-05-02 | 2014-01-14 | Biosense Webster, Inc. | Catheter with omni-directional optical lesion evaluation |
WO2007134039A2 (en) | 2006-05-08 | 2007-11-22 | Medeikon Corporation | Interferometric characterization of ablated tissue |
US20100198065A1 (en) | 2009-01-30 | 2010-08-05 | VyntronUS, Inc. | System and method for ultrasonically sensing and ablating tissue |
AU2007249248B2 (en) | 2006-05-12 | 2013-07-11 | Auris Health, Inc. | Device for ablating body tissue |
JP2007313169A (ja) | 2006-05-29 | 2007-12-06 | Olympus Corp | 病変抽出装置および病変抽出方法 |
JP2009538672A (ja) | 2006-05-30 | 2009-11-12 | コーニンクレッカ フィリップス エレクトロニクス エヌ ヴィ | 組織属性の奥行き解像された測定のための装置 |
EP2034890A4 (en) | 2006-06-01 | 2011-02-16 | Gen Hospital Corp | IN VIVO OPTICAL IMAGING METHOD COMPRISING THE ANALYSIS OF DYNAMIC IMAGES |
US9220402B2 (en) | 2006-06-07 | 2015-12-29 | Intuitive Surgical Operations, Inc. | Visualization and treatment via percutaneous methods and devices |
US8567265B2 (en) | 2006-06-09 | 2013-10-29 | Endosense, SA | Triaxial fiber optic force sensing catheter |
US8048063B2 (en) | 2006-06-09 | 2011-11-01 | Endosense Sa | Catheter having tri-axial force sensor |
US7662152B2 (en) | 2006-06-13 | 2010-02-16 | Biosense Webster, Inc. | Catheter with multi port tip for optical lesion evaluation |
WO2008002654A2 (en) | 2006-06-28 | 2008-01-03 | C.R. Bard, Inc. | Methods and apparatus for assessing and improving electrode contact with cardiac tissue |
US20080033241A1 (en) | 2006-08-01 | 2008-02-07 | Ruey-Feng Peh | Left atrial appendage closure |
US20080097476A1 (en) | 2006-09-01 | 2008-04-24 | Voyage Medical, Inc. | Precision control systems for tissue visualization and manipulation assemblies |
EP2063781A4 (en) | 2006-09-01 | 2010-07-28 | Voyage Medical Inc | ELECTROPHYSIOLOGY CARTOGRAPHY AND VISUALIZATION SYSTEM |
US10004388B2 (en) | 2006-09-01 | 2018-06-26 | Intuitive Surgical Operations, Inc. | Coronary sinus cannulation |
CA2662893A1 (en) | 2006-09-06 | 2008-03-13 | University Health Network | Fluorescence quantification and image acquisition in highly turbid media |
US8147484B2 (en) | 2006-10-23 | 2012-04-03 | Biosense Webster, Inc. | Apparatus and method for monitoring early formation of steam pop during ablation |
US10335131B2 (en) | 2006-10-23 | 2019-07-02 | Intuitive Surgical Operations, Inc. | Methods for preventing tissue migration |
DE102006050885B4 (de) | 2006-10-27 | 2016-11-03 | Siemens Healthcare Gmbh | Vorrichtung zur Erzeugung von Gewebeschnittbildern |
US20080183036A1 (en) | 2006-12-18 | 2008-07-31 | Voyage Medical, Inc. | Systems and methods for unobstructed visualization and ablation |
US8131350B2 (en) | 2006-12-21 | 2012-03-06 | Voyage Medical, Inc. | Stabilization of visualization catheters |
US9226648B2 (en) | 2006-12-21 | 2016-01-05 | Intuitive Surgical Operations, Inc. | Off-axis visualization systems |
US7766907B2 (en) | 2006-12-28 | 2010-08-03 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Ablation catheter with sensor array and discrimination circuit to minimize variation in power density |
US7591816B2 (en) | 2006-12-28 | 2009-09-22 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Irrigated ablation catheter having a pressure sensor to detect tissue contact |
US8460285B2 (en) | 2006-12-29 | 2013-06-11 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Ablation catheter electrode having multiple thermal sensors and method of use |
EP2131741A4 (en) | 2007-03-02 | 2010-05-05 | Wisconsin Alumni Res Found | USE OF ENDOGENOUS FLUORESCENCE TO IDENTIFY INVASIVE METASTATIC BREAST TUMER CELLS |
US20080221448A1 (en) | 2007-03-07 | 2008-09-11 | Khuri-Yakub Butrus T | Image-guided delivery of therapeutic tools duing minimally invasive surgeries and interventions |
US20080228079A1 (en) | 2007-03-16 | 2008-09-18 | Donaldson Brenda L | Clinical utilization of contrast agents to define specific areas within the myocardial wall to provide guidance and localization for ablation, cyroablation, or other techniques in patients with post myocardial infarction |
JP2008229024A (ja) | 2007-03-20 | 2008-10-02 | Olympus Corp | 蛍光観察装置 |
WO2008118992A1 (en) | 2007-03-26 | 2008-10-02 | Boston Scientific Scimed, Inc. | High resolution electrophysiology catheter |
JP2010524651A (ja) | 2007-04-27 | 2010-07-22 | ボエッジ メディカル, インコーポレイテッド | 複雑な形状の操縦可能な組織可視化および操作カテーテル |
US8657805B2 (en) | 2007-05-08 | 2014-02-25 | Intuitive Surgical Operations, Inc. | Complex shape steerable tissue visualization and manipulation catheter |
EP3025636B1 (en) | 2007-05-11 | 2017-11-01 | Intuitive Surgical Operations, Inc. | Visual electrode ablation systems |
US10220187B2 (en) | 2010-06-16 | 2019-03-05 | St. Jude Medical, Llc | Ablation catheter having flexible tip with multiple flexible electrode segments |
US20080306337A1 (en) | 2007-06-11 | 2008-12-11 | Board Of Regents, The University Of Texas System | Characterization of a Near-Infrared Laparoscopic Hyperspectral Imaging System for Minimally Invasive Surgery |
US7976537B2 (en) | 2007-06-28 | 2011-07-12 | Biosense Webster, Inc. | Optical pyrometric catheter for tissue temperature monitoring during cardiac ablation |
US8123745B2 (en) | 2007-06-29 | 2012-02-28 | Biosense Webster, Inc. | Ablation catheter with optically transparent, electrically conductive tip |
US20090030276A1 (en) | 2007-07-27 | 2009-01-29 | Voyage Medical, Inc. | Tissue visualization catheter with imaging systems integration |
US8131379B2 (en) | 2007-08-27 | 2012-03-06 | St. Jude Medical Atrial Fibrillation Division, Inc. | Cardiac tissue elasticity sensing |
US8235985B2 (en) | 2007-08-31 | 2012-08-07 | Voyage Medical, Inc. | Visualization and ablation system variations |
US20090062790A1 (en) | 2007-08-31 | 2009-03-05 | Voyage Medical, Inc. | Direct visualization bipolar ablation systems |
DE102007043732A1 (de) | 2007-09-13 | 2009-04-02 | Siemens Ag | Herzmuskelgewebe-Ablationsvorrichtung zur Behandlung von Herzrhythmusstörungen durch Ablation von Herzmuskelgewebe bei einem Patienten sowie zugehöriger Katheter und zugehöriges Verfahren |
DE102007043731A1 (de) | 2007-09-13 | 2009-04-02 | Siemens Ag | Medizinische Bildaufnahmeeinrichtung, insbesondere zur Erstellung von Bildaufnahmen im Rahmen einer Behandlung von Herzrhythmusstörungen, sowie zugehöriges Verfahren |
US20090082660A1 (en) | 2007-09-20 | 2009-03-26 | Norbert Rahn | Clinical workflow for treatment of atrial fibrulation by ablation using 3d visualization of pulmonary vein antrum in 2d fluoroscopic images |
NL2002010C2 (en) | 2007-09-28 | 2009-10-06 | Gen Electric | Imaging and navigation system. |
US8535308B2 (en) | 2007-10-08 | 2013-09-17 | Biosense Webster (Israel), Ltd. | High-sensitivity pressure-sensing probe |
JP5372356B2 (ja) | 2007-10-18 | 2013-12-18 | オリンパスメディカルシステムズ株式会社 | 内視鏡装置及び内視鏡装置の作動方法 |
US8195271B2 (en) | 2007-11-06 | 2012-06-05 | Siemens Aktiengesellschaft | Method and system for performing ablation to treat ventricular tachycardia |
US20090125022A1 (en) | 2007-11-12 | 2009-05-14 | Voyage Medical, Inc. | Tissue visualization and ablation systems |
US8500730B2 (en) | 2007-11-16 | 2013-08-06 | Biosense Webster, Inc. | Catheter with omni-directional optical tip having isolated optical paths |
US8906011B2 (en) | 2007-11-16 | 2014-12-09 | Kardium Inc. | Medical device for use in bodily lumens, for example an atrium |
WO2009065140A1 (en) | 2007-11-16 | 2009-05-22 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Device and method for real-time lesion estimation during ablation |
US20090143640A1 (en) | 2007-11-26 | 2009-06-04 | Voyage Medical, Inc. | Combination imaging and treatment assemblies |
US8849380B2 (en) | 2007-11-26 | 2014-09-30 | Canfield Scientific Inc. | Multi-spectral tissue imaging |
US8353907B2 (en) | 2007-12-21 | 2013-01-15 | Atricure, Inc. | Ablation device with internally cooled electrodes |
US8998892B2 (en) | 2007-12-21 | 2015-04-07 | Atricure, Inc. | Ablation device with cooled electrodes and methods of use |
US9204927B2 (en) | 2009-05-13 | 2015-12-08 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for presenting information representative of lesion formation in tissue during an ablation procedure |
US7996078B2 (en) | 2007-12-31 | 2011-08-09 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Systems and methods of photodynamic-based cardiac ablation via the esophagus |
US8858609B2 (en) | 2008-02-07 | 2014-10-14 | Intuitive Surgical Operations, Inc. | Stent delivery under direct visualization |
US20090306643A1 (en) | 2008-02-25 | 2009-12-10 | Carlo Pappone | Method and apparatus for delivery and detection of transmural cardiac ablation lesions |
US10219742B2 (en) | 2008-04-14 | 2019-03-05 | Novadaq Technologies ULC | Locating and analyzing perforator flaps for plastic and reconstructive surgery |
US8298227B2 (en) | 2008-05-14 | 2012-10-30 | Endosense Sa | Temperature compensated strain sensing catheter |
US10568535B2 (en) | 2008-05-22 | 2020-02-25 | The Trustees Of Dartmouth College | Surgical navigation with stereovision and associated methods |
US8357149B2 (en) | 2008-06-05 | 2013-01-22 | Biosense Webster, Inc. | Filter for simultaneous pacing and ablation |
WO2010011820A2 (en) | 2008-07-23 | 2010-01-28 | St. Jude Medical, Inc. | Ablation and monitoring system including a fiber optic imaging catheter and an optical coherence tomography system |
JP2010029382A (ja) | 2008-07-28 | 2010-02-12 | Olympus Medical Systems Corp | 内視鏡挿入補助具及び内視鏡装置 |
EP2165643B1 (en) | 2008-09-17 | 2012-04-18 | FUJIFILM Corporation | Image obtaining method and image obtaining apparatus |
US8333012B2 (en) | 2008-10-10 | 2012-12-18 | Voyage Medical, Inc. | Method of forming electrode placement and connection systems |
EP2349452B1 (en) | 2008-10-21 | 2016-05-11 | Microcube, LLC | Microwave treatment devices |
US9033885B2 (en) | 2008-10-30 | 2015-05-19 | Vytronus, Inc. | System and method for energy delivery to tissue while monitoring position, lesion depth, and wall motion |
US9192789B2 (en) | 2008-10-30 | 2015-11-24 | Vytronus, Inc. | System and method for anatomical mapping of tissue and planning ablation paths therein |
US8414508B2 (en) | 2008-10-30 | 2013-04-09 | Vytronus, Inc. | System and method for delivery of energy to tissue while compensating for collateral tissue |
US9220924B2 (en) | 2008-10-30 | 2015-12-29 | Vytronus, Inc. | System and method for energy delivery to tissue while monitoring position, lesion depth, and wall motion |
US9468364B2 (en) | 2008-11-14 | 2016-10-18 | Intuitive Surgical Operations, Inc. | Intravascular catheter with hood and image processing systems |
WO2010057211A1 (en) | 2008-11-17 | 2010-05-20 | Vytronus, Inc. | Systems and methods for ablating body tissue |
US20100152728A1 (en) | 2008-12-11 | 2010-06-17 | Park Christopher J | Method and apparatus for determining the efficacy of a lesion |
US20100160768A1 (en) | 2008-12-24 | 2010-06-24 | Marrouche Nassir F | Therapeutic outcome assessment for atrial fibrillation |
US8864757B2 (en) | 2008-12-31 | 2014-10-21 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for measuring force and torque applied to a catheter electrode tip |
US8948851B2 (en) | 2009-01-20 | 2015-02-03 | The Trustees Of Dartmouth College | Method and apparatus for depth-resolved fluorescence, chromophore, and oximetry imaging for lesion identification during surgery |
JP5297826B2 (ja) * | 2009-01-30 | 2013-09-25 | Hoya株式会社 | 内視鏡用処置具 |
US20100204561A1 (en) | 2009-02-11 | 2010-08-12 | Voyage Medical, Inc. | Imaging catheters having irrigation |
GB0903534D0 (en) | 2009-03-03 | 2009-04-08 | Leicester Gordon C | Safety harness |
US8480759B2 (en) | 2009-04-28 | 2013-07-09 | Cadence Biomedical, Inc. | Adjustable prosthesis |
CA2703347C (en) | 2009-05-08 | 2016-10-04 | Endosense Sa | Method and apparatus for controlling lesion size in catheter-based ablation treatment |
CN102421356B (zh) | 2009-05-15 | 2014-09-10 | 皇家飞利浦电子股份有限公司 | 用于确定心脏的性质的装置、方法以及计算机程序 |
EP2440129A4 (en) | 2009-06-08 | 2015-06-03 | Mri Interventions Inc | MRI-CONTROLLED SURGICAL SYSTEMS WITH PRESET SCAN SURFACES |
US8597222B2 (en) | 2009-06-12 | 2013-12-03 | Under Armour, Inc. | Garment with adjustable compression |
PL2612631T3 (pl) | 2009-06-16 | 2015-03-31 | Bock Healthcare Gmbh | Opatrunek podtrzymujący |
US20100331838A1 (en) | 2009-06-25 | 2010-12-30 | Estech, Inc. (Endoscopic Technologies, Inc.) | Transmurality clamp systems and methods |
DE102009034249A1 (de) | 2009-07-22 | 2011-03-24 | Siemens Aktiengesellschaft | Verfahren und Vorrichtung zur Regelung der Ablationsenergie zur Durchführung einer elektrophysiologischen Katheteranwendung |
US9326814B2 (en) | 2009-09-15 | 2016-05-03 | The Arizona Board Of Regents On Behalf Of The University Of Arizona | System and method for predicting lesion size shortly after onset of RF energy delivery |
WO2011035253A1 (en) | 2009-09-18 | 2011-03-24 | Mahon Joseph A | Adjustable prosthetic interfaces and related systems and methods |
EP2482744A4 (en) | 2009-10-02 | 2017-01-04 | Cardiofocus, Inc. | Cardiac ablation system with inflatable member having multiple inflation settings |
WO2011041638A2 (en) | 2009-10-02 | 2011-04-07 | Cardiofocus, Inc. | Cardiac ablation system with automatic safety shut-off feature |
EP2485671B1 (en) | 2009-10-06 | 2019-03-20 | Cardiofocus, Inc. | Cardiac ablation image analysis system |
US20110257563A1 (en) | 2009-10-26 | 2011-10-20 | Vytronus, Inc. | Methods and systems for ablating tissue |
US8568401B2 (en) | 2009-10-27 | 2013-10-29 | Covidien Lp | System for monitoring ablation size |
US8382750B2 (en) | 2009-10-28 | 2013-02-26 | Vivant Medical, Inc. | System and method for monitoring ablation size |
KR101791019B1 (ko) | 2009-12-16 | 2017-10-27 | 매크로프라타, 아이엔씨. | 위장 병변을 치료하기 위한 실질적으로 강성이고 안정적인 관내 수술 스위트 |
CA2784856C (en) | 2009-12-18 | 2019-05-07 | University Health Network | System and method for sub-surface fluorescence imaging |
US8926604B2 (en) | 2009-12-23 | 2015-01-06 | Biosense Webster (Israel) Ltd. | Estimation and mapping of ablation volume |
CA2788018C (en) | 2010-01-25 | 2020-12-29 | University Health Network | Device, system and method for quantifying fluorescence and optical properties |
JP5719159B2 (ja) | 2010-03-15 | 2015-05-13 | ソニー株式会社 | 評価装置 |
WO2011113162A1 (en) | 2010-03-17 | 2011-09-22 | Haishan Zeng | Rapid multi-spectral imaging methods and apparatus and applications for cancer detection and localization |
JP5432793B2 (ja) | 2010-03-29 | 2014-03-05 | オリンパス株式会社 | 蛍光内視鏡装置 |
JP6085553B2 (ja) | 2010-04-13 | 2017-02-22 | センターハート・インコーポレイテッドSentreHEART, Inc. | 心臓にデバイスをアクセスおよび送達するためのデバイスおよび方法 |
US9918787B2 (en) | 2010-05-05 | 2018-03-20 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Monitoring, managing and/or protecting system and method for non-targeted tissue |
US20140171806A1 (en) | 2012-12-17 | 2014-06-19 | Biosense Webster (Israel), Ltd. | Optical lesion assessment |
DE102010032755B4 (de) | 2010-07-29 | 2019-05-23 | Siemens Healthcare Gmbh | Verfahren zur Visualisierung eines Vorhofs des Herzens eines Patienten |
EP2608720B1 (en) | 2010-08-23 | 2019-07-31 | Koninklijke Philips N.V. | Mapping system for medical procedures |
CN103153174B (zh) | 2010-10-14 | 2015-08-19 | 皇家飞利浦电子股份有限公司 | 用于确定对象的性质的性质确定装置 |
US9254090B2 (en) | 2010-10-22 | 2016-02-09 | Intuitive Surgical Operations, Inc. | Tissue contrast imaging systems |
US20120123276A1 (en) | 2010-11-16 | 2012-05-17 | Assaf Govari | Catheter with optical contact sensing |
WO2012066430A1 (en) | 2010-11-18 | 2012-05-24 | Koninklijke Philips Electronics N.V. | Medical device with ultrasound transducers embedded in flexible foil |
US11246653B2 (en) | 2010-12-07 | 2022-02-15 | Boaz Avitall | Catheter systems for cardiac arrhythmia ablation |
US8998893B2 (en) | 2010-12-07 | 2015-04-07 | Boaz Avitall | Catheter systems for cardiac arrhythmia ablation |
JP2012147937A (ja) | 2011-01-19 | 2012-08-09 | Sony Corp | レーザ治療装置、レーザ治療システム及び判別方法 |
JP5485190B2 (ja) | 2011-01-19 | 2014-05-07 | 富士フイルム株式会社 | 内視鏡装置 |
JP5485191B2 (ja) | 2011-01-19 | 2014-05-07 | 富士フイルム株式会社 | 内視鏡装置 |
US9265557B2 (en) | 2011-01-31 | 2016-02-23 | Medtronic Ablation Frontiers Llc | Multi frequency and multi polarity complex impedance measurements to assess ablation lesions |
EP2673038B1 (en) | 2011-02-10 | 2017-07-19 | Corvia Medical, Inc. | Apparatus to create and maintain an intra-atrial pressure relief opening |
US9233241B2 (en) | 2011-02-28 | 2016-01-12 | Ethicon Endo-Surgery, Inc. | Electrical ablation devices and methods |
WO2012131577A2 (en) | 2011-03-29 | 2012-10-04 | Koninklijke Philips Electronics N.V. | Functional-imaging-based ablation monitoring |
US8986292B2 (en) | 2011-04-13 | 2015-03-24 | St. Jude Medical, Inc. | Optical feedback RF ablator and ablator tip |
US9387031B2 (en) | 2011-07-29 | 2016-07-12 | Medtronic Ablation Frontiers Llc | Mesh-overlayed ablation and mapping device |
WO2013022853A1 (en) | 2011-08-05 | 2013-02-14 | Mc10, Inc. | Catheter balloon methods and apparatus employing sensing elements |
US8900228B2 (en) | 2011-09-01 | 2014-12-02 | Biosense Webster (Israel) Ltd. | Catheter adapted for direct tissue contact and pressure sensing |
US9084611B2 (en) | 2011-09-22 | 2015-07-21 | The George Washington University | Systems and methods for visualizing ablated tissue |
US9014789B2 (en) | 2011-09-22 | 2015-04-21 | The George Washington University | Systems and methods for visualizing ablated tissue |
DE102011083522B4 (de) | 2011-09-27 | 2015-06-18 | Friedrich-Alexander-Universität Erlangen-Nürnberg | Verfahren und Vorrichtung zur Visualisierung der Qualität eines Ablationsvorgangs |
US10791950B2 (en) | 2011-09-30 | 2020-10-06 | Biosense Webster (Israel) Ltd. | In-vivo calibration of contact force-sensing catheters using auto zero zones |
JP5830348B2 (ja) | 2011-10-26 | 2015-12-09 | オリンパス株式会社 | 撮像装置 |
MX2014005382A (es) | 2011-11-07 | 2014-07-30 | Koninkl Philips Nv | Aparato de deteccion para determinar el estado de un tejido. |
US10456196B2 (en) | 2011-12-15 | 2019-10-29 | Biosense Webster (Israel) Ltd. | Monitoring and tracking bipolar ablation |
CN104125811B (zh) | 2011-12-28 | 2016-10-26 | 波士顿科学医学有限公司 | 具有超声成像能力的切除探针 |
US9687289B2 (en) | 2012-01-04 | 2017-06-27 | Biosense Webster (Israel) Ltd. | Contact assessment based on phase measurement |
US8876817B2 (en) | 2012-01-10 | 2014-11-04 | Boston Scientific Scimed Inc. | Electrophysiology system and methods |
US20150044098A1 (en) | 2012-01-30 | 2015-02-12 | Scanadu Incorporated | Hyperspectral imaging systems, units, and methods |
JP6038957B2 (ja) | 2012-02-14 | 2016-12-07 | セント・ジュード・メディカル・エイトリアル・フィブリレーション・ディヴィジョン・インコーポレーテッド | 光音響法を用いた心臓組織のアブレーション治療の効果を評価するためのシステム |
WO2013126489A1 (en) | 2012-02-24 | 2013-08-29 | Isolase, Ltd. | Improvements in ablation techniques for the treatment of atrial fibrillation |
US20130281920A1 (en) | 2012-04-20 | 2013-10-24 | Elwha LLC, a limited liability company of the State of Delaware | Endometrial Ablation |
US20130282005A1 (en) | 2012-04-24 | 2013-10-24 | Siemens Corporation | Catheter navigation system |
US20130296840A1 (en) | 2012-05-01 | 2013-11-07 | Medtronic Ablation Frontiers Llc | Systems and methods for detecting tissue contact during ablation |
US8900225B2 (en) | 2012-05-07 | 2014-12-02 | Biosense Webster (Israel) Ltd. | Automatic ablation tracking |
BR112014028131A2 (pt) | 2012-05-11 | 2017-06-27 | Medtronic Ardian Luxembourg | aparelho de cateter, sistema de neuromodulação renal, e, método para realizar neuromodulação renal |
WO2013177061A1 (en) | 2012-05-21 | 2013-11-28 | The Regents Of The University Of Colorado, A Body Corporate | Three-dimensional mapping and therapy of prostate cancer |
WO2014028770A1 (en) | 2012-08-15 | 2014-02-20 | Burdette Everette C | Mri compatible ablation catheter system incorporating directional high-intensity ultrasound for treatment |
US20140073907A1 (en) | 2012-09-12 | 2014-03-13 | Convergent Life Sciences, Inc. | System and method for image guided medical procedures |
US20140058244A1 (en) | 2012-08-21 | 2014-02-27 | Regents Of The University Of Minnesota | Photoacoustic monitoring |
US20140058246A1 (en) | 2012-08-27 | 2014-02-27 | Birinder Robert Boveja | System and methods for real-time cardiac mapping |
US8923959B2 (en) | 2012-08-27 | 2014-12-30 | Birinder Robert Boveja | Methods and system for real-time cardiac mapping |
US10098692B2 (en) | 2012-11-30 | 2018-10-16 | Intuitive Surgical Operations, Inc. | Apparatus and method for delivery and monitoring of ablation therapy |
US20140163360A1 (en) | 2012-12-07 | 2014-06-12 | Boston Scientific Scimed, Inc. | Irrigated catheter |
US20140171936A1 (en) | 2012-12-17 | 2014-06-19 | Biosense Webster (Israel) Ltd. | Irrigated catheter tip with temperature sensor and optic fiber arrays |
US9615878B2 (en) | 2012-12-21 | 2017-04-11 | Volcano Corporation | Device, system, and method for imaging and tissue characterization of ablated tissue |
CA2897530A1 (en) | 2013-01-08 | 2014-07-17 | The Brigham And Women's Hospital, Inc. | Metabolic imaging methods for assessment of oocytes and embryos |
US20140276687A1 (en) | 2013-03-15 | 2014-09-18 | Volcano Corporation | Assessment of varicose vein ablation via imaging or functional measurement analysis |
US20140276771A1 (en) | 2013-03-15 | 2014-09-18 | Volcano Corporation | Systems and methods for controlled tissue ablation |
US10194830B2 (en) | 2013-03-15 | 2019-02-05 | University Of Utah Research Foundation | High temporal resolution monitoring of contact between catheter tip and target tissue during a real-time-MRI-guided ablation |
US10098694B2 (en) | 2013-04-08 | 2018-10-16 | Apama Medical, Inc. | Tissue ablation and monitoring thereof |
CA2908517A1 (en) | 2013-04-08 | 2014-10-16 | Apama Medical, Inc. | Cardiac ablation catheters and methods of use thereof |
US9907471B2 (en) | 2013-10-08 | 2018-03-06 | The Board Of Trustees Of The Leland Stanford Junior University | Visualization of heart wall tissue |
CN203525125U (zh) | 2013-10-30 | 2014-04-09 | 山西医科大学 | 可视化膀胱水囊扩张专用装置 |
EP3068288A4 (en) | 2013-11-14 | 2017-07-26 | The George Washington University | Systems and methods for determining lesion depth using fluorescence imaging |
WO2015073871A2 (en) | 2013-11-14 | 2015-05-21 | The George Washington University | Systems and methods for determining lesion depth using fluorescence imaging |
WO2015077474A1 (en) | 2013-11-20 | 2015-05-28 | The George Washington University | Systems and methods for hyperspectral analysis of cardiac tissue |
US10278775B2 (en) | 2013-12-31 | 2019-05-07 | Biosense Webster (Israel) Ltd. | Catheter utilizing optical spectroscopy for measuring tissue contact area |
JP6771731B2 (ja) | 2014-11-03 | 2020-10-21 | 460メディカル・インコーポレイテッド460Medical, Inc. | 接触性評価システム及び方法 |
US10722301B2 (en) | 2014-11-03 | 2020-07-28 | The George Washington University | Systems and methods for lesion assessment |
CN107106221A (zh) | 2014-11-25 | 2017-08-29 | 拉克斯凯瑟有限责任公司 | 可视化导管 |
US10779904B2 (en) | 2015-07-19 | 2020-09-22 | 460Medical, Inc. | Systems and methods for lesion formation and assessment |
CN108472475A (zh) | 2015-11-13 | 2018-08-31 | 波士顿科学国际有限公司 | 用于跨室间隔穿越的直接可视化装置、***和方法 |
CN115103647A (zh) | 2020-01-08 | 2022-09-23 | 460医学股份有限公司 | 用于消融损伤的光学询问的***和方法 |
WO2021243061A1 (en) | 2020-05-27 | 2021-12-02 | The George Washington University | Lesion visualization using dual wavelength approach |
WO2022026625A1 (en) | 2020-07-28 | 2022-02-03 | 460Medical, Inc. | Systems and methods for lesion formation and assessment |
-
2012
- 2012-09-22 US US13/624,902 patent/US9084611B2/en active Active
- 2012-09-22 CN CN201280051914.XA patent/CN104066368B/zh active Active
- 2012-09-22 JP JP2014532054A patent/JP5926806B2/ja active Active
- 2012-09-22 KR KR1020147010603A patent/KR20140102643A/ko not_active Application Discontinuation
- 2012-09-22 AU AU2012312066A patent/AU2012312066C1/en active Active
- 2012-09-22 WO PCT/US2012/056771 patent/WO2013044182A1/en active Application Filing
-
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- 2015-04-17 US US14/689,475 patent/US10076238B2/en active Active
-
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- 2016-02-29 JP JP2016037741A patent/JP6694123B2/ja active Active
- 2016-03-03 AU AU2016201418A patent/AU2016201418B2/en active Active
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- 2018-05-23 US US15/986,970 patent/US10716462B2/en active Active
- 2018-06-15 AU AU2018204324A patent/AU2018204324B2/en active Active
-
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- 2019-07-18 JP JP2019132842A patent/JP7185601B2/ja active Active
-
2020
- 2020-05-21 US US16/879,929 patent/US11559192B2/en active Active
- 2020-08-07 AU AU2020213406A patent/AU2020213406B2/en active Active
-
2023
- 2023-01-20 US US18/099,480 patent/US20230293000A1/en active Pending
Patent Citations (8)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN1289239A (zh) * | 1998-01-26 | 2001-03-28 | 麻省理工学院 | 荧光成象内窥镜 |
US20070083217A1 (en) * | 2002-05-30 | 2007-04-12 | Eversull Christian S | Apparatus and Methods for Placing Leads Using Direct Visualization |
CN1764419A (zh) * | 2003-02-20 | 2006-04-26 | 普罗里森姆股份有限公司 | 心脏消融装置 |
US20050119523A1 (en) * | 2003-09-03 | 2005-06-02 | Guided Delivery Systems, Inc. | Cardiac visualization devices and methods |
US20090012367A1 (en) * | 2003-12-17 | 2009-01-08 | Boston Scientific Scimed, Inc. | Medical device with oled illumination light source |
CN101199410A (zh) * | 2006-11-17 | 2008-06-18 | 韦伯斯特生物官能公司 | 带具有单独光路的全方向光学尖端的改进型导管 |
CN102099671A (zh) * | 2008-05-20 | 2011-06-15 | 大学健康网络 | 用于基于荧光的成像和监测的装置和方法 |
WO2011025640A1 (en) * | 2009-08-27 | 2011-03-03 | New Jersey Institute Of Technology | Integrated fiber optic raman spectroscopy and radio frequency ablation |
Cited By (24)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US11684415B2 (en) | 2013-04-08 | 2023-06-27 | Boston Scientific Scimed, Inc. | Tissue ablation and monitoring thereof |
CN107613849A (zh) * | 2014-11-03 | 2018-01-19 | 乔治华盛顿大学 | 用于损伤评估的***和方法 |
CN113208723A (zh) * | 2014-11-03 | 2021-08-06 | 460医学股份有限公司 | 用于接触质量的评估的***和方法 |
CN105877910A (zh) * | 2015-01-16 | 2016-08-24 | 上海交通大学 | 一种对硬化血管或肿瘤进行精确诊断与治疗的一体化*** |
CN104874091A (zh) * | 2015-06-26 | 2015-09-02 | 吴奇 | 一种可视光纤球囊导管 |
CN107920723A (zh) * | 2015-06-26 | 2018-04-17 | 阿帕玛医疗公司 | 组织映射和可视化*** |
CN108135645A (zh) * | 2015-10-20 | 2018-06-08 | 美敦力 | 在冷冻消融过程中的温度和应变测量技术 |
US10799280B2 (en) | 2015-10-22 | 2020-10-13 | Medtronic Cryocath Lp | Post ablation tissue analysis technique |
US11806064B2 (en) | 2015-10-22 | 2023-11-07 | Medtronic Cryocath Lp | Post ablation tissue analysis technique |
CN108135496A (zh) * | 2015-10-22 | 2018-06-08 | 美敦力 | 消融后组织分析技术 |
CN109310333A (zh) * | 2016-06-11 | 2019-02-05 | 波士顿科学医学有限公司 | 使用组织自体荧光监视组织消融的***和方法 |
CN110139688A (zh) * | 2016-08-14 | 2019-08-16 | 迪格玛医疗有限公司 | 用于胃肠道壁中的神经消融的装置和方法 |
CN108694743A (zh) * | 2017-03-31 | 2018-10-23 | 韦伯斯特生物官能(以色列)有限公司 | 将二维图像/照片投影到3d重建诸如心脏的心外膜视图上的方法 |
CN108694743B (zh) * | 2017-03-31 | 2023-10-03 | 韦伯斯特生物官能(以色列)有限公司 | 将二维图像/照片投影到3d重建诸如心脏的心外膜视图上的方法 |
CN111107793A (zh) * | 2017-07-13 | 2020-05-05 | 米特瑞克斯公司 | 进入左心房进行心脏手术的装置和方法 |
WO2019047747A1 (zh) * | 2017-09-11 | 2019-03-14 | 上海微创医疗器械(集团)有限公司 | 冷冻消融球囊及冷冻消融医疗器械 |
CN109480997A (zh) * | 2017-09-11 | 2019-03-19 | 上海微创医疗器械(集团)有限公司 | 冷冻消融球囊及冷冻消融医疗器械 |
CN111278343A (zh) * | 2017-10-25 | 2020-06-12 | 波士顿科学国际有限公司 | 直接可视化导管和*** |
CN112274238A (zh) * | 2019-07-25 | 2021-01-29 | 江苏霆升科技有限公司 | 一种介入治疗***及方法 |
US11253183B2 (en) | 2019-10-16 | 2022-02-22 | Biosense Webster (Israel) Ltd. | Data reuse for filling in missing data points |
US11701050B2 (en) | 2019-10-16 | 2023-07-18 | Biosense Webster (Israel) Ltd. | Data reuse for filling in missing data points |
RU2758749C1 (ru) * | 2019-10-16 | 2021-11-01 | Байосенс Вебстер (Изрэйл) Лтд. | Способ повторного использования данных в системе обработки и отображения электрической активности сердца |
CN115515470A (zh) * | 2020-07-08 | 2022-12-23 | 普罗赛普特生物机器人公司 | 止血方法及装置 |
CN114469277A (zh) * | 2022-01-18 | 2022-05-13 | 蓝线铂立生命科技(苏州)有限公司 | 可视穿刺微波消融*** |
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KR20140102643A (ko) | 2014-08-22 |
JP6694123B2 (ja) | 2020-05-13 |
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