阅读说明：本技术 组织移除导管 (tissue removal catheter ) 是由 A·詹莫斯 J·凯利 C·麦克马伦 M·弗莱明 C·米德 G·卡罗尔 于 2018-05-03 设计创作，主要内容包括：一种用于移除体腔中的组织的组织移除导管(10)包括细长主体(12),该细长主体的尺寸和形状设计成接纳在体腔中。手柄(40)安装在导管(10)的近端部分处并且可操作以使得细长主体(12)的旋转。组织移除元件(20)安装在细长主体(12)的远端部分上。组织移除元件(20)构造成随着该组织移除元件(20)在体腔内由细长主体(12)旋转而移除组织。导丝内腔(24)从导管(10)的远端延伸穿过细长主体(12)至导管(10)上的中间位置,该中间位置与导管(10)的近端部分向远侧间隔开。导丝内腔构造成接纳导丝(26),使得可以在不从体腔中移除导丝(26)的情况下通过沿着导丝(26)牵拉导管(10)来将导管(10)从体腔中移除。(a tissue-removing catheter (10) for removing tissue in a body lumen includes an elongate body (12) sized and shaped to be received in a body lumen. A handle (40) is mounted at a proximal end portion of the catheter (10) and is operable to cause rotation of the elongate body (12). A tissue-removing element (20) is mounted on a distal portion of the elongate body (12). The tissue-removing element (20) is configured to remove tissue as the tissue-removing element (20) is rotated within the body lumen by the elongate body (12). A guidewire lumen (24) extends through the elongate body (12) from the distal end of the catheter (10) to an intermediate location on the catheter (10) that is spaced distally from the proximal portion of the catheter (10). The guidewire lumen is configured to receive a guidewire (26) such that the catheter (10) can be removed from the body lumen by pulling the catheter (10) along the guidewire (26) without removing the guidewire (26) from the body lumen.)

1. A tissue-removing catheter for removing tissue in a body lumen, the tissue-removing catheter comprising:

an elongated body having an axis and proximal and distal portions spaced apart from each other along the axis, the elongated body sized and shaped to be received in the body lumen;

A handle mounted at a proximal end portion of the catheter and operable to rotate the elongated body;

A tissue-removing element mounted on the distal end portion of the elongate body, the tissue-removing element configured to remove the tissue as the elongate tissue rotates the tissue-removing element within the body lumen; and

A guidewire lumen extending through the elongate body from a distal end of the catheter to an intermediate location on the catheter, the intermediate location being spaced distally from the proximal portion of the catheter, the guidewire lumen being configured to receive a guidewire such that the catheter can be removed from the body lumen by pulling the catheter along the guidewire without removing the guidewire from the body lumen.

2. The tissue-removing catheter set forth in claim 1, further comprising an inner liner received within the elongate body, the inner liner defining at least a portion of the guidewire lumen.

3. The tissue-removing catheter set forth in claim 2, further comprising a junction box at the intermediate location of the catheter, the junction box defining a guidewire port for receiving the guidewire.

4. The tissue-removing catheter set forth in claim 3, further comprising a gear assembly disposed in the junction box, the gear assembly cooperating with the elongated body to rotate the elongated body.

5. The tissue-removing catheter set forth in claim 4, further comprising a motor in the handle and a drive extending distally from the motor to the junction box, the drive engaging the gear assembly to rotate the elongate body and the tissue-removing element mounted thereon.

6. the tissue-removing catheter set forth in claim 5, wherein the driver defines a longitudinal axis that is parallel to and spaced apart from a longitudinal axis of the elongate body.

7. the tissue-removing catheter set forth in claim 5, further comprising a drive tube extending from the handle to the junction box, the drive tube defining a fluid port for introducing fluid into the gear assembly.

8. The tissue-removing catheter set forth in claim 5, further comprising an actuator positioned on the handle and configured to selectively actuate the motor to drive rotation of the elongate body and the tissue-removing element.

9. the tissue-removing catheter set forth in claim 3, wherein the gear assembly includes a first gear fixedly attached to the driver and a second gear engaged with the first gear and fixedly attached to the elongate member.

10. The tissue-removing catheter set forth in claim 9, wherein the second gear defines a channel for receiving the inner liner.

11. The tissue-removing catheter set forth in claim 2, wherein the distal end of the inner sleeve extends distally of the tissue-removing element.

12. The tissue-removing catheter set forth in claim 1, wherein the tissue-removing element comprises an abrasive rasp.

13. A tissue-removing catheter for removing tissue in a body lumen, the tissue-removing catheter comprising:

an elongated body having an axis and proximal and distal portions spaced apart from each other along the axis, the elongated body being rotatable and sized and shaped to be received in the body lumen; and

A tissue-removing element mounted on the distal end portion of the elongate body, the tissue-removing element configured to remove the tissue as the elongate tissue rotates the tissue-removing element within the body lumen; and

A guidewire lumen extending through the elongate body from the distal end of the catheter to an intermediate location on the catheter, the intermediate location being distally spaced from the proximal end of the catheter, the guidewire lumen being configured to receive a guidewire such that the catheter can be removed from the body lumen by pulling the catheter along the guidewire without removing the guidewire from the body lumen.

14. The tissue-removing catheter set forth in claim 13, further comprising an inner liner received within the elongate body, the inner liner defining at least a portion of the guidewire lumen.

15. the tissue-removing catheter set forth in claim 14, further comprising a junction box at the intermediate location of the catheter, the junction box defining a guidewire port for receiving the guidewire.

16. The tissue-removing catheter set forth in claim 15, further comprising a gear assembly disposed in the junction box, the gear assembly cooperating with the elongated body to rotate the elongated body.

17. the tissue-removing catheter set forth in claim 16, wherein the gear assembly includes a gear fixedly attached to an elongate member, the gear defining a channel for receiving the inner hub.

18. A method of removing tissue in a body lumen, the method comprising:

Advancing a tissue-removing catheter over a guidewire in the body lumen to position a distal end of the catheter adjacent the tissue and to position a proximal portion of the catheter outside the body lumen, the catheter including an elongate body, a tissue-removing element mounted on a distal portion of the elongate body, and a guidewire lumen within the elongate body in which the guidewire is disposed during advancement of the catheter;

Rotating the elongate body of the catheter and the tissue-removing element using a motor and drive operably connected to the elongate body and the tissue-removing element to remove the tissue; and

Transmitting torque from the motor and the driver to the elongate body and the tissue-removing element using a gear assembly located at an intermediate position along the catheter.

19. the method of claim 18, further comprising extending the guidewire along only a portion of the catheter such that the guidewire exits the catheter at the intermediate location.

20. The method of claim 18, further comprising removing the catheter from the body lumen by pulling the catheter along the guidewire without removing the guidewire from the body lumen.

Referring to the drawings, and in particular to FIG. 1, a rotary tissue removal catheter for removing tissue in a body lumen is generally indicated by reference numeral 10. The illustrated catheter 10 is an atherectomy device adapted to remove (e.g., abrade, cut, resect, ablate, etc.) occlusive tissue (e.g., embolic tissue, plaque tissue, atherosclerosis, thrombolysis tissue, stenotic tissue, hyperplastic tissue, neoplastic tissue, etc.) from a vessel wall (e.g., a coronary artery wall, etc.). The catheter 10 may be used to facilitate percutaneous coronary angioplasty (PTCA) or subsequent stent delivery. Features of the disclosed embodiments may also be suitable for treating Chronic Total Occlusion (CTO) of blood vessels, as well as strictures of other body lumens such as ureters, biliary tracts, respiratory tracts, pancreatic ducts, lymphatic vessels, and the like, and strictures of other proliferative and neoplastic diseases in other body lumens. Tumors surrounding and invading body cavities often result in the growth of neoplastic cells. Thus, removing such material may be beneficial for maintaining patency of the body cavity.

The catheter 10 is sized to be received in a blood vessel of a subject. Thus, the maximum dimension of the catheter 10 may be 3, 4, 5, 6, 7, 8, 9, 10, or 12 French (1, 1.3, 1.7, 2, 2.3, 2.7, 3, 3.3, or 4 millimeters) and the working length may be 20, 30, 40, 60, 80, 100, 120, 150, 180, or 210 centimeters, depending on the body lumen. While the remaining discussion is directed to a catheter for removing tissue in a blood vessel, it should be understood that the teachings of the present disclosure are also applicable to other types of tissue removal catheters, including, but not limited to, catheters for penetrating and/or removing tissue from various occlusions, stenoses, or proliferations in various body lumens.

Referring to fig. 1-3, a catheter 10 includes an elongate outer layer 12 (broadly, an elongate body) disposed about an elongate inner liner 14. The outer layer 12 and the inner liner 14 extend along a first longitudinal axis LA1 of the catheter from a terminal box 15 of the catheter to a distal end portion 18. Terminal block 15 is located at an intermediate position along conduit 10. In one embodiment, junction box 15 is disposed about 20 to about 30 centimeters from the distal end of catheter 10. A tissue-removing element 20 is disposed on the distal end of the outer layer 12 and is configured to rotate to remove tissue from a body lumen, as will be described in more detail below. A sleeve 22 (fig. 1 and 2) is disposed about the outer layer 12. The catheter 10 is sized and shaped for insertion into a body lumen of a subject. The sleeve 22 isolates the body cavity from at least a portion of the outer layer 12 and the inner liner 14. Sleeve 22, outer layer 12, and inner liner 14 extend distally from junction box 15. The inner liner 14 at least partially defines a guidewire lumen 24 for slidably receiving a guidewire 26 therein such that the catheter 10 can be advanced through a body lumen by traveling along the guidewire. Terminal box 15 defines a guidewire port 39, which guidewire port 39 may also define a portion of guidewire lumen 24. The guidewire port 39 provides an exit location for the guidewire at an intermediate location on the catheter 10. The guidewire 26 may be a standard 0.014 inch outer diameter guidewire. However, junction box 15 allows for a shorter guidewire to be used with catheter 10 because the guidewire exits catheter 10 at an intermediate location of the catheter, rather than extending along the entire working length of the catheter. In one embodiment, a guidewire of less than about 200 centimeters (79 inches) in length may be used with the catheter 10. In one embodiment, a guidewire having a length of between about 150 centimeters (59 inches) and about 190 centimeters (75 inches) may be used. In certain embodiments, inner liner 14 may have a lubricious inner surface for sliding over guidewire 26 (e.g., the lubricious surface may be provided by a lubricious polymer layer or a lubricious coating). In the illustrated embodiment, the guidewire lumen 24 extends from the terminal box 15 of the catheter 10 through the distal portion 18 such that the guidewire 26 may extend along only a portion of the working length of the catheter 10. In one embodiment, the total working length of the catheter 10 may be between about 135 centimeters (53 inches) to about 142 centimeters (56 inches).

the catheter 10 also includes a handle 40 secured at the proximal portion 16 of the catheter. The handle 40 supports an actuator 42 (e.g., a lever, button, dial, switch, or other device), which actuator 42 is configured for selectively actuating a motor 43 disposed in the handle to drive rotation of a drive member 48 extending from the motor to the terminal box 15. Drive member 48 may have a length of about 100 centimeters to space terminal box 15 from handle 40. The driver 48 may have other lengths without departing from the scope of the present disclosure. In the illustrated embodiment, the driver 48 is a coil shaft. Drive tube 27 encloses drive member 48 and extends from handle 40 to junction box 15 to isolate the body cavity from the rotating drive member. Drive tube 27 and drive member 48 extend from handle 40 to junction box 15 along second longitudinal axis LA2 of catheter 10. The second longitudinal axis LA2 extends parallel to the first longitudinal axis LA1 and is spaced apart from the first longitudinal axis LA 1. As will be explained in more detail below, junction box 15 transmits the torque of driver 48 to outer layer 12 to rotate tissue-removing element 20 mounted at the distal end of the outer layer. An irrigation port 46 may also be provided at the proximal portion 10 of the catheter 16. Irrigation port 46 communicates with the space between guide conduit 128 (fig. 4 and 7) and drive tube 27 to deliver a fluid (e.g., saline) to cool rotating components in junction box 15 and rotating outer layer 12 during use.

It should be understood that in other embodiments, other suitable actuators, including but not limited to touch screen actuators, wireless controlled actuators, automatic actuators guided by a controller, etc., may be suitable for selectively actuating the motors. In some embodiments, the power supply may come from a battery (not shown) housed within the handle 40. In other embodiments, the power supply may be from an external source.

Referring to fig. 1, 3-5, and 8-13, terminal box 15 includes a housing 90 that encloses a gear assembly 92 for operatively connecting drive member 48 to outer layer 12. Gear assembly 92 in junction box 15 is configured to efficiently transfer motor torque from motor 43 of up to about 13 milli-newton-meters (mn.m). During torque transfer, the gears of gear assembly 92 may rotate up to 10,000 revolutions per minute, and even up to 100,000 revolutions per minute. Housing 90 includes a rigid central portion 94 that generally surrounds gear assembly 92, and flexible proximal and distal portions 96 that provide strain relief functions for the housing to relieve tension applied to the proximal and distal ends of junction box 15 when catheter 10 is bent during use. The rigid central portion 94 includes a housing 98 and first and second bearing retainers 100 and 102 mounted on proximal and distal ends of the housing, respectively. The housing 98 may be formed of Polyetheretherketone (PEEK).

The gear assembly 92 includes a pinion gear 104 (broadly, a first gear) that meshes with a coil gear 106 (broadly, a second gear). The pinion gear 104 is attached to the driver 48 such that rotation of the driver causes rotation of the pinion gear, which in turn rotates the coil gear. The coil gear 106 is attached to the outer layer 12 such that rotation of the coil gear causes rotation of the outer layer. Specifically, the pinion gear 104 includes a proximal attachment portion 108, a distal end portion 110, and an intermediate gear portion 112. The proximal attachment portion 108 includes a receiver 114, the receiver 114 receiving a distal end portion of the driver 48. A distal end portion of the driver 48 is secured within the receptacle 114 to attach the driver to the pinion gear 104. In the illustrated embodiment, the intermediate gear portion 112 includes ten (10) teeth 113. The intermediate gear portion 112 may have an outer diameter of about 0.8 millimeters (about 0.03 inches) and the teeth 113 of the intermediate gear portion may have a pitch diameter of about 0.6 millimeters (about 0.02 inches) and a pressure angle of about 20 degrees. Other sizes of the pinion gear 104 are also contemplated. A first pair of jewel bearings 116 are received about proximal and distal portions 108 and 110, respectively, of pinion 104 and facilitate rotation of the pinion within junction box 15.

The coil gear 106 includes a distal attachment portion 118, a proximal portion 120, and an intermediate gear portion 122. The distal attachment portion 118 is attached to the outer layer 12. Specifically, a portion of the distal attachment portion 118 is received in and fixedly attached to the proximal end of the outer layer 12. In the illustrated embodiment, the intermediate gear portion 122 includes seventeen (17) teeth 123. The intermediate gear portion 122 may have an outer diameter of about 1.3 millimeters (about 0.05 inches). The teeth 123 of the intermediate gear portion 122 may have a pitch diameter of about 1.1 millimeters (about 0.04 inches) and a pressure angle of about 20 degrees. Other sizes of the coil gear 106 are also contemplated.

In one embodiment, the gear ratio of gear assembly 92 is between about 1 to 1 and about 2 to 1. In one embodiment, gear assembly 92 has a gear ratio of about 1.7 to 1. The coil gear 106 having a greater number of teeth than the pinion gear 104 means that the gear assembly 92 will reduce the rotational speed of the coil gear 106 and the outer layer 12 compared to the rotational speed of the driver 48 and the pinion gear 104. However, a decrease in rotational speed will result in an increase in force or torque output. Thus, coil gear 106, and thus outer layer 12 and tissue-removing element 20, will rotate with an increased force/torque as compared to driver 48. This will allow the tissue-removing element 20 to better remove occluded tissue in the body lumen to separate the tissue from the body lumen wall.

a second pair of jewel bearings 124 are received around distal and proximal portions 118 and 120, respectively, of coil gear 106 and facilitate rotation of the coil gear in terminal block 15. A channel 126 extends through coil gear 106 and receives a proximal portion of inner liner 14. The first bearing retainer 100 is disposed about the bearings 116, 124 about the proximal end portions 108, 120 of the gears 104, 106, and the second bearing retainer 102 is disposed about the bearings 116, 124 about the distal end portions 110, 118 of the gears. The bearings 116, 124 may be made of bronze. However, other materials are also contemplated. For example, the bearing may also be made of zirconia.

Housing 90 of junction box 15 is sized such that conduit 10 may be received within guide conduit 128, thus providing a gap on the opposite lateral side of the junction box (fig. 7) to allow for the infusion of saline or contrast between guide conduit 128 and conduit 10. Specifically, the central portion 94 of the housing 90 has flat side surfaces that form gaps 129 between the sides of the central portion and the curved inner walls of the guide conduit 128. In one embodiment, the housing 90 is sized such that the catheter 10 can be received in a 7F (about 2 mm) or smaller diameter catheter. In another embodiment, the housing 90 is sized such that the catheter 10 can be received in a catheter of 6F (about 1.8 millimeters) or less diameter.

referring to fig. 6-8, a fluid port 130 may be provided in drive tube 27 for introducing flushing/lubricating fluid into gear assembly 92. In the illustrated embodiment, the port 130 is located in the distal end portion of the drive tube 27 and is disposed in registry with the proximal attachment portion 108 of the pinion gear 104. Fluid introduced at the proximal end of catheter 10 is delivered through guide catheter 128 and may be directed into fluid port 130 and delivered to intermediate gear portion 112 of pinion 104 where rotation of the pinion transfers fluid around the pinion and to intermediate gear portion 122 of coil gear 106. Rotation of the coil gear caused by rotation of the pinion gear 104 moves the fluid around the coil gear 106 and delivers the fluid to the distal attachment portion 118 of the coil gear where it may be introduced into the space between the sleeve 22 and the outer layer 12. Thus, gear assembly 92 in junction box 15 is configured to deliver fluid from the proximal end of the junction box to the distal end of the junction box to cool gear assembly 92 with the fluid. Furthermore, by delivering fluid through junction box 15, fluid introduced at the proximal end of the junction box may be delivered to the distal end of the junction box and pumped into the space between sleeve 22 and outer layer 12. In addition, the asymmetric configuration of bearing retainers 100, 102 facilitates fluid flow from the proximal end to the distal end of terminal block 15.

Referring to fig. 5, 8 and 9, a sleeve 132 may also be disposed about the proximal portion 120 of the coil gear 106. The sleeve 132 is configured to reduce friction on the coil gear 106 caused by the thrust force induced by advancing the catheter 10 through the body lumen. The sleeve 132 may be made of graphite or other low friction material. The sleeve 132 is configured to erode in response to thrust forces experienced at the coil gear 106 during use of the catheter 10. By reducing the friction around coil gear 106, the efficiency of terminal block 15 may be maximized.

referring to fig. 1-4 and 15, the outer cannula 22 includes a tubular sleeve configured to isolate and protect arterial tissue within a body lumen of a subject from the rotating outer layer 12. The inner diameter of the sleeve 22 is sized to provide clearance for the outer layer 12. The space between the sleeve 22 and the outer layer 12 allows the outer layer to rotate within the sleeve and provides an area for saline infusion between the sleeve and the outer layer. In one embodiment, the cannula 22 has an inner diameter of about 0.050 inches (1.27 millimeters) and an outer diameter of 0.055 inches (1.4 millimeters). The sleeve 22 may have other dimensions without departing from the scope of the present disclosure. In one embodiment, the outer sleeve 22 is made of Polytetrafluoroethylene (PTFE). Alternatively, the outer sleeve 22 may comprise a multi-layer configuration. For example, the outer sleeve 22 may include an inner layer of Perfluoroalkoxy (PFA), an intermediate braided wire layer, and an outer layer of Pebax.

referring to fig. 1-4, 14, and 15, outer layer 12 may comprise a tubular stainless steel coil configured to transmit rotation and torque from motor 43 and gear assembly 92 to tissue-removing element 20. Configuring the outer layer 12 into a coiled configuration, thereby provides flexibility to the outer layer that facilitates delivery of the catheter 10 through a body lumen. Further, the coil configuration allows rotation and torque of outer layer 12 to be applied to tissue-removing element 20 as catheter 10 traverses a curved path. The stiffness of the outer layer 12 also affects the ease with which the coil traverses the body lumen and the ability of the coil to effectively transfer torque to the tissue-removing element 20. In one embodiment, the outer layer 12 is relatively rigid such that axial compression and extension of the coil is minimized during movement of the catheter 10 through a body lumen. The coil configuration of outer layer 12 is also configured to expand its inner diameter as the coil rotates so that the outer layer remains spaced from inner liner 14 during operation of catheter 10. In one embodiment, the outer layer 12 has an inner diameter of about 0.023 inches (0.6 millimeters) and an outer diameter of 0.035 inches (0.9 millimeters). The outer layer 12 may have a single layer configuration. For example, the outer layer may comprise a 7-filament (i.e., wire) coil having a lay angle of about 30 degrees. Alternatively, the outer layer 12 may be constructed from multiple layers without departing from the scope of the present disclosure. For example, the outer layer 12 may include a base coil layer and a sheath (e.g., Tecothane) disposed over the base layer^TM). In one embodiment, the outer layer comprises 15-wire coils having a lay angle of about 45 degrees. Tecothane^TMA sheath may be disposed over the coil. Alternatively, the outer layer 12 may include a dual coil layer configurationAn additional sheath layer over the two coil layers is also included. For example, the outer layer may include an inner coil layer comprising a 15-wire coil having a lay angle of about 45 degrees and an outer coil layer comprising a 19-wire coil having a lay angle of about 10 degrees. Outer layers having other configurations are also contemplated.

Referring to fig. 1-4 and 14-16, inner liner 14 includes a multi-layered tubular body configured to isolate guidewire 26 from coil gear 106, outer layer 12, and tissue-removing element 20. Inner liner 14 may extend through junction box 15 to the distal end of catheter 10. In one embodiment, inner liner 14 is fixedly attached to terminal box 15. Inner liner 14 has an inner diameter sized to pass guidewire 26. The inner liner 14 protects the wire from damage caused by rotation of the coil gear and 106 outer layer 12 by isolating the wire from the rotatable coil gear and outer layer. Inner sleeve 14 also extends past tissue-removing element 20 to protect guidewire 26 from the rotating tissue-removing element. Thus, inner liner 14 is configured to prevent any contact between guidewire 26 and components of catheter 10 that rotate about the guidewire. Thus, inner liner 14 eliminates any metal-to-metal fit. This isolation of the coil gear 106, the outer layer 12, and the tissue removal element 20 from the guidewire 26 also ensures that rotation of the outer layer and the tissue removal element is not transferred or transmitted to the guidewire. As a result, a standard guidewire 26 may be used with the catheter 10 because the guidewire does not have to be configured to withstand the twisting action of the rotating components. In addition, by extending through tissue-removing element 20 and past the distal end of the tissue-removing element, inner sleeve 14 stabilizes the tissue-removing element by providing a centering shaft for rotating the tissue-removing element about the inner sleeve.

In the illustrated embodiment, inner liner 14 includes an inner PTFE layer 60, an intermediate braid layer 62 composed of stainless steel, and an outer polyimide layer 64. The PTFE inner layer 60 provides a lubricious interior to the inner liner 14 that facilitates passage of the guidewire 26 therethrough. The braided stainless steel intermediate layer 62 provides rigidity and strength to the inner liner 14 so that the liner can withstand torsional forces exerted by the outer layer 12 on the inner liner. In one embodiment, the intermediate layer 62 is formed from 304 stainless steel. The polyimide outer layer 64 provides wear resistance and has lubricity that reduces friction between the inner liner 14 and the outer layer 12. In addition, a lubricating film such as silicone may be added to inner liner 14 to reduce friction between the inner and outer layers 12. In one embodiment, inner liner 14 has an inner diameter ID of about 0.016 inches (0.4 mm), an outer diameter OD of about 0.019 inches (0.5 mm), and a length between about 7.9 inches (200 mm) and about 15.7 inches (400 mm). The inner diameter ID of inner liner 14 provides clearance for a standard 0.014 inch guidewire 26. The outer diameter OD of inner sleeve 14 provides clearance for coil gear 106, outer layer 12, and tissue-removing element 20. Having a space between inner liner 14 and outer layer 12 reduces friction between the two components and allows saline between the components to be poured.

In the illustrated embodiment, marker bands 66 (FIG. 2) are disposed on the outer surface of the distal end of inner liner 14. Marker band 66 configures the tip of inner liner 14 to be visible under fluoroscopy, which allows the physician to verify the position of the liner during a medical procedure. In this embodiment, the distal end of inner liner 14 may be laser cut to provide a low profile tip. In one embodiment, marker band 66 comprises a platinum iridium strip.

Referring to fig. 1, 2 and 17, tissue-removing element 20 extends along a first longitudinal axis LA1 from a proximal end adjacent the distal portion of outer layer 12 to an opposite distal end. Tissue-removing element 20 is operatively connected to motor 43 for rotation by the motor. When the catheter 10 is inserted into a body cavity and the motor 43 is actuated to rotate the drive member 48, the tissue-removing element is configured to remove occluded tissue in the body cavity to separate the tissue from the body cavity wall, the drive member 48 rotates the gear assembly 92, and the gear assembly 92 then transmits the motor torque to the outer layer 12, thereby rotating the tissue-removing element 20. In one or more embodiments, any suitable tissue-removing element for removing tissue in a body lumen as the body lumen is rotated can be used. In one embodiment, the tissue removal element 20 comprises an abrading rasp configured to abrade tissue in a body cavity as the motor 43 rotates the abrading rasp. The grinding rasp 20 may have a ground outer surface formed, for example, by diamond grit coating, surface etching, or the like. In one embodiment, the tissue-removing element comprises a stainless steel sphere, the outer surface of which comprises 5 microns of exposed diamond crystals. The tissue-removing element 20 may also be radiopaque to allow the tissue-removing element to be visible under fluoroscopy. In other embodiments, the tissue-removing elements may include one or more cutting elements having smooth or serrated cutting edges, macerators, thrombectomy lines, or the like.

Cavity 72 extends longitudinally through tissue-removing element 20 such that the tissue-removing element defines openings at its proximal and distal ends. The cavity 72 receives a portion of the outer layer 12 for mounting the tissue-removing element 20 to the outer layer. The cavity 72 includes a first diameter portion 74 extending from the proximal end of the tissue removal element 20, a tapered diameter portion 76 extending from the first diameter portion toward the distal end of the tissue removal element, and a second diameter portion 78 extending from the tapered diameter portion to the distal end of the tissue removal element. The diameters of the first diameter portion 74 and the second diameter portion 78 are constant along their lengths. In the illustrated embodiment, the diameter D1 of the first diameter portion 74 is greater than the diameter D2 of the second diameter portion 78. In one embodiment, the diameter D1 of the first diameter portion 74 is approximately 0.035 inches (0.9 millimeters) and the diameter D2 of the second diameter portion 78 is approximately 0.022 inches (0.56 millimeters). The tapered diameter portion 76 provides a transition between the first diameter portion 74 and the second diameter portion 78. The outer layer 12 is received in the first diameter portion 74 and the distal end of the outer layer abuts the tapered diameter portion 76. Tissue-removing element 20 may be fixedly attached to the distal end of outer layer 12 by any suitable means. In one embodiment, an adhesive bonds tissue-removing element 20 to outer layer 12. Inner sleeve 14 extends through outer layer 12 and second diameter portion 78 of tissue-removing element 20. Second diameter portion 78 is sized to allow inner liner 14 to pass therethrough with a small clearance. Inner diameter D2 provides clearance between tissue-removing element 20 and inner sleeve 14 to reduce friction between the components and allow space for saline perfusion. Thus, the tissue-removing elements 20 are shaped and arranged to extend around at least a portion of the inner and outer liners 14, 12 and thus provide a relatively compact assembly for abrading tissue at the distal portion of the catheter 10.

The outer surface of tissue-removing element 20 includes a proximal section 80, an intermediate section 82, and a distal section 84. The diameter of proximal section 80 increases from the proximal end of tissue-removing element 20 to intermediate section 82. The intermediate section has a constant diameter and extends from the proximal section 80 to the distal section 84. The diameter of distal section 84 tapers from intermediate section 82 to the distal end of tissue-removing element 20. The tapered distal section 84 provides the tissue-removing element 20 with a generally wedge-like shape to wedge the narrowed tissue channel open as it simultaneously clears the channel by removing tissue using the abrasive action of the tissue-removing element. The distal end of tissue-removing element 20 is also rounded to provide a blunt distal end for the tissue-removing element.

referring to fig. 1 and 2, to remove tissue in a body lumen of a subject, a physician inserts a guidewire 26 into the body lumen of the subject to a location distal to the tissue to be removed. Subsequently, the physician inserts the proximal end portion of guidewire 26 through guidewire lumen 24 of inner liner 14 and through junction box 15, extending through guidewire port 39 in the junction box to exit catheter 10. The guidewire port 39 allows the catheter 10 to be used in rapid exchange and single operator rapid procedures. With the catheter 10 loaded onto the guidewire 26, the physician advances the catheter along the guidewire until the tissue-removing element 20 is positioned proximal to and adjacent to the tissue. When tissue-removing element 20 is positioned proximal to and adjacent tissue, the physician uses actuator 42 to actuate motor 43 to rotate drive member 48, gear assembly 92, outer layer 12, and the tissue-removing element mounted thereon. As the tissue-removing element is rotated, tissue-removing element 20 abrades (or otherwise removes) tissue in the body lumen. While tissue-removing element 20 is rotated, the physician may selectively move catheter 10 distally along guidewire 26 to abrade tissue and, for example, increase the size of the passage through the body lumen. The physician may also move the catheter 10 proximally along the guidewire 26 and may repeatedly move the components in the distal and proximal directions to achieve a back and forth movement of the tissue-removing element 20 across the tissue. During the milling process, inner liner 14 isolates guidewire 26 from rotating coil gear 106, outer layer 12, and tissue-removing element 20 to protect the guidewire from damage by rotating components. As such, inner sleeve 14 is configured to withstand the torsional and frictional effects of the rotating coil gear 106, outer layer 12, and tissue-removing element 20 without transmitting those effects to guidewire 26. After the physician has completed the procedure using the catheter 10, the catheter may be removed from the body cavity. Because the guidewire lumen 24 is much shorter than the overall length of the catheter 10, the catheter can be removed from the body lumen by a quick exchange or single operator exchange procedure without having to pull the guidewire 26 out of the body lumen with the catheter, since the length of the guidewire protruding from the subject is longer than the length of the guidewire lumen 24 of the catheter. Thus, at least a portion of the guidewire 26 is always exposed and can be grasped by the physician.

referring to fig. 18-24, another embodiment of a catheter is generally indicated at 10'. Conduit 10 'includes a junction box 15' similar to junction box 15 of the first embodiment. The junction box 15 'includes a housing 90', which housing 90 'encloses a gear assembly 92' for operatively connecting the drive member 48 'to the outer layer 12'. Housing 90' includes a rigid central portion 94' that substantially surrounds gear assembly 92', and proximal and distal portions 96', which proximal and distal portions 96' provide strain relief functions for the housing to relieve tension applied to the proximal and distal ends of junction box 15' when catheter 10' is bent during use.

The gear assembly 92 includes a pinion gear 104 'that meshes with a coil gear 106'. The pinion gear 104' is attached to the driver 48' such that rotation of the driver causes rotation of the pinion gear, which in turn rotates the coil gear 106 '. The coil gear is attached to the outer layer 12' such that rotation of the coil gear causes rotation of the outer layer. Pinion gear 104 'proximal attachment portion 108', distal end portion 110', and intermediate gear portion 112'. The driver 48 'is received in the proximal attachment portion 108'. The driver 48 is secured within the proximal attachment portion 108 'to attach the driver to the pinion gear 104'. In the illustrated embodiment, the intermediate gear portion 112 'includes eight (8) teeth 113'. The intermediate gear portion 112 'may have an outer diameter of about 0.8 millimeters (about 0.03 inches) and the teeth 113' of the intermediate gear portion may have a pitch diameter of about 0.6 millimeters (about 0.02 inches) and a pressure angle of about 20 degrees. Other sizes of the pinion gear 104' are also contemplated.

The coil gear 106' includes an attachment portion 118' and a gear portion 122 '. A channel 126 'extends through coil gear 106' and receives proximal portions of inner sleeve 14 'and outer layer 12'. The attachment portion 118 'is attached to the proximal end of the outer layer 12'. Specifically, the outer layer 12 'is received in the attachment portion 118' of the coil gear 106 'and fixedly attached to the attachment portion 118'. In the illustrated embodiment, the gear portion 122 'includes fourteen (14) teeth 123'. Gear portion 122' may have an outer diameter of about 1.3 millimeters (about 0.05 inches). The teeth 123 'of the gear portion 122' may have a pitch diameter of about 1.1 millimeters (about 0.04 inches) and a pressure angle of about 20 degrees. Other sizes of the coil gear 106' are also contemplated. In one embodiment, the gear ratio of the gear assembly 92' is between about 1 to 1 and about 2 to 1. In one embodiment, gear assembly 92' has a gear ratio of about 1.75 to 1.

the first bearing 116 'is received around the inner bushing 14' and the proximal portion 108 'of the pinion gear 104'. The first bearing 116 'includes a first bore for receiving the proximal portion 108' of the pinion gear 104 'and a second bore for receiving the inner bushing 14'. The second bearing 124' is received about the distal end portion 110' of the pinion gear 104' and the distal end portion 118' of the coil gear 106', respectively. The second bearing 124' includes a first aperture for receiving the distal end portion 110' of the pinion gear 104' and a second aperture for receiving the distal end portion 118' of the coil gear 106 '. The bearings 116', 124' may be made of bronze. However, other materials are also contemplated. For example, the bearings 116', 124' may also be made of zirconia.

when introducing elements of the present invention or one or more embodiments thereof, the articles "a," "an," "the," and "said" are intended to mean that there are one or more of the elements. The terms "comprising," "including," and "having" are intended to be inclusive and mean that there may be additional elements other than the listed elements.

as various changes could be made in the above devices, systems, and methods without departing from the scope of the invention, it is intended that all matter contained in the above description and shown in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.