|Publication number||USRE42756 E1|
|Application number||US 11/377,894|
|Publication date||Sep 27, 2011|
|Filing date||Mar 15, 2006|
|Priority date||Mar 13, 1990|
|Also published as||USRE41029|
|Publication number||11377894, 377894, US RE42756 E1, US RE42756E1, US-E1-RE42756, USRE42756 E1, USRE42756E1|
|Inventors||Guido Guglielmi, Ivan Sepetka|
|Original Assignee||The Regents Of The University Of California|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (99), Non-Patent Citations (309), Classifications (44) |
|External Links: USPTO, USPTO Assignment, Espacenet|
Endovascular electrolytically detachable wire and tip for the formation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas
US RE42756 E1
An artery, vein, aneurysm, vascular malformation or arterial fistula is occluded through endovascular occlusion by the endovascular insertion of a platinum wire and/or tip into the vascular cavity. The vascular cavity is packed with the tip to obstruct blood flow or access of blood in the cavity such that the blood clots in the cavity and an occlusion if formed. The tip may be elongate and flexible so that it packs the cavity by being folded upon itself a multiple number of times, or may pack the cavity by virtue of a filamentary or fuzzy structure of the tip. The tip is then separated from the wire mechanically or by electrolytic separation of the tip from the wire. The wire and the microcatheter are thereafter removed leaving the tip embedded in the thrombus formed within the vascular cavity. Movement of wire in the microcatheter is more easily tracked by providing a radioopaque proximal marker on the microcatheter and a corresponding indicator marker on the wire. Electrothrombosis is facilitate by placing the ground electrode on the distal end of the microcatheter and flowing current between the microcatheter electrode and the tip.
1. A method for forming an occlusion within a body cavity comprising the steps of:
disposing a wire near an opening into said cavity;
disposing a distal tip of said wire into said cavity to pack said cavity to mechanically form said occlusion within said cavity about said distal tip; and
detaching said distal tip from said wire to leave said distal tip within said cavity without applying any force by said distal tip to any surface within said body cavity,
whereby said cavity is occluded by said distal tip.
2. The method of claim 1 wherein said step of detaching said distal tip from said wire comprises the step of mechanically detaching said distal tip from said wire.
3. The method of claim 1 where said wire and tip are used within a catheter and where in said step of detaching said distal tip from said wire, said wire and tip are longitudinally displaced within said catheter, said catheter having a radio-opaque proximal marker, said wire and tip having collectively a single radio-opaque marker, said displacement of said wire and tip moving said single radio-opaque marker to the proximity of said proximal marker on said catheter when said tip is fully deployed.
4. The method of claim 1 wherein said step of disposing said tip into said cavity to pack said cavity comprises the step of disposing a long flexible tip folded upon itself a multiple number of times to pack said cavity.
5. A method for forming an occlusion within a cavity comprising the steps of:
disposing a wire near an opening into said cavity;
disposing a distal tip of said wire into said cavity to pack said cavity to mechanically form said occlusion within said cavity about said distal tip, and
detaching said distal tip from said wire to leave said distal tip within said cavity without applying any force by said distal tip to any surface within said cavity,
where said step of disposing said tip into said cavity to pack said cavity comprises the step of disposing a tip having a plurality of filaments extending therefrom to pack said cavity,
whereby said cavity is occluded by said distal tip.
6. A wire for use in formation of an occlusion within a cavity used in combination with a catheter comprising: a core wire having a tip portion end; and a detachable elongate tip portion extending said core wire adapted to being packed into said cavity to form said occlusion in said cavity, said detachable elongate tip portion being temporarily coupled to said distal end of said core wire and detachable from said core wire without applying any force by said distal tip to any surface within said body cavity, whereby occlusion of said cavity can be performed.
7. The wire of claim 6 wherein said elongate tip portion is a long and substantially pliable segment adapted to be multiply folded upon itself to substantially pack said cavity.
8. The wire of claim 6 wherein said catheter has a pair of radioopaque markers disposed thereon and wherein said core wire has a radioopaque marker disposed thereon, said marker on said core wire being positioned in the proximity of one of said pair of markers on said catheter when said core wire is deployed, said other marker on said catheter indicating the distal end of said catheter.
9. The wire of claim 6 where said core wire and tip portion are coupled by polyester.
10. A wire for use in formation of an occlusion within a cavity used in combination with a catheter comprising:
a core wire having a distal end; and a detachable elongate tip portion extending from said core wire and adapted to being packed into said cavity to form said occlusion in said cavity, said detachable elongate tip portion being temporarily coupled to said distal end of said core wire and detachable from said core wire without applying any force by said tip portion to any surface within said body cavity,
wherein said elongate tip portion is a segment adapted to be disposed in said cavity and having a plurality of filaments extending therefrom to substantially pack said cavity when disposed therein, whereby occlusion of said cavity can be performed.
This application is a continuation of application Ser. No. 08/801,795 filed Feb. 14, 1997, issued as U.S. Pat. No. 5,855,578, which in turn wasis a continuation of application Ser. No. 08/485,821, filed Jun. 6, 1995, now abandoned, which is a divisional of application Ser. No. 08/311,508, filed on Sep. 23, 1994, issued as U.S. Pat. No. 5,540,680, which is a continuation application of application Ser. No. 07/840,211 filed on Feb. 24, 1992, issued as U.S. Pat. No. 5,354,295, and which in its turn wasis a continuation-in-part application of application Ser. No. 07/492,717, filed Mar. 13, 1990, issued as U.S. Pat. No. 5,122,136.
BACKGROUND OF THE INVENTION
1. Field of the Invention
The invention relates to a method and apparatus for endovascular electrothrombic formation of thrombi in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas.
2. Description of the Prior Art
Approximately 25,000 intracranial aneurysms rupture every year in North America The primary purpose of treatment for ruptured intracranial aneurysm is to prevent rebleeding. At the present time, three general methods of treatment exist, namely an extravascular, endovascular and extra-endovascular approach.
The extravascular approach is comprised of surgery or microsurgery of the aneurysm or treatment site for the purpose of preserving the parent artery. This treatment is common with intracranial berry aneurysms. The methodology comprises the step of clipping the neck of the aneurysm, performing a suture-ligation of the neck, or wrapping the entire aneurysm. Each of these surgical procedures is performed by intrusive invasion into the body and performed from outside the aneurysm or target site. General anesthesia, craniotomy, brain retraction and arachnoid dissection around the neck of the aneurysm and placement of a clip are typically required in these surgical procedures. Surgical treatment of vascular intracranial aneurysm can expect a mortality rate of 4-8% with a morbidity rate of 18-20%. Because of the mortality and morbidity rate expected, the surgical procedure is often delayed while waiting for the best surgical time with the result that an additional percentage of patients will die from the underlying disease or defect prior to surgery. For this reason the prior art has sought alternative means of treatment.
In the endovascular approach, the interior of the aneurysm is entered through the use of a microcatheter. Recently developed microcatheters, such as those shown by Engelson, “Catheter Guidewire”, U.S. Pat. No. 4,884,579 and as described in Engelson, “Catheter for Guidewire Tracking”, U.S. Pat. No. 4,739,768 (1988), allow navigation into the cerebral arteries and entry into a cranial aneurysm.
In such procedures a balloon is typically attached to the end of the microcatheter and it is possible to introduce the balloon into the aneurysm, inflate it, and detach it, leaving it to occlude the sac and neck with preservation of the parent artery. While endovascular balloon embolization of berry aneurysms is an attractive method in situations where an extravascular surgical approach is difficult, inflation of a balloon into the aneurysm carries some risk of aneurysm rupture due to possible over-distention of portions of the sac and due to the traction produced while detaching the balloon.
While remedial procedures exist for treating a ruptured aneurysm during classical extravascular surgery, no satisfactory methodology exists if the aneurysm breaks during an endovascular balloon embolization.
Furthermore, an ideal embolizing agent should adapt itself to the irregular shape of the internal walls of the aneurysm. On the contrary, in a balloon embolization the aneurysmal wall must conform to the shape of the balloon. This may not lead to a satisfactory result and further increases the risk of rupture.
Still further, balloon embolization is not always possible. If the diameter of the deflated balloon is too great to enter the intracerebral arteries, especially in the cases where there is a vasospasm, complications with ruptured intracranial aneurysms may occur. The procedure then must be deferred until the spasm is resolved and this then incurs a risk of rebleeding.
In the extra-intravascular approach, an aneurysm is surgically exposed or stereotaxically reached with a probe. The wall of the aneurysm is then perforated from the outside and various techniques are used to occlude the interior in order to prevent it from rebleeding. These prior art techniques include electrothrombosis, isobutyl-cyanoacrylate embolization, hog-hair embolization and ferromagnetic thrombosis.
In the use of electrothrombosis for extra-intravascular treatment the tip of a positively charged electrode is inserted surgically into the interior of the aneurysm. An application of the positive charge attracts white blood cells, red blood cells, platelets and fibrinogen which are typically negatively charged at the normal pH of the blood. The thrombic mass is then formed in the aneurysm about the tip. Thereafter, the tip is removed. See Mullan, “Experiences with Surgical Thrombosis of Intracranial Berry Aneurysms and Carotid Cavernous Fistulas”, J. Neurosurg., Vol. 41, December 1974; Hosobuchi, “Electrothrombosis Carotid-Cavernous Fistula”, J. Neurosurg., Vol. 42, January 1975; Araki et al., “Electrical Induced Thrombosis for the Treatment of Intracranial Aneurysms and Angiomas”, Excerpta Medica International Congress Series, Amsterdam 1965, Vol. 110, 651-654; Sawyer et al., “Bio-Electric Phenomena as an Etiological Factor in Intravascular Thrombosis”, Am. J. Physiol., Vol. 175, 103-107 (1953); J. Piton et al., “Selective Vascular Thrombosis Induced by a Direct Electrical Current; Animal Experiments”, J. Neuroradiology, Vol. 5, pages 139-152 (1978). However, each of these techniques involves some type of intrusive procedure to approach the aneurysm from the exterior of the body.
The prior art has also devised the use of a liquid adhesive, isobutyl-cyanoacrylate (IBCA) which polymerizes rapidly on contact with blood to form a firm mass. The liquid adhesive is injected into the aneurysm by puncturing the sac with a small needle. In order to avoid spillage into the parent artery during IBCA injection, blood flow through the parent artery must be momentarily reduced or interrupted. Alternatively, an inflated balloon may be placed in the artery at the level of the neck of the aneurysm for injection. In addition to the risks caused by temporary blockage of the parent artery, the risks of seepage of such a polymerizing adhesive into the parent artery exists, if it is not completely blocked with consequent occlusion of the artery.
Still further, the prior art has utilized an air gun to inject hog hair through the aneurysm wall to induce internal thrombosis. The success of this procedure involves exposing the aneurysm sufficiently to allow air gun injection and has not been convincingly shown as successful for thrombic formations.
Ferromagnetic thrombosis in the prior art in extra-intravascular treatments comprises the stereotactic placement of a magnetic probe against the sac of the aneurysm followed by injection into the aneurysm by an injecting needle of iron microspheres. Aggregation of the microspheres through the extravascular magnet is followed by interneuysmatic thrombus. This treatment has not been entirely successful because of the risk of fragmentation of the metallic thrombus when the extravascular magnet is removed. Suspension of the iron powder in methyl methymethacrylate has been used to prevent fragmentation. The treatment has not been favored, because of the need to puncture the aneurysm, the risk of occlusion of the parent artery, the use of unusual and expensive equipment, the need for a craniectomy and general anesthesia, and the necessity to penetrate cerebral tissue to reach the aneurysm.
Endovascular coagulation of blood is also well known in the art and a device using laser optically generated heat is shown by O'Reilly, “Optical Fiber with Attachable Metallic Tip for Intravascular Laser Coagulation of Arteries, Veins, Aneurysms, Vascular Malformation and Arteriovenous Fistulas”, U.S. Pat. No. 4,735,201 (1988). See also, O'Reilly et al., “Laser Induced Thermal Occlusion of Berry Aneurysms: Initial Experimental Results”, Radiology, Vol. 171, No. 2, pages 471-74 (1989). O'Reilly places a tip into an aneurysm by means of an endovascular microcatheter. The tip is adhesively bonded to a optic fiber disposed through the microcatheter. Optical energy is transmitted along the optic fiber from a remote laser at the proximal end of the microcatheter. The optical energy heats the tip to cauterize the tissue surrounding the neck of the aneurysm or other vascular opening to be occluded. The catheter is provided with a balloon located on or adjacent to its distal end to cut off blood flow to the site to be cauterized and occluded. Normally, the blood flow would carry away the heat at the catheter tip, thereby preventing cauterization. The heat in the tip also serves to melt the adhesive used to secure the tip to the distal end of the optical fiber. If all goes well, the tip can be separated from the optical fiber and left in place in the neck of the aneurysm, provided that the cauterization is complete at the same time as the hot melt adhesive melts.
A thrombus is not formed from the heated tip. Instead, blood tissue surrounding the tip is coagulated. Coagulation is a denaturation of protein to form a connective-like tissue similar to that which occurs when the albumen of an egg is heated and coagulates from a clear running liquid to an opaque white solid. The tissue characteristics and composition of the coagulated tissue is therefore substantially distinct from the thrombosis which is formed by the thrombotic aggregation of white and red blood cells, platelets and fibrinogen. The coagulative tissue is substantially softer than a thrombic mass and can therefore more easily be dislodged.
O'Reilly's device depends at least in part upon the successful cauterization timed to occur no later than the detachment of the heat tip from the optic fiber. The heated tip must also be proportionally sized to the neck of the aneurysm in order to effectively coagulate the tissue surrounding it to form a blockage at the neck It is believed that the tissue in the interior of the aneurysm remains substantially uncoagulated. In addition, the hot melt adhesive attaching the tip to the optic fiber melts and is dispersed into the adjacent blood tissue where it resolidifies to form free particles within the intracranial blood stream with much the same disadvantages which result from fragmentation of a ferromagnetic electrothrombosis.
Therefore, what is needed is an apparatus and methodology which avoids each of the shortcomings and limitations of the prior art discussed above.
BRIEF SUMMARY OF THE INVENTION
The invention is a method for forming an occlusion within a vascular cavity having blood disposed therein comprising the steps of endovascularly disposing a wire and/or tip near an endovascular opening into the vascular cavity. The wire may include a distinguishable structure at its distal end, which is termed a tip, in which case the remaining portion of the wire may be termed a guidewire. The term “wire” should be understood to collectively include both guidewires and tips and simply wires without distinct tip structures. However, the tip may also simply be the extension of the wire itself without substantial distinction in its nature. A distal tip of the wire is disposed into the vascular cavity to pack the cavity to mechanically form the occlusion within the vascular cavity about the distal tip. The distal tip is detached from the guidewire (or wire) to leave the distal tip within the vascular cavity. As a result, the vascular cavity is occluded by the distal tip, and by any thrombus formed by use of the tip.
In one embodiment, the step of detaching the distal tip from the guidewire (or wire) comprises the step of mechanically detaching the distal tip from the guidewire (or wire).
In another embodiment, the guidewire and tip (or wire) are used within a microcatheter and in the step of detaching the distal tip from the guidewire (or wire), the guidewire and tip (or wire) are longitudinally displaced within the microcatheter. The microcatheter has radio-opaque proximal and tip markers. The guidewire and tip (or wire) have collectively a single radio-opaque marker. The displacement of the guidewire and tip (or wire) moves the single radio-opaque marker to the proximity of the proximal marker on the microcatheter. At this point the tip will be fully deployed in the vascular cavity and tip separation may proceed. It is not necessary then in this embodiment to be able to see actual deployment of the tip before separation. The tip marker allows and enhances direct observation of the correct placement of the catheter tip into the opening of the vascular cavity.
In one embodiment the step of disposing the tip (or wire) into the vascular cavity to pack the cavity comprises the step of disposing a tip (or wire) having a plurality of filaments extending therefrom to pack the cavity.
In another embodiment the step of disposing the tip (or wire) into the vascular cavity to pack the cavity comprises the step of disposing a long flexible tip (or wire) folded upon itself a multiple number of times to pack the cavity.
The invention can also be characterized as a method for forming an occlusion within a vascular cavity having blood disposed therein comprising the steps of endovascularly disposing a wire within a microcatheter near an endovascular opening into the vascular cavity. The microcatheter has a distal tip electrode. The distal tip of the wire is disposed into the vascular cavity to pack the cavity to form the occlusion within the vascular cavity about the distal tip of the wire by applying a current between the distal tip electrode and the distal end of the wire packed into the cavity. The distal tip of the wire is detached from the wire to leave the distal tip of the wire within the vascular cavity. As a result, the vascular cavity is occluded by the distal tip, and by any thrombus formed by use of the tip.
The invention is also a wire for use in formation of an occlusion within a vascular cavity used in combination with a microcatheter comprising a core wire, and a detachable elongate tip portion extending the core wire for a predetermined lineal extent. The tip portion is adapted to be packed into the vascular cavity to form the occlusion in the vascular cavity and coupled to the distal portion of the core wire. As a result, endovascular occlusion of the vascular cavity can be performed.
In one embodiment, the elongate tip portion is a long and substantially pliable segment adapted to be multiply folded upon itself to substantially pack said vascular cavity.
In another embodiment, the elongate tip portion is a segment adapted to be disposed in said vascular cavity and having a plurality of filaments extending therefrom to substantially pack said vascular cavity when disposed therein.
In still another embodiment, the microcatheter has a pair of radioopaque markers disposed thereon and the core wire has a radioopaque marker disposed thereon. The marker on the core wire is positioned in the proximity of one of the pair of markers on the microcatheter when the core wire is fully deployed. The other marker on the core wire marks the position of the catheter tip.
The invention is still further characterized as a microcatheter system for use in formation of an occlusion within a vascular cavity comprising a microcatheter having a distal end adapted for disposition in the proximity of the vascular cavity. The distal end has an electrode disposed thereon. A conductive guidewire is disposed in the microcatheter and longitudinally displaceable therein. The guidewire comprises a core wire, and an elongate tip portion extending the core wire for a predetermined lineal extent. The tip portion is adapted to be packed into the vascular cavity to form the occlusion in the vascular cavity. The tip portion is coupled to the distal portion of the core wire. The occlusion is formed by means of applying a current between the tip portion and the electrode on the microcatheter when the tip portion is disposed into the vascular cavity. As a result, endovascular occlusion of the vascular cavity can be performed.
More generally speaking, the invention is a method for forming an occlusion within a vascular cavity having blood disposed therein comprising the steps of disposing a body into the cavity to substantially impede movement of blood in the cavity. The body is employed in the cavity to form the occlusion within the vascular cavity. As a result, the vascular cavity is occluded by the body.
The step of disposing the body in the vascular cavity comprises the step of packing the body to substantially obstruct the cavity.
In one embodiment the step of packing the cavity with the body comprises the step of obstructing the cavity with a detachable elongate wire tip multiply folded upon itself in the cavity.
The step of disposing the body into the vascular cavity comprises disposing in the vascular cavity means for slowing blood movement in the cavity to initiate formation of the occlusion in the cavity.
In another embodiment the step of packing the cavity with the body comprises the step of obstructing the cavity with a body having a compound filamentary shape.
The step of employing the body in the vascular cavity to form the occlusion comprises the step of applying an electrical current to the body or mechanically forming the occlusion in the body or both simultaneously.
The invention is also wire for use in formation of an occlusion within a vascular cavity used in combination with a microcatheter. The invention comprises a core wire and a detachable elongate tip portion extending the core wire for a predetermined lineal extent. The core wire is adapted to being packed into the vascular cavity to form the occlusion in the vascular cavity and is coupled to the distal portion of the core wire. The tip portion includes a first segment for disposition into the cavity and a second segment for coupling the first portion to the core wire. The second segment is adapted to be electrolysized upon application of current. An insulating coating is disposed on the first segment. The second segment is left exposed to permit selective electrolysis thereof. As a result, endovascular occlusion of the vascular cavity can be performed.
The invention can better be visualized by now turning to the following drawings wherein like elements are referenced by like numerals.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is an enlarged partially cross-sectioned side view of a first embodiment of the distal end of the guidewire and tip of the invention.
FIG. 2 is an enlarged longitudinal cross section of a second embodiment of the guidewire and tip of the invention.
FIG. 3 is an enlarged side view of a third embodiment of the invention with a microcatheter portion cut away in a longitudinal cross-sectional view.
FIG. 4 is a simplified depiction of the wire of FIG. 3 shown disposed within a simple cranial aneurysm.
FIG. 5 is a depiction of the wire of FIG. 4 shown after electrolytic detachment of the tip.
FIG. 6 is a plan view of another embodiment of the guidewire and tip portion wherein the type is provided with a plurality of polyester filamentary hairs.
FIGS. 7 and 8 are a diagrammatic depictions of the use of the invention wherein position markers have been provided on the catheter and wire to assist in proper fluoroscopic manipulation.
FIG. 9 is a simplified cross-sectional view of the catheter and wire showing a ground electrode disposed on the distal tip of the catheter.
The invention and its various embodiments are best understood by now turning to the following detailed description.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
An artery, vein, aneurysm, vascular malformation or arterial fistula is occluded through endovascular occlusion by the endovascular insertion of a platinum tip into the vascular cavity. The vascular cavity is packed with the tip to obstruct blood flow or access of blood in the cavity such that the blood clots in the cavity and an occlusion if formed. The tip may be elongate and flexible so that it packs the cavity by being folded upon itself a multiple number of times, or may pack the cavity by virtue of a filamentary or fuzzy structure of the tip. The tip is then separated from the wire mechanically or by electrolytic separation of the tip from the wire. The wire and the microcatheter are thereafter removed leaving the tip embedded in the thrombus formed within the vascular cavity. Movement of wire in the microcatheter is more easily tracked by providing a radioopaque proximal marker on the microcatheter and a corresponding indicator marker on the wire. Electrothrombosis is facilitate by placing the ground electrode on the distal end of the microcatheter and flowing current between the microcatheter electrode and the tip.
When the tip is separated from the wire by electrolytic separation of the tip from the wire, a portion of the wire connected between the tip and the body of the wire is comprised of stainless steel and exposed to the bloodstream so that upon continued application of a positive current to the exposed portion, the exposed portion is corroded away at least at one location and the tip is separated from the body of the wire.
FIG. 1 is an enlarged side view of a first embodiment of the distal end of the wire and tip shown in partial cross-sectional view. A conventional Teflon laminated or similarly insulated stainless steel wire 10 is disposed within a protective nicrocatheter (not shown). Stainless steel wire 10 is approximately 0.010-0.020 inch (0.254-0.508 mm) in diameter. In the illustrated embodiment, wire 10 is tapered at its distal end to form a conical section 12 which joins a section 14 of reduced diameter which extends longitudinally along a length 16 of wire 10. Section 16 then narrows gradually down to a thin threadlike portion 18 beginning at a first bonding location 20 and ending at a second bonding location 22.
The stainless steel wire 10, comprised of that portion disposed within the microcatheter body, tapered section 12, reduced diameter section 16 and threadlike section 18, is collectively referred to as a core wire which typically is 50-300 cm. in length.
In the illustrated embodiment the portion of the core wire extending from tapered section 12 to second bonding location 22 is collectively referred to as the grinding length and may typically be between 20 and 50 cm. in length.
Reduced diameter portion 14 and at least part of sections 12 and first bonding location 20 may be covered with an insulating Teflon laminate 24 which encapsulates the underlying portion of wire 10 to prevent contact with the blood.
A stainless steel coil 26 is soldered to the proximate end of threadlike portion 18 of wire 10 at first bonding location 20. Stainless steel coil 26 is typically 3 to 10 cm. in length and like wire 10 has a diameter typically between 0.010. to 0.020 inch (0.254-0.508 mm).
The distal end of stainless steel coil 26 is soldered to the distal end of threadlike portion 18 of wire 10 and to the proximal end of a platinum secondary coil 28 at second bonding location 22. Secondary coil 28 itself forms a spiral or helix typically between 2 to 10 mm in diameter. The helical envelope formed by secondary coil 28 may be cylindrical or conical. Like wire 10 and stainless steel coil 26, secondary coil 28 is between approximately 0.010 and 0.020 inch (0.254-0.508 mm) in diameter. The diameter of the wire itself forming stainless steel coil 26 and coil 28 is approximately between 0.001-0.005 inch.
The distal end of secondary coil 28 is provided with a platinum soldered tip 30 to form a rounded and smooth termination to avoid puncturing the aneurysm or tearing tissue.
Although prebiased to form a cylindrical or conical envelope, secondary coil 28 is extremely soft and its overall shape is easily deformed. When inserted within the microcatheter (not shown), secondary coil 28 is easily straightened to lie axially within the microcatheter. Once disposed out of the tip of the microcatheter, secondary coil 28 forms the shape shown in FIG. 1 and may similarly be loosely deformed to the interior shape of the aneurysm.
As will be described below in greater detail in connection with the third embodiment of FIG. 3, after placement of secondary coil 28 within the interior of the aneurysm, a direct current is applied to wire 10 from a voltage source exterior to the body. The positive charge on secondary coil 28 within the cavity of the aneurysm causes a thrombus to form within the aneurysm by electrothrombosis. Detachment of the tip occurs either: (1) by continued application of current for a predetermined time when the portion 18 is exposed to blood; or (2) by movement of the wire to expose portion 18 to blood followed by continued current application for a predetermined time. Ultimately, both threadlike portion and stainless steel coil 26 will be completely disintegrated at least at one point, thereby allowing wire 10 to be withdrawn from the vascular space while leaving secondary coil 28 embedded within the thrombus formed within the aneurysm.
FIG. 2 illustrates in enlarged partially cross-sectional view a second embodiment of the invention. Stainless steel core 32 terminates in a conical distal portion 34. Stainless steel coil 36, shown in cross-sectional view, is soldered to distal portion 34 of wire 32 at bonding location 38. The opposing end of the stainless steel coil 36 is provided with a soldered, rounded platinum tip 40. In the illustrated embodiment, stainless steel core wire 32 is approximately 0.010 inch in diameter with the length of stainless steel coil 36 being approximately 8 cm. with the longitudinal length of platinum tip 40 being between 3 and 10 mm. The total length of wire 32 from tip 40 to the proximate end is approximately 150 cm.
The embodiment of FIG. 2 is utilized in exactly the same manner as described above in connection with FIG. 1 to form a thrombic mass within an aneurysm or other vascular cavity. The embodiment of FIG. 2 is distinguished from that shown in FIG. 1 by the absence of the extension of stainless core 32 through coil 36 to tip 40. In the case of the embodiment of FIG. 2 no inner core or reinforcement is provided within stainless steel coil 36. Threadlike portion 18 is provided in the embodiment of FIG. 1 to allow increased tensile strength of the wire. However, a degree of flexibility of the wire is sacrificed by the inclusion even of threadlike tip 18, so that the embodiment of FIG. 2 provides a more flexible tip, at least for that portion of the micro-guidewire constituting the stainless steel coil 36.
It is expressly understood that the helical secondary coil tip of the embodiment of FIG. 1 could similarly be attached to stainless steel coil 36 of the embodiment of FIG. 2 without departing from the spirit and scope of the invention.
Thinned and threadlike portion guidewires disposed concentrically within coiled portions are well known and are shown in Antoshkiw, “Disposable Guidewire”, U.S. Pat. No. 3,789,841 (1974); Sepetka et al., “Guidewire Device”, U.S. Pat. No. 4,832,047 (1989); Engelson, “Catheter Guidewire”, U.S. Pat. No. 4,884,579 (1989); Samson et al., “Guidewire for Catheters”, U.S. Pat. No. 4,538,622 (1985); and Samson et al., “Catheter Guidewire with Short Spring Tip and Method of Using the Samson”, U.S. Pat. No. 4,554,929 (1985).
Turn now to the third embodiment of the invention as shown in FIG. 3. FIG. 3 shows an enlarged side view of a wire, generally denoted by reference numeral 42, disposed within a microcatheter 44 shown in cross-sectional view. Like the embodiment of FIG. 1, a stainless steel coil 46 is soldered to a conical portion 48 of wire 22 at a first bonding location 50. A thin threadlike extension 52 is then longitudinally disposed within stainless steel coil 46 to a second bonding location 54 where stainless steel wire 46 and threadlike portion 52 are soldered to a soft platinum coil 56. Platinum coil 56 is not prebiased, nor does it contain any internal reinforcement, but is a free and open coil similar in that respect to stainless steel coil 36 of the embodiment of FIG. 2.
However, platinum coil 56 is particularly distinguished by its length of approximately 1 to 50 cm. and by its flexibility. The platinum or platinum alloy used is particularly pliable and the diameter of the wire used to form platinum coil 56 is approximately 0.001-0.005 inch in diameter. The distal end of platinum coil 56 is provided with a smooth and rounded platinum tip 58 similar in that respect to tips 30 and 40 of FIGS. 1 and 2, respectively.
When coil 56 is disposed within microcatheter 44, it lies along the longitudinal lumen 60 defined by microcatheter 44. The distal end 62 of microcatheter 60 is then placed into the neck of the aneurysm and the wire 42 is advanced, thereby feeding tip 58 in platinum coil 56 into aneurysm 64 until bonding location 50 resides in the neck of the aneurysm as best depicted in the diagrammatic cross-sectional view of FIG. 4.
FIG. 4 illustrates the insertion of the embodiment of FIG. 3 within a vessel 66 with distal tip of microcatheter 44 positioned near neck 68 of aneurysm 64. Coil 56 is fed into aneurysm 64 until at least a portion of stainless steel coil 46 is exposed beyond the distal tip 62 of microcatheter 44. A positive electric current of approximately 0.01 to 2 milliamps at 0.1-6 volts is applied to wire 42 to form the thrombus. Typically a thrombus will form within three to five minutes. The negative pole 72 of voltage source 70 is typically placed over and in contact with the skin.
After the thrombus has been formed and the aneurysm completely occluded, tip 58 and coil 56 are detached from wire 42 by electrolytic disintegration of at least one portion of stainless steel coil 46. In the illustrated embodiment this is accomplished by continued application of current until the total time of current application is almost approximately four minutes.
At least one portion of stainless steel coil 46 will be completely dissolved through by electrolytic action within 3 to 10 minutes, usually about 4 minutes. After separation by electrolytic disintegration, wire 42, microcatheter 44 and the remaining portion of coil 46 still attached to wire 42 are removed from vessel 66, leaving aneurysm 64 completely occluded as diagrammatically depicted in FIG. 5 by thrombus 74. It will be appreciated that the time of disintegration may be varied by altering the dimensions of the portions of the wire and/or the current.
The process is practiced under fluoroscopic control with local anesthesia at the groin. A transfemoral microcatheter is utilized to treat the cerebral aneurysm. The platinum is not affected by electrolysis and the remaining portions of the microcatheter are insulated either by a Teflon lamination directly on wire 42 and/or by microcatheter 44. Only the exposed portion of the wire 46 is affected by the electrolysis.
It has further been discovered that thrombus 74 continues to form even after detachment from wire 42. It is believed that a positive charge is retained on or near coil 56 which therefore continues to attract platelets, white blood cells, red blood cells and fibrinogen within aneurysm 64.
Although the foregoing embodiment has been described as forming an occlusion within a blood-filled vascular cavity by means of electrothrombosis, the above disclosure must be read to expressly include formation of the occlusion by mechanical mechanisms without resort to the application of electrical current. A mechanical mechanism which can be safely disposed into the vascular cavity to impede, slow or otherwise initiate clotting of the blood or formation of the occlusion is within the scope of the invention. The insertion within the vascular cavity and maintenance therein of an object with an appropriate blood-clotting characteristics can and does in many cases cause the formation of an occlusion by itself. Depicted in FIG. 6 is an embodiment of the invention wherein such mechanical thrombosis can be achieved. Wire 10 has a tapering end portion 14 covered with a Teflon laminate 24 similar to that described in connection with the embodiment of FIG. 1. Wire 10 is attached by means of a mechanical coupling 100 to a platinum coil 102 which has a plurality of filaments or fine hairs 104 extending therefrom. In the illustrated embodiment, hairs 104 have a length as may be determined from the size of the vascular cavity in which coil 102 is to be used. For example, in a small vessel hair lengths of up to 1 mm are contemplated. An example of polyester filaments or hairs attached to a coil which was not used in electro-thrombosis may be seen in the copending application entitled Vasoocclusion Coil with Attached Fiberous Elements, filed Oct. 2, 1991, Ser. No. 07/771,013.
Coil 102 has sufficient length and flexibility that it can be inserted or coiled loosely into the vascular cavity. The length of coil 102 need not be so long that the coil itself is capable of being multiply folded on itself and fill or substantially fill the vascular cavity. Hairs 104 extending from coil 102 serve to substantially pack, fill or at least impede blood flow or access in the vascular cavity. Hairs 104, which are generally inclined backwardly away from extreme tip 106 when delivered, are thus easily able to slide forward with little friction through restrictions in the vessels and aneurysm. Additionally, hairs 104 do not have sufficient length, strength or sharpness to provide any substantial risk or potential for a puncture of the thin vascular wall. The plurality of hairs 104, when coiled within the vascular cavity, provide an extremely large surface for attachment of blood constituents to encourage and enhance the formation of a mechanical occlusion within the vascular opening.
In the preferred embodiment, coil 102 is mechanically coupled to thin tapered portion 104 of wire 10 by means of a small drop of polyester 100. Polyester may be substituted for the gold solder of the previously described embodiments in order to reduce concern or risk of toxic reactions in the body.
Tip portion 104 may also be mechanically separated from wire 10 by means other than electrolysis. One method is make the connection between tip 104 and wire 10 by means of a spring loaded mechanical clasp (not shown). The clasps are retained on tip 104 as long as the clasps remain inside of the catheter, but spring open and release tip 104 when extended from the catheter. The catheter and clasps may then be removed from the insertion site. This type of mechanical connection is described in the copending application entitled, “Detachable Pusher-Vasoocclusive Coil Assembly with Interlocking Coupling”, filed Dec. 12, 1991 with Ser. No. 07/806,979 which is incorporated herein by reference and assigned to Target Therapeutics Inc. An alternative nonresilient mechanical ball and clasp capturing mechanism is described in the copending application entitled “Detachable Pusher-Vasoocclusive Coil Assembly with Interlocking Ball and Keyway Coupling”, filed Dec. 12, 1991 with Ser. No. 07/806,912 which is also incorporated herein by reference and assigned to Target Therapeutics Inc.
In another embodiment wire 10 and tip portion 104 screw into each other and can be unscrewed from each other by rotation of the catheter or wire with respect to tip 104. An extendable sheath (not shown) in the microcatheter is advanced to seize tip 104 to prevent its rotation with wire 10 during the unscrewing process. This type of mechanical connection is described in the copending application entitled “Detachable Pusher-Vasoocclusive Coil Assembly with Threaded Coupling”, filed Dec. 12, 1991 with Ser. No. 07/806,898 which is incorporated herein by reference and assigned to Target Therapeutics Inc.
In any case the specific means disclosed here of mechanically detaching tip 104 from wire 10 forms no part of the present invention apart from its combination as a whole with other elements of the invention. Specific disclosure of the mechanical means of detachment have been set forth only for the purposes of providing an enabling disclosure of the best mode presently known for practicing the claimed invention.
Even where the occlusion is not formed by electrothrombosis, separation of tip 104 may be effected by electrolysis. In such situations, the electrolysing current may be concentrated on the sacrificial stainless steel portion of tip 104 by disposition of an insulative coating on the remaining platinum portion. For example, tip 104 may be provided with a polyethylene coating save at least a portion of the stainless steel length. This has the effect of decreasing the time required to electrolytically sufficiently disintegrate the steel portion to allow detachment of the platinum tip, which is an advantageous feature in those cases where a large aneurysm must be treated and a multiple number of coils must be deployed within the aneurysm.
Notwithstanding the fact that wire 10 and platinum coil 102 in the embodiment FIG. 6 or wire 10 and platinum coil 28, 36 and 56 in the embodiments of FIGS. 1-5 are radiopaque, there is still some difficulty when manipulating the device under fluoroscopy to be able to determine the exact position or movement of the probe relative to the aneurysm. This is particularly true when a large number of coils are deployed and one coil then radiographically hides another. FIG. 7 illustrates an improvement of, for example, the embodiment of FIGS. 4 and 5. Microcatheter 144 is positioned so that its distal end 162 within vessel 66 is positioned at the opening aneurysm 64. Microcatheter 144 is provided with radiopaque marker 108 at distal tip 162, a tip marker. Moving toward the proximal end of microcatheter 144 is a second radiopaque marker 110, a proximal marker. Radiopaque markers 108 and 110 are, for example, in the form of radiopaque rings made of platinum, approximately 1-3 mm in longitudinal length along the axis of microcatheter 144. Rings 110 and 108 are typically separated by about 3 cm on microcatheter 144. Similarly, wire 10 has a radiopaque marker 112 defined on it such that marker 112 on wire 10 is approximately with aligned with marker 110 on microcatheter 14 when coil 56 is fully deployed into aneurysm 64. Typically, full deployment will place the solder or connection point 54 of the order of 2-3 mm past opening 68 of aneurysm 64. Distal marker 108 on microcatheter 144 is used to facilitate the location of the microcatheter tip, which can often be obscured by the coils which have been previously deployed. The coils are a varying lengths depending on the application or size of the aneurysm or vascular cavity being treated. Coil lengths of 4-40 cm are common. Therefore, even though the thinness of coil 56 may make it difficult to see under standard fluoroscopy and even though the fineness of wire 10 may similarly be obscured or partly obscured, radiopaque markers 108, 110 and 112 are clearly visible. Manipulation of wire 10 to proximal marker 110 can then easily be observed under conventional fluoroscopy even when there are some loss of resolution or fluoroscopic visual obstruction of the coil.
Further, in the previous embodiments, such as that shown in FIGS. 4 and 5, when electrothrombosis is used to form the occlusion within vascular aneurysm 64, coil 56 is used as the electrical anode while the cathode is a large skin electrode 72 typically conductively applied to the groin or scalp. FIG. 9 illustrates an alternative embodiment wherein microcatheter 144 is supplied with an end electrode 114 coupled to an electrical conductor 116 disposed along the length of microcatheter 144. Wire 116 is ultimately led back to voltage source 70 so that ring electrode 114 is used as the cathode during electrothrombosis instead of an exterior skin electrode 72. With the embodiment of FIG. 9, the electrical currents and electrical current paths which are set up during the electrothrombosis formation are local to the site of application which allows even smaller currents and voltages to be used to initiate electrothrombosis than in the situation when an exterior skin electrode must be utilized. The electrothrombosic current distributions are also better controlled and localized to the site of the thrombus formation. The possibility of stray thrombus formations occurring at unwanted sites or uncontrolled and possibly unwanted electrical current patterns being established elsewhere in the brain or body is therefore largely avoided.
Many alterations and modifications may be made by those having ordinary skill in the art without departing from the spirit and scope of the invention. Therefore, it must be understood that the shape of the tip or distal platinum coil used in combination with the wire according to the invention may be provided with a variety of shapes and envelopes. In addition thereto, the composition of the micro-guidewire tip may be made of elements other than platinum including stainless steel, beryllium, copper and various alloys of the same with or without platinum. Still further, the diameter of the wire; various of the wire described above and the stainless steel coil immediately proximal to the detachable tip may be provided with differing diameters or cross sections to vary the times and current magnitudes necessary in order to effectuate electrolytic detachment from the tip. Still further, the invention may include conventional electronics connected to the proximal end of the wire for determining the exact instant of detachment of the distal tip from the wire.
Therefore, the illustrated embodiment has been set forth only for the purposes of clarity and example and should not be taken as limiting the invention as defined by the following claims, which include all equivalent means whether now known or later devised.
|Cited Patent||Filing date||Publication date||Applicant||Title|
|US3334629||Nov 9, 1964||Aug 8, 1967||Bertram D Cohn||Occlusive device for inferior vena cava|
|US3452742||Jun 29, 1966||Jul 1, 1969||Us Catheter & Instr Corp||Controlled vascular curvable spring guide|
|US3521620||Oct 30, 1967||Jul 28, 1970||Cook William A||Vascular coil spring guide with bendable tip|
|US3547103||Oct 29, 1965||Dec 15, 1970||William A Cook||Coil spring guide|
|US3605750||Apr 7, 1969||Sep 20, 1971||David S Sheridan||X-ray tip catheter|
|US3773034||Nov 24, 1971||Nov 20, 1973||Itt Research Institute||Steerable catheter|
|US3789841||Sep 15, 1971||Feb 5, 1974||Becton Dickinson Co||Disposable guide wire|
|US3868956||Jun 5, 1972||Mar 4, 1975||Ralph J Alfidi||Vessel implantable appliance and method of implanting it|
|US3952747||Mar 28, 1974||Apr 27, 1976||Kimmell Jr Garman O||Filter and filter insertion instrument|
|US3996938||Jul 10, 1975||Dec 14, 1976||Clark Iii William T||Expanding mesh catheter|
|US4003369||Apr 22, 1975||Jan 18, 1977||Medrad, Inc.||Angiographic guidewire with safety core wire|
|US4080706||Nov 4, 1976||Mar 28, 1978||Medrad, Inc.||Method of manufacturing catheter guidewire|
|US4114603||Aug 6, 1976||Sep 19, 1978||Wilkinson Harold A||Intracranial pressure monitoring catheter|
|US4147169||May 2, 1977||Apr 3, 1979||The Kendall Company||Balloon catheter with balloon retaining sleeves|
|US4190057||Dec 27, 1977||Feb 26, 1980||Thoratec Laboratories Corporation||Device for determining the patentcy of a blood vessel|
|US4213461||Sep 15, 1977||Jul 22, 1980||Pevsner Paul H||Miniature balloon catheter|
|US4323071||May 19, 1980||Apr 6, 1982||Advanced Catheter Systems, Inc.||Vascular guiding catheter assembly and vascular dilating catheter assembly and a combination thereof and methods of making the same|
|US4327734||Sep 29, 1980||May 4, 1982||White Jr Robert I||Therapeutic method of use for miniature detachable balloon catheter|
|US4341218||Mar 6, 1980||Jul 27, 1982||University Of California||Detachable balloon catheter|
|US4346712||Feb 13, 1980||Aug 31, 1982||Kuraray Company, Ltd.||Releasable balloon catheter|
|US4402319||Dec 30, 1981||Sep 6, 1983||Kuraray Co., Ltd.||Releasable balloon catheter|
|US4411648||Jun 11, 1981||Oct 25, 1983||Board Of Regents, The University Of Texas System||Iontophoretic catheter device|
|US4413989||Aug 17, 1981||Nov 8, 1983||Angiomedics Corporation||Expandable occlusion apparatus|
|US4512338||Jan 25, 1983||Apr 23, 1985||Balko Alexander B||Process for restoring patency to body vessels|
|US4517979||Jul 14, 1983||May 21, 1985||Cordis Corporation||Detachable balloon catheter|
|US4522205||Sep 3, 1981||Jun 11, 1985||The University Court Of The University Of Edinburgh||Therapeutic device and method of inducing thrombosis in a blood vessel|
|US4538622||Nov 10, 1983||Sep 3, 1985||Advanced Cardiovascular Systems, Inc.||Guide wire for catheters|
|US4545367||Nov 18, 1983||Oct 8, 1985||Cordis Corporation||Detachable balloon catheter and method of use|
|US4545390||Sep 22, 1982||Oct 8, 1985||C. R. Bard, Inc.||Steerable guide wire for balloon dilatation procedure|
|US4554929||Jul 13, 1983||Nov 26, 1985||Advanced Cardiovascular Systems, Inc.||Catheter guide wire with short spring tip and method of using the same|
|US4576174||Jun 29, 1983||Mar 18, 1986||Shionogi & Company, Ltd.||Micro electrode|
|US4597389||Feb 25, 1985||Jul 1, 1986||Ibrahim Adel A||Device for removing objects from tubular body passages|
|US4613324||Jun 17, 1985||Sep 23, 1986||Ghajar Jamshid B G||Method and apparatus for guiding catheter into ventricular system of human brain|
|US4619274||Apr 18, 1985||Oct 28, 1986||Advanced Cardiovascular Systems, Inc.||Torsional guide wire with attenuated diameter|
|US4641654||Jul 30, 1985||Feb 10, 1987||Advanced Cardiovascular Systems, Inc.||Steerable balloon dilatation catheter assembly having dye injection and pressure measurement capabilities|
|US4655746||Dec 2, 1985||Apr 7, 1987||Target Therapeutics||Catheter device|
|US4660571||Jul 18, 1985||Apr 28, 1987||Cordis Corporation||Percutaneous lead having radially adjustable electrode|
|US4669465||Dec 10, 1984||Jun 2, 1987||Gv Medical, Inc.||Laser catheter control and connecting apparatus|
|US4682596||May 22, 1984||Jul 28, 1987||Cordis Corporation||Electrosurgical catheter and method for vascular applications|
|US4723556||Apr 14, 1986||Feb 9, 1988||Cordis Corporation||Intracranial ventricular catheter assembly|
|US4729914||May 22, 1987||Mar 8, 1988||Tyndale Plains-Hunter Ltd.||Hydrophilic coating and substrate coated therewith|
|US4735201||Jan 30, 1986||Apr 5, 1988||The Beth Israel Hospital Association||Optical fiber with detachable metallic tip for intravascular laser coagulation of arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas|
|US4739768||Jun 2, 1986||Apr 26, 1988||Target Therapeutics||Catheter for guide-wire tracking|
|US4748986||Jan 29, 1987||Jun 7, 1988||Advanced Cardiovascular Systems, Inc.||Floppy guide wire with opaque tip|
|US4782834||Jan 6, 1987||Nov 8, 1988||Advanced Cardiovascular Systems, Inc.||Dual lumen dilatation catheter and method of manufacturing the same|
|US4787899||Dec 10, 1986||Nov 29, 1988||Lazarus Harrison M||Intraluminal graft device, system and method|
|US4793359||Apr 24, 1987||Dec 27, 1988||Gv Medical, Inc.||Centering balloon structure for transluminal angioplasty catheter|
|US4800882||Mar 13, 1987||Jan 31, 1989||Cook Incorporated||Endovascular stent and delivery system|
|US4813934||Aug 7, 1987||Mar 21, 1989||Target Therapeutics||Valved catheter device and method|
|US4820298||Nov 20, 1987||Apr 11, 1989||Leveen Eric G||Internal vascular prosthesis|
|US4821722||Jan 6, 1987||Apr 18, 1989||Advanced Cardiovascular Systems, Inc.||Self-venting balloon dilatation catheter and method|
|US4830003||Jun 17, 1988||May 16, 1989||Wolff Rodney G||Compressive stent and delivery system|
|US4832047||Dec 15, 1987||May 23, 1989||Target Therapeutics||Guide wire device|
|US4838268||Mar 7, 1988||Jun 13, 1989||Scimed Life Systems, Inc.||Non-over-the wire balloon catheter|
|US4838879||May 1, 1987||Jun 13, 1989||Terumo Kabushiki Kaisha||Catheter|
|US4878906||Jun 6, 1988||Nov 7, 1989||Servetus Partnership||Endoprosthesis for repairing a damaged vessel|
|US4884579||Apr 18, 1988||Dec 5, 1989||Target Therapeutics||Catheter guide wire|
|US4907336||Sep 9, 1988||Mar 13, 1990||Cook Incorporated||Method of making an endovascular stent and delivery system|
|US4917088||Jan 30, 1989||Apr 17, 1990||C. R. Bard, Inc.||Balloon dilation probe|
|US4943278||Feb 29, 1988||Jul 24, 1990||Scimed Life Systems, Inc.||Dilatation balloon catheter|
|US4944746||Mar 14, 1989||Jul 31, 1990||Kabushiki-Kaisha Tokai-Rika-Denki-Seisakusho||Method of and apparatus for separating a balloon in a balloon catheter|
|US4950239||Aug 9, 1988||Aug 21, 1990||Worldwide Medical Plastics Inc.||Angioplasty balloons and balloon catheters|
|US4968306||Jul 7, 1989||Nov 6, 1990||Advanced Cardiovascular Systems, Inc.||Intravascular catheter having an adjustable length infusion section to delivery therapeutic fluid|
|US4969458||Jul 6, 1987||Nov 13, 1990||Medtronic, Inc.||Intracoronary stent and method of simultaneous angioplasty and stent implant|
|US4986830||Sep 22, 1989||Jan 22, 1991||Schneider (U.S.A.) Inc.||Valvuloplasty catheter with balloon which remains stable during inflation|
|US4989608||Apr 28, 1989||Feb 5, 1991||Ratner Adam V||Device construction and method facilitating magnetic resonance imaging of foreign objects in a body|
|US4991069||May 21, 1990||Feb 5, 1991||Welch Allyn, Inc.||End cap for rechargeable battery instrument handle|
|US4994069||Nov 2, 1988||Feb 19, 1991||Target Therapeutics||Vaso-occlusion coil and method|
|US4998933||Jun 10, 1988||Mar 12, 1991||Advanced Angioplasty Products, Inc.||Thermal angioplasty catheter and method|
|US5002556||Nov 27, 1987||Mar 26, 1991||Terumo Kabushiki Kaisha||Balloon catheter assembly|
|US5011482||May 3, 1989||Apr 30, 1991||Cook Pacemaker Corporation||Apparatus for removing an elongated structure implanted in biological tissue|
|US5019075||Jul 31, 1990||May 28, 1991||The Beth Israel Hospital||Method and apparatus for angioplasty|
|US5021043||Sep 11, 1989||Jun 4, 1991||C. R. Bard, Inc.||Method and catheter for dilatation of the lacrimal system|
|US5041090||Jan 12, 1988||Aug 20, 1991||Scheglov Viktor I||Occluding device|
|US5055101||Dec 8, 1989||Oct 8, 1991||Catheter Research, Inc.||Variable shape guide apparatus|
|US5061914||Jun 27, 1989||Oct 29, 1991||Tini Alloy Company||Shape-memory alloy micro-actuator|
|US5102390||May 2, 1985||Apr 7, 1992||C. R. Bard, Inc.||Microdilatation probe and system for performing angioplasty in highly stenosed blood vessels|
|US5104376||Dec 29, 1989||Apr 14, 1992||C. R. Bard, Inc.||Torsionally rigid balloon dilatation probe|
|US5108407||Jun 8, 1990||Apr 28, 1992||Rush-Presbyterian St. Luke's Medical Center||Method and apparatus for placement of an embolic coil|
|US5108416||Feb 13, 1990||Apr 28, 1992||C. R. Bard, Inc.||Stent introducer system|
|US5109867||Apr 19, 1991||May 5, 1992||Target Therapeutics||Extendable guidewire assembly|
|US5116652||Oct 13, 1989||May 26, 1992||Abbott Laboratories||Kink-resistant medical tubing and catheters|
|US5122136||Mar 13, 1990||Jun 16, 1992||The Regents Of The University Of California||Endovascular electrolytically detachable guidewire tip for the electroformation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas|
|US5133731||Nov 9, 1990||Jul 28, 1992||Catheter Research, Inc.||Embolus supply system and method|
|US5135516||Dec 15, 1989||Aug 4, 1992||Boston Scientific Corporation||Lubricious antithrombogenic catheters, guidewires and coatings|
|US5143085||Oct 1, 1990||Sep 1, 1992||Wilson Bruce C||Steerable memory alloy guide wires|
|US5154179||Jan 22, 1991||Oct 13, 1992||Medical Magnetics, Inc.||Device construction and method facilitating magnetic resonance imaging of foreign objects in a body|
|US5167624||Nov 9, 1990||Dec 1, 1992||Catheter Research, Inc.||Embolus delivery system and method|
|US5169386||Jun 25, 1990||Dec 8, 1992||Bruce B. Becker||Method and catheter for dilatation of the lacrimal system|
|US5171233||Apr 25, 1990||Dec 15, 1992||Microvena Corporation||Snare-type probe|
|US5171297||Apr 21, 1992||Dec 15, 1992||Angeion Corporation||Balloon catheter|
|US5178618||Jan 16, 1991||Jan 12, 1993||Brigham And Womens Hospital||Method and device for recanalization of a body passageway|
|US5180368||Oct 11, 1991||Jan 19, 1993||Advanced Cardiovascular Systems, Inc.||Rapidly exchangeable and expandable cage catheter for repairing damaged blood vessels|
|US5188621||Aug 26, 1991||Feb 23, 1993||Target Therapeutics Inc.||Extendable guidewire assembly|
|US5191297||Jul 25, 1991||Mar 2, 1993||Iomega Corporation||Transconductance amplifier having sensfets which drive a load with linearly proportional current|
|US5201323||Feb 20, 1991||Apr 13, 1993||Brigham & Women's Hospital||Wire-guided cytology brush|
|US5201754||Feb 2, 1990||Apr 13, 1993||C. R. Bard, Inc.||Balloon dilatation catheter with varying radiopacity|
|USRE32348||Dec 31, 1979||Feb 10, 1987|| ||Miniature balloon catheter method and apparatus|
|USRE33925||Dec 8, 1988||May 12, 1992||Cordis Corporation||Electrosurgical catheter aned method for vascular applications|
|1||"All Things Considered," of NPR, Jun. 28, 2000, Hour 1, pp. 10-20.|
|2||"Amendment in U.S. Appl. No. 07/492,717," Aug. 7, 1991, pp. 8.|
|3||"Amendment Under 37 C.F.R. § 1.111 in U.S. Appl. No. 08/147,529," Jun. 30, 1994, pp. 1-12.|
|4||"Dendron Electrolytically Detachable Coil (EDC II) Package Info.," 8 pages.|
|5||"Dendron Electrolytically Detachable Coils," Dendron GmbH, pp. 1-5, & Jul. 23, 2001.|
|6||"Dendron New Positioning System for the EDC II and VDS: Technical Note," 2 pages.|
|7||"Device for the Implantation of Occlusion Means," pp. 1-27.|
|8||"Excelsior 1018 Microcatheter," Boston Scientific Therapeutic, 2000, 4 pages.|
|9||"Guglielmi Detachable Coil (GDC®) Product Information Summary," 36 pages.|
|10||"Prowler Select: Microcatheter Select Performance," Cordis, 3 pages.|
|11||"Reaction to the Inventive Step Arguments From the Groeneveld Report of Nov. 4, 2002 on EP-B-0 484 468, EP-B-0 800 790, EP-B-0 804 905 in the case EV3 et al. / The Regents & Boston," 11 pages.|
|12||"Renegade Fiber Braided Microcatheter," Boston Scientific Target, 1998, 4 pages.|
|13||"Replication of the Thompson et al. Transcatheter Electrocoagulation Experimental Evaluation of the Anode Experiments," Apr. 30, 2003, 16 pages.|
|14||"Seeker Flexible 16," Target Therapeutics, 1 page.|
|15||"Seeker Lite™—10 Steerable Guidewire," Target Therapeutics, 1 page.|
|16||"Seeker® Standard 14 Steerable Guidewire," Target Therapeutics, 1 page.|
|17||"Spinnaker™ 1.8F-L w/Hydrolene® Flow Directed Catheter," Target Therapeutics, 1 page.|
|18||"Target Therapeutics: Recommended Start Up Products: Guglielmi Detachable Coil (GDC) (Investigational Device), " 1 page.|
|19||"Third Amendment After Final in U.S. Appl. No. 10/170,897," Dec. 2, 2002, 4 pages.|
|20||"Tracker® Excel™—14 Microcatheter Engineered for GDC® Coil Delivery," Boston Scientific Target, 1998, 4 pages.|
|21||"Tracker®—18 Hi-Flow Infusion Catheter Applications," Target Therapeutics, 1 page.|
|22||"Tracker®—18 Hi-Flow Infusion Catheter Specifications," Target Therapeutics, 1 page.|
|23||Abramson, H.A., "A Possible Relationship Between the Current of Injury and the White-Blood Cell in Inflamation," American J. Medical Sciences, 1924, pp. 702-711, vol. CLXVII.|
|24||Alksne et al. "Stereotaxic Occlusion of 22 Consecutive Anterior Communicating Artery Anuerysms," J. Neurosurg., 1980, pp. 790-793, vol. 52.|
|25||Alksne et al., "Stereotactic Occlusion of 22 consecutive anterior communicating artery anuerysms", J. Neurosurg., vol. 52, Jan. 1980, pp. 790-793.|
|26||Almgard, L.E. et al., "Embolic Occlusion of an Intrarenal Aneurysm: A Case Report," British Journal of Urology, 1973, pp. 485-486, vol. 45.|
|27||Amplatz, K., "A New, Simple Test for Thrombogenicity," Radiology, Jul.-Sep. 1976, pp. 53-55, vol. 120.|
|28||Amplatz, K., "Vessel Occlusion With Transcatheter Electrocoagulation: Negative Results," pp. 253-255.|
|29||Anderson et al, "Transcatheter Intravascular Coil Occlusion of Experimental Arteriovenous Fistulas", AM. J. Roentgenol. vol. 129, pp. 795-798, Nov. 1977.|
|30||Anderson et al., "Transcatheter Intravascular Coil Occlusion of Experimental Arteriovenous Fistulas," Am. J. Roentgenology, Oct./Nov. 1977, pp. 795-798, vol. 129.|
|31||Anderson, J. H. et al., ""Mini" Gianturco Stainless Steel Coils for Transcatheter Vascular Occlusion," Radiology, Aug. 1979, pp. 301-303, vol. 132, No. 2.|
|32||Araki et al., "Electrically Induced Thrombosis For The Treatment Of Intracranial Aneurysms And Angiomas," Department of Neurosurgery, Kyoto University Medical School, Kyoto, Japan, pp. 651-654.|
|33||Araki et al., "Electrically Induced Thrombosis for the Treatment of Intracranial Aneurysms and Angiomas", Excerpta Medica International Congress Series, Amsterdam 1965, vol. 110, pp. 651-654.|
|34||Araki, C. et al., "Electrically Induced Thrombosis for the Treatment of Intracranial Aneurysms and Angiomas," Proceedings of the Third International Congress of Neurological Surgery, Aug. 23-27, 1965, pp. 651-654.|
|35||ASNR Section, Highlights of the 28th Annual Meeting of the American Society or Neuroradiology, Los Angeles, CA, Mar. 19-23, pp. 1057-1069, 1990.|
|36||Auger, R. G. et al., "Management of Unruptured Intracranial Aneurysms," J. Stroke Cerebrovasc. Dis., 1991, pp. 174-181, vol. 1, No. 4.|
|37||Ausman, J. I. et al., "Current Management of Cerebral Aneurysms: Is It Based on Facts or Myths?" Surg. Neurol., 1985, pp. 625-634, vol. 24.|
|38||Barth, K. H. et al., "Chronic Vascular Reactions to Steel Coil Occlusion Devices," Am. J. Roentgenol., Sep. 1978, pp. 455-458, vol. 131.|
|39||Bavinzski, G. et al., "Gross and Microscopic Histopathological Findings in Aneurysms of the Human Brain Treated With Guglielmi Detachable Coils," J. Neurosurg., Jul. 1999, pp. 284-293, vol. 91, No. 1.|
|40||Bendok, B. et al., "Coil Embolization of Intracranial Aneurysms," Neurosurgery, May 2003, pp. 1125-1130, vol. 52, No. 5.|
|41||Berenstein, A., "Embolization of Spinal Cord AVMS," 4 pages.|
|42||Berenstein, A., "Tissue Response to Guglielmi Detachable Coils: Present Implications and Future Developments," AJNR, Apr. 1999, vol. 20.|
|43||Berenstein, A., et al., "Transvascular Treatment of Giant Aneurysms of the Cavernous Carotid and Vertebral Arteries," Surg Neurol, 1984, pp. 3-12, vol. 21.|
|44||Billmeyer, F.W., "Textbook of Polymer Science," 1961, pp. 108-113.|
|45||Blakemore, A. H. et al., "Electrothermic Coagulation of Aortic Aneurysms," The Journal of the American Medical Association, Oct. 1, 1938, pp. 1821-1827, vol. III, No. 20.|
|46||Blakemore, A.H., "Progressive Constrictive Occlusion of the Abdominal Aorta With Wiring and Electrothermic Coagulation," Annals of Surgery, Jan.-Jun. 1951, pp. 447-462, vol. 133.|
|47||Braun et al. "Use of Coils for Transcatheter Carotid Occlusion," AJNR, Dec. 1985, pp. 953-956, vol. 6.|
|48||Brendler, H. "Early Days of Urology At Mount Sinai," Urology, Jun. 1974, pp. 246-250, vol. III, No. 6.|
|49||Brunelle, F. et al., ""Micro" Stainless Steel Coils for Transcatheter Vascular Occlusion in Children," Pediatr. Radiol., 1983, pp. 332-334, vol. 13.|
|50||Brunelle, F. et al., "A Bipolar Electrode for Vascular Electrocoagulation With Alternating Current," Radiology, Oct.-Dec. 1980, pp. 239-240, vol. 137.|
|51||Bursch, J. H. et al., "Assessment of Arterial Blood Flow Measurement by Digital Angiography," Radiology, Oct. 1981, pp. 39-47, vol. 141.|
|52||Butto, F. et at., "Coil-In-Coil Technique for Vascular Embolization," Radiology, Nov. 1986, pp. 554-555, vol. 161.|
|53||Byrne et al., "The Nature Of Thrombosis Induced By Platinum And Tungsten Coils In Saccular Aneurisms," AJNR, 1997, pp. 29-33, vol. 18.|
|54||Byrne, J.V. et al., "The Nature of Thrombosis Induced by Platinum and Tungsten Coils in Saccular Aneurysms," Am J. Neuroradiology, Jan. 1997, pp. 29-33, vol. 18.|
|55||Canadian Patent Application No. 2,055,492, Patent Application File History, 93 pages.|
|56||Canadian Patent Application No. 2,160,640 Patent Application Status, 1 page.|
|57||Canadian Patent Application No. 2,179,863 Patent Application File History, 39 pages.|
|58||Casasco, A. E. et al., "Selective Endovascular Treatment of 71 Intracranial Aneurysms With Platinum Coils," J. Neurosurg., 1993, pp. 3-10, vol. 79.|
|59||Casasco, A. et al., "Percutaneous Transvenous Catheterization and Embolization of Vein of Galen Aneurysms," Neurosurgery, 1991, pp. 260-266, vol. 28.|
|60||Casta neda-Zuniga, WR; M Epstein, et al. "Embolization of Multiple Pulmonary Artery Fistulas," Radiology 134:309-10, Feb. 1980.|
|61||Castaneda-Zuniga et al., "A New Device For The Safe Delivery of Stainless Steel Coils," Radiology, Jul. 1980, pp. 230-131, vol. 136.|
|62||Castaneda-Zuniga, W. et al., "A New Device for the Safe Delivery of Stainless Steel Coils," Radiology, Jul. 1980, pp. 230-231, vol. 136.|
|63||Castaneda-Zuniga, W. R. et aL, "Nonsurgical Closure of Large Arteriovenous Fistulas," JAMA, Dec. 6, 1976, pp. 2649-2650, vol. 236, No. 23.|
|64||Castaneda-Zuniga, W. R. et al., "Experimental Venous Occlusion With Stainless Steel Spiders," Radiology, Oct.-Dec. 1981, pp. 238-242, vol. 141.|
|65||Castaneda-Zuniga, W. R. et al., "Single Barbed Stainless Steel Coils for Venous Occlusion a Single But Useful Modification," Investigative Radiology, Mar.-Apr. 1982, pp. 186-188, vol. 17, No. 2.|
|66||Castaneda-Zuniga, W. R. et al., "Therapeutic Embolization of Facial Arteriovenous Fistulae," Radiology, Jul.-Sep. 1979, pp. 599-602, vol. 132.|
|67||Castaneda-Zuniga, W.R. et al., "A Rare Source of Pulmonary Embolization in Catheterization Procedures," Radiology, Oct.-Dec. 1981, pp. 237-242, vol. 141.|
|68||Castel, J. C. et at, "Les Anevrysmes <<Hypergeants>> Intracraniens Sus-Tentoriels—Pieges Diagnostiques," J. Neuroradiology, 1985, pp. 135-149, vol. 12.|
|69||Castro, E. et al., "Long-Term Histopathologic Findings in Two Cerebral Aneurysms Embolized With Guglielemi Detachable Coils," AJRN, Apr. 1999, pp. 549-552, vol. 20.|
|70||Choi, I., "Spinal Cord Tumors," pp. 57-61.|
|71||Chuang, V. P. et al., "A New Improved Coil for Tapered-Tip Catheter for Arterial Occlusion," Radiology, May 1980, pp. 507-509, vol. 135.|
|72||Claiborne Johnston et al. "Recommendations For The Endovascular Treatment Of Intracranial Aneurysms," Stroke, 2002, pp. 2536-2544, vol. 33.|
|73||Cook Catalog with Hilal-Coils, 1988, pp. 1-5.|
|74||Cragg et al. "Nonsurgical Placement of Arterial Endoprostheses: A New Technique Using Nitinol Wire", Radiology, Apr. 1983, pp. 261-263, vol. 147.|
|75||Davis, P., "Southeastern Neuroradiological Society: 15th Annual Meeting, Oct. 2-6, 1991, Williamsburg, VA," AJNR, May/Jun. 1992, p. 1038, vol. 13.|
|76||de los Reyes, R. A. et al., "Transcallosal, Transventricular Approach to a Basilar Apex Aneurysm," Neurosurgery, Sep. 1992, p. 397, vol. 31, No. 3.|
|77||Debrun et al. "Detachable Balloon and Calibrated-leak balloon techniques in the treatment of cerebral vascular lesions," J. Neurosurg, 1978, pp. 635-649, vol. 49.|
|78||Debrun, et al., "Detachable balloon and calibrated-leak ballon techniques in the treatment of cerebral vascular lesions," J. Neurosurg, vol. 49, Nov. 1978, pp. 635-649.|
|79||Debrun, G. et al., "Experimental Approach to the Treatment of Carotid Cavernous Fistulas with an Inflatable and Isolated Balloon," Neuroradiology, 1975, pp. 9-12, vol. 9.|
|80||Debrun, G., "Dural AVM's of the Cavernous Sinus Region: Clinical Presentation, Angiographic Evaluation, Embolization and Complications," 2 pages.|
|81||Disclosure of Expert Testimony of Dr. Randall T. Higashida Under Fed. R. Civ. P. 26(A)(2), 198 pages.|
|82||Donauer et al., "Intracranial Aneurysms: The surgical and Endovascular Approach," Dendron, 2002, Lanzer and Topol eds., Springer Verlag, pp. 1154-1216.|
|83||Dovey et al. "Guglielmi Detachable Coiling For Intracranial Aneurysms," Arch Neurol., 2001, pp. 559-564, vol. 58,.|
|84||Dowd et al. "Endovascular Coil Embolization Of Unusual Posterior Inferior Cerebellar Artery Aneurysms," Neurosurgery, 1990, pp. 954-961, vol. 27.|
|85||Eskridge, J. M. et al., "Endovascular Embolization of 150 Basilar Tip Aneurysms With Guglielmi Detachable Coils: Results of the Food and Drug Administration Multicenter Clinical Trial," J. Neurosurg., Jul. 1998, pp. 81-86, vol. 89.|
|86||Formanek, A. et al., "Transcatheter Embolization (Interventive Radiology) in the Pediatric Age Group and Adolescent," Annales De Radiologie Medecine Nuceaire, Jan.-Feb. 1979, pp. 150-159, No. 1.|
|87||Fox, A., "Notes on the Working Group in Interventional Neuroradiology," AJNR, Jan. 13-20, 1990, pp. 840-841, vol. 11.|
|88||Fox, A., Highlights of the First Congress of the World Federation of Interventional and Therapeutic Neuroradiology, Oct. 11-13, 1991, Zurich, Switzerland,' pp. 1021-1023.|
|89||Fox, A.J. et al., "Use of Detachable Balloons for Proximal Artery Occlusion in the Treatment of Unclippable Cerebral Aneurysms," J Neurosurg, 1987, pp. 40-46, vol. 66.|
|90||Frazer, H., "Balloons and Electricity: Treating Brain Aneurysms," Diagnostic Imaging, Jul. 1990, pp. 115-117.|
|91||Gangarosa, E.J. et al., "Ristocetin-Induced Thrombocytopenia: Site and Mechanism of Action," A.M.A. Archives of Internal Medicine, 1960, pp. 83-89, vol. 105.|
|92||Gelfand, D. W. et al., "Gastric Ulcer Scars," Radiology, Jul. 1981, pp. 37-43, vol. 140, No. 1.|
|93||Gianturco et al., "Mechanical Devices For Arterial Occlusion", Am. J. Roentgenology Radium Therapy and Nuclear Medicine (AJR), 1975, pp. 428-435, vol. 124.|
|94||Gibbs, J., "Medical Device Investigations Understanding IRB and Informed Consent Requirements," Medical Device & Diagnostic Industry, Jun. 1989, pp. 103-106.|
|95||Gold, R. F. et al., "Transarterial Electrocoagulation Therapy of a Pseudoaneurysm in the Head of the Pancreas," Oct. 1975, pp. 422-426.|
|96||Goldman, M. L. et al., "Transcatheter Embolization With Bucrylate (In 100 Patients)," RadioGraphics, Aug. 1982, pp. 340-375, vol. 2, No. 3.|
|97||Gomes, A.S. et al., "The Use of the Bristle Brush for Transcatheter Embolization," Radiology, Nov. 1978, pp. 345-350, vol. 129.|
|98||Graves et al., "Treatment Of Carotid Artery Aneurysms With Platinum Coils: An Experimental Study In Dogs," AJNR, 1990, pp. 249-252, vol. 11.|
|99||Groeneveld, Y. G., "Rapport Intake EP-484.468 & EP-800.790 & EP-804.905 Niet-inbreuk & Ongeldigheid," 43 pages.|
|100||Guarda, F. et al., "Histological Reactions of Porous Tip Endocardial Electrodes Implanted in Sheep," pp. 267-273.|
|101||Guerrisi et al. "L'elettrotrombosi Intravasale Nelle Malformazioni Vascolari Sperimentalmente Provocate," Proceedings of the Bari Congress, Sep. 29/30, 1983, pp. 139-146, translation included.|
|102||Guglielm, G., "In Re: Radiologic and Histopathology Evaluation of Canine Artery Occlusion After Collagen-Coated Platinum Microcoil Delivery," Letters, p. 607.|
|103||Guglielmi et al., "Electrothrombosis Of Saccular Aneurysms Via Endovascular Approach, Part 1: Electrochemical Basis, Technique, And Experimental Results," J. Neurosurg., 1991, pp. 1-7, vol. 75.|
|104||Guglielmi et al., "Electrothrombosis Of Saccular Aneurysms Via Endovascular Approach, Part 21: Preliminary Clinical Experience," J. Neurosurg., 1991, pp. 8-14, vol. 75.|
|105||Guglielmi et al., "Intravascular Electrothrombosis in Experimentally Induced Vascular Malformation," Assoziazone Italiani di Neuroradiologia, Sep. 29-30, 1983, pp. 139-146.|
|106||Guglielmi Record of Invention Disclosure to UC, Jun. 15, 1989.|
|107||Guglielmi, G. et al., "Carotid-Cavernous Fistula Caused by a Ruptured Intracavernous Aneurysm: Endovascular Treatment by Electrothrombosis With Detachable Coils," Neurosurgery, Sep. 1992, pp. 591-597, vol. 31, No. 3.|
|108||Guglielmi, G. et al., "Detachable Microcoils in the Endovascular Treatment of Intracranial Aneurysms: Preliminary Clinical Experience," Endovascular Therapy, Session VII/Paper 35, p. 73.|
|109||Guglielmi, G. et al., "Detachable Microcoils in the Endovascular Treatment of Intracranial Aneurysms; Preliminary Clinical Experience."|
|110||Guglielmi, G. et al., "Electrothrombosis of Saccular Aneurysms Via Endovascular Approach, Part 2" J. Neurosurg., 1991, pp. 8-14, vol. 75.|
|111||Guglielmi, G. et al., "Endovascular Treatment of Intracranial Saccular Aneurysms With Detachable Coils and Electrothrombosis: Experience With 39 Cases," 1992 AANS Annual Meeting San Francisco, CA, Apr. 11-16, 1992.|
|112||Guglielmi, G. et al., "Endovascular Treatment of Posterior Circulation Aneurysms by Electrothrombosis Using Electrically Detachable Coils," J. Neurosurg., Oct. 1992, pp. 515-524.|
|113||Guglielmi, G., "Embolization Of Intracranial Aneurysms With Detachable Coils And Electrothrombosis," Interventional Neuradiology: Endovascular Therapy of the Central Nervous System, Ed. F. Vinuela et al. Raven Press, New York, 1992, pp. 63-75.|
|114||Guglielmi, G., "Historical Note," AJNR, 2002, p. 342, vol. 23.|
|115||Guglielmi, G., "Endovascular Treatment of Intracranial Aneurysms," Interventional Neuroradiology, May 1992, pp. 269-278, vol. 2, No. 2.|
|116||Guglielmi, G., "Generations of Guglielmi Detachable Coils," AJNR, Jun. 1997, p. 1195, vol. 16.|
|117||Guglielmi, G., Vinuela, Becker, D, et al: "Experimental endovascular occlusion of small and medium-sized saccular aneurysms by electrothrombosis. Potential uses in the clinical setting." In: Proceedings of the 58th Annual Meeting of the American Association of Neurological Surgeons, Nashville, Tennessee. Apr.-May 1990. (Presentation).|
|118||Gyo, K., "Hilstological Study of Chronic Electrode Implantation Through the Round Window of the Guinea Pig," Acta Otolaryngol (Stockh), 1988, pp. 248-254, vol. 105.|
|119||Halbach, V. V. et al., "Embolization of Brain AVMS With Particles," 4 pages.|
|120||Halbach, V. V. et al., "Paper 221: Metallic Fragment Emboli Resulting From Treatment With Electrolytically Detachable Coils (GDC)," Proceedings of the American Society of Neuroradiology (ASNR), May 3-7, 1994, pp. 155-156.|
|121||Halbach, V.V. et al., "Transvenous Embolization of Direct Carotid Cavernous Fistulas," AJNR, Jul./Aug. 1988, pp. 741-747, vol. 9.|
|122||Han, M. et al., "Gas Generation and Clot Formation During Electrolytic Detachment of Guglielmi Detachable Coils: In Vitro Observations and Animal Experiment," AJNR, Mar. 2003, pp. 539-544, vol. 24.|
|123||Handley, D. A. et al., "Colloidal Gold Labeling Studies Related to Vascular and Endothelial Function, Hemostasis and Receptor-Mediated Processing of Plasma Macromolecules," European Journal of Cell Biology, 1987, pp. 163-174, vol. 43.|
|124||Hanner et al., "Gianturco Coil Embolization Of Vein Of Galen Aneurysms: Technical Aspects," Radiographics, Sep. 1988, pp. 935-946, vol. 8, No. 5.|
|125||Hanner, J. et al., "Gianturco Coil Embolization of Vein of Galen Aneurysms: Technical Aspects," RadioGraphics, Sep. 1988, pp. 935-946, vol. 8, No. 5.|
|126||Hare, H. "Wiring With Electrolysis in Saccular Aneurysm," Jour. A.M.A (JAMA), 38:230-232, Jan. 22, 1927.|
|127||Hawkins et al., "Retrievable Gianturco-Coil Introducer," Radiology, Jan. 1986, pp. 262-264.|
|128||Heilman, C. B. et al., "Elimination of a Cirsoid Aneurysm of the Scalp by Direct Percutaneous Embolization With Thrombogenic Coils," J. Neurosurg., 1990, pp. 296-300, vol. 73.|
|129||Heros, R. C., "Intracranial Aneurysms," Minnesota Medicine, Oct. 1990, pp. 27-32, vol. 73.|
|130||Hieshima, G. B. et al., "Intracranial Embolotherapy: Plugging Aneurysms With Balloons," Diagnostic Imaging, 1986.|
|131||Higashida et al., "Interventional Neurovascular Treatment Of A Giant Intracranial Aneurysm Using Platinum Microcoils," Surg. Neurol., Jan. 1991, pp. 64-68, vol. 35, No. 1.|
|132||Hilal Coils in Cook Incorporated Catalog, 1988, 9 pages.|
|133||Hilal et al., "Synthetic Fiber-Coated Platinum Coils Successfully Used for the Endovascular Treatement of Arteriovenous Malformations, Aneurysms And Direct Arteriovenous Fistulas Of The CNS," 26th Annual Meeting, Session 10G, Paper 175, 1988.|
|134||Hilal presentation at Stonwin Medical Conference, Scarsdale, NY, Jul. 10-12, 1989. "Treatment of Intracranial aneurysms and arteriovenous malformations with preshaped thrombogenic coils". Hilal SK.|
|135||Hilal, et al., "Synthetic Fiber-Coated Platium Coils Successfully Used for the Endovascular Treatment of Arteriovenous Malformations, . . . ", Twenty-Sixth Annual Meeting, Session 10G, Paper 175, May 15, 1988.|
|136||Hilal, S. K. et al., "Synthetic Fiber-Coated Platinum Coils Successfully Used for the Endovascular Treatment of Arteridvenous Malformations, Aneurysms and Direct Arteriovenous Fistulas of the CNS," ASNR Twenty-Sixth Annual Meeting, May 15-20, 1988, pp. 224-225.|
|137||Hilal, S. K. et al., Endovascular Treatment of Aneurysms With Coils, J. Neurosurg., Feb. 1992, pp. 337-339, vol. 76.|
|138||Hodes, J. E. et al., "Endovascular Occlusino of Intracranial Vessels for Curative Treatment of Unclippable Aneurysms: Report of 16 Cases," J. Neurosurg., 1991, pp. 694-701, vol. 75.|
|139||Horowitz et al., "Does Electrothrombosis Occur Immediately After Embolization Of An Aneurysm With Guglielmi Detachable Coils," AJNR, 1997, pp. 510-513, vol. 18.|
|140||Horowitz, M. B. et al., "Scanning Electron Microscopic Findings in a Basilar Tip Aneurysm Embolized With Guglielmi Detachable Coils," AJRN, Apr. 1997, pp. 688-690, vol. 18.|
|141||Horowitz, M. et al., "Does Electrothrombosis Occur Immediately After Embolization of an Aneurysm With Guglielmi Detachable Coils," AJNR, Mar. 1997, pp. 510-513, vol. 18.|
|142||Hosobuchi, "Electrothrombosis Carotid-Cavernous Fistula", J. Neurosurg., vol. 42, Jan. 1975, pp. 76-85.|
|143||Hosobuchi, Y., "Electrothrombosis Of Carotid-Cavernous Fistula," J. Neurosurg., Jan. 1975, pp. 76-85, vol. 42.|
|144||Huckman, M. et al., "Highlights of the 28th Annual Meeting of the American Society of Neuroradiology, Los Angeles, Mar. 19-23, 1990," AJNR, Sep./Oct. 1990, pp. 1057-1068.|
|145||Huckman, M. et al., "Meeting Summaries, XIVth Symposium Neuroradiologicum: Jun. 17-23, 1990, the Queen Elizabeth Centre, London," AJNR, Nov./Dec. 1990, pp. 1273-1279, vol. 11.|
|146||Huckman, M., "Founding of the Mexican Society of Diagnostic and Therapeutic Neuroradiology (SMNR)," AJNR, May/Jun. 1992, pp. 1024-1026, vol. 13.|
|147||Hunner, G.L., "Aneurysm Of The Aorta Treated By The Insertion Of A Permanent Wire And Galvanism Moore-Corradi Method," Bulletin of the Johns Hopkins Hospital; 1900, pp. 263-279, vol. XI, No. 116.|
|148||Ison, K. T., " Platinum and Platinum/Iridium Electrode Properties When Used for Extracochlear Electrical Stimulation of the Totally Deaf," Medical & Biological Engineering & Computing, Jul. 1987, pp. 403-413, vol. 25.|
|149||J. Piton et al., "Selective Vascular Thrombosis Induced by a Direct Electrical Current; Animal Experiments", J. Neuroradiology, vol. 5, pp. 139-152 (1978).|
|150||Ji et al., "Endovascular Electrocoagulation: Concept, Technique, And Experimental Results," AJNR, 1997, pp. 1669-1678, vol. 18.|
|151||Johnston, S.C. et al., "Recommendations for the Endovascular Treatment of Intracranial Aneurysms," Stroke, 2002, pp. 2536-2544, vol. 33.|
|152||Joseph, GJ. "Platinum Wire Microcoils for Transvascular Embolization with Microcatheter Systems," Radiology, 169(P):341, 1988.|
|153||Kassell, N. F. et al., "The International Cooperative Study on the Timing of Aneurysm Surgery," J. Neurosurg., 1990, pp. 18-36, vol. 73.|
|154||Kassell, N. F. et al., "Timing of Aneurysm Surgery," Neurosurgery, 1982, pp. 514-519, vol. 10.|
|155||Kichikawa, K. et al., "Iliac Artery Stenosis and Occlusion: Preliminary Results of Treatment With Gianturco Expandable Metallic Stents," Radiology, pp. 799-802, vol. 177, No. 3.|
|156||Konishi et al., "Congenital Fistula Of The Dural Carotid-Cavernous Sinus: Case Report And Review Of The Literature," Neurosurgery, 1990, pp. 120-125, vol. 27, No. 1.|
|157||Konishi Y. et al., "Evaluation of Acute Thrombogenesis of Microcoil for Treatment of Experimental Aneurysms," 1 page.|
|158||Kwan, E.S.K. et al., "Enlargement of Basilar Artery Aneurysms Following Balloon Occlusion-"Water Hammer Effect"" J Neurosurg, 1991, pp. 963-968, vol. 75.|
|159||Kwan, E.S.K. et al., "Enlargement of Basilar Artery Aneurysms Following Balloon Occlusion—"Water Hammer Effect"" J Neurosurg, 1991, pp. 963-968, vol. 75.|
|160||Lammer, J. Biliary Endoprostheses; Radiologic Clinics of North America, Nov. 1990, pp. 1211-1222, vol. 28, No. 6.|
|161||Lane, B. et al., "Coil Embolization of an Acutely Ruptuired Saccular Aneurysm," AJRN, Nov./Dec. 1991, pp. 1067-1069, vol. 12.|
|162||Leonardi, M., "A History of Neuroradiology in Italy," AJRN, Apr. 1996, pp. 721-730, vol. 17.|
|163||Linton, R. et al., "Treatment of Thoracic Aortic Aneurysms by the "Pack" Method of Intrasaccular Wiring," The New England Journal of Medicine, Jan.-Jun. 1952, pp. 847-855, vol. 246.|
|164||Linton, R. R. et al., "Treatment of Thoracic Aortic Aneurysms by the "Pack" Method of Intrasaccular Wiring," The New England Journal of Medicine, Jan.-Jun. 1952, pp. 847-855, vol. 246.|
|165||Linton, R., "Intrasaccular Wiring of Abdominalarteriosclerotic Aortic Aneurysms by the "Pack" Method," Angiology, 1951, pp. 485-498, vol. II.|
|166||Ljunggren, B. et al., "Early Management of Aneurysmal Subarachnoid Hemorrhage," Neurosurgery, 1981, pp. 412-418, vol. 11, No. 3.|
|167||Ljunnggren, B. et al., "Early Operation and Overall Outcome in Aneurysmal Subarachnoid Hemorrhage," J. Neurosurg., Apr. 1985, pp. 547-551, vol. 62.|
|168||Loucks, R. B. et al., "The Erosion of Electrodes by Small Currents," Electrocephalography and Clinical Neurophysiology, 159, pp. 823-826, vol. IX.|
|169||Lozier, A. P. et al., "Guglielmi Detachable Coil Embolization of Posterior Circulation Aneurysms," Stroke, Oct. 2002, pp. 2509-2518.|
|170||Lund et al., "Detachable Steel Spring Coils For Vessel Occlusion," Radiology, May 1985, p. 530, vol. 155.|
|171||Lund, G. et al., "Detachable Stainless-Steel Spider," Radiology, Aug. 1983, pp. 567-568, vol. 148, No. 2.|
|172||Lylyk et al., "Therapeutic Alternatives For Vein Of Galen Vascular Malformations," J. Neurosurg., Mar. 1993, pp. 438-445, vol. 78.|
|173||Lylyk, P. et al., "Therapeutic Alternatives for Vein of Galen Vascular Malformations," J. Nurosurg., Mar. 1993, pp. 438-445, vol. 78.|
|174||Malisch, T. et al., "What You Should Know About Aneurysms," brochure, 6 pages.|
|175||Manabe, H. et al., "Embolisation of Ruptured Cerebral Aneurysms With Interlocking Detachable Coils in Acute Stage," Interventional Neuroradiology, 1997, pp. 49-63, vol. 3.|
|176||Marshall, M. W. et al., "Ferromagnetism and Magnetic Resonance Artifacts of Platinum Embolization Microcoils," Cardiovasc. Intervent. Radiol., 1991, pp. 163-166, vol. 14.|
|177||Marsman et al., "A Safe Technique For The Delivery Of 'Mini' Gianturco Stainless Steel Coils," Diagnostic Imaging, 1981, pp. 43-46, vol. 50.|
|178||Marsman et al., "A Safe Technique For The Delivery Of ‘Mini’ Gianturco Stainless Steel Coils," Diagnostic Imaging, 1981, pp. 43-46, vol. 50.|
|179||Marsman, "Evaluation of a New Distal Delivery Guidewire for Steel Coils," Europ. J. Radiol., 2:250-253, 1982.|
|180||Marsman, J.W.P. et al., "A Safe Technique for the Delivery of ‘Mini’ Gianturco Stainless Steel Coils," Diagnostic Imaging, 1981, pp. 43-46, vol. 50.|
|181||Massoud, T.F. et al., "Laboratory Simulations and Training in Endovascular Embolotherapy with a Swine Arteriovenous Malformation Model," AJNR, Feb. 1996, pp. 271-279, vol. 17.|
|182||Mazer, M. J. et al., "Therapeutic Embolization of the Renal Artery With Gianturco Coils: Limitations and Technical Pitfalls," Radiology, Jan. 1981, pp. 37-46, vol. 138.|
|183||McAlister et al., "Occlusion Of Acquired Renal Arteriovenous Fistula With Transcatheter Electrocoagulation," Am. J. Roentgenol., Jun. 1979, pp. 998-1000, vol. 132.|
|184||McAlister et al., "Transcatheter Electrocoagulation Of The Pulmonary Artery: An Experimental Model In Dogs For Studying Pulmonary Thrombosis," Invest Radiol., 1981, pp. 289-297, vol. 16.|
|185||McAlister, D.S. et al., "Occlusion of Acquired Renal Arteriovenous Fistula With Transcatheter Electrocoagulation," AJR, Jun. 1979, pp. 998-1000, vol. 132.|
|186||McConnell, A. A., "Subchiasmal Aneurysm Treated by Implantation of Muscle," Zentralblatt Fur Neurochirurgie, 1937, pp. 269-274, No. 5-6.|
|187||McDermott, J. C. et al., "Review of the Uses of Digital Roadmap Techniques in Interventional Radiology," CIRSE-SCVIR, Jun. 12-17, 168, pp. 11-13.|
|188||McDougall, C. G. et al., "Endovascular Treatment of Basilar Tip Aneurysms Using Electrolytically Detachable Coils," J. Neurosurg., Mar. 1996, pp. 393-399, vol. 84.|
|189||McDougall, C.G. et al., "Causes and Management of Aneurysmal Hemmorage Occurring During Embolization With Guglielmi Detachable Coils," J. Neurosurg., 1998, pp. 87-92, vol. 89.|
|190||McKissock, W., "Anterior Communicating Aneurysms a Trial of Conservative and Surgical Treatment," The Lancet, Apr. 24, 1965, pp. 873-876.|
|191||MDR Database , Brand Name Flex-Tip Guidewire and Tracker Hi-Flow, 1998, Access No. M162232.|
|192||MDR Database, Brand Name 10 Unibody Infusion Catheter, May 1991, Access No. M231556.|
|193||MDR Database, Brand Name Target Therapeutics Coil Pusher 16, Dec. 1989, Access No. M181514.|
|194||MDR Database, Brand Name Target Therapeutics Coil Pusher 16, Jan. 1990, Access No. M183709.|
|195||MDR Database, Brand Name Target Therapeutics Tracker 18 Catheter, 1991, Access No. M235647.|
|196||MDR Database, Brand Name Target Therapeutics Tracker 18 LF Catheter, 1990, Access No. M220254.|
|197||MDR Database, Brand Name Target Therapeutics Tracker 18 Unibody Catheter, Oct. 1991, Access No. M246650.|
|198||MDR Database, Brand Name Target Therapeutics, 1990, Access No. M183708.|
|199||MDR Database, Brand Name Tracker 18 Dual Marker, Jan. 1992, Access No. M264109.|
|200||Mehringer, C.M. et al., "Therapeutic Embolization for Vascular Trauma of the Head and Neck," AJNR, pp. 137-142, Mar.-Apr. 1983, vol. 4.|
|201||Mickle, J.P. et al., "The Transtorcular Embolization of Vein of Galen Aneurysms," J. Neurosurg., May 1986, vol. 64., pp. 731-735.|
|202||Micropaw 20 Micro-Plasma Welding Systems, 1 page.|
|203||Miller et al., "Clinical Use Of Transcatheter Electrocoagulation," Radiol., 1978, pp. 211-214, vol. 129.|
|204||Miller, D.L., "Arterial Occlusion With Coils," Arch. Intern. Med., Sep. 1985, p. 1737, vol. 145.|
|205||Mizoi, K. et al., "A Pitfall in the Surgery of a Recurrent Aneurysm After Coil Embolization and Its Histological Observation: Technical Case Report," Neurosurgery, Jul. 1996, vol. 39, No. 1.|
|206||Molyneux, A. J. et al., "Histological Findings in Giant Aneurysms Treated With Guglielmi Detachable Coils," J. Neurosurg., 1995, pp. 129-132, vol. 83.|
|207||Morag et al., "The Role of Spermatic Venography After Surgical High Ligation of the Left Spermatic Veins: Diagnosis and Percutaneous Occlusion," Urologic Radiology, 1985, pp. 32-34, vol. 7.|
|208||Morse et al., "Platinum Microcoils For Therapeutic Embolization: Nonneuroradiologic Applications," AJR, 1990, pp. 401-403, vol. 155.|
|209||Mullan et al., "Electrically Inducted Thrombosis In Intracranial Aneurysms," J. Neurosurg., Jan.-Jun. 1965, pp. 539-547, vol. 22.|
|210||Mullan et al., "Stereotactic Copper electric Thrombosis of Intracranial Aneurysms," Progr. Nuerol. Surg., 1969, pp. 193-211, vol. 2.|
|211||Mullan et al., "Stereotactic Copper electric Thrombosis of Intracranial Aneurysms," Progr. nuerol., Surg., vol. 3, pp. 193-211 (1969).|
|212||Mullan, "Eperiences with Surgical Thrombosis of Intracranial Berry Aneurysms and Carotide Cavernous Fistulas", J. Neurosurg., vol. 41, Dec. 1974, pp. 657-670.|
|213||Mullan, S. et al., "Simplified Thrombosis of a Large, Hypertrophic Hemangioma of the Scalp," J. Neurosurg., 1964, pp. 68-72, vol. XXI.|
|214||Mullan, S., "Experiences with Surgical Thrombosis of Intracranial Berry Aneurysms and Cartotid Cavernour Fistulas," J. Neurosurg., 1974, pp. 657-670, vol. 41.|
|215||Murayama, Y. et al., "Guglielmi Detachable Coil Embolization of Cerebral Aneurysms: 11 Years' Experience," J. Neurosurg., 2003, pp. 959-966, vol. 98.|
|216||Murayama, Y. et al., "Ion Implantation: A New Experimental Approach to Surface Modification of Electrolytically Detachable Coils," 1 page.|
|217||Nahser, H. C. et al., "Okklusion Von Aneurysmata Mit Platincoils," Neuroradiologie des Alfred-Krupp-Krankenhauses, pp. 203-207.|
|218||Nakahara, I. et al., "Endovascular Coil Embolization of a Recurrent Giant Internal Carotid Artery Aneurysm Via a Posterior Communicating Artery After Cervical Carotid Litigation: Case Report," Surg. Neurol., 1992, pp. 57-61, vol. 38.|
|219||Nakahara, I. et al., "Treatment of Giant Anterior Communicating Artery Aneurysm Via an Endovascular Approach Using Detachable Balloons and Occlusive Coils," AJNR, Nov./Dec. 1990, pp. 1195-1197, vol. 11.|
|220||Nancarrow, P. A. et al., "Stability of Coil Emboli: An In Vitro Study," Cardiovasc. Intervent. Radiol., 1987, pp. 226-229, vol. 10.|
|221||Nasa Tech Briefs; "Implantable Electrode for Critical Locations," Aug. 1990, p. 74.|
|222||Nishioka H. et al., "Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage: A Long-Term Prognostic Study," Arch. Neurol., Nov. 1984, vol. 41.|
|223||Numoguchi, Y. et al., "Platinum Coil Treatment of Complex Aneurysms of the Vertebrobasilar Circulation," Neuroradiology, 1992, pp. 252-255, vol. 34.|
|224||Okazaki, M. et al., "A Coaxial Catheter and Steerable Guidewire Used to Embolize Branches of the Splanchnic Arteries," AJR, Aug. 1990, pp. 405-406, vol. 155.|
|225||O'Reilly, G. V. et al., "Transcatheter Fiberoptic Laser Coagulation of Blood Vessels," Radiology, Mar. 1982, pp. 777-779, vol. 142, No. 3.|
|226||Ovitt et al., "Guide Wire Thrombogenicity and Its Reduction," Radiology, 1974, pp. 43-46, vol. 111, No. 1.|
|227||Padolecchia, R. et al., "Role of Electrothrombosis in Aneurysm Treatment With Guglielmi Detachable Coils: An In Vitro Scanning Electron Microscopic Study," AJNR, Oct. 2001, pp. 1757-1760, vol. 22.|
|228||Pakarinen, S., "Incidence, Aetiology and Prognosis of Primary Surarachnoid Haemorrhage," Acta Neurologica Scandinavica, 1967, pp. 9-128, Supplementum 29, vol. 43.|
|229||Parsonnet, V. et al., "Corrosion of Pacemaker Electrodes," Pace, May-Jun. 1981, pp. 289-297, vol. 4.|
|230||Peerless, S. J. et al., "Giant Intracranial Aneurysms," Vascular Disease, Chapter 57, 1987, pp. 1742-1763.|
|231||Peterson, E. W. et al., (abstract) "291. Electrically Induced Thrombosis of the Cavernous Sinus in the Treatment of Carotid Cavernous Fistula," Fourth Internatinal Congress of Neurological Surgery Ninth International Congress of Neurology, Sep. 20-27, 1969, p. 105.|
|232||Pevsner, Paul. "Micro-Balloon Catheter for Superselective Angiography and Therapeutic Occlusion," AMJR, Feb. 1977, pp. 225-230, vol. 128.|
|233||Phillips, J., "Transcatheter Electrocoagulation of Blood Vessels," Invest. Rad., 1973, pp. 295-304, vol. 8.|
|234||Phillips, J.F. et al., "Experimental Closure of Arteriovenous Fistula by Transcatheter Electrocoagulation," Diagnostic Radiology May 1975, pp. 319-321, vol. 115.|
|235||Phillips, J.F., "Transcatheter Electrocoagulation of Blood Vessels," Investigative Radiology, Sep.-Oct. 1973, pp. 295-304, vol. 8.|
|236||Philpott et al., "The Mechanism of Transcatheter Electrocoagulation (TCEC)," Investigative Radiology, 1983, pp. 100-104, vol. 18.|
|237||Piton et al., "Embolisation Par Courant Electrique Continu : ECEC," J. Radiol., 1979, pp. 799-808, vol. 60, No. 12 (including English translation).|
|238||Piton et al., "Selective Vascular Thrombosis Induced by a Direct Electrical Current: animal experiments," J. Neuroradiology, 1978, pp. 139-152, vol. 5.|
|239||Piton et al., "Vascular Thrombosis Induced by Direct Electrical Current," Neuroradiology, 1978, pp. 385-388, vol. 16.|
|240||Probst, P. et al., "Nonsurgical Treatment of Splenic-Artery Aneurysms," Radiology, Jul.-Sep. 1978, pp. 619-623, vol. 128.|
|241||Probst, P. et al., "Which Embolic Material Is Best Suited for Which Embolization Procedure?" Fortschr. Rontgenstr., 1978, pp. 447-454, vol. 129, No. 4.|
|242||Purdy, P.D., "Imaging Cerebral Blood Flow in Interventional Neuroradiology: Choice of Technique and Indications," AJNR, May/Jun. 1991, pp. 424-427, vol. 12.|
|243||Quereshi, A.I. et al., "Endovascular Treatment of Intracranial Aneurysms by Using Guglielmi Detachable Coils in Awake Patients: Safety and Feasability," Neurosurgery Focus, May 2001, pp. 1-6, vol. 10, No. 5.|
|244||Quinn, S. F. et al., "Complications From 0.018-in. Floppy Platinum-Tip Guidewires," AJR, May 1990, pp. 1103-1104, vol. 154.|
|245||Qureshi et al., "Endovascular Treatment of Intracranial Aneurysm by Using Guglielmi Detachable Coils in Awake Patients: Safety and Feasability," Neurosurg. Focus, 2001, pp. 1-6, vol. 10, No. 5.|
|246||Ralston, M. D. et al., "Effect of Increasing Current and Decreasing Blood Flow for Transcatheter Electrocoagulation (TCEC)," Investigative Radiology, Mar.-Apr. 1982, pp. 171-177, vol. 17, No. 2.|
|247||Rao, V. R. et al., "Embolization of Large Saccular Aneurysms With Gianturco Coils," Radiology, 1990, pp. 407-410, vol. 175.|
|248||Reul, J. et al., "Long-Term Angiographic and Histopathologic Findings in Experimental Aneurysms of the Carotid Bifurcation Embolized With Platinum and Tungsten Coils," AJRN, Jan. 1997, pp. 35-42, vol. 18.|
|249||Rodriguez, F., "Principles of Polymer Systems," Second Edition, 1982, pp. 534-537.|
|250||Rufenacht, D. et al., "Principles and Methodology of Intracranial Endovascular Access," Interventional Neuroradiology, May 1992, pp. 251-268, vol. 2, No. 2.|
|251||Ruscalleda, J. et al., "Neuroradiological Features of Intracranial and Intraorbital Meningeal Haemangiopericytomas," Neuroradiology, 1994, pp. 440-445, vol. 36.|
|252||Russell, E., "Highlights of the Scientific Exhibits of the 29th Annual Meeting of the American Society of Neuroradiology, Washington, D.C., Jun. 9-14, 1991," pp. 1251-1257.|
|253||Sadato et al., "Treatment of a Spontaneous Carotid Cavernous Fistula Using an Electrodetachable Microcoil," AJNR, 1993, pp. 334-336, vol. 14.|
|254||Sadato et al., "Immediately Detachable Coil for Aneurysms Treatment," ANJR 16: 1459-1462 Aug. 1995.|
|255||Sadato, A. et al., "Immediately Detachable Coil for Aneurysm Treatment," AJRN, Aug. 1995, pp. 1459-1462, vol. 16.|
|256||Sadato, A. et al., "Treatment of a Spontaneous Carotid Cavernous Fistula Using an Electrodetachable Microcoil," AJNR, Mar./Apr. 1993, pp. 334-336, vol. 14.|
|257||Salazar, A. E., "Experimental Myocardial Infarction," Circulation Research, Nov. 1961, vol. IX.|
|258||Samuelsson L. et al., "Electrolytic Destruction of Tissue in the Normal Lung of the Pig," Acta Radiologica Diagnosis, 1981, pp. 9-14, vol. 22.|
|259||Samuelsson, L. et al., "Electrocoagulation," Acta Radiologica Diagnosis, 1982, pp. 459-462, vol. 23.|
|260||Sawyer et al. "Bio-Electric Phenomena as an Etiological Factor in Intravascular Thrombosis," Am. J. Physiol., 1953, pp. 103-107, vol. 175.|
|261||Sawyer et al., "Bio-Electric Phenomena as an Etiological Factor in Intravascular Thrombosis", Am., J. Physiol., vol. 175, pp. 103-107 (1953).|
|262||Sawyer, P. N. et al., "Electrical Potential Differences Across the Normal Aorta and Aortic Grafts of Dogs," Am. J. Physiol., Oct. 1953, pp. 113-117, vol. 175.|
|263||Serbinenko, "Balloon catherization and occlusion of major cebral vessels," J. Neurosurg., vol. 41, Aug. 1974, pp. 125-145.|
|264||Serbinenko, F. A., "Balloon Catheterization and Occlusion of Major Cerebral Vessels," J. Neurosurg., Aug. 1974, vol. 41.|
|265||Serbinenko, F., "Balloon Catherization and Occlusion of Major Cerebral Vessels," J. Neurosurg., 1974, pp. 125-145, vol. 41.|
|266||Setton, A. et al., "Interventional Neuroradiology," Current Opinion in Neurology and Neurosurgery, 1992, pp. 870-880, vol. 5.|
|267||Shah, P. M. et al., "Pseudoaneurysm of Anterior Tibial Artery After Occlusion From Blunt Trauma: Nonoperative Management," The Journal of Trauma, 1985, pp. 656-657, vol. 25, No. 7.|
|268||Shimizu, S. et al., "Tissue Response of a Small Saccular Aneurysm After Incomplete Occlusion With a Guglielmi Detachable Coil, "AJNR, Apr. 1999, pp. 546-548, vol. 20.|
|269||Sorteberg, A. et al., "Effect of Guglielmi Detachable Coils on Intraaneurysmal Flow: Experimental Study in Canines," AJNR, Feb. 2002, pp. 288-294, vol. 23.|
|270||Sosman, M. C. et al., "Aneurysms of the Internal Carotid Artery and the Circle of Willis, From a Roentgenological Viewpoint," The American Journal of Roentgenology and Radium Therapy, Jan.-Jun. 1926, vol. XV.|
|271||Steiner, L., "Gamma Knife Radiosurgery in Arteriovenous Malformations of the Brain," 6 pages.|
|272||Strother, C., "Electrothrombosis of Saccular Aneurysms Via Endovascular Approach Part 1 and Part 2," AJNR, May 2001, pp. 1010-1012, vol. 22.|
|273||Strother, C., ed., "Electrothrombosis of Saccular Aneurysms Via Endovascular Approach: Part 1 and Part 2", AJNR, 2002, pp. 1011-1012, vol. 22.|
|274||Strother, C.M., "Electrothrombosis of Saccular Aneurysms Via Endovascular Approach: Part 1 and Part 2," Historical Perspective, AJNR, May 2001, pp. 1011-1012, vol. 22.|
|275||Taki et al., "Radiopaque Solidifying Liquids for Releasable Balloon Technique: A Technique Note," Surg. Neurol., 1980, pp. 140-142, vol. 13.|
|276||Taki et al., "Selection and Combination of Various Endovascular Techniques in the Treatment of Giant Aneurysms," J. Neurosurg., 1992, pp. 37-42, vol. 77.|
|277||Taki, W. et al., "Balloon Embolization of a Giant Aneurysm Using a Newly Developed Catheter," Surg. Neurol., Nov. 1979, pp. 363-365, vol. 12.|
|278||Taki, W. et al., "Radiopaque Solidifying Liquids for Releasable Balloon Technique: A Technical Note," Surg. Neurol., Feb. 1980, pp. 140-142, vol. 13.|
|279||Target Therapeutic Dec. 3, 1991 letter to Food and Drug Administration with Submission of Supplemental IDE-G900241-Detachable Platinum Coil.|
|280||Target Therapeutic Dec. 3, 1991 letter to Food and Drug Administration with Submission of Supplemental IDE—G900241—Detachable Platinum Coil.|
|281||Target Therapeutics Catalogue 1993-95, 1997, 2003.|
|282||Target Therapeutics, "History of the Guglielmi Detachable Coil," History of the GDC, Oct. 1995, pp. 1-6.|
|283||Terbrugge, K., "Duram AVMs of the Posterior Fossa: Clinical Presentation, Classification, Angiographic Evaluation and Treatment," 4 pages.|
|284||Thompson et al., "Transcatheter Electrocoagulation: A Therapeutic Angiographic Technique for Vessel Occlusion," Invest. Radiol., 1977, pp. 146-153, vol. 12.|
|285||Thompson et al., "Transcatheter Electrocoagulation: Experimental Evaluation of the Anode," Invest. Radiol., 1979, pp. 41-47, vol. 14.|
|286||Thompson et al., "Vessel Occlusion With Transcatheter Electrocoagulation," Cardio Vasc. Intervent. Radiol., 1980, pp. 244-253, vol. 3.|
|287||Thompson et al., "Vessel Occlusion With Transcatheter Electrocoagulation: Initial Clinical Experience." Radiol., 1979, pp. 335-340, vol. 133.|
|288||Thompson et al., "Transcatheter Electrocoagulation; Experimental Evaluation of the Anode", Investigative Radiology, vol. 14, Jan.-Feb. 1979, pp. 41-47.|
|289||Thompson, W. M. et al., "Vessel Occlusion With Transcatheter Electrocoagulation," Cardiovasc. Intervent. Radiol., 1980, pp. 244-255, vol. 3, No. 4.|
|290||Thompson, W. M. et al., "Vessel Occlusion With Transcatheter Electrocoagulation: Initial Clinical Experience," Radiology, Oct.-Dec. 1979, pp. 335-340, vol. 133.|
|291||Tragardh, Bengi et al., "Intravascular Electrically Inducted Thrombosis in the Dog," Radiology, Oct.-Dec. 1976, pp. 55-56, vol. 121.|
|292||Vinuela, F. et al., "Electrolytically Detachable Microcoils," AJNR, Mar./Apr. 1993, pp. 337-339, vol. 14.|
|293||Vinuela, F. et al., "Embolization of Brain AVMs With Liquids," 4 pages.|
|294||Wallace et al., "Therapeutic Vascular Occlusion Utilizing Steel Coil Technique: Clinical Applications," American J. Roentgenology,1976, pp. 381-387, vol. 127.|
|295||Wallace, S. et al., "Steel Coil Embolus and Its Therapeutic Applications," Abrams Angiography, 1983, pp. 2151-2173, Third Edition, vol. III.|
|296||Werner, S. C. et al., "Aneurysm of the Internal Carotid Artery Within the Skull," The Journal of the American Medical Association, Jan.-Jun. 1941, pp. 578-582, vol. 116.|
|297||White Jr., R. I. et al., "Therapeutic Embolization With Long-Term Occluding Agents and Their Effects on Embolized Tissues," Radiology, Dec. 1977, pp. 677-687, vol. 125.|
|298||Wiebers, D. O. et al., "Impact of Unruptured Intracranial Aneurysms on Public Health in the United States," Stroke, Oct. 1992, pp. 1416-1419, vol. 23, No. 10.|
|299||Wiebers, D. O. et al., "The Significance of Unruptured Intracranial Saccular Aneurysms," J. Neurosurg., Jan. 1987, pp. 23-29, vol. 66.|
|300||Workman, M. et al., "Thrombus Formation At the Neck of Cerebral Aneurysms During Treatment With Guglielmi Detachable Coils," AJNR, Oct. 2002, pp. 1568-1576, vol. 23.|
|301||Xinan, H. "Transcatheter Electrocoagulation: A Preliminary Experimental Study," Chinese Journal of Radiology, Apr. 1987, pp. 241-245.|
|302||Xinan, H. et al., "Vascular Embolization Utilizing Transcatheter Electrocoagulation in Combination With Steel Coil: An Experimental Study," Chinese Journal of Radiology, Mar. 1988, pp. 180-183.|
|303||Yang et at., "Platinum Wire: A New Transvascular Embolic Agent," AJRN, May/Jun. 1988, pp. 547-550, vol. 9.|
|304||Yoneda, S. et al., "Electrothrombosis of Ateriovenous Malformation," Neurologia Medico-Chirurgica, 1997, pp. 19-28, vol. 17, Part I, No. 1.|
|305||Yoneda, S. et al., "Treatment of Spontaneous Carotid-Cavernous Fistula," Neurol. Med. Chir., 1979, pp. 141-147, vol. 10.|
|306||Yoshida, K., "Experimental Studies on the Production and Treatment of the Carotid Thrombosis in Dogs," Archiv fur Japanische Chirurgie, May 1964, pp. 502-524, vol. 33, No. 3.|
|307||Yuen, T. G. H. et al., "Tissue Response to Potential Neuroprosthetic Materials Implanted Subdurally," Biomaterials, Mar. 1987, pp. 138-140, vol. 8.|
|308||Zollikofer, C. et al., "A Combination of Stainless Steel Coil and Compressed Ivalon: A New Technique for Embolization of Large Arteries and Arteriovenous Fistulas," Radiology, Jan.-Mar. 1981, pp. 229-231, vol. 138.|
|309||Zuniga et al, "A New Device for Safe Delivery of Stainless Steel Coils" Radiology vol. 136, pp. 230-231, Jul. 1980.|
| || |
|U.S. Classification||606/32, 606/108, 606/191, 606/41|
|International Classification||A61B17/12, A61B18/12, A61B19/00, A61B18/14, A61B18/08, A61B17/00|
|Cooperative Classification||A61B17/12172, A61B2017/12063, A61B17/12145, A61B18/1492, A61B2018/00875, A61B19/54, A61B2017/1205, A61B2018/1435, A61B2018/00761, A61B2018/00886, A61B18/1402, A61M25/09, A61M2025/09175, A61B17/1215, A61B17/1214, A61B17/12113, A61B2017/00292, A61B2018/1253, A61B2018/00678, A61B17/12022, A61B2018/1495, A61B2018/126, A61B2017/22038, A61B2018/1226, A61B2018/1266, A61B2019/5466|
|European Classification||A61M25/09, A61B17/12P, A61B18/14V, A61B17/12P7C1, A61B17/12P7W1, A61B17/12P5B1, A61B17/12P7C, A61B17/12P7C3|