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WO1997047253A1 - Methods and devices for reducing angina, enhancing myocardial perfusion and increasing cardiac function - Google Patents

Methods and devices for reducing angina, enhancing myocardial perfusion and increasing cardiac function Download PDF

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Publication number
WO1997047253A1
WO1997047253A1 PCT/US1997/010024 US9710024W WO9747253A1 WO 1997047253 A1 WO1997047253 A1 WO 1997047253A1 US 9710024 W US9710024 W US 9710024W WO 9747253 A1 WO9747253 A1 WO 9747253A1
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WO
WIPO (PCT)
Prior art keywords
patient
blood vessels
cardiac function
myocardial perfusion
angiogenic
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US1997/010024
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French (fr)
Inventor
Robert B. Fine
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Kriton Medical Inc
Original Assignee
Kriton Medical Inc
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Filing date
Publication date
Application filed by Kriton Medical Inc filed Critical Kriton Medical Inc
Priority to AU33085/97A priority Critical patent/AU3308597A/en
Publication of WO1997047253A1 publication Critical patent/WO1997047253A1/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22082—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for after introduction of a substance
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00351—Heart
    • A61B2018/00392—Transmyocardial revascularisation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A61F2/062—Apparatus for the production of blood vessels made from natural tissue or with layers of living cells

Definitions

  • the field of this invention concerns methods and devices for the treatment of disorders related to decreased myocardial perfusion and cardiac function, and, in particular, methods and devices for reducing angina pain, enhancing myocardial perfusion and/or increasing cardiac function.
  • Various surgical and pharmaceutical procedures have been used to attempt to enhance myocardial perfusion and/or cardiac function.
  • One such procedure currently being evaluated in human clinical trials is transmyocardial laser revascularization (TMLR) in which a laser is directed to the heart and traverses the myocardium.
  • TMLR transmyocardial laser revascularization
  • TMLR transmyocardial laser revascularization
  • TMLR transmyocardial laser revascularization
  • TMLR as currently practiced has not shown success in all instances, however. Levels of success rates are also variable. In addition, some
  • SUMMARY OF THE INVENTION Methods and devices are disclosed for reducing angina pain, enhancing myocardial perfusion and/or increasing cardiac function.
  • the present invention is based on the novel recognition by the inventor that the administration to a patient of angiogenic substances capable of stimulating the growth of blood vessels in combination with TMLR procedures and/or procedures for forming channels in the myocardium, can improve the reduction of angina pain, the enhancement of myocardial perfusion and/or the increase in cardiac function currently associated with TMLR procedures.
  • the inventor has recognized that administering angiogenic substances in conjunction with TMLR procedures and/or procedures for forming channels in the myocardium can expand the pool of patients who would benefit from treatment to reduce angina, to enhance myocardial perfusion and/or to increase cardiac function.
  • Myocardial perfusion includes blood flow to the heart tissue including myocardium, sub-endocardium, endocardium, sub-epicardium, and/or epicardium.
  • Angiogenic substances include substances capable of stimulating the growth of blood vessels.
  • Channels include holes, lumens or passageways, and other perforations in the heart.
  • TMLR procedures include procedures for directing a beam of radiation to heart tissue.
  • methods for reducing angina pain, enhancing myocardial perfusion and/or increasing cardiac function include
  • the method can involve producing the radiation from a laser, such as a carbon dioxide laser or other radiation producing elements known to those of ordinary skill in the art; and/or forming at least one channel in the myocardium.
  • the channel forming step can include forming the channel to link epicardial and endocardial surfaces of the heart.
  • the method can also be employed in conjunction with implanting and or removing at least one ventricular assist device (VAD).
  • VADs hereinafter can include left, right or bi- ventricular assist devices.
  • the angiogenic substance capable of stimulating the growth of blood vessels in the patient can include an angiogenic growth factor.
  • the angiogenic growth factor can include vascular endothelial growth factor (VEGF) vascular permeability factor (VPF) in native and/or non-native forms.
  • VEGF vascular endothelial growth factor
  • VPF vascular permeability factor
  • the angiogenic growth factor also can include a fibroblast growth factor, such as a basic fibroblast growth factor (bFGF or FGF- 2), in native and/or non-native forms, and/or acidic fibroblast growth factor (aFGF or FGF-1), in native and/or non-native forms.
  • bFGF or FGF-2 basic fibroblast growth factor
  • aFGF or FGF-1 acidic fibroblast growth factor
  • angiogenic substances include, but are not limited to, platelet-derived growth factor (PDGF) such as PDGF-AA, PDGF-BB, and PDGF-AB; hepatocyte growth factor/scatter factor (HGF/SF); placenta growth factor; endothelial cell growth factor (ECGF); platelet-derived endothelial cell growth factor (PD-ECGF); and urokinase plasminogen activator (uPA).
  • PDGF platelet-derived growth factor
  • HGF/SF hepatocyte growth factor/scatter factor
  • ECGF endothelial cell growth factor
  • PD-ECGF platelet-derived endothelial cell growth factor
  • uPA urokinase plasminogen activator
  • the angiogenic substance can be administered to the patient in a variety of ways.
  • methods of administering the angiogenic substance include one or more of the following steps; directly injecting the angiogenic substance into the atria, the ventricles, the veins, the arteries, and/or the formed channels; applying a slow-release formulation of the angiogenic substance into the formed channels; administering a slow-release formulation of the angiogenic substance orally, and/or via a skin patch; applying a material, such as a biologically compatible or incompatible, resorbable or non-resorbable material, contacted with the angiogenic substance, over the surface of the heart; and infusing the angiogenic substance into the patient via a pump connected to the atria, the ventricles, the veins, the arteries, and/or the formed channels.
  • methods of administering the angiogenic substance include one or more of the following steps: implanting a catheter, such as a slow-release catheter, contacted with the angiogenic substance, into the atria, the ventricles, and/or the formed channels; loading a sleeve, such as an infusion sleeve, contacted with the angiogenic substance, over a catheter and introducing the catheter into the formed channels; applying bead carriers, such as heparin- alginate beads, contacted with the angiogenic substance, over the epicardial and/or endocardial surfaces of the heart; inserting an implant, such as a fibrin-glue implant, contacted with the angiogenic substance, between, for example, the aorta and the myocardium, and/or in other positions of the epicardial and/or endocardial surfaces; injecting retroviral and/or non-retroviral vectors enclosing a gene for the angiogenic substance into the myocardi
  • methods for reducing angina pain, and/or enhancing myocardial perfusion and/or cardiac function include forming at least one channel in the myocardium of a patient, and administering to the
  • the channel forming step can include forming the channel to link epicardial and endocardial surfaces of the heart.
  • the method can also be employed in conjunction with implanting and/or removing a VAD.
  • the angiogenic substances and/or methods for administering the same discussed above can be used.
  • methods for reducing angina pain, and/or enhancing myocardial perfusion and/or cardiac function include forming at least one channel in the myocardium of the patient, and inserting into the channel at least one stent contacted with one or a mixture of angiogenic
  • the stent can be biologically compatible or incompatible, and the channel forming step can include forming the channel to link epicardial and endocardial surfaces of the heart.
  • the method can also include implanting and/or removing a VAD.
  • the angiogenic substances and/or methods for administering the same discussed above can be used with these aspects of the invention.
  • devices for reducing angina pain, and/or enhancing the myocardial perfusion and/or cardiac function of a patient include a stent contacted with at least one angiogenic substance capable of stimulating the growth of blood vessels in the patient and adapted for insertion into a channel formed in a myocardium of the heart of the patient.
  • the stent can be biologically compatible or non-compatible, resorbable or non-resorbable.
  • the devices of the invention can be self-expanding; and/or can further include an element for expanding the stent from a first to a second position.
  • the angiogenic substances discussed above can be used in these aspects of the invention.
  • devices for reducing angina in a patient and/or enhancing the myocardial perfusion and/or cardiac function of a patient include an element for directing a selected beam of radiation for a pre-determined time period to a heart of the patient, and an element for administering to the patient at least one angiogenic substance capable of stimulating growth of blood vessels in the patient.
  • the angiogenic substances discussed above can be used in these aspects of the invention.
  • devices for reducing angina in a patient and/or enhancing the myocardial perfusion and/or cardiac function of a patient include an element for forming at least one channel in a myocardium in a heart of the patient, and an element for administering to the patient at least one angiogenic substance capable of stimulating growth of blood vessels in the patient.
  • the angiogenic substances discussed above can be used in these aspects of the invention.
  • the present invention benefits from the recognition that TMLR procedures and/or procedures for forming channels in the myocardium can be performed in conjunction with the administration of angiogenic substances capable of stimulating the growth of blood vessels in a patient.
  • the methods and devices of the present invention have several advantages over the prior art.
  • the present invention can improve in patients the level of angina pain reduction, and/or enhance myocardial perfusion and/or cardiac function. Accordingly, the present invention can improve the treatment of disorders associated with reduced myocardial perfusion such as angina and/or improve cardiac functions in patients experiencing different levels of heart failure. In addition, the present invention can expand the pool of patients who can be eligible for TMLR procedures and/or procedures involving the formation of channels in the myocardium.

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  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Public Health (AREA)
  • Animal Behavior & Ethology (AREA)
  • Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Physics & Mathematics (AREA)
  • General Health & Medical Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Optics & Photonics (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Otolaryngology (AREA)
  • Electromagnetism (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
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Abstract

A method and apparatus for the treatment of disorders related to decreased myocardial perfusion and cardiac function is provided. A selected beam of radiation is directed to the patient's heart for a predetermined time period, and an angiogenic substance, capable of stimulating growth of blood vessels in the patient, is administered to the patient.

Description

METHODS AND DEVICES FOR REDUCING ANGINA,
ENHANCING MYOCARDIAL PERFUSION AND
INCREASING CARDIAC FUNCTION
This application claims the benefit of U.S. Provisional application Ser. No. 60/020,482 filed June 14, 1996.
BACKGROUND OF THE INVENTION
The field of this invention concerns methods and devices for the treatment of disorders related to decreased myocardial perfusion and cardiac function, and, in particular, methods and devices for reducing angina pain, enhancing myocardial perfusion and/or increasing cardiac function. Various surgical and pharmaceutical procedures have been used to attempt to enhance myocardial perfusion and/or cardiac function. One such procedure currently being evaluated in human clinical trials is transmyocardial laser revascularization (TMLR) in which a laser is directed to the heart and traverses the myocardium. Following TMLR, some patients have experienced a dramatic reduction in angina pain. In addition, in some instances, TMLR has resulted in significant improvements in myocardial perfusion and/or cardiac function. In many cases, enhanced perfusion of the heart and/or cardiac function have persisted for at least six months.
TMLR as currently practiced has not shown success in all instances, however. Levels of success rates are also variable. In addition, some
patients, such as, for example, patients with an unprotected anterior myocardium or patients experiencing frank congestive heart failure, are presently not good candidates for receiving TMLR procedures.
In addition, the mechanism of TMLR is not clearly understood. One hypothesis, among others, is that channels in the heart resulting from TMLR provide oxygenated blood to the diseased myocardium. Another hypothesis is that new vessels form in the myocardium surrounding lased channels resulting from TMLR. With respect to the aforementioned hypotheses, investigators have not yet convincingly proved channel persistence or meaningful new vessel formation and persistence in all cases of TMLR. Accordingly, procedures for forming channels in the myocardium, such as forming channels with different types of lasers or mechanical elements, and forming channels in different lengths and directions, have also been discussed as alternative procedures for reducing angina pain, enhancing myocardial perfusion or increasing cardiac function.
Therefore, there exists a need to improve TMLR procedures, and/or procedures involving the formation of channels in the myocardium of the heart, to better reduce angina pain, to enhance myocardial perfusion, to increase cardiac function, and/or to expand the pool of patients who could benefit from such procedures.
SUMMARY OF THE INVENTION Methods and devices are disclosed for reducing angina pain, enhancing myocardial perfusion and/or increasing cardiac function. The present invention is based on the novel recognition by the inventor that the administration to a patient of angiogenic substances capable of stimulating the growth of blood vessels in combination with TMLR procedures and/or procedures for forming channels in the myocardium, can improve the reduction of angina pain, the enhancement of myocardial perfusion and/or the increase in cardiac function currently associated with TMLR procedures. In addition, the inventor has recognized that administering angiogenic substances in conjunction with TMLR procedures and/or procedures for forming channels in the myocardium can expand the pool of patients who would benefit from treatment to reduce angina, to enhance myocardial perfusion and/or to increase cardiac function.
Myocardial perfusion, for the purposes of this invention, includes blood flow to the heart tissue including myocardium, sub-endocardium, endocardium, sub-epicardium, and/or epicardium. Angiogenic substances, for the purposes of this invention, include substances capable of stimulating the growth of blood vessels. Channels, for the purposes of this invention, include holes, lumens or passageways, and other perforations in the heart.
TMLR procedures, for the purposes of this invention, include procedures for directing a beam of radiation to heart tissue.
DETAILED DESCRIPTION OF THE INVENTION In aspects of the invention, methods for reducing angina pain, enhancing myocardial perfusion and/or increasing cardiac function include
directing a beam of radiation for a predetermined time period to the heart of a patient, and administering to the patient at least one angiogenic substance capable of stimulating the growth of blood vessels in the patient. In alternative embodiments of the invention, the method can involve producing the radiation from a laser, such as a carbon dioxide laser or other radiation producing elements known to those of ordinary skill in the art; and/or forming at least one channel in the myocardium. The channel forming step can include forming the channel to link epicardial and endocardial surfaces of the heart. The method can also be employed in conjunction with implanting and or removing at least one ventricular assist device (VAD). VADs hereinafter can include left, right or bi- ventricular assist devices. In other embodiments of the invention, the angiogenic substance capable of stimulating the growth of blood vessels in the patient can include an angiogenic growth factor. The angiogenic growth factor can include vascular endothelial growth factor (VEGF) vascular permeability factor (VPF) in native and/or non-native forms. The angiogenic growth factor also can include a fibroblast growth factor, such as a basic fibroblast growth factor (bFGF or FGF- 2), in native and/or non-native forms, and/or acidic fibroblast growth factor (aFGF or FGF-1), in native and/or non-native forms. Other examples of angiogenic substances include, but are not limited to, platelet-derived growth factor (PDGF) such as PDGF-AA, PDGF-BB, and PDGF-AB; hepatocyte growth factor/scatter factor (HGF/SF); placenta growth factor; endothelial cell growth factor (ECGF); platelet-derived endothelial cell growth factor (PD-ECGF); and urokinase plasminogen activator (uPA). Other angiogenic substances for the growth of vessels known to those of ordinary skill in the art may be useful in the practice of this invention.
The angiogenic substance can be administered to the patient in a variety of ways. Examples of methods of administering the angiogenic substance include one or more of the following steps; directly injecting the angiogenic substance into the atria, the ventricles, the veins, the arteries, and/or the formed channels; applying a slow-release formulation of the angiogenic substance into the formed channels; administering a slow-release formulation of the angiogenic substance orally, and/or via a skin patch; applying a material, such as a biologically compatible or incompatible, resorbable or non-resorbable material, contacted with the angiogenic substance, over the surface of the heart; and infusing the angiogenic substance into the patient via a pump connected to the atria, the ventricles, the veins, the arteries, and/or the formed channels.
Other examples of methods of administering the angiogenic substance include one or more of the following steps: implanting a catheter, such as a slow-release catheter, contacted with the angiogenic substance, into the atria, the ventricles, and/or the formed channels; loading a sleeve, such as an infusion sleeve, contacted with the angiogenic substance, over a catheter and introducing the catheter into the formed channels; applying bead carriers, such as heparin- alginate beads, contacted with the angiogenic substance, over the epicardial and/or endocardial surfaces of the heart; inserting an implant, such as a fibrin-glue implant, contacted with the angiogenic substance, between, for example, the aorta and the myocardium, and/or in other positions of the epicardial and/or endocardial surfaces; injecting retroviral and/or non-retroviral vectors enclosing a gene for the angiogenic substance into the myocardium, arterial walls and/or other areas of uptake, such as the skin, of the patient; infusing the angiogenic substance into veins and/or arteries; and inserting a stent, contacted with the angiogenic substance, into the formed channels. The stent can be biologically compatible or incompatible, resorbable or non-resorbable. Other methods of administration known to those of ordinary skill in the art may be useful in the practice of this invention.
In other aspects of the invention, methods for reducing angina pain, and/or enhancing myocardial perfusion and/or cardiac function include forming at least one channel in the myocardium of a patient, and administering to the
patient at least one angiogenic substance capable of stimulating growth of blood vessels in the patient. In alternative embodiments of the invention, the channel forming step can include forming the channel to link epicardial and endocardial surfaces of the heart. The method can also be employed in conjunction with implanting and/or removing a VAD. In other embodiments of the invention, the angiogenic substances and/or methods for administering the same discussed above can be used.
In still other aspects of the invention, methods for reducing angina pain, and/or enhancing myocardial perfusion and/or cardiac function include forming at least one channel in the myocardium of the patient, and inserting into the channel at least one stent contacted with one or a mixture of angiogenic
substances capable of stimulating the growth of blood vessels in the patient. In embodiments of the invention, the stent can be biologically compatible or incompatible, and the channel forming step can include forming the channel to link epicardial and endocardial surfaces of the heart. The method can also include implanting and/or removing a VAD. The angiogenic substances and/or methods for administering the same discussed above can be used with these aspects of the invention. In further aspects of the invention, devices for reducing angina pain, and/or enhancing the myocardial perfusion and/or cardiac function of a patient are disclosed that include a stent contacted with at least one angiogenic substance capable of stimulating the growth of blood vessels in the patient and adapted for insertion into a channel formed in a myocardium of the heart of the patient. In embodiments of the invention, the stent can be biologically compatible or non-compatible, resorbable or non-resorbable. The devices of the invention can be self-expanding; and/or can further include an element for expanding the stent from a first to a second position. The angiogenic substances discussed above can be used in these aspects of the invention.
In other aspects of the invention, devices for reducing angina in a patient and/or enhancing the myocardial perfusion and/or cardiac function of a patient are disclosed that include an element for directing a selected beam of radiation for a pre-determined time period to a heart of the patient, and an element for administering to the patient at least one angiogenic substance capable of stimulating growth of blood vessels in the patient. The angiogenic substances discussed above can be used in these aspects of the invention. In still other aspects of the invention, devices for reducing angina in a patient and/or enhancing the myocardial perfusion and/or cardiac function of a patient are disclosed that include an element for forming at least one channel in a myocardium in a heart of the patient, and an element for administering to the patient at least one angiogenic substance capable of stimulating growth of blood vessels in the patient. The angiogenic substances discussed above can be used in these aspects of the invention. In sum, the present invention benefits from the recognition that TMLR procedures and/or procedures for forming channels in the myocardium can be performed in conjunction with the administration of angiogenic substances capable of stimulating the growth of blood vessels in a patient. The methods and devices of the present invention have several advantages over the prior art. In comparison with current TMLR procedures and/or procedures for forming channels in the myocardium, the present invention can improve in patients the level of angina pain reduction, and/or enhance myocardial perfusion and/or cardiac function. Accordingly, the present invention can improve the treatment of disorders associated with reduced myocardial perfusion such as angina and/or improve cardiac functions in patients experiencing different levels of heart failure. In addition, the present invention can expand the pool of patients who can be eligible for TMLR procedures and/or procedures involving the formation of channels in the myocardium. It will be understood that the above description pertains to only several embodiments of the present invention. That is, the description is provided by way of illustration and not by way of limitation. The invention is further characterized according to the following claims.

Claims

What Is Claimed Is:
1. A method for reducing angina in a patient comprising:
directing a selected beam of radiation for a predetermined time period to a heart of the patient; and administering to the patient at least one angiogenic substance capable of stimulating growth of blood vessels in the patient.
2. A method for enhancing myocardial perfusion in a patient comprising: directing a selected beam of radiation for a predetermined time period to a heart of the patient; and administering to the patient at least one angiogenic substance capable of stimulating growth of blood vessels in the patient.
3. A method for enhancing cardiac function in a patient comprising: directing a selected beam of radiation for a predetermined time period to a heart of the patient; and administering to the patient at least one angiogenic substance capable of stimulating growth of blood vessels in the patient.
4. A method for reducing angina in a patient comprising: forming at least one channel in a myocardium of the patient; and administering to the patient at least one angiogenic substance capable of stimulating growth of blood vessels in the patient.
5. A method for reducing angina in a patient comprising: forming at least one channel in a myocardium of the patient; and inserting at least one stent contacted with at least one angiogenic substance capable of stimulating growth of blood vessels in the patient into the channel.
6. An apparatus for reducing angina in a patient comprising: a stent contacted with at least one angiogenic substance capable of stimulating growth of blood vessels in the patient and adapted for insertion into a channel formed in the myocardium of the patient.
7. An apparatus for reducing angina in a patient comprising: means for directing a selected beam of radiation for a pre¬ determined time period to a heart of the patient; and means for administering to the patient at least one angiogenic substance capable of stimulating growth of blood vessels in the patient.
8. An apparatus for reducing angina in a patient comprising: means for forming at least one channel in a myocardium of the patient; and means for administering to the patient at least one angiogenic substance capable of stimulating growth of blood vessels in the patient.
PCT/US1997/010024 1996-06-14 1997-06-11 Methods and devices for reducing angina, enhancing myocardial perfusion and increasing cardiac function Ceased WO1997047253A1 (en)

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AU33085/97A AU3308597A (en) 1996-06-14 1997-06-11 Methods and devices for reducing angina, enhancing myocardial perfusion and increasing cardiac function

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US2048296P 1996-06-14 1996-06-14
US60/020,482 1996-06-14

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Cited By (22)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5925012A (en) * 1996-12-27 1999-07-20 Eclipse Surgical Technologies, Inc. Laser assisted drug delivery
WO1999039624A1 (en) * 1998-02-05 1999-08-12 Biosense Inc. Intracardiac drug delivery
US5999678A (en) * 1996-12-27 1999-12-07 Eclipse Surgical Technologies, Inc. Laser delivery means adapted for drug delivery
US6067988A (en) * 1996-12-26 2000-05-30 Eclipse Surgical Technologies, Inc. Method for creation of drug delivery and/or stimulation pockets in myocardium
US6152141A (en) * 1994-07-28 2000-11-28 Heartport, Inc. Method for delivery of therapeutic agents to the heart
US6251079B1 (en) 1998-09-30 2001-06-26 C. R. Bard, Inc. Transthoracic drug delivery device
US6254573B1 (en) 1998-02-05 2001-07-03 Biosense, Inc. Intracardiac drug delivery device utilizing spring-loaded mechanism
US6551302B1 (en) 1997-09-24 2003-04-22 Michael J. Rosinko Steerable catheter with tip alignment and surface contact detector
US6591129B1 (en) 1996-02-15 2003-07-08 Biosense, Inc. Method for treating tissue through injection of a therapeutic agent
US6676679B1 (en) 1999-11-05 2004-01-13 Boston Scientific Corporation Method and apparatus for recurrent demand injury in stimulating angiogenesis
US6695808B2 (en) 2000-03-23 2004-02-24 Scimed Life Systems, Inc. Pressure sensor for therapeutic delivery device and method
US6748258B1 (en) 1999-11-05 2004-06-08 Scimed Life Systems, Inc. Method and devices for heart treatment
US6746686B2 (en) 2000-01-24 2004-06-08 Biocompatibles Uk Limited Coated implants
US6855160B1 (en) 1999-08-04 2005-02-15 C. R. Bard, Inc. Implant and agent delivery device
US6949117B2 (en) 1998-09-30 2005-09-27 C. R. Bard, Inc. Vascular inducing implants
US6986784B1 (en) 1999-05-14 2006-01-17 C. R. Bard, Inc. Implant anchor systems
US7147633B2 (en) 1999-06-02 2006-12-12 Boston Scientific Scimed, Inc. Method and apparatus for treatment of atrial fibrillation
US7204847B1 (en) 2000-07-28 2007-04-17 C. R. Bard, Inc. Implant anchor systems
US7214223B2 (en) 2000-03-24 2007-05-08 Boston Scientific Scimed, Inc. Photoatherolytic catheter apparatus and method
US7232421B1 (en) 2000-05-12 2007-06-19 C. R. Bard, Inc. Agent delivery systems
EP1753451A4 (en) * 2004-06-07 2008-11-12 Conor Medsystems Inc LOCAL DELIVERY OF GROWTH FACTORS FOR THE TRANSPLANTATION OF STEM CELLS
US7588554B2 (en) 2000-06-26 2009-09-15 Boston Scientific Scimed, Inc. Method and apparatus for treating ischemic tissue

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5287861A (en) * 1992-10-30 1994-02-22 Wilk Peter J Coronary artery by-pass method and associated catheter
US5429144A (en) * 1992-10-30 1995-07-04 Wilk; Peter J. Coronary artery by-pass method
US5464650A (en) * 1993-04-26 1995-11-07 Medtronic, Inc. Intravascular stent and method
US5527337A (en) * 1987-06-25 1996-06-18 Duke University Bioabsorbable stent and method of making the same

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5527337A (en) * 1987-06-25 1996-06-18 Duke University Bioabsorbable stent and method of making the same
US5287861A (en) * 1992-10-30 1994-02-22 Wilk Peter J Coronary artery by-pass method and associated catheter
US5429144A (en) * 1992-10-30 1995-07-04 Wilk; Peter J. Coronary artery by-pass method
US5464650A (en) * 1993-04-26 1995-11-07 Medtronic, Inc. Intravascular stent and method

Non-Patent Citations (2)

* Cited by examiner, † Cited by third party
Title
AMERICAN HEART JOURNAL, September 1983, Volume 106, Number 3, LEE et al., "Effects of Laser Irradiation Delivered by Flexible Fiberoptic System on the Left Ventricular Internal Myocardium", pages 587-590. *
IEEE JOURNAL OF QUANTUM ELECTRONICS, December 1984, Vol. QE-20, No. 12, ISNER et al., "The Current Status of Lasers in Treatment of Cardiovascular Disease", pages 1406-1420. *

Cited By (28)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6152141A (en) * 1994-07-28 2000-11-28 Heartport, Inc. Method for delivery of therapeutic agents to the heart
US6591129B1 (en) 1996-02-15 2003-07-08 Biosense, Inc. Method for treating tissue through injection of a therapeutic agent
US6067988A (en) * 1996-12-26 2000-05-30 Eclipse Surgical Technologies, Inc. Method for creation of drug delivery and/or stimulation pockets in myocardium
US6482220B1 (en) 1996-12-26 2002-11-19 Eclipse Surgical Technologies Inc. Method and apparatus for creation of drug delivery and/or stimulation pockets in myocardium
US5999678A (en) * 1996-12-27 1999-12-07 Eclipse Surgical Technologies, Inc. Laser delivery means adapted for drug delivery
US5925012A (en) * 1996-12-27 1999-07-20 Eclipse Surgical Technologies, Inc. Laser assisted drug delivery
US6551302B1 (en) 1997-09-24 2003-04-22 Michael J. Rosinko Steerable catheter with tip alignment and surface contact detector
WO1999039624A1 (en) * 1998-02-05 1999-08-12 Biosense Inc. Intracardiac drug delivery
US6254573B1 (en) 1998-02-05 2001-07-03 Biosense, Inc. Intracardiac drug delivery device utilizing spring-loaded mechanism
US6309370B1 (en) 1998-02-05 2001-10-30 Biosense, Inc. Intracardiac drug delivery
US6733488B2 (en) 1998-09-30 2004-05-11 C.R. Bard, Inc. Transthoracic drug delivery device
US6251079B1 (en) 1998-09-30 2001-06-26 C. R. Bard, Inc. Transthoracic drug delivery device
US6517527B2 (en) 1998-09-30 2003-02-11 C. R. Bard, Inc. Transthoracic drug delivery device
US6949117B2 (en) 1998-09-30 2005-09-27 C. R. Bard, Inc. Vascular inducing implants
US6986784B1 (en) 1999-05-14 2006-01-17 C. R. Bard, Inc. Implant anchor systems
US7147633B2 (en) 1999-06-02 2006-12-12 Boston Scientific Scimed, Inc. Method and apparatus for treatment of atrial fibrillation
US6855160B1 (en) 1999-08-04 2005-02-15 C. R. Bard, Inc. Implant and agent delivery device
US6748258B1 (en) 1999-11-05 2004-06-08 Scimed Life Systems, Inc. Method and devices for heart treatment
US6676679B1 (en) 1999-11-05 2004-01-13 Boston Scientific Corporation Method and apparatus for recurrent demand injury in stimulating angiogenesis
US7392077B2 (en) 1999-11-05 2008-06-24 Boston Scientific Scimed, Inc. Method for treating a patient at risk of loss of cardiac function by cardiac ischemia
US6746686B2 (en) 2000-01-24 2004-06-08 Biocompatibles Uk Limited Coated implants
US6695808B2 (en) 2000-03-23 2004-02-24 Scimed Life Systems, Inc. Pressure sensor for therapeutic delivery device and method
US7211063B2 (en) 2000-03-23 2007-05-01 Boston Scientific Scimed, Inc. Pressure sensor for therapeutic delivery device and method
US7214223B2 (en) 2000-03-24 2007-05-08 Boston Scientific Scimed, Inc. Photoatherolytic catheter apparatus and method
US7232421B1 (en) 2000-05-12 2007-06-19 C. R. Bard, Inc. Agent delivery systems
US7588554B2 (en) 2000-06-26 2009-09-15 Boston Scientific Scimed, Inc. Method and apparatus for treating ischemic tissue
US7204847B1 (en) 2000-07-28 2007-04-17 C. R. Bard, Inc. Implant anchor systems
EP1753451A4 (en) * 2004-06-07 2008-11-12 Conor Medsystems Inc LOCAL DELIVERY OF GROWTH FACTORS FOR THE TRANSPLANTATION OF STEM CELLS

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