Stone destroying catheter and method of use

Abstract

Apparatus for disintegrating or otherwise destroying a stone, such as a gallstone, within the body of a living being. The apparatus comprises a small diameter catheter having a longitudinal axis and a working head located at the distal end thereof. The catheter is capable of being located at any position within the body so that the working head is adjacent the stone. The working head is arranged to be rotated at a high speed about the longitudinal axis of the catheter. The working head comprises at least one bladed member having an impacting surface thereon. The bladed member is arranged to move from a retracted position wherein its impacting surface is located adjacent the periphery of the catheter to an extended position wherein the impacting surface extend substantially beyond the periphery of the catheter when the working head is rotated. The impacting surface is arranged so that when it rotates in the extended position, it impacts the stone to disintegrate or otherwise destroy the stone. A shroud is provided about the distal end of the catheter to aid in directing the stone to the rotating blade while also projecting adjacent body tissue from being engaged by the rotating blade. The rotating blade creates a vortex tending to pull the stone into the blade.

What is claimed is: 
     
       1. Apparatus for disintegrating or otherwise destroying a stone within the body of a living being, said apparatus comprising a small diameter instrument having an elongated portion including a longitudinal axis and comprising a working head, said elongated portion capable of being located at a position within said body wherein said working head is adjacent the stone, said working head being coupled to means for rotating said working head at a high speed about said axis, said working head comprising a first portion, at least one impacting member having an impacting surface thereon .Iadd.adjacent only one end of said at least one impacting member.Iaddend., and coupling means movably coupling .Iadd.only the end of .Iaddend.said impacting member . .to said first portion.!. .Iadd.opposed to the end to which the impacting surface is adjacent .Iaddend.for enabling said impacting member to move from a retracted position to an extended position, said impacting surface being located a greater radial distance from the longitudinal axis of the elongated portion of the apparatus when in said extended position than when in said retracted position, said impacting surface being arranged when rotating in said extended position to impact said stone to disintegrate or otherwise destroy it. 
     
     
       2. The apparatus of claim 1 additionally comprising means for directing said stone to said rotating impacting member. 
     
     
       3. The apparatus of claim 2 wherein said directing means comprises a shroud located adjacent said working head. 
     
     
       4. The apparatus of claim 3 wherein said shroud has an open distal end and is flared outward from a point closely adjacent said working head to said distal end, said distal end of said shroud defining an enlarged mouth into which at least a portion of said stone can enter. 
     
     
       5. The apparatus of claim 4 wherein said shroud is expandable from a retracted position to an expanded position wherein said shroud is flared outward to define said enlarged mouth. 
     
     
       6. The apparatus of claim 5 wherein said shroud comprises a plurality of elongated ribs. 
     
     
       7. The apparatus of claim 4 wherein said shroud comprises a plurality of elongated ribs. 
     
     
       8. The apparatus of claim 1 additionally comprising means for protecting adjacent body tissue from being engaged by said impacting member as it rotates. 
     
     
       9. The apparatus of claim 8 wherein said protecting means comprises a shroud located adjacent said working head. 
     
     
       10. The apparatus of claim 9 wherein said shroud has an open distal end and is flared outward from a point closely adjacent said working head to said distal end, said distal end of said shroud defining an enlarged mouth into which at least a portion of said stone can enter. 
     
     
       11. The apparatus of claim 10 wherein said shroud is expandable from a retracted position to an expanded position wherein said shroud is flared outward to define said enlarged mouth. 
     
     
       12. The apparatus of claim 11 wherein said shroud comprises a plurality of elongated ribs. 
     
     
       13. The apparatus of claim 10 wherein said shroud comprises a plurality of elongated ribs. 
     
     
       14. The apparatus of claim 1 wherein said working head comprises a pair of impacting members, said impacting members being disposed diametrically opposite each other with respect to said axis. 
     
     
       15. The apparatus of claim 14 wherein each of said impacting members comprises a blade. 
     
     
       16. The apparatus of claim 15 wherein each of said blades is disposed at an angle so that upon the rotation of said working head said blades create a vortex tending to pull said stone into said blades. 
     
     
       17. The apparatus of claim 16 wherein each of said blades is connected to said coupling means and is arranged to pivot with respect to a respective axis each oriented transverse to said longitudinal axis to enable each of said blades to pivot from said retracted position to said extended position. 
     
     
       18. The apparatus of claim 17 additionally comprising stop means located between said blades to hold said blades apart when said blades are in said retracted position. 
     
     
       19. The apparatus of claim 16 additionally comprising means to direct said stone to said blades. 
     
     
       20. The apparatus of claim 19 wherein said directing means comprises a shroud located adjacent said working head. 
     
     
       21. The apparatus of claim 20 wherein said shroud has an open distal end and is flared outward from a point closely adjacent said working head to said distal end, said distal end of said shroud defining an enlarged mouth into which at least a portion of said stone can enter. 
     
     
       22. The apparatus of claim 16 additionally comprising means to protect adjacent body tissue from being engaged by said blades. 
     
     
       23. The apparatus of claim 22 wherein said protecting means comprises a shroud located adjacent said working head. 
     
     
       24. The apparatus of claim 23 wherein said shroud has an open distal end and is flared outward from a point closely adjacent said working head to said distal end, said distal end of said shroud defining an enlarged mouth into which at least a portion of said stone can enter. 
     
     
       25. The apparatus of claim 1 wherein said coupling means for enabling said impacting member to move from said retracted position to said extended position comprises means for enabling said movement when said working head is rotated. 
     
     
       26. The apparatus of claim 25 wherein said working head comprises a pair of impacting members, said impacting members being disposed diametrically opposite each other with respect to said axis. 
     
     
       27. The apparatus of claim 26 wherein each of said impacting members comprises a blade. 
     
     
       28. The apparatus of claim 27 wherein each of said blades is disposed at an angle so that upon the rotation of said working head said blades create a vortex tending to pull said stone into said blades. 
     
     
       29. The apparatus of claim 28 wherein each of said blades is connected to said coupling means and is arranged to pivot with respect to a respective axis each oriented transverse to said longitudinal axis to enable each of said blades to pivot from said retracted position to said extended position upon the rotation of said working head about said axis. 
     
     
       30. A method for disintegrating or otherwise destroying a stone within the body of a living being by the use of a small diameter instrument, said instrument comprising an elongated portion having a longitudinal axis and a working head, said working head being arranged to be rotated at a high speed about said axis and comprising at least one impacting member having an impacting surface thereon .Iadd.adjacent only one end of said at least one impacting member.Iaddend., said method comprising the steps of introducing said instrument into the body of a living being so that said working head is located adjacent said stone, causing said impacting member to move from a retracted position to an extended position .Iadd.through a moveable coupling to which is attached only the end of said at least one impacting member opposite said the end to which the impacting surface is adjacent.Iaddend., said impacting surface being located a greater radial distance from the longitudinal axis of the elongated portion of the instrument when in said extended position than when in said retracted position, causing the rotation of said working head, whereupon said impacting surface when rotating in said extended position impacts said stone to disintegrate or otherwise destroy it. 
     
     
       31. The method of claim 30 wherein said rotation of said impacting member creates a vortex tending to pull said stone into engagement with said impacting member. 
     
     
       32. The method of claim 30 additional comprising the step of introducing means adjacent said working head to protect adjacent body tissue from being engaged by said impacting member as it rotates. 
     
     
       33. The method of claim 30 additionally comprising the step of introducing means adjacent said working head to direct said stone to said rotating impacting member. .Iadd. 
     
     
       34.  Apparatus for disintegrating or otherwise destroying a stone within the body of a living being, said apparatus comprising an instrument having an elongate portion including a longitudinal axis and comprising a working head, said elongate portion capable of being located at a position within said body wherein said working head is adjacent the stone, said working head being coupled to means for rotating said working head at a high speed about said axis, said working head comprising an impacting member for impacting said stone to disintegrate or otherwise destroy it, a shroud around said working head and being expandable from a retracted position to an expanded position, said shroud in its expanded position, protecting adjacent body tissue from being engaged by said impacting member as said working head rotates and including an open distal end defining an enlarged mouth for receiving at least a portion of a stone to be disintegrated or otherwise destroyed by the rotating impacting member. .Iaddend..Iadd.35. The apparatus of claim 34 wherein the open distal end of said shroud is located distally of the rotating working head. .Iaddend..Iadd.36. The apparatus of claim 35 wherein said shroud comprises prongs with spaces therebetween when the shroud is in its expanded position, the distal ends of said prongs defining the enlarged mouth into which at least a portion of the stone can enter when the shroud is in its expanded position. 
     
     
        .Iaddend..Iadd.37.  The apparatus of claim 34 wherein said working head is configured to create a vortex tending to pull said stone into engagement with said impacting member when said working head is being rotated. .Iaddend..Iadd.38. The apparatus of claim 37 wherein said shroud comprises prongs with spaces therebetween when the shroud is in its expanded position, the distal ends of said prongs defining the enlarged mouth into which at least a portion of the stone can enter when the shroud is in its expanded position. .Iaddend..Iadd.39. The apparatus of claim 34 wherein said shroud, in its expanded position, includes open areas therethrough around the working head. .Iaddend..Iadd.40. The apparatus of claim 39 wherein said shroud comprises prongs with spaces therebetween when the shroud is in its expanded position, the distal ends of said prongs defining the enlarged mouth into which at least a portion of the stone can enter when the shroud is in its expanded position. .Iaddend..Iadd.41. The apparatus of claim 34 wherein said shroud comprises prongs with spaces therebetween when the shroud is in its expanded position, the distal ends of said prongs defining the enlarged mouth into which at least a portion of the stone can enter when the shroud is in its expanded position. 
     
     
        .Iaddend..Iadd.42.  A method for disintegrating or otherwise destroying a stone within the body of a living being by the use of an instrument comprising an elongated portion having a longitudinal axis and a working head, said working head being arranged to be rotated at a high speed about said axis and comprising at least one impacting surface, said instrument including a shroud around said working head and being expandable from a retracted position to an expanded position, said shroud, in its expanded position, being flared outwardly to define an enlarged mouth into which at least a portion of said stone can enter, said method comprising the steps of introducing said instrument into the body of a living being with the shroud in a retracted position to locate the head adjacent said stone, moving the shroud into its expanded position and causing said working head to rotate to thereby rotate said at least one impacting surface thereof into engagement with said stone to disintegrate or otherwise destroy it, said shroud aiding in guiding said stone into engagement with said rotating impacting member. .Iaddend..Iadd.43. The method of claim 42 wherein said rotation of said working head creates a vortex tending to pull said stone into engagement with said impacting member. .Iaddend..Iadd.44. The method of claim 42 including the step of engaging large stones with the distal end of said shroud and with a portion of said stone extending into engagement with the rotating impacting member. .Iaddend..Iadd.45. Apparatus for disintegrating or otherwise destroying a stone within the body of a living being, said apparatus comprising an instrument having a elongate portion including a longitudinal axis and comprising a working head, said elongate portion capable of being located at a position within said body wherein said working head is adjacent the stone, means for rotating the working head at a high speed in either rotational direction being coupled to the working head for rotating the working head in both rotational directions to enhance stone destruction 
     
     
        and/or disintegration. .Iaddend..Iadd.46.  The apparatus of claim 45 wherein said working head comprises an impacting member for impacting said stone to disintegrate or otherwise destroy it, and wherein a shroud is included around the working head and is expandable from a retracted position to an expanded position, said shroud, in its expanded position protecting adjacent body tissue from being engaged by said impacting member as said working head rotates and including an open distal end defining an enlarged mouth for receiving at least a portion of a stone to be disintegrated or otherwise destroyed by the rotating impacting member. .Iaddend..Iadd.47. The apparatus of claim 46 wherein the open distal end of the shroud is located distally of the rotating working head. .Iaddend..Iadd.48. The apparatus of claim 46 wherein the working head is configured to create a vortex tending to pull said stone into engagement with said impacting member when said working head is being rotated. .Iaddend..Iadd.49. The apparatus of claim 46 wherein said shroud, in its expanded position, includes open areas therethrough around the working head. .Iaddend..Iadd.50. The apparatus of claim 46 wherein said shroud comprises prongs with spaces therebetween when the shroud is in its expanded position, the distal ends of said prongs defining the enlarged mouth into which at least a portion of the stone can enter when the shroud 
     
     
        is in its expanded position. .Iaddend..Iadd.51.  A method for disintegrating or otherwise destroying a stone within the body of a living being by the use of an instrument comprising an elongate portion having a longitudinal axis and a working head, said working head being arranged to be rotated at a high speed about its axis in either rotational direction and comprising at least one impacting surface, said method comprising the steps of introducing said instrument into the body of a living being to locate the working head adjacent the stone, rotating the working head in a first direction at a high speed to thereby rotate the impacting member thereof into engagement with the stone to aid in disintegrating or otherwise destroying said stone, and reversing the rotational direction of the working head to aid in the stone disintegrating and destroying functions. .Iaddend..Iadd.52. The method of claim 51, wherein the step of reversing the rotational direction is carried out periodically during said method. .Iaddend..Iadd.53. The method of claim 51 wherein the instrument also includes a shroud around the working head, said shroud being expandable from its retracted position to an expanded position, said shroud, in its expanded position, being flared outwardly to define an enlarged mouth into which at least a portion of said stone can enter, said method comprising the steps of introducing the instrument into the body of a living being with the shroud in a retracted position to locate the head adjacent the stone, moving the shroud into its expanded position and causing said working to rotate in said one rotational direction after the shroud has been expanded, and thereafter reversing the direction of rotation of the working head. .Iaddend..Iadd.54. The method of claim 51 wherein rotation of the working head creates a vortex tending to pull the stone into engagement with the impacting member. .Iaddend..Iadd.55. The method of claim 51 including the step of engaging large stones with the distal end of the shroud and with a portion of the stone extending into engagement with the rotating impacting surface. .Iaddend..Iadd.56. The apparatus of claim 1 wherein said means for rotating the working head rotates the working head in both rotational directions. .Iaddend..Iadd.57. The method of claim 30 wherein the step of causing the rotation of the working head is carried out by rotating the working head in one direction and then reversing the direction of rotation. .Iaddend..Iadd.58. The method of claim 57 wherein the step of reversing the rotational direction 
     
     
        is carried out periodically during said method. .Iaddend..Iadd.59. Apparatus for disintegrating or otherwise destroying a stone within the body of a living being, said apparatus comprising an instrument having an elongate portion including a longitudinal axis and comprising a working head, said elongate portion capable of being located at a position within said body wherein said working head is adjacent the stone, said working head being coupled to means for rotating said working head in both rotational directions at a high speed about said axis, said working head comprising an impacting member for impacting said stone to disintegrate or otherwise destroy it, and prong means adjacent the impacting member for engaging and restricting motion of the stone in a position wherein the impacting member impacts upon said stone. .Iaddend..Iadd.60. A method for disintegrating or otherwise destroying a stone within the body of a living being by the use of an instrument comprising an elongate portion having a longitudinal axis and a working head, said working head being arranged to be rotated at a high speed about said axis and comprising at least one impacting surface, said instrument including prong means adjacent said at least one impacting surface for engaging and restricting motion of a stone to be disintegrated or otherwise destroyed, said method comprising the steps of introducing said instrument into the body of a living being to locate the head adjacent said stone, causing said working head to rotate by rotating the working head in one direction and then reversing the direction of rotation to thereby rotate said at least one impacting surface into engagement with said stone to disintegrate or otherwise destroy it, and while said at least one impacting surface is being rotated, engaging a stone to be disintegrated or otherwise destroyed with the prong means to restrict motion of the stone in a position wherein the 
     
     
        impacting member impacts upon said stone. .Iaddend..Iadd.61.  The method of claim 60 wherein the step of reversing the rotational direction is carried out periodically during said method. .Iaddend.