the present invention involves an atherectomy catheter in which a rotatable cutter is disposed at the distal end and in which means are provided at the proximal end for driving the cutter at a high rotational speed while simultaneously injecting a flushing liquid and aspirating the treatment site . the invention further provides a cutter head or cutter tool of improved safety coordinated and operated with a guidewire system to aid and facilitate guiding the catheter through the tortuous path of the vascular system to the treatment site . the invention will be described with particular reference to the drawing figures in which like numerals will be utilized to designate like parts throughout the same . fig1 illustrates the surgical device of the present invention with respect to a typical atherectomy catheter system which is indicated generally by the numeral 10 . the system includes a control and drive system located within a proximal housing 11 , which may be of high impact plastic material . the catheter itself is of the coaxial bi - lumener type . the housing is connected to an elongated outer flexible tubular member 12 extending between a distal end 13 and a proximal end 14 fixed to the housing 11 . the hollow lumen of the outer tubular member 12 carries a concentrically disposed , coaxial elongated , flexible inner tubular member 15 which extends beyond the full length of the outer tubular member 12 . the inner tubular member 15 , in the embodiment of fig1 also is threaded over a non - rotating or stationary guidewire 16 which extends the full length of the inner tubular member 15 and protrudes therefrom and along which the catheter is free to travel . as can better been seen in fig2 and 3 , and will be described in greater detail below , the distal end of the catheter carries a hollow cutting head or cutting tool 17 which is fixed to the inner tubular member 15 and is free to rotate about the outer tubular member 12 . the outer tubular member 12 is tapered down to a distal end portion 18 that creates a bearing surface which allows easy journaled rotation of the inner tube 15 carrying cutter head 17 . an infusion system is provided including an indented annular area of reduced diameter 19 near the distal end of the outer tubular member 12 which contains a series of radially disposed openings or holes 20 ( fig1 ). liquid contained in the annular space in the lumen of the member 12 surrounding the member 15 as at 21 can be ejected through the holes 20 to flush the operating site . an annular spacer member 22 is provided which is bonded both to the distal tip of the inner tubular member 15 and the inner surface of the cutter head 17 to fix the cutter head to the distal tip of the inner tubular member 15 . the guidewire 16 is slidably threaded and extends through a central hole 23 in the distal tip of the cutter member 17 , throughout the length of the inner tubular member 15 and housing , and is separately controlled . the catheter system is free to move along the guidewire , and it is designed to remain stationary as the cutter head member 17 is rotated . the cutter head 17 contains a plurality of elongated openings 24 disposed in radial symmetry about the center of the distal nose as shown in fig3 . the cutter head may typically be initially cylindrical and taper off in a symmetrical oval shape as it approaches the distal end . the plurality of openings 24 is usually an even number from two to six and the openings are placed close to the nose of the oval - shaped cutter head 17 so that the possibility of inadvertently contacting and cutting the side wall of the vessel parallel to the member 22 from which the plaque or other blockage is to be excised is virtually eliminated . a drive means is contained within the rigid tubular housing 11 located at the proximal end of the outer tubular member . the drive functions to rotate the inner tubular member within the lumen of the outer tubular member . the outer tubular member is joined to the tubular housing 11 as through end plug member 30 and is secured as by a compression fitting 31 which creates a liquid - tight seal . a rotary union shown generally at 32 is positioned within the housing 11 and includes a stationary tubular sleeve member 33 fixed to the housing 11 by pins or screws 34 . a pair of o - ring seals 35 and 36 are disposed in annular grooves in the tubular sleeve 33 to preclude flushing liquid contained in the chamber 37 from passing beyond the rotary union . inside of the stationary sleeve 33 is a rotating hollow manifold member 38 which rotates within the bore of the member 33 when driven by a motor such as that depicted generally at 39 having a drive shaft 40 and a coupling 41 connected in driving relation to the proximal end of the hollow manifold member 38 . the hollow manifold member 38 further contains an annular recess 42 connected to a central bore 43 which , in turn , is joined to the proximal end of the inner elongated flexible tubular member 15 by a coupling member 44 . the central inner bore 43 , via the annular recess 42 , is connected to a further tubular fitting 45 which passes through a bore in sleeve member 33 and the housing 11 to provide a suction outlet for aspirating the inner elongated flexible tubular member 15 . by making the motor drive shaft itself hollow , the stationary guidewire can be fed through the entire system . flushing saline or other solution input is provided through a further access tube 46 which extends through an additional bore in the housing 11 which communicates with the chamber 37 . in operation , the elongated catheter assembly is appropriately introduced into the vascular system , as through the femoral artery , and advanced along the previously inserted guidewire 16 , navigating through the vascular system to the appropriate arterial or other location of interest placing the cutter tip 17 adjacent to the atheroma or other lesion or blockage material to be excised from the vessel . the annular recessed diameter of the outer catheter member 12 , at 19 , aids in preventing clogging of the ports 20 during the insertion of the catheter through the arterial system . a flushing liquid such a saline is introduced through the fitting 46 into the chamber 37 of the housing 11 and flows through the lumen of the outer tubular member 12 outside the outer wall of the inner tubular member 15 . the liquid then exits the radial ports 20 located radially about the side wall of the outer tubular member 12 near is distal end 13 . concurrently , a suitable source of suction or negative pressure is applied to the fitting 45 in a well - known matter to operate in conjunction with the flushing solution to aspirate the flushing liquid along with blood and / or tissue or other debris which may be excised from the atheroma or arterial blockage is drawn through the openings 24 in the cutter head 17 through the lumen of the inner tubular member into a suitable receptacle ( not shown ). the motor 39 is energized to rotate the hollow manifold member of the rotary union within its tubular sleeve and thereby drive the tube 15 to rotate the cutter head 17 as desired . the catheter is advanced utilizing modest pressure between the cutter head 17 and the tissue to be excised so that the tissue is finely divided by the rapidly spinning cutter head and washed by blood and flushing liquid through the central lumen of the tube 15 and into a collecting receptacle ( not shown ). once the atheroma has been completed penetrated , blood flow through the blood vessel is restored . the position of the cutter head within the vessel can be adjusted with the necessary degree of precision during the procedure utilizing the guidewire to achieve complete removal of the blockage . in this manner , the attitude of the cutting head can be controlled and modulated with some leeway without the danger of inadvertent or unintentional damage to the vessel wall . fig4 and 5 show an alternate embodiment of the atherectomy catheter of the invention in which an alternative guidewire 50 is provided in the nose of the cutter head 17 and which is fixed in a manner which allows it to rotate with the cutter head in a loosely fitted or journaled arrangement in which it is free to be held or free to turn with the cutter element 17 depending on the resistance to turning . this form of guidewire provides a certain amount of guidance for the catheter through the arterial system of interest without the necessity of having the guidewire extend throughout the entire length of the inner lumen at 15 . thus , the guidewire 50 may be rivetted to the opening 23 and the cutter member 17 in a manner which allows very little wobble of the guidewire but which allows it to rotate freely within the opening 23 . fig6 illustrates yet another embodiment of the atherectomy catheter of the invention in which the annular spacer member 22 is not used and the cutter head or cutting tool 117 is in the shape of a full oval section and connected directly to the inner catheter 15 . in addition , openings 20 may be replaced by annular space 120 or a combination of the holes 20 ( shown in phantom ) and annular spacer 120 used for the infusion of flushing liquid . the present invention has been described herein in considerable detail in order to comply with the patent statutes and to provide those skilled in the art with the information needed to apply the novel principles and to construct and use such specialized components as are required . however , it is to be understood that the invention can be carried out by specifically different equipment and devices and that various modifications , both as to equipment details and operating procedures , can be accomplished without departing from the scope of the invention itself .
an atherectomy catheter is provided with an improved high speed rotating cutting head is disclosed in which the cutting head has a generally oval - shaped nose portion which includes a plurality of radially disposed excising openings extending along and rearward from a point near the center of the nose . the openings are elongated but do not extend beyond the elliptical portion of reduced diameter , and , therefore , do not damage the lining of the vessel involved .