fig1 shows a steerable catheterization device 10 in accordance with the present invention , which includes a handle 12 , an elongated body 14 , and an active tip assembly 16 that is controlled by the handle . device 10 may be , for example , a guidewire such as is commonly inserted preparatory to placing a catheter into a position near to a patient &# 39 ; s heart , or may be a catheter itself , such as is commonly used , for example to insert a balloon to that region for angioplasty . the tip assembly is bent away from the nominal axis &# 34 ; a &# 34 ; of the body , by virtue of one or more active elements . while not specifically shown , the handle 12 includes a mechanism of conventional type , for example a spring loaded collet , that may be moved axially to grip the wire or body 14 and advance it inch by inch through the vascular system of a patient . the handle is preferably also adapted to rotate the wire as it advances , to steer the point of the off - axis tip assembly into branches or around curves as the body 14 is advanced along a vessel pathway . a control button 18 is ergometrically positioned on the handle 12 to control electrical actuation signals which are conducted through the body 14 to actuate the tip 16 . this in turn controls the magnitude of off - axis deviation of the tip , or in some embodiments , the angle of tip direction in two planes or other tip characteristic . as will be readily appreciated by those skilled in the art , the body 14 may be a guidewire , having a diameter of about 0 . 010 to 0 . 040 inches , a guide catheter having a diameter of about 0 . 060 - 0 . 135 inches , or other form of catheter or catheter - based device . the general form also mirrors that of certain other insertable instruments , e . g . ; devices such as endoscopes and laparoscopy implements . because of its small dimensions , a guidewire embodiment of the present invention offers the greatest challenges to implementation , and accordingly will be described below to best illustrate details of construction . the overall architecture of this tip is shown in fig3 a , and includes a piezoelectric bimorph mounted as a steerable wiggler at the end . fig2 shows a detailed cross - sectional view of the distal tip region 115 of one embodiment of a guidewire 114 in accordance with the present invention . guidewire 114 includes a hollow wire body 117 approximately 36 - 48 inches long , and a steerable tip 119 , which is approximately 5 - 10 inches long . by way of scale , body 117 is preferably formed of a thin metal tube , having an outer diameter illustratively 0 . 014 inches in diameter , with a wall thickness of 0 . 004 - 0 . 005 inches , leaving a four to six mil lumen . the tubular wall has a high degree of torsional and compressional stiffness to resist twisting and buckling , while allowing the body to bend freely as it is steered and pushed along the vascular system . a tapered nose piece 121 is attached to the end of the tube 117 , and extends the internal lumen while tapering to a substantially smaller cross - section . nose piece 121 may be formed of polycarbonate , stainless steel or the like . at the end of nose piece 121 an electrically actuated bending element 123 extends an additional one or two inches . element 123 is actuated by one or more electrical conductors 125a , 125b which extend back through the body 117 to the control circuitry of the handle 12 . the conductors are shown extending from the proximal end to the handle ( fig1 ), but in alternate embodiments , they may reside entirely within body 117 , and connect to surface access pads which are distributed along the body at its proximal end . in this case , the handle contacts the pads to apply control signals to element 123 . surrounding the nose piece and bending element is a biocompatible and flexible spiral winding 127 which may , for example , be formed of one to three rail diameter platinum wire . an electrically insulating potting agent 128 , such as a silicone elastomer , fills the space 130 between the bending element 123 and the biocompatible winding 127 . the three structures together -- winding 127 , potting medium 128 and the actuating element 123 -- have a high degree of flexibility comparable to that of a conventional ( non - steered ) guidewire . that is , the tip is floppy allowing the point to enter into branches and flex as it bumps its way around curves , while the elongated wire body 117 follows along . a thin outer shell or lubricous film such as polyurethane film ( not shown ), may encase the assembly to reduce friction of the device in the artery . by way of scale , the distances &# 34 ; a &# 34 ; and &# 34 ; b &# 34 ; may be , for example , two to seven inches , and one to two inches , respectively . in accordance with a principal aspect of the invention , element 123 is electrically actuated by a driving voltage from outside to bend the tip off the longitudinal axis by an amount which , in the illustrated embodiment , is controlled up to a deviation calculated to exceed thirty degrees . a deflected position is indicated by &# 34 ; d &# 34 ; in phantom in the figure . greater deflections may be achieved by lengthening the element 123 . furthermore , the deflected tip may be rotated 360 ° about the longitudinal axis by torquing the insertion handle 12 . in the presently preferred embodiment of the invention , the adjustable element is fabricated out of piezoceramic plates , which are thinned to a dimension such that a completed multi - layer assembly made with the plates has a passive or non - actuated state bending stiffness comparable to the stiffness of a conventional wire steering tip , while remaining strong enough to deflect the tip when actuated . in the illustrated construction , the electrically actuated element is formed with first and second strips of piezoelectric material 132 , 134 bonded to opposite sides of a thin metal strip 135 , and poled in opposite senses . the metal strip 135 serves as a common electrode for actuation of the elements , while wires 125a , 125b are connected to respective opposing plates . to achieve a suitable flexibility , for a guidewire having a diameter under about fourteen mils , the plates 132 , 134 may , for example , be formed of lead zirconium titanate , worked to a thickness of about one mil , and cut in strips six mils wide ; the metal strip 135 may be about one mil thick , and also about six mils wide . the plates 132 , 134 are 1 - 11 / 2 inches long , and preferably the metal shim extends another half inch or more to the tip of the catheter or wire assembly . a solder dot 136 seals the end , enclosing the metal shim 135 and plates 132 , 134 within the wire wrap , which as shown is filled with a potting medium 128 . with this construction the fragile tip element is securely protected against fragments leaking out into the blood stream in the event of a fracture , while the entire tip assembly remains as supple and flexible as a prior art wire steering tip . electrical actuation of the device of fig2 is performed via leads 125a , 125b which are connected to outer electrode surfaces of the plates 132 , 134 , and preferably also by the common electrode formed by the thin metal strip 135 . the common electrode may be conductively connected to plated or metalized lines on the surface of the nose piece 121 ( if a non - conductive material is used to form the nose piece ) which , in turn , contact the conductive metal wire body 117 , or may be connected to a separate insulated lead extending through the nosepiece . as noted above , the dimensional limitations of a guidewire render the implementation of an active piezoelectric steering tip challenging . the thin plates of lead zirconium titanate are formed by taking commercial plates of small grain , low void lead zirconium titanate of greater thickness ( e . g ., 5 , 7 or 10 mil plates as available from suppliers such as edo , morgan matroc , or american piezoceramics ), bonding a plate with a high strength conductive adhesive to each side of a one rail metal sheet , to form a very high shear strength thin bonding layer , and then lapping the outer faces on an optical grinding or lapping jig to achieve a one mil thickness of each piezoceramic plate . the outer faces of each piezoceramic plate are then metallized , preferably with gold or other biocompatible metal to form electrode surfaces , and are then laser cut into strips six mils wide . after fabrication , the piezoceramic material is poled , by application of a high electric field between the conductive electrode faces . this produces a completed piezo bender unit for incorporation into the steering tip . in addition to achieving a high degree of flexibility in the plates 132 , 134 , the thin dimensions result in an actuator that operates with low actuation voltages , so that full displacements are readily achieved with signals below thirty volts and one hundred fifty microamperes or less . this allows the device to be actuated by a current - limited electrical control signal , that is safe even in the event of leakage or a short circuit of wires 125a , 125b and body 117 . in addition , sufficient actuation signals may be provided by batteries located within the handle 12 . fig3 c illustrates an architecture wherein a steering tip 200 is formed by a lever arm 201 flexibly but inextensibly attached by a central wire 202 to a body 203 corresponding to the guidewire 117 of the preceding embodiment , or to a catheter . a piezoelectric post or stack 205 extends off - center and is operated in extension to rock the lever 201 to a desired angle . as in the preceding embodiments , the joint bearing the piezo element is preferably encased and encapsulated , e . g ., by a sheath or wire wrap , and potting material . fig3 b shows a third tip architecture 300 . in this embodiment the bending tip 301 may be formed with a single metal shim extending the full length of the bending region ( as in fig3 a or 2 ), but a plurality of piezoceramic plates or sheet elements are positioned at discrete separated positions along the metal shim to induce different degrees of bending . as in the device of fig2 the plates are arranged on opposite sides to form piezo benders which are localized along the tip length . when stiffness and dimensional constraints permit sufficient electrical leads , this embodiment may be actuated to undergo more complex bends , such as s - shaped bends , or may be actuated to bend at one position while stiffening the tip at a different position . in accordance with a principal method of use of the present invention , the guidewire or catheter device is advanced within the vascular system of a patient , e . g ., via the femoral artery , and is simultaneously visualized using a contrast medium under a fluoroscope . as the tip nears an arterial branch point or narrowed passage , control signals are applied from the handle to steer the tip , changing its direction as required to an appropriate angle or position , and the device is then rotated ( if necessary for a one - dimensional deflector tip ) and advanced further . in accordance with another method of use in accordance with the invention , the tip may be actuated to assume an arc - shape that anchors it in position in a particular position , such as in in the aortic arch . for effecting this latter method , the active strain elements of the tip assembly are preferably mounted over an extended length , perhaps four to six inches , ahead of the tip area . in this case , the elements may be actuated to form a smooth are of a radius that matches the arch curvature , so that the catheter resides in position without irritating the vessel walls . alternatively , the elements may be actuated so that the catheter assumes a larger or smaller curvature , or has several polygonal bends , contacting the wall in several places to anchor it against sliding or creeping out of position . by way of particular example , the device may be a tube 600 as shown in fig7 which is preformed to assume an arc - shape to position it in the aortic arch 70 . tube 600 has a pair of sharp bends or elbows , 602 , 604 which are spaced to fit the arch , but which have relatively low bending stiffness , so that the tube readily straightens and passes through the patient &# 39 ; s vessels during the insertion procedure . however , each elbow has respective piezoelectric strain elements 603 , 605 mounted about the elbow . these are actuated , once the tube has been positioned , to rigidify the bends and firmly lodge the tube in the desired position to support passage of coaxial catheters and wires within the lumen . in accordance with yet a third method in accordance with the present invention , actuators may be energized to stiffen the tip or a portion of the tip assembly along its length to rigidify it for entering a branch point or passing an obstruction . advantageously , by employing electrical signals to stiffen a region of the catheter or wire , the stiffness of the non - actuated positions of the wire or catheter body 117 remains flexible and unaffected . fig4 a and 4b illustrate two methods of tip actuator placement , shown here for a guide catheter . in fig4 a a tip assembly 400 has a plurality of identically - sized strain actuators 405 placed on opposed sides of the tip at a number of equally - spaced intervals along its length , along a region where bending is desired , an inch or two from the end . in fig4 b , a tip assembly 410 has both larger strain elements 415 and smaller elements 416 , which may be positioned to optimize one or more properties , such as to maximize deflection , avoid fracture of the elements , or speed up the response time of the actuator . preferably , smaller elements are located at joint or flexure areas . fig5 a - 5c illustrate variations in actuator placement along the tip , either at the extreme end ( fig5 a ), an inch or two back ( fig5 b ) or extending over a major segment of both regions of the end ( fig5 c ). in the latter case , elements at one position may be wired oppositely to those at another position to form a zig - zag rather than a single bend . such shape , in conjunction with conventional torquing ( rotation ) of the wire or catheter body may offer enhanced vessel branch navigation abilities . preferably the overall tip construction is a multi - layered construction as illustrated in fig6 with an insulating but flexible sheath and a protective coil exterior , as described in respect of fig2 above . fig8 a , 8b and 8c illustrate , greatly enlarged , one embodiment of a tip construction 500 for bending along two degrees of freedom about the longitudinal axis &# 34 ; l &# 34 ; of a steered insertable device . first and second steel shims 510 , 511 are mounted to cross each other as a pair of crossing vanes with oppositely - actuated strain elements 550a , 550b , and 551a , 551b positioned on the respective shims to deflect them in first and second planes , respectively . geometric constraints due to the small geometry are largely avoided by mounting the strain actuators of each vane on opposite faces of the vane , and opposite sides of the vane &# 39 ; s crossing axis 520 . furthermore , the actuators of the first vane are mounted at a different position along the axis l , than are the actuators of the second vane . thus , as illustrated in perspective view fig8 a , the first set 550a , 550b bends the tip in the plane of the drawing , when actuated , while the second set causes out - of - plane deflections . it will be understood that the constructions described above for guidewires , may be readily scaled to form an active steerable tip for a guide catheter , for a related instrument incorporating catheter or wire features , such as a balloon pump , or for an endoscope or specialized treatment device . in such cases , when devices are generally of greater diameter but the inner lumen must remain open , it may be desirable to use other strain actuated materials , such as polyvinylidene difluoride ( pvdf ), which may be bonded to the outside of the catheter , but below a protective layer . while generally capable of applying less force , pvdf actuators on larger tubes or catheters may benefit from the larger moment arm from the neutral axis . further increases in mechanical advantage are obtained by mounting on the outer skin of the tube or catheter . alternatively , one or more layers of a piezoelectric polymer material may form the tip body itself . in general , however , constructions using piezoceramics as described above , are preferred for their greater force characteristics and desirable low level signal requirements . the invention being thus disclosed , further variations and modifications will occur to those skilled in the art , and all such variations and modifications are intended to be within the scope of the invention , as defined in the claims appended hereto .
a remotely steerable guidewire , catheter or insertable active implement is disclosed . a steerable guidewire or a catheter for coronary and peripheral catheterizations is illustrated , using smart materials such as piezoelectrics for controlling its motions inside the body via control inputs applied from outside the body . a steerable portion of the device , which may be either an active flexible tip or an active region along the length of the implement , controls the shaft position or modifies its stiffness . in one embodiment , manipulation of electrical control inputs permits deflection of the steerable region through a range of motion about the axis of the implement in a single plane . in further embodiments , the tip may deflect in multiple planes about its longitudinal axis , or the catheter may be selectively stiffened to assume an arc shape or to firmly lodge the tip in position in a vessel .