Laser catheter with use of reflected light and force indication to determine material type in vascular system

Abstract

Apparatus and methods for determining a type of a material in a region within a vascular system of a patient are provided. The determination is made after light has been reflected from the region after being supplied to the region from a light source by at least one optical fiber. The determination is made based on an analysis of the light reflected from the region and of a received at least one indication of a force applied to the material in the region by one or more of the at least one optical fiber. The indication of the force applied by the one or more of the at least one optical fiber is provided by at least one force sensor coupled to the at least one optical fiber.

Claims

1. An apparatus for determining a type of a material in a region within a vascular system of a patient, the apparatus comprising: a laser catheter coupled to a light source, the laser catheter comprising: a distal end and a tip at the distal end; at least one optical fiber disposed at the tip and configured to: supply light from the light source to a contact region within a vascular system of a patient; and receive light reflected from the contact region within the vascular system of the patient, wherein the light reflected from the contact region is indicative of diffuse absorbance and transmittance characteristics of the contact region within the vascular system of the patient; and at least one force sensor coupled to the at least one optical fiber, the at least one force sensor configured to provide at least one indication of a force applied by one or more of the at least one optical fiber to a material in the contact region within the vascular system of the patient; and at least one controller configured to: determine diffuse absorbance and transmittance characteristics of the contact region within the vascular system of the patient by separating the light reflected from the contact region into a plurality of channels and determining an intensity value for each plurality of channels; receive the at least one indication of the force applied by the one or more of the at least one optical fiber to the material in the contact region within the vascular system of the patient; determine a waveform, wherein the waveform represents the diffuse absorbance and transmittance characteristics for each plurality of channels for the least one indication of force; determine a type of the material in the contact region based on the waveform; and determine, based on the at least one indication of force and the waveform, a confidence value indicative of a likelihood of whether the type of the material in the contact region is correct.

2. The apparatus of claim 1, wherein the at least one controller is further configured to perform a discriminant analysis by performing a kernel discriminant analysis.

3. The apparatus of claim 1, wherein the at least one optical fiber comprises a first number of optical fibers, wherein the at least one force sensor comprises a second number of force sensors, wherein the first number is equal to the second number, and wherein each force sensor of the second number of force sensors is communicatively coupled to the at least one controller to provide a respective one of the at least one indication of the force applied to the material in the contact region, the respective indication being an indication of a force applied to the material in the contact region by a respective one of the at least one optical fiber.

4. The apparatus of claim 1, wherein the at least one optical fiber comprises a first number of optical fibers, wherein the at least one force sensor comprises a second number of force sensors, wherein the first number is different from the second number, and wherein each force sensor of the second number of force sensors is communicatively coupled to the at least one controller to provide a respective one of the at least one indication of the force applied to the material in the contact region, the respective indication being an indication of a force applied to the material in the contact region by one or more of the at least one optical fiber.

5. The apparatus of claim 1, wherein the at least one controller is further configured to cause one or more of the at least one optical fiber to supply light from a laser source to ablate the material in the contact region based on the determination of the type of the material in the contact region.

6. The apparatus of claim 1, wherein the at least one force sensor comprises a Bragg diffraction grating.

7. The apparatus of claim 1, wherein the at least one force sensor comprises a Fabry-Perot interferometric force sensor.

8. The apparatus of claim 1, further comprising a lead locking device for use in a lead extraction procedure in the contact region within the vascular system, wherein a sheath is advanced over the lead locking device for use in the lead extraction procedure, and wherein the at least one force sensor configured to provide the at least one indication of the force applied by the one or more of the at least one optical fiber to the material in the contact region is mounted on a flat portion of the lead locking device.

9. The apparatus of claim 1, wherein the laser catheter is configured to supply a differentiating substance to the material in the contact region within the vascular system so as to facilitate the determination of the type of the material in the contact region based on the analysis of the light reflected from the contact region and of the received at least one indication of the force applied to the material in the contact region.

10. The apparatus of claim 1, wherein the confidence value varies with the at least one indication of force.

11. A method for determining a type of a material in a region within a vascular system of a patient, the method comprising: supply light from a light source to a contact region within a vascular system of a patient; and receive light reflected from the contact region within the vascular system of the patient, wherein the light reflected from the contact region is received from at least one return fiber disposed at the tip of a laser catheter, wherein the light reflected from the contact region is indicative of diffuse absorbance and transmittance characteristics of the contact region within the vascular system of the patient; determining diffuse absorbance and transmittance characteristics of the contact region within the vascular system of the patient by separating the light reflected from the contact region into a plurality of channels and determining an intensity value for each plurality of channels; receiving, from at least one force sensor, at least one indication of a force applied by one or more of at least one optical fiber of a laser catheter to material in a contact region within a vascular system of a patient; determining, based on a waveform, a type of the material in the contact region, wherein the waveform represents the diffuse absorbance and transmittance characteristics for each plurality of channels for the least one indication of force; and determining, based on the at least one indication of force and the waveform, a confidence value indicative of a likelihood of whether the type of the material in the contact region is correct.

12. The method of claim 11, further comprising performing a discriminant analysis comprises performing a kernel discriminant analysis of the at least one optical characteristic of the light reflected from the contact region and of the received at least one indication of the force applied to the material in the contact region.

13. The method of claim 11, wherein the at least one optical fiber comprises a first number of optical fibers, wherein the at least one force sensor comprises a second number of force sensors, and wherein receiving the at least one indication of the force applied to the material in the contact region comprises receiving, from each force sensor of the second number of force sensors, a respective one of the at least one indication of the force applied to the material in the contact region, the respective indication being an indication of a force applied to the material in the contact region by one or more of the at least one optical fiber.

14. The method of claim 11, further comprising causing one or more of the at least one optical fiber to supply light from a laser source to ablate the material in the contact region based on determining the type of the material in the contact region.

15. The method of claim 11, wherein the at least one force sensor comprises at least one of a Bragg diffraction grating and a Fabry-Perot interferometric sensor.

16. The method of claim 11, wherein receiving the at least one indication of a force applied to the material in the contact region comprises receiving the at least one indication from the at least one force sensor when the at least one force sensor is mounted on a flat portion of a lead locking device for use in a lead extraction procedure in the contact region within the vascular system.

17. The method of claim 11, wherein the confidence value varies with the at least one indication of force.

18. A non-transitory computer-readable medium comprising executable instructions that when executed by one or more processors cause the one or more processors to: supply light from a light source to a contact region within a vascular system of a patient; and receive light reflected from the contact region within the vascular system of the patient, wherein the light reflected from the contact region is received from at least one return fiber disposed at the tip of a laser catheter, wherein the light reflected from the contact region is indicative of diffuse absorbance and transmittance characteristics of the contact region within the vascular system of the patient; determining diffuse absorbance and transmittance characteristics of the contact region within the vascular system of the patient by separating the light reflected from the contact region into a plurality of channels and determining an intensity value for each plurality of channels; receive, from at least one force sensor, at least one indication of a force applied by one or more of at least one optical fiber of a laser catheter to material in a contact region within a vascular system of a patient; determine, based on a waveform, a type of the material in the contact region, the waveform represents the diffuse absorbance and transmittance characteristics for each plurality of channels for the least one indication of force; and determine, based on the at least one indication of force and the waveform, a confidence value indicative of a likelihood of whether the type of the material in the contact region is correct.

19. The non-transitory computer-readable medium of claim 18, wherein the executable instructions that when executed by one or more processors cause the one or more processors to vary the confidence value with the at least one indication of force.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) The accompanying drawings are incorporated into and form a part of the specification to illustrate several examples of the present disclosure. These drawings, together with the description, explain the principles of the disclosure. The drawings simply illustrate preferred and alternative examples of how the disclosure can be made and used and are not to be construed as limiting the disclosure to only the illustrated and described examples. Further features and advantages will become apparent from the following, more detailed, description of the various aspects, embodiments, and configurations of the disclosure, as illustrated by the drawings referenced below.

(2) FIG. 1 shows an example apparatus for determining a type of a material in a region within a vascular system of a patient and a distance to the material, thereby facilitating ablation of the material in example ways discussed herein;

(3) FIG. 2 is a top perspective view of a distal portion of a catheter, such as a laser catheter;

(4) FIG. 3 is an elevation view of a distal portion of a catheter, such as a laser catheter;

(5) FIG. 4 is a cross-sectional perspective view of a distal portion of a catheter, such as a laser catheter;

(6) FIG. 5 is a functional block diagram of the example apparatus of FIG. 1;

(7) FIGS. 6A, 6B, 7A, and 7B are simplified views of reflected diffuse absorbance and transmittance (DAAT) characteristics from the perspective of outputs of return fibers;

(8) FIG. 8 illustrates a group of video frames of each of four return fibers, including example intensities of a red channel, a green channel, and a blue channel for each of the return fibers and example corresponding indications of type of a material and/or distance to a material in a region within a vascular system of a patient;

(9) FIGS. 8A-8C illustrate several magnified views of different portions of the video frame for one of the four return fibers of FIG. 8, including several magnified views of the example intensities shown in FIG. 8 of the red, green, and blue channels for the fiber and several of the example corresponding indications shown in FIG. 8 of type of a material and/or distance to a material;

(10) FIG. 9 is a flowchart of an example method for determining a type of a material in a region in a vascular system of a patient, thereby facilitating ablation of the material in example ways discussed herein;

(11) FIG. 10 is a flowchart depicting the steps of a surgical procedure using an embodiment of the laser catheter of the present disclosure;

(12) FIG. 11 illustrates an example use of displacement of source and/or return fibers to treat a broader area within a vascular system of a patient;

(13) FIG. 12 illustrates an example use of an offset between ends of source and/or return fibers and a tip of a laser catheter to facilitate determination of properties of reflected light;

(14) FIG. 13 illustrates an example portion of a human vasculature, such as an example portion of a blood vessel;

(15) FIGS. 13A-13C illustrate an example portion of a human vasculature, such as an example portion of a blood vessel, with examples of positioning and/or use of a laser catheter for ablation;

(16) FIG. 14 is a schematic section view of another example portion of a vasculature;

(17) FIG. 15 is an example cross-sectional view of a laser catheter illustrating two innermost rings of optical fibers, and further illustrating light being transmitted radially from fibers in an outermost ring of optical fibers after deflection by at least one light-deflecting object;

(18) FIG. 16 illustrates an example portion of a human vasculature, such as an example portion of a blood vessel, with an example implementation of anchoring components;

(19) FIG. 17 illustrates another example portion of a human vasculature, such as an example portion of a blood vessel, with another example implementation of an anchoring component;

(20) FIG. 18 is a flowchart of an example method for ablating material in a region within a vascular system of a patient using an embodiment of the present disclosure;

(21) FIG. 19 illustrates an elevation view of an embodiment of a distal portion of a laser catheter that may be used to, for example, determine an indication of a type of a material;

(22) FIG. 19A is an example plot of diffuse reflectance versus wavelength of reflected light from porcine fat tissue immersed in blood at various contact force levels;

(23) FIG. 20A is another example functional block diagram of the apparatus of FIG. 1;

(24) FIG. 20B is another example functional block diagram of the apparatus of FIG. 1;

(25) FIG. 21A illustrates an example lead locking device that may be used in some embodiments of the present disclosure;

(26) FIG. 21B is an example close-up view of a portion of the example lead locking device of FIG. 21A;

(27) FIG. 21C illustrates an example environment in which the lead locking device of FIG. 21A may be used in a lead extraction procedure and in which various principles described herein may be incorporated; and

(28) FIG. 22 is a flowchart of an example method for diagnosis and/or treatment of material in a region within a vascular system of a patient.

DETAILED DESCRIPTION

(29) Laser catheters typically transmit laser energy through optical fibers housed in a relatively flexible tubular catheter inserted into a body lumen, such as a part of the vasculature, ureter, fallopian tube, and the like to remove obstructions in the lumen. Catheters used for laser angioplasty and other procedures may have a central passageway or tube which receives a guide wire inserted into the body lumen (e.g., vasculature) prior to catheter introduction. The guide wire facilitates the advancement and placement of the catheter to the selected portion(s) of the body lumen for laser ablation of vascular material, e.g., non-biological vascular material.

(30) Examples of laser catheters or laser sheath are sold by the Spectranetics Corporation under the trade names ELCA and Turbo Elite (each of which is used for coronary intervention or catheterization such as recanalizing occluded arteries, changing lesion morphology, and facilitating stent placement) and SLSII and GlideLight (which is used for surgically implanted lead removal). The working (distal) end of a laser catheter typically has a plurality of laser emitters, such as ends of source fibers, which emit energy and ablate the targeted vascular material. The opposite (proximal) end of a laser catheter typically has a fiber optic coupler, which connects to a laser system or device or generator including a light source. One such example of a laser system is the CVX-300 Excimer Laser System, which is also sold by the Spectranetics Corporation.

(31) Referring now to FIG. 1, an example apparatus 100 for determining a type of a material in a region within a vascular system of a patient and a distance to the material (e.g., to a boundary of the material, as further discussed below) is shown in accordance with one embodiment of the present disclosure. The determination of the type of the material and/or the distance to the material may facilitate ablation of the material in example ways discussed further below. The example apparatus 100 is illustrated as generally including a laser device 130, which may include a light source such as a laser (e.g., an excimer laser or any suitable laser), coupled to a proximal end of a laser catheter 170 by way of a coupler 140.

(32) In another embodiment, a separate light source for purposes of determining the type of the material and the distance to the material in the region within the vascular system of the patient, which may at times be referred to as a diagnostic light source, may be included in the laser device 130 and also coupled to the proximal end of the laser catheter 170 by way of, for example, the coupler 140. The diagnostic light source may be any suitable light source and need not be a laser. For example, the diagnostic light source may be or may include one or more light-emitting diodes (LEDs), broadband light source(s) (e.g., halogen light source(s)), xenon flash light source(s), etc. In such an implementation, the laser device 130 may still include at least one treatment light source, which may also be referred to as a therapeutic light source, such as a laser for ablating bodily material such as buildup of plaque, calcium deposits, scar tissue, or the like. The therapeutic/treatment light source may be adjusted (e.g., in intensity, in distance from vascular material, etc., as further described below) based on the determined type of the material in the region and/or the distance to the material in the region. It will be understood in light of the following disclosure that references herein to light source may include either or both of (e.g., collectively) the therapeutic/treatment light source and a diagnostic light source.

(33) The laser catheter 170 is also connected to at least one controller 180 by any suitable connection, such as, for example, by way of a wired connection via the coupler 140, a return connection portion 172, and if desired a device such as a USB microscope 175 to aid in producing images of the material in the region of the vascular system of the patient and/or other suitable data as discussed below. The laser catheter 170 may also be connected to the at least one controller 180 by any other suitable wired or wireless connection. While illustrated as a computing device, the at least one controller 180 may be implemented, for example, by executing suitable instructions on any suitable processor(s), by at least one digital signal processor, by one or more application-specific integrated circuits (ASICs), or by any other suitable hardware, firmware, or software implementation or any suitable combination of the example implementations described above. In another embodiment, the at least one controller 180 is connected to the laser device 130 and receives and/or analyzes reflected light from a region within the vascular system of the patient, as further described below, after such reflected light is received by the laser device 130. In yet another embodiment, the at least one controller 180 may be internal to the laser device 130.

(34) As also illustrated in FIG. 1, a distal end of the laser catheter 170 may be inserted into a patient 110, such as into the vasculature of the patient 110. In some embodiments, the example apparatus 100 employs a plurality of fibers, such as optical fibers, as light guides that guide laser light from the laser device 130 through the laser catheter 170 and toward a target area or region within the vascular system of the patient 110.

(35) FIGS. 2 and 3 are a top perspective view and an elevation view, respectively, of a distal portion of a catheter, such as the example laser catheter 170, according to an embodiment of the present disclosure. As shown in the example of FIGS. 2 and 3, the distal portion of the laser catheter 170 may include an outer jacket 200 or sleeve, and may include a distal end 202. The outer jacket 200 of the example of FIGS. 2 and 3 comprises a flexible assembly with the ability to resist user-applied forces such as torque, tension, and compression. The proximal end (not shown) of the laser catheter 170 is attached to a fiber optic coupler, such as the coupler 140 as shown in FIG. 1. The laser catheter 170 includes an outer jacket, inner band, and at least one optical fiber similar to the configuration and orientation of such components as shown in FIGS. 2 and 3 and further described herein. The distal end 202 of the laser catheter 170 comprises a plurality of optical fibers, including at least one source fiber acting as a laser emitter or emitters, and at least one return fiber as further described below. The energy emitted by the laser emitter(s) cuts, separates, and/or ablates the scar tissue, plaque build-up, calcium deposits, and other types of undesirable lesion or bodily material within the vascular system of the patient 110.

(36) The distal end 202 of the laser catheter 170 may, in some embodiments, include a lumen 206. If the lumen 206 is included in the laser catheter 170, a clinician may insert the laser catheter 170 into the vasculature over a guidewire (not shown) through the lumen 206. It may, however, be preferable for the laser catheter 170 to have a separate guidewire lumen. Incorporation of such a guidewire lumen is generally known to one of ordinary skill in the art, and all such guidewire lumens within the knowledge of one skilled in the art are considered within the scope of the present disclosure. The lumen 206 may also be used to slide the laser catheter 170 over an electrical lead in a lead removal procedure. The lumen may also include one or more fixed and/or removable conduit(s) for additional tools to assist in vascular material removal or navigation, such as but not limited to optical coherence tomography (OCT) catheters or intravascular ultrasound (IVUS) catheters. The additional tools may assist in procedures associated with vascular material removal or navigation such as saline injection, suction, balloon deployment, and/or use of injectable contrast agents that can amplify the sensed optical contrast of targeted vascular material so as to improve the ability to correctly discriminate such vascular material.

(37) The aforementioned laser emitter(s), as further described below, may be provided in a generally concentric configuration or in any other suitable configuration such as an eccentric configuration. For example, the lumen 206, in embodiments where the laser catheter includes the lumen 206, may be provided substantially concentric with and interior to the laser emitter(s) (and optical fiber(s)), or eccentric with respect to the laser emitter(s), thereby providing a potential conduit or passageway for translocation of materials cut or ablated by the laser emitter(s).

(38) Although FIGS. 2 and 3 illustrate the laser emitter(s) in a generally concentric configuration, those skilled in the art will appreciate that there are numerous other ways and configurations (e.g., eccentric configurations, as discussed above) in which to arrange at least one laser emitter. Additionally, although these two figures illustrate an outer jacket 200 and a distal end 202, those of skill in the art will appreciate that distinct components need not be used, and the optical fibers may be encapsulated within a single sleeve. Accordingly, FIGS. 2 and 3, as well as FIG. 4 discussed below, are not intended to represent the only way that a laser catheter such as the laser catheter 170 may be configured and constructed, and all such configurations and constructions within the knowledge of one skilled in the art are considered within the scope of this disclosure.

(39) With continued reference to FIG. 3, a more particular example implementation of the plurality of optical fibers is shown, according to an embodiment of the present disclosure. As shown in FIG. 3, the plurality of optical fibers may include at least one source fiber 300 configured to supply light from a light source to a region within the vascular system of a patient so as to illuminate the region, and at least one return fiber 302 configured to receive light reflected from the region, as further described below. In particular, the at least one source fiber may include one or, as shown, a plurality of source fibers 300. The at least one return fiber 302 may include one or, as shown, a plurality of return fibers 302a, 302b, 302c, and 302d. The plurality of optical fibers may, if desired, be implemented such that fewer return fibers than source fibers are used, and where the return fibers may have larger cross-sectional area. The return fiber(s) 302 may be evenly or unevenly spaced around, for example, a lumen 206 within the laser catheter 170. For example, if two return fibers 302 are used, the return fibers 302 may be spaced 180 degrees apart from one another; if three return fibers 302 are used, the return fibers 302 may be spaced 120 degrees apart from one another; and if four return fibers 302 are used as shown in FIG. 3, the return fibers 302 may be spaced 90 degrees apart from one another. In other embodiments, the return fibers 302 may not be evenly spaced with respect to one another in manners such as the example manners provided above. The plurality of optical fibers may also include at least one additional fiber 304 coupled to the light source (the light source being discussed above with respect to FIG. 1 and further below with respect to FIG. 5). The at least one additional fiber 304 may also be coupled, along with the source fiber(s) 300 and return fiber(s) 302, to the at least one controller 180 to enable the at least one controller 180 to use information from the additional fiber(s) 304 regarding light from the light source to determine an intensity of the light supplied by the source fiber(s) 300.

(40) FIG. 4 is a cross-sectional perspective view of a distal portion of a laser catheter, which may be used to implement the laser catheter 170, according to one embodiment of the present disclosure. As discussed above, the laser catheter 170 may include a distal end 202 that may, in some embodiments, include the lumen 206. The distal end 202 may be operable by a user, and the position of the distal end 202 is controlled by, for example, deflection means such as pullwires, shaping wires, and similar force-transmitting features controlled by the user at a user-proximal location of the laser catheter 170.

(41) FIG. 5 is a functional block diagram of the example apparatus 100 for determining a type of a material in a region within a vascular system of a patient and a distance to the material, according to one embodiment of the present disclosure. As in FIG. 1, the example apparatus 100 includes the laser device 130, the coupler 140, the laser catheter 170, and the at least one controller 180. The laser device 130 includes a light source to which the laser catheter 170 is coupled by way of the coupler 140. As shown in FIG. 5, the light source may take the form of a laser source 500 (e.g., an excimer laser, etc.) or a diagnostic light source 502 (e.g., an LED), where the laser source 500 is used for treatment (e.g., therapeutic purposes such as ablation). In another example, both the laser source 500 and the diagnostic light source 502 may be used at differing times as desired or as best suited to a particular application (e.g., a particular region of the vasculature under analysis).

(42) The laser catheter 170 includes at least one fiber bundle 504, which in turn may include the at least one source fiber 300 configured to supply light from the light source to a region 506 within the vascular system of a patient so as to illuminate the region 506. The region 506 may comprise an electrical lead or leads as discussed above and, in some cases, buildup or deposit of unwanted material on or surrounding the lead(s). The at least one fiber bundle 504 may also include the at least one return fiber 302 configured to receive light reflected from the region 506 and the at least one additional fiber 304 to enable determination of the intensity of the light supplied by the source fiber(s) 300 from the light source. The at least one return fiber (e.g., return fibers 302a-302d) may, for example, be configured to receive the reflected light between pulses of laser light supplied from the light source via the source fiber(s) 300. In another embodiment, the at least one return fiber 302 may be configured to receive the reflected light from the region 506 within the vascular system of the patient where the light source is the diagnostic light source 502. The at least one return fiber 302 may provide the reflected light to the coupler 140, which may in turn provide the reflected light to the at least one controller 180 for analysis as described below.

(43) In various vascular intervention procedures, including in lead removal procedures, it may be desirable to control the intensity of light supplied via the source fiber(s) 300 to the region 506 for each individual fiber; that is, on a fiber-by-fiber basis. For example, a typical electrical lead passes through a portion of the superior vena cava (SVC), and the SVC includes a relatively notable bend. In passing the laser catheter 170 through that bend during a lead removal procedure, it may be useful for a clinician to be able to control the amount of laser energy being emitted by the various fibers within the laser ablation catheter. That is, the intensities in individual ones of the source fibers 300 may be varied with respect to one another under control of the laser device 130. This may be done by the clinician or automatically by the device itself. For example, source fibers 300 interior to the bend in the SVC may not need an adjustment of the intensity of light passing therethrough from the light source, but source fibers 300 on the outside portion of the bend in the SVC may need a reduction in the intensity of source light passing therethrough.

(44) Similarly, there may be situations in which a clinician wishes to control, or needs the ability to control, intensities of light supplied by different ones of the source fibers 300 based on the intensities of reflected light received by different ones of the return fibers 302 (which reflected light is discussed in further detail below) in order to avoid vascular tissue tearing and other dangerous or undesirable results. Accordingly, in an embodiment of the present disclosure, intensities of light supplied by various ones of the source fibers 300 near a particular one of the return fibers 302 (e.g., return fiber 302a) may not be adjusted, while intensities of light supplied by various ones of the source fibers 300 near another particular one of the return fibers 302 (e.g., return fiber 302c) may be adjusted, such as when the intensity of reflected light received by the return fiber 302c meets particular conditions such as falling within a color-specific range or ranges of intensity, exceeding color-specific thresholds, etc.

(45) Still further, in an embodiment of the present disclosure, the intensity/intensities of reflected light received by one or more of the return fibers 302 may be used to adjust the intensity/intensities of light supplied by various ones of the source fibers 300 within the laser catheter 170. As just several examples, the intensity of reflected light received by one return fiber (e.g., return fiber 302a) may be used to adjust the intensity of light supplied by source fibers 300 near the one return fiber, the intensity of light supplied by all source fibers 300, or the intensity of reflected light received by more than one of the return fibers 302 may be averaged or weighted in any other suitable manner and similarly used to adjust the intensity of light supplied by some or all of the source fibers 300. Any suitable use of the intensity/intensities of reflected light received by one or more of the return fiber(s) 302 to adjust the intensity of one or more of the source fiber(s) 300 may be implemented. Such suitable uses further include, by way of example, applications such as controlling therapeutic energy based on contacted vascular material, e.g., increasing laser energy or selecting different laser types for ablating calcified plaque and decreasing energy for ablating soft plaque.

(46) As shown in FIG. 5, the at least one controller 180 may include at least one processor 508 coupled to at least one memory 510 and input/output (I/O) device(s) 512. The I/O device(s) 512 may include one or more keys, touch screens or other displays, dials, lights, audio input or output devices, a mouse, and/or any other suitable I/O device(s). The at least one processor 508 may include laser device output logic 514 coupled to the laser device 130 and configured to control at least one of a pulse rate, a power level, and other characteristics of the optical energy output by the laser source 500 and/or the diagnostic light source 502. The at least one processor 508 may also include optical property sensing logic 515 configured to receive the output of the coupler 140, after the coupler 140 receives the reflected light from the at least one return fiber 302 (e.g., return fibers 302a-302d), and to generate signals indicative of sensed optical properties of the reflected light.

(47) In one embodiment, the optical property sensing logic 515 may be implemented in hardware and may include, for example, at least one of a spectrometer, filtered light sensor(s), charge-coupled device (CCD) array with suitable optics and/or filters, etc. The at least one processor 508 may further include optical property determining logic 516 coupled to the optical property sensing logic 515, and the optical property determining logic 516 may be coupled to material type determining logic 518 and material distance determining logic 520 in order to determine a type of a material in the region 506 within the vascular system of the patient and in order to determine a distance to the material in the region 506, respectively.

(48) Each of the laser device output logic 514 and other logic described herein may be implemented as software by executing suitable instructions on, for example, the at least one processor 508, or by storing executable instructions on a computer-readable medium (e.g., in the at least one memory 510), where the executable instructions are executable by at least one processor such as the at least one processor 508 to cause the at least one processor to perform the actions described herein. The various logic described herein may also be implemented in any other suitable manner, such as but not limited to a hardware implementation or any suitable combination of the example implementations described above. In the case of, for example, a hardware implementation, it will be appreciated from the disclosure herein that the various logic described may be physically distinct from the at least one processor 508. Additionally, in some cases, one or more of the logic elements described herein may be implemented as or considered as a single logic element, such as, for example, the optical property sensing logic 515 and the optical property determining logic 516. For example, the optical property sensing logic 515 and the optical property determining logic 516 may be implemented as or considered as a single logic element that senses optical properties of the reflected light, generates signals indicative of the sensed optical properties, and determines the optical properties based on the generated signals.

(49) The reflected light received from the at least one return fiber 302 may be indicative of at least one of a transmittance, a reflectance, an absorbance, and a scattering coefficient of the region 506 within the vascular system of the patient. As understood by one skilled in the art, transmittance may be expressed as the percentage of incident light (electromagnetic radiation) on a sample (e.g., vascular material) at a particular wavelength that is transmitted through the sample. Absorbance may be expressed as the percentage of incident light (electromagnetic radiation) on a sample at a particular wavelength that is absorbed by the sample. Reflectance may be expressed as the percentage of incident light (electromagnetic radiation) on a sample at a particular wavelength that is reflected by the sample. The reflected light received from the at least one return fiber 302 may also be indicative of at least one of a polarization of vascular material in the region 506 and optical coherence tomography data associated with the material in the region 506, and/or these and/or other suitable optical properties of the region 506 may be sampled and indicated by the output of the at least one return fiber 302 to the coupler 140.

(50) The output of the coupler 140, which may be a modified coupler so as to couple both the at least one source fiber 300 and the at least one return fiber 302, and if desired the at least one additional fiber 304 as well, to the laser device 130 and/or the at least one controller 180, may be provided (e.g., as an image or video frame) to the optical property sensing logic 515 as described above. In another embodiment, a coupler separate from the coupler 140 (which separate coupler is not shown) may couple, for example, the at least one return fiber 302 and, in some cases, the at least one additional fiber 304 to, for example, the at least one controller 180.

(51) The optical property sensing logic 515 may receive the output of the coupler 140 so as to generate at least one signal indicative of sensed optical property or properties of the reflected light. The at least one signal generated by the optical property sensing logic 515 may be provided to the optical property determining logic 516, which may determine at least one property (e.g., at least one optical property) of the region 506 based on the at least one signal provided by the optical property sensing logic 515. The at least one property of the region 506 may include at least one of a transmittance of the region 506, a reflectance of the region 506, an absorbance of the region 506, a scattering coefficient of the region 506, and an intensity of the reflected light within a spectrum. For example, the optical property sensing logic 515 and the optical property determining logic 516 may use changes in intensity of reflected light to determine the reflectance of the region 506. Other example ways of receiving the output of the coupler 140 so as to determine the at least one property of the region 506 will be understood by those of skill in the art after understanding the present disclosure.

(52) The optical property determining logic 516 may send information regarding the determined at least one property of the region 506 to the material type determining logic 518. In some embodiments, the optical property determining logic 516 may also or alternatively send information regarding the determined at least one property to the material distance determining logic 520. The material type determining logic 518 may determine, based on the information from the optical property determining logic 516, the type of the material in the region 506. As just one example, the material type determining logic 518 may analyze the determined at least one property of the region 506 within the vascular system by analyzing diffuse absorbance and transmittance (DAAT) characteristics of the region 506 as determined by the optical property determining logic 516 to determine that the type of the material in the region 506 comprises biological material and, more particularly, that the type of the material comprises one of blood or tissue.

(53) In other embodiments, the analysis by the material type determining logic 518 may further indicate that the type of the material in the region is biological material, for example, a particular cell type or biomolecule associated with the cells of a particular tissue, such as SVC tissue, which may be particularly useful in assisting a clinician in avoiding dangerous SVC tears when performing ablation using the laser catheter 170. In still further examples, the material type determining logic 518 may determine that the type of the material in the region 506 comprises non-biological material, such as, for example, fat deposits (e.g., cholesterol monohydrate, cholesterol esters and phospholipids), fibrous tissue (e.g., fibrin, proteoglycans, collagen), calcium deposits (e.g., calcium oxide, calcium carbonate, calcium phosphates), and remnants of dead cells and cellular debris in the region 506, etc.

(54) As discussed above, the optical property determining logic 516 may also or alternatively send the information regarding the determined at least one property of the region 506 within the vascular system of the patient to the material distance determining logic 520. The material distance determining logic 520 may determine, based on the information from the optical property determining logic 516, an indication of a distance to the material in the region 506 within the vascular system. For example, the material distance determining logic 520 may cause the at least one controller 180 to generate an indication (e.g., via the I/O device(s) 512) that the distance to the material in the region 506 is shorter than desired based on the determined type of the material in the region (e.g., based on determining that the type of the material in the region 506 is SVC tissue, the at least one controller 180 may generate an indication of a risk of causing an SVC tear given the distance to the SVC). The material distance determining logic 520, and/or the material type determining logic 518, may also determine whether the material in the region 506 is a proper target for laser ablation (e.g., based on the type of the material in the region 506 and/or the distance to the material in the region 506). For example, if the material distance determining logic 520 indicates that the laser catheter 170 is in dangerously close contact with the SVC, the material distance determining logic 520 may determine that the material in the region 506 is not a proper target for ablation.

(55) The material type determining logic 518 and the material distance determining logic 520 may also or alternatively be configured to cause the at least one controller 180 to generate, such as via the I/O device(s) 512, an alert based on the determined type of the material in the region 506 and/or the determined distance to the material. The alert may, for example, prompt a clinician to adjust an intensity of the light source (e.g., laser source 500 or diagnostic light source 502), power off the light source, or supply light at reduced intensity to a particular area within the region 506, etc., as discussed below. Such adjustments may instead be automatic (e.g., caused at least in part by the at least one controller 180) if desired.

(56) In accordance with an embodiment of the present disclosure, the material type determining logic 518 and/or the material distance determining logic 520 may analyze the information from the optical property determining logic 516 (e.g., determined transmittance, reflectance, absorbance, and/or scattering coefficient of the region 506) with respect to a library of information regarding different types of materials and/or distances to materials in order to determine material type and/or indication of distance, respectively. The library of information may, in one embodiment, be contained within the at least one memory 510, and may comprise any suitable executable instructions or other content within memory to allow the material type determining logic 518 and/or the material distance determining logic 520 to determine material type in the region 506 and/or indication of distance to the material in the region 506. The information from the optical property determining logic 516 regarding the determined at least one property of the region 506 may, for example, be compared against information in the library to determine the type of the material in the region 506 and/or the distance to the material.

(57) Furthermore, in accordance with an embodiment of the present disclosure, the optical property determining logic 516 may receive the output of the coupler 140 so as to determine at least one property of the region 506 on a fiber-by-fiber basis. That is, the optical property determining logic 516 may determine the at least one property individually for each of the return fibers 302, thus allowing the determining of the type of the material in the region 506 and/or the indication of the distance to the material in the region 506 to be performed/provided for each individual one of the fibers 302. Such individualized determinations may be useful when, for example, the laser catheter 170 is contacting blood or tissue (e.g., tissue that is biological material) at an angle and thus the characteristics of reflected light at each of the return fibers 302 are different (see, e.g., discussion of FIG. 7B below). Additionally, the I/O device(s) 512 may, for example, display per-fiber feedback in real time and/or in a visual arrangement that corresponds to the geometric arrangement of the fibers at the tip of the laser catheter 170. In one embodiment, real-time visualizations may be displayed, on a per-fiber basis if desired, by overlaying the real-time visualizations onto existing fluoroscopy displays.

(58) Still further, in some embodiments, the light reflected from the region 506 after the region 506 is illuminated by the at least one source fiber 300 (which as discussed above, may be by way of, for example, the laser source 500 or the diagnostic light source 502) may be received by the at least one return fiber 302, and then by the optical property sensing logic 515 from the output of the coupler 140. The material type determining logic 518 may then ultimately determine how much material remains to be ablated in the region 506. For example, the material type determining logic 518 may determine the type of the material in the region 506, where the type of the material in the region 506 is material to be ablated (e.g., by laser ablation). The laser catheter 170 may also be positioned (e.g., manually or under automatic control such as by way of the at least one controller 180) at different areas within the region 506 so that the at least one source fiber 300 illuminates such different areas. The light reflected from such different areas within the region 506 may allow determination of how much material remains to be ablated in each area of the region 506.

(59) Once it is determined that a type of a material in the region 506, and more specifically in a particular area of the region 506, is biological material and not, for example, plaque or other material to be ablated, it may be determined that no more material remains to be ablated in that particular area of the region 506. For example, it may be determined that the material remaining in that particular area of the region 506 is a smooth muscle layer of an artery that is not to be ablated, an endothelial layer of the vasculature that is not to be ablated, etc. Such a determination may, in some examples, be also or alternatively made using a coating, marker, or other suitable material such as a layer of reflective coating placed on an outside of a blood vessel to provide information via, for example, the at least one return fiber 302 to indicate when any of the fibers 300, 302, and 304 is too close to (e.g., within a particular distance of) the marking or an area within the vasculature associated with the marking.

(60) As such, the laser catheter 170 may be positioned accordingly so that further treatment of the region 506 does not cause ablation in the particular area of the region 506 that has been determined to contain no more material to be ablated, and/or individual ones of the source fibers 300 may be controlled so that particular ones of the source fibers 300 that may ablate the particular area of the region 506 do not supply treatment/therapeutic light to the particular area of the region 506. Particular ones of the source fibers 300 may also, for example, supply a reduced intensity of treatment/therapeutic light to the particular area of the region 506 as the amount of material to be ablated in the particular area of the region 506 diminishes. It will thus be appreciated based on the above examples and other examples herein that ablation of particular areas of the region 506 (at times referred to as particular positions in the region 506 or the like) may be controlled in a closed-loop manner, with information from the reflected light allowing determinations of the type of the material in such particular areas of the region 506, and the supply (or lack thereof) of treatment/therapy to such particular areas of the region 506 being controlled accordingly.

(61) FIGS. 6A, 6B, 7A, and 7B are simplified views of reflected diffuse absorbance and transmittance (DAAT) characteristics from the perspective of, for example, a clinician viewing the outputs of the return fibers 302, as understood by one skilled in the art in view of the present disclosure, based on the laser catheter 170 being in regions with different types of materials and being at different distances (including different angles) to such types of materials. In particular, FIG. 6A illustrates a view 600 of reflected DAAT characteristics as viewed from the outputs of return fibers 302a-302d when a catheter tip, such as a tip of the laser catheter 170, is in an approximately ten millimeter (mm) deep pool of blood. FIG. 6B illustrates the slightly more visible reflected DAAT characteristics, as indicated by cross-hatched lines not present in FIG. 6A, when the catheter tip is in a shallower (e.g., approximately four mm) deep pool of blood. FIG. 7A illustrates the increasingly visible reflected DAAT characteristics, as indicated by solid lines not present in either of FIG. 6A or 6B, when the catheter tip is in full (e.g., normal) contact with tissue (e.g., tissue that is biological material). FIG. 7B illustrates a relatively mixed visibility of reflected DAAT characteristics that may be present when, for example, the catheter tip is in contact with planar tissue (e.g., tissue that is biological material) at an angle (e.g., an approximately 15 degree angle).

(62) Turning now to FIG. 8, as noted above with respect to FIG. 5, the optical property determining logic 516 may determine at least one property of the region 506 from the reflected light from the region 506, and the at least one property may include an intensity of the reflected light within a spectrum. In particular, as discussed above, the optical property determining logic 516 may use changes in intensity of reflected light to determine the reflectance of the region 506. In one embodiment, the optical property determining logic 516 may apply pixel masks to image or video frames corresponding to each of the return fibers 302 in order to separate out red, green, and blue channel intensity values associated with the reflected light for each return fiber 302, thereby analyzing the reflected light from the region 506 to determine the intensity values. FIG. 8 illustrates a group 800 of video frames of each of four return fibers 802, 804, 806, and 808, which may be the return fibers 302a-302d previously discussed herein.

(63) More specifically, the group 800 of video frames shows example intensities of a red channel 810, a green channel 812, and a blue channel 814 for each of the return fibers 802, 804, 806, and 808 and example corresponding indications of type of a material and/or distance to a material. For example, along the horizontal (time) axis, indication 816 shows that a catheter tip (e.g., a tip of laser catheter 170) is contacting an exposed vessel within the vascular system of a patient. Indication 818 shows that the catheter tip is in blood; indication 820 shows that the catheter tip is in the SVC; indication 822 shows that the catheter tip is moving along the SVC; indications 824 and 826 show that the catheter tip is in blood; indication 828 may alert a clinician to move or push the catheter to the left; indication 830 may alert the clinician to move or push the catheter to the right; indication 832 may alert the clinician to move or push the catheter up; indication 834 may alert the clinician to move or push the catheter down; and indication 836 may alert the clinician that the catheter tip is in blood. It will be appreciated upon review of the present disclosure that the waveforms of intensities of the red, green, and blue channels 810, 812, and 814, and the corresponding indicators 816-836, are not necessarily indicative of the conditions that may exist in a particular application, as such intensities and conditions may depend upon a number of factors such as characteristics of the catheter employed, fiber characteristics, etc.

(64) FIGS. 8A-8C illustrate several magnified views of different portions of the video frame for one of the four return fibers of FIG. 8, specifically in this example the return fiber 808. The magnified views include magnified views of the example intensities shown in FIG. 8 of the red channel 810, the green channel 812, and the blue channel 814 for the return fiber 808 and several of the corresponding indications shown in FIG. 8. In particular, in the example of FIG. 8A, a magnified view is shown of the portion of the video frame for the return fiber 808 near the indication 818 that the catheter tip is in blood. As shown in FIG. 8A, the intensity of the red channel 810 may, for example, be greater than the intensities of both the green channel 812 and the blue channel 814. In the example of FIG. 8B, a magnified view is shown of the portion of the video frame for the return fiber 808 near the indication 820 that the catheter tip is in the SVC. In the example of FIG. 8C, a magnified view is shown of the portion of the video frame for the return fiber 808 near the indication 822 that the catheter tip is moving along the SVC. As shown in FIGS. 8A and 8B, the intensities of the red, green, and blue channels may, for example, each be higher when the catheter tip is in the SVC, as shown in FIG. 8B, as compared to when the catheter tip is in blood, as shown in FIG. 8A. Additionally, as shown in FIGS. 8B and 8C, the intensities of the red, green, and blue channels may, for example, each be higher when the catheter tip is in the SVC as compared to when the catheter tip is moving along the SVC. Furthermore, the intensities of the green channel 812 and the blue channel 814 may, for example, be notably lower when the catheter tip is moving along the SVC, both compared to the intensity of the red channel 810 when the catheter tip is moving along the SVC and compared to the intensities of the green and blue channels when the catheter tip is in the SVC.

(65) FIG. 9 is a flowchart of an example method for determining a type of a material and an indication of a distance to the material in a region in a vascular system of a patient. The determination of the type of the material and/or the distance to the material may facilitate ablation of the material in example ways discussed further below. Each of the method illustrated in FIG. 9 and the other methods illustrated further below may be carried out by one or more suitably programmed controllers or processors executing software (e.g., by the at least one controller 180). Each of the methods may also be embodied in hardware or a combination of hardware and hardware executing software. Suitable hardware may include one or more application specific integrated circuits (ASICs), state machines, field programmable gate arrays (FPGAs), digital signal processors (DSPs), and/or other suitable hardware. Although the methods are described with reference to the illustrated flowcharts, it will be appreciated that many other ways of performing the acts associated with the methods may be used. For example, the order of some operations may be changed, and some of the operations described may be optional. Additionally, while the methods may be described with reference to the example apparatus 100 or other example structure herein, it will be appreciated that the methods may be implemented by other apparatus and/or using other structure as well, and that the apparatus 100 and other example structure herein may implement other suitable methods.

(66) As to FIG. 9, as shown in block 900, the method may include receiving an output of a coupler (e.g., receiving, by the at least one controller 180, an output of the coupler 140) coupled to at least one return fiber (e.g., 302) that receives light reflected from a region (e.g., 506) within a vascular system of a patient after at least one source fiber (e.g., 300) has supplied light to the region.

(67) As shown in block 902, the method may also include determining (e.g., by the optical property determining logic 516) at least one property of the region within the vascular system from the reflected light from the region.

(68) As shown in block 904, the method may also include determining (e.g., by the material type determining logic 518) a type of a material in the region within the vascular system based on determining the at least one property from the reflected light.

(69) As shown in block 906, the method may also include determining (e.g., by the material distance determining logic 520) an indication of a distance to the material in the region within the vascular system based on determining the at least one property from the reflected light. The method may then end and may be repeated as needed or desired.

(70) FIG. 10 is a flowchart of an example method for determining a type of a material and an indication of a distance to the material in a region in a vascular system of a patient, and for controlling a light source and/or controlling laser catheter positioning accordingly. Additional aspects of the present disclosure that may be used in conjunction with the method illustrated in FIG. 10 are described in further detail below. As shown in block 1000, the method may include positioning a tip of a laser catheter (e.g., 170) adjacent to unwanted blockage and/or deposits, such as those surrounding an electrical lead or those in, for example, a peripheral artery.

(71) As shown in block 1002, the method may also include supplying diagnostic light to a region (e.g., 506) containing the unwanted blockage/deposits using at least one source fiber (e.g., 300) of the laser catheter.

(72) As shown in block 1004, the method may include receiving light reflected from the region containing unwanted blockage/deposits using at least one return fiber (e.g., 302) of the laser catheter 170.

(73) As shown in block 1006, the method may also include determining at least one property (e.g., by the optical property sensing logic 515 receiving the output of the coupler 140 and generating at least one signal indicative of a sensed property of the reflected light, and by the optical property determining logic 516 determining the at least one property based on the signal generated by the optical property sensing logic 515) of the region containing the unwanted blockage/deposits from the reflected light.

(74) As shown in block 1008, the method may include determining a type of a material in the region and/or an indication of a distance to the material in the region (e.g., by the material type determining logic 518 and/or the material distance determining logic 520) based on determining the at least one property of the region.

(75) As shown in block 1010, the method may also include generating an indication (e.g., by the I/O device(s) 512) that an intensity of the light source is to be adjusted, that the light source is to be turned off, and/or that the laser catheter is to be moved further from the material in the region. Alternatively, an indication may be generated that the laser catheter is to be moved closer to the material in the region. The indication may be generated based on the determination(s) made in block 1008.

(76) As shown in block 1012, the method may also include controlling the light source and/or controlling the positioning of the laser catheter 170 based on the generated indication (e.g., block 1010). The method may then end and may be repeated as needed or desired.

(77) FIG. 11 illustrates an example of displacement of source and/or return fibers to treat a broader area within a vascular system of a patient, such as to treat a broader area within the region 506, as compared to when such displacement of source and/or return fibers is not implemented. As shown in FIG. 11, the laser catheter 170 may, for example, be in contact with a portion of tissue (e.g., tissue that is biological material) 1100. One of the source fibers 300 and one return fiber, in this example the return fiber 302a, is also shown within the laser catheter 170. As shown in the example of FIG. 11, one or both of an end portion 1102 of the source fiber 300 and an end portion 1104 of the return fiber 302a may be capable of being displaced at any suitable time during illumination via the source fiber 300 and/or collection of light via the return fiber 302a. Such displacement may allow information to be gathered, by way of the reflected light as discussed above, from a broader (e.g., more expansive) area within the region 506 (e.g., from more of the portion of the tissue (e.g., tissue that is biological material) 1100), and/or may allow treatment of a broader area within the region 506 as compared to when such displacement is not used. The displacement of the end portion 1102 and/or the end portion 1104 may be implemented in any suitable manner, such as but not limited to actuation by resonant vibrations or static displacements via piezo-electric or laser-induced thermal actuation. Additionally, it will be understood that the illustration in FIG. 11 is one example implementation of displacement of, for example, the source fiber 300 and/or the return fiber 302a, and that other suitable ways of implementing such displacement may also be employed.

(78) FIG. 12 illustrates an example of an offset between ends of source and/or return fibers and a tip of a laser catheter to facilitate determination of properties of the reflected light. As shown in FIG. 12, the laser catheter 170 may, for example, be in contact with another example portion of tissue (e.g., tissue that is biological material) 1200. One of the source fibers 300 and several return fibers, such as the return fibers 302a, 302b, and 302c are shown within the laser catheter 170 in FIG. 12. The ends of the source fiber 300 and the return fibers 302a-302c may be offset from the point (e.g., surface) at which the laser catheter 170 is in contact with the portion of the tissue (e.g., tissue that is biological material) 1200. Any suitable offsets may be used, and some offsets may be the same, as in the case of the return fibers 302a-302c in the example of FIG. 12. Additionally, if desired, one or more fibers may not be offset. The use of offsets may facilitate more accurate diffuse reflection measurements, which may, for example, result in more accurate reflected DAAT characteristics as discussed above with respect to, for example, FIGS. 6A, 6B, 7A, and 7B.

(79) FIG. 13 illustrates an example portion of a human vasculature, such as an example portion 1300 of a blood vessel. The portion 1300 of the blood vessel may include an endothelial cell layer 1302 and a buildup (or deposit) 1304, which may be or may include plaque, between the endothelial cell layer 1302 and a vessel wall 1306. It will be understood from the present disclosure that in various embodiments, the portion 1300 of the blood vessel shown in FIG. 13 may be, may include, or may be included within the region 506 of the vascular system as discussed above. The buildup 1304 includes a fatty core 1308. It may be necessary or desirable to ablate the fatty core 1308, which may be or may contain hardened plaque, without ablating other portions of the buildup 1304. By removing (e.g., ablating) the fatty core 1308 without removing other portions of the buildup 1304, more living layers of tissue may be spared from lasing, which may lessen inflammatory and immune responses. As a result, the risk of restenosis may advantageously be reduced.

(80) Through the use of techniques such as those described above to determine a type of a material in a region within the vascular system, and an indication of a distance to such material, selective ablation of the fatty core 1308 may be achieved. Selective ablation of the fatty core 1308 may also be achieved using directional lasing techniques that are further disclosed below. In any event, based on a determined type of a material and/or indication of distance to such material, the buildup 1304 and the fatty core 1308 may be identified and the at least one source fiber 300 may ablate a portion of the buildup 1304 so as to create an entry path 1310 into the fatty core 1308. Lasing may then cause the fatty core 1308 to ablate, and the resulting ablated plaque may pass through an exit path 1312. A guidewire 1314 may hold the laser catheter 170 in a position so as to perform the ablation and so that the ablated plaque that passes through the exit path 1312 is collected with a downstream occlusion filter 1316 that ensures, for example, that the ablated plaque does not mix into the bloodstream of the patient.

(81) FIGS. 13A-13C illustrate an example portion of a human vasculature, such as an example portion 1350 of a blood vessel, with examples of positioning and/or use of a laser catheter for ablation. It will be understood from the present disclosure that in various embodiments, the portion 1350 of the blood vessel may be, may include, or may be included within the region 506 of the vascular system as discussed above. For example, FIG. 13A shows that the example portion 1350 may include a portion of the endothelium 1302 in vasculature, a portion of the intima 1352 in vasculature, and a portion of the media 1354 in vasculature. A buildup including the fatty core (e.g., containing hardened plaque) 1308 is shown in the intima 1352. The guidewire 1314 may position the laser catheter 170 in preparation for ablation, with the downstream occlusion filter 1316 positioned to collect ablated material in order to ensure that, for example, the ablated material does not mix into the bloodstream of the patient. The endothelium 1356, the intima 1358, and the media 1360 on an opposite wall of the portion 1300 of the blood vessel are also illustrated for completeness.

(82) As shown in FIG. 13B, the laser catheter 170 may be advanced, using, e.g., the guidewire 1314, into the intima 1352 so that the laser catheter 170 is adjacent the fatty core 1308. As shown in FIG. 13C, the laser catheter 170 may be further advanced into the fatty core 1308 for ablation of the fatty core, including, for example, radial ablation of the fatty core using emitters in the laser catheter 170 as further described below. By removing (e.g., ablating) the fatty core 1308 without removing other portions of the intima 1352, more living layers of tissue may be spared from lasing, which may lessen inflammatory and immune responses. In particular, through the use of techniques such as those described above to determine a type of a material in a region within the vascular system, and an indication of a distance to such material, selective ablation of the fatty core 1308 may be achieved. As a result, the risk of restenosis may advantageously be reduced.

(83) FIG. 14 is a schematic section view of another example portion 1400 of a vasculature. As with the example portion 1350 of FIGS. 13A-13B, in various embodiments the example portion 1400 of the vasculature may be, may include, or may be included in the region 506 within the vascular system. As shown in FIG. 14, a laser catheter, such as the laser catheter 170, is located in the example portion 1400 of the vasculature at a particular position defined by a first (e.g., proximal) anchoring component 1402 and a second (e.g., distal) anchoring component 1404. The first and second anchoring components 1402 and 1404 may be any suitable components configured to move within the vasculature while the laser catheter 170 is moved within the vasculature, e.g., using a guidewire 1405, and further configured to anchor the laser catheter 170 against a wall of the vasculature. For example, the first and second anchoring components 1402 and 1404 may be inflatable elements such as balloons that are configured to support the laser catheter 170 against a wall of the region 506 within the vascular system (e.g., against the wall at the particular position within the portion 1400 of the vasculature) such that the laser catheter 170 is oriented to ablate material in the region 506 as further discussed below. In one embodiment, any suitable number of anchoring components, including in some cases one anchoring component, may be used to fix the laser catheter 170 at the particular position in the region 506 while the at least one source fiber 300 supplies light from the light source (e.g., the laser source 500).

(84) As shown in FIG. 14, the example portion 1400 of the vasculature includes a buildup 1406 such as, for example, atherosclerotic plaque. Additionally, in the example of FIG. 14, the buildup 1406 is primarily located to the side or along the exterior of the length of the laser catheter 170, though as discussed below additional buildup may be located distal to a distal end of the laser catheter 170. In order to provide for ablation of buildup along or within a vessel wall such as the buildup 1406, the laser catheter 170 may include at least one ring of optical fibers that is movable axially along a longitudinal axis from a proximal end of the laser catheter 170 to the distal end of the laser catheter 170 and, if desired, at least one ring of optical fibers that is not movable axially (e.g., is stationary).

(85) In the example of FIG. 14, the laser catheter 170 is shown as including an inner ring 1410 of optical fibers and an outer ring 1412 of optical fibers. Each ring of optical fibers may be associated with a separate sheath or a common sheath within the laser catheter 170. One of the rings of optical fibers may move axially relative to the other ring of optical fibers or both of the rings of optical fibers may be stationary with respect to one another. For example, the inner ring 1410 of optical fibers, with the optical fibers being represented by dashed lines, may be axially movable or stationary with respect to the outer ring 1412 of optical fibers. The outer ring 1412 of optical fibers may also be movable or stationary with respect to the inner ring 1410 of optical fibers. Another example includes one of or both of the inner ring 1410 and the outer ring 1412 of optical fibers as being movable with respect to the laser catheter 170.

(86) Referring to FIG. 14, the laser catheter 170 is shown as including an outer ring 1412 of axially-movable optical fibers with respect to the inner ring 1410 and the laser catheter 170. This figure also depicts the inner ring 1410 as having two rows of optical fibers, and the outer ring 1412 as having one row of optical fibers. The inner ring 1410 may have one row of optical fibers or more than two rows of optical fibers, and the outer ring 1412 may have more than one row of optical fibers. For each of the inner and outer rings 1410 and 1412 of optical fibers, the optical fibers may include at least one source fiber, such as at least one source fiber similar to one of the source fibers 300, and at least one return fiber, such as at least one return fiber similar to one of the return fibers 302. In some embodiments, a source fiber and a return fiber may be the same fiber, with such a fiber receiving return (e.g., reflected) light during, for example, the off time between pulses of laser light. For example, as discussed above, an optical fiber may have an end portion thereof (e.g., an emitter) that emits light toward a desired target or region (e.g., radially and/or distally, as further discussed below), and that end portion (e.g., the same emitter) may also receive light from the desired target or region so that the optical fiber acts as both a source fiber and a return fiber.

(87) The ability of the outer ring 1412 of optical fibers to move axially along a longitudinal axis passing through the proximal end and/or the distal end of the laser catheter 170 is shown by representative movement arrows 1414 and 1416. Additionally, at least one emitter is disposed proximate of the distal end of the laser catheter 170, and at least one emitter is disposed at the distal end of the laser catheter. For example, at least one emitter is associated with the outer ring 1412 of optical fibers (and/or, in other examples not shown, in other ring(s) that is/are axially movable), and at least one emitter is associated with the inner ring 1410 of optical fibers.

(88) As defined above, an emitter shall mean a portion of a fiber or a physical device (e.g., an optical component) that emits light from a portion of a catheter towards a desired target or region, which typically comprises vascular material (e.g., biological material and/or non-biological material). Accordingly, in some examples, the emitter may also include a light-deflecting object(s) that not only emit(s) light, but also deflect(s) light from the light source (e.g., laser source 500), such as a mirror(s) (e.g., conical mirror(s)). A section view of a first conical mirror 1418 and a second conical mirror 1420 in the outer ring 1412 of optical fibers is shown in the example implementation of FIG. 14. Although the first conical mirror 1418 and the second conical mirror 1420 are depicted as two separate mirrors, the mirrors may be configured to be one mirror, particularly in the event that the mirror is oriented radially with the optical fibers. The outer ring 1412 may, in some examples, not include optical fibers distal to the first and second conical mirrors 1418 and 1420, although the outer ring 1412 may still move axially distal to the first and second conical mirrors 1418 and 1420 as shown by the representative movement arrow 1416. The first and second conical mirrors 1418 and 1420 may receive light transmitted through the optical fibers in the outer ring 1412 and deflect the received light so that the received light is emitted towards and impinges upon and advantageously ablates the buildup 1406 through an opening in the length of the laser catheter 170, as shown by a representative arrow 1424 and a representation 1426 of impinging light in FIG. 14. It will be appreciated that light from the diagnostic light source 502 may also be radially emitted and/or reflected from the material in the region 506 through the opening in the length of the laser catheter 170 in order to determine the type of the material in the region 506 and/or the indication of the distance to the material in the region 506.

(89) It is advantageous to have at least one emitter disposed along the length of the laser catheter 170 and proximate of the distal end of the laser catheter 170 because the emitter is able to emit light radially from the length (or side) of the laser catheter 170, thereby ablating the biological material and/or non-biological material as the at least one emitter and the length of the catheter 170 passes by a buildup 1406. Further advantageously, because the outer ring 1412 is axially movable, light may be deflected by, for example, the first and second conical mirrors 1418 and 1420 so as to impinge upon and ablate the buildup 1406 through a number of different positions along the opening in the length of the laser catheter 170. It will be appreciated that the opening in the length of the laser catheter 170 may be of any suitable size and/or shape.

(90) It will also be appreciated that any suitable number of emitters, which may include light-deflecting objects (such as mirrors, and more particularly such as, for example, conical mirrors), may be used. For example, any suitable number of emitters may be spaced radially around the outer ring 1412 of optical fibers. Furthermore, the emitter(s) may be adjustable so as to control the direction(s) in which the emitter(s) deflect the received light. FIG. 15 is an example cross-sectional view of the laser catheter 170 illustrating the inner ring 1410 of optical fibers, and further illustrating light being transmitted radially (as shown by the representative arrow 1424 and other arrows) from optical fibers in the outer ring 1412 of optical fibers after deflection by emitters (such as, but not limited to, the first and second conical mirrors 1418 and 1420) (not shown in FIG. 15).

(91) It will be appreciated that while light from the optical fibers in the outer ring 1412 is deflected by the at least one emitter (e.g., first and second conical mirrors 1418 and 1420), light from the optical fibers in the inner ring 1410 may be transmitted distally and/or radially through the distal end of the laser catheter 170 to further ablate material (not shown) distal to the laser catheter 170. More particularly, as discussed above, at least one emitter may be disposed at the distal end of the laser catheter 170 and may be associated with the inner ring 1410 of optical fibers. The at least one emitter, as further discussed above, may be comprised of the distal portions of such fibers, and may distally and/or radially transmit (emit) the light from the optical fibers in the inner ring 1410.

(92) In the case of either or both of the inner ring 1410 and the outer ring 1412 of optical fibers, the intensity/intensities of reflected light, and other properties of such reflected light, received by the optical fibers (which may include return fibers that may or may not be physically distinct from source fibers, as discussed above) may be received at the at least one controller 180 by way of providing the reflected light to at least one optical receiver, and analysis by the at least one controller 180 using techniques such as those discussed above may provide indications of progress of ablation of the material in the region 506. The indications of progress of ablation of the material in the region 506 may be used to adjust the intensity/intensities of light supplied by particular ones of the optical fibers to the at least one emitter proximal of the distal end and/or the at least one emitter at the distal end of the laser catheter 170 so as to provide closed-loop control of the ablation process. The intensity/intensities of reflected light may also be used to adjust the intensity/intensities of light supplied by particular ones of the optical fibers in the outermost ring 1412 of optical fibers.

(93) Furthermore, the various optical fibers in the laser catheter 170in one example, the optical fibers in the inner ring 1410may be oriented in various directions so as to emit light in various directions from the laser catheter 170. For example, the optical fibers in the inner ring 1410 may be oriented at angles to the longitudinal axis passing through the center of the proximal end and the center of the distal end of the laser catheter 170. The orientation of the optical fibers may be controlled by the clinician or automatically, such as by the at least one controller 180, depending upon, for example, the type of material in the region 506 and/or the indication of the distance to the material. The intensity of light supplied by each one of the optical fibers acting as a source fiber may also vary with the direction in which the optical fiber is oriented based on the indication of the distance to the material.

(94) FIG. 16 illustrates an example portion of a human vasculature, such as an example portion of a blood vessel, with a different example implementation of anchoring components. In particular, in the example of FIG. 16, a proximal anchoring component 1600 and a distal anchoring component 1602 each include annular inflatable elements, such as annular balloons, to support the laser catheter 170 against a wall of the vasculature. A guidewire 1604 may also be used to assist in positioning the laser catheter 170, if desired. In particular, the proximal and distal anchoring components 1600 and 1602 may support the laser catheter 170 against a wall 1606 of the vasculature and against a buildup that has formed on another wall 1608. For example, a buildup 1610 may include a fatty core 1612 to be ablated, as discussed above with reference to FIGS. 13A-13C. An expandable or stretchable membrane 1614 may connect the proximal and distal anchoring components 1600 and 1602 and may be adjusted (e.g., moved through the vasculature, expanded, compressed, etc.) so as to position the laser catheter 170 for ablation of the fatty core 1612. Advantageously, the expandable membrane 1614 may provide a controlled workspace 1616 for ablation, which may prevent ablated material from mixing with the bloodstream and may also allow for continued blood flow during the ablation process. If desired, saline or similar bio-compatible fluid may flow from, for example, the proximal anchoring component 1600 toward the distal anchoring component 1602 to flush material as it is ablated. The saline or other bio-compatible fluid may also facilitate determination of optical properties of the material, and thus may facilitate identification of the type of the material.

(95) FIG. 17 illustrates an example portion of a human vasculature, such as an example portion of a blood vessel, with another example implementation of an anchoring component. In the example of FIG. 17, an anchoring component 1700 supports the laser catheter 170 against a wall 1702 of the vasculature, such as that disclosed in U.S. Pat. No. 8,702,773, the contents of which are incorporated by reference herein for all that it discloses. A guidewire 1704 may also be used to assist in positioning the laser catheter 170, if desired. The laser catheter 170 may be positioned to ablate a buildup 1706 that has formed on another wall 1708 of the vasculature by way of transmitting (emitting) light by optical fibers through a distal end of the laser catheter 170 (e.g., by way of emitting light from the inner ring 1410 discussed with respect to FIG. 14 (not shown in FIG. 17)).

(96) FIG. 18 is a flowchart of an example method for ablating material in a region within a vascular system of a patient. It will be understood upon review of the following disclosure that one or more of the acts associated with the method illustrated in FIG. 18 may, in some examples, be used in conjunction with aspects of the method(s) illustrated in one or more of FIGS. 9 and 10. As an example, some aspects of the method illustrated in FIG. 18 may include more detail regarding implementation of block 1012 of the method illustrated in FIG. 10.

(97) As shown in block 1800, the method may include supplying diagnostic light to the region 506 containing unwanted blockage/deposits using optical fiber(s) of the laser catheter 170, which as discussed above may include source fibers, return fibers, and/or one or more fibers that are both source and return fibers.

(98) As shown in block 1802, the method may include receiving light reflected from the region 506 containing unwanted blockage/deposits using the optical fibers.

(99) As shown in block 1804, the method may include determining a type of a material in the region 506 and/or an indication of a distance to the material from the reflected light.

(100) As shown in block 1806, the method may include anchoring the laser catheter 170 in place using one or more anchoring components, such as according to one or more of the example implementations of an anchoring component or components described above.

(101) As shown in block 1808, the method may include transmitting light from the light source (e.g., the laser source 500) through at least one optical fiber to at least one emitter (e.g., the first and second conical mirrors 1418 and 1420) so that the light is deflected by the emitter and impinges upon and ablates the material in the region 506 through an opening in a length of the laser catheter 170 (see, e.g., FIG. 14), when it is determined that the type of the material is a type of material to be ablated.

(102) As shown in block 1810, the method may also or alternatively include transmitting light distally and/or radially from the light source through at least another optical fiber (e.g., through at least another emitter that emits light distally and/or radially) so as to transmit light through a distal end of the laser catheter 170 or through another opening closer to the distal end of the laser catheter 170 but oriented in a different direction than along a longitudinal axis running from a proximal end of the laser catheter 170 to the distal end of the laser catheter 170.

(103) As shown in block 1812, the method may also include adjusting an intensity and/or direction of light transmitted as described above from the optical fibers, based on an indication(s) of progress of ablation of the material in the region 506, the type of the material in the region 506, and/or an indication of a distance to the material in the region 506. The method may then end and be repeated as needed or desired.

(104) FIG. 19 illustrates an elevation view of an embodiment of a distal portion of the laser catheter 170 that may be used to, for example, determine an indication of the type of the material in the region 506 based on an analysis of, for example: (i) light reflected from the region 506 and (ii) at least one received indication of a force applied to the material in the region 506. The force applied to the material in the region 506 may be, for example, applied by one or more of the optical fibers 300. In some examples discussed below, at least one source optical fiber 300 may also be a return optical fiber, and the return optical fibers 302 described above may not be implemented. The example of FIG. 19 shows an implementation without the return optical fibers 302, and shows an example without the additional optical fibers 304 discussed above. It will be appreciated that one or more additional optical fibers 304, as with one or more return optical fibers 302 distinct from the optical fibers 300, may be implemented if desired.

(105) As shown in the example of FIG. 19, at least one force sensor 1900 may be coupled to at least one optical fiber 300. For example, force sensors 1900a, 1900b, 1900c, and 1900d may be connected to or otherwise electrically or communicatively coupled to various ones of the at least one optical fiber 300. In one embodiment, the force sensor 1900a may be used to provide an indication of a force applied to the material in the region 506 by one or more of the at least one optical fiber 300 that are in contact with the material in the region 506, and in particular, a force applied by those ones of the optical fibers 300 that are closest to the force sensor 1900a as compared to the other force sensors 1900b-1900d. The force sensor 1900a, and each of the force sensors 1900, may be or may include, for example, a Bragg diffraction grating or a Fabry-Perot interferometric sensor. Each of the force sensors 1900b-1900d may similarly provide an indication, by virtue of its measurement of applied force at or near one of the fibers 300 to which it is attached, of a force applied by one or more nearby optical fibers 300. It will be appreciated that more or fewer force sensors 1900 may be implemented than are shown in FIG. 19. For example, in some embodiments, the number of force sensors 1900 may be the same as the number of optical fibers 300 in the laser catheter 170 that are in contact with the material in the region 506. Each force sensor 1900 may, in such embodiments, provide an indication of force applied by the one optical fiber 300 to which it is attached or otherwise coupled.

(106) Among other advantages, use of the at least one force sensor 1900 may provide additional data that is useful to, for example, the at least one controller 180 in determining the type of the material in the region 506 with which the at least one optical fiber 300 is in contact. In particular, while the at least one controller 180 may determine one or more optical properties or characteristics of light reflected from the region 506 (e.g., light reflected after being supplied from the diagnostic light source 502) and may use the determined optical property(ies) to determine the type of the material in the region 506, optical properties of the material in the region 506 may change when contacted, e.g., by the at least one optical fiber 300. More particularly, the optical properties of the material in the region 506 may change based on the force with which each of one or more of the optical fibers 300 contacts the material in the region 506. By using the at least one force sensor 1900 to provide an indication(s) of such force, more accurate determination(s) of the type of the material in the region 506 may be made, as further discussed below.

(107) As an example of the use of force applied by optical fibers changing the sensed optical properties of contacted material (e.g., tissue), FIG. 19A is an example plot of diffuse reflectance versus wavelength of reflected light from porcine fat tissue immersed in blood at various contact force levels. In particular, in the example of FIG. 19A, the diffuse reflectance is shown by a first waveform 1950 for a first range of gram force (e.g., 1-11 gram force); by a second waveform 1952 for a second range of gram force (e.g., 50-60 gram force); by a third waveform 1954 for a third range of gram force (e.g., 100-110 gram force); by a fourth waveform 1956 for a fourth range of gram force (e.g., 150-160 gram force); and by a fifth waveform 1958 for a fifth range of gram force (e.g., 200-210 gram force).

(108) FIG. 20A is another example functional block diagram of the apparatus of FIG. 1. As shown in FIG. 20A, the functional block diagram of FIG. 5 is modified to include the indication(s) 2000 of force applied to the material in the region 506 by one or more of the at least one optical fiber 300, such as indication(s) 2000 from the at least one force sensor 1900. The indication(s) 2000 may be provided from the coupler 140 to the material type determining logic 518 in addition to the reflected light being provided to the optical property sensing logic 515 as discussed above. In this manner, the indication(s) 2000 of force may be used to calibrate the analysis of the determination of the type of the material in the region 506, and the accuracy of the determination may be improved.

(109) FIG. 20B is another example functional block diagram of the apparatus of FIG. 1, showing a different representation and/or implementation of the processor 508 in order to use the indication(s) 2000 of force received from the at least one force sensor 1900 to improve accuracy of determination of the type of the material in the region 506. As shown in FIG. 20B, the processor 508 may be represented as including the laser device output logic 514 as described above, as well as optical characteristic(s) determining logic 2052, analysis/material type determining logic 2054, and material distance determining logic 2056. The coupler 140 may provide the reflected light to the optical characteristic(s) determining logic 2052, which may be the same as or similar to the optical property determining logic 516 and/or the optical property sensing logic 515 in combination with the optical property determining logic 516, for example. The optical characteristic(s) determining logic 2052 may determine one or more optical characteristics, such as, for example, a diffuse absorbance of each of a number of colors within a spectrum of the reflected light. Indication(s) of the determined optical characteristic(s) may be provided to the analysis/material type determining logic 2054 and to the material distance determining logic 2056, as illustrated in FIG. 20B.

(110) The coupler 140 may also provide the indication(s) 2000 of force to the analysis/material type determining logic 2054. The analysis/material type determining logic 2054 may analyze the reflected light, e.g., the indication(s) of the determined optical characteristic(s), and the indication(s) 2000 of force applied by the one or more of the at least one optical fiber 300. In some embodiments, the analysis/material type determining logic 2054 may implement machine learning techniques to analyze the reflected light and the indication(s) 2000 of force. In one embodiment, the machine learning techniques may include principal component analysis (PCA). In another embodiment, the machine learning techniques may also or alternatively include a discriminant analysis of the indication(s) of the determined optical characteristic(s). In some embodiments, a principal component analysis may not be implemented as a PCA analysis may result in undesirably discarding data important for use in a discriminant analysis.

(111) In one example, the discriminant analysis may be a linear discriminant analysis (LDA). In another example, the discriminant analysis may be a non-linear kernel discriminant analysis. The kernel discriminant analysis may advantageously allow non-linear mapping or classification of the indication(s) of the determined optical characteristic(s) and the indication(s) 2000 of the applied force. In any event, a machine learning training procedure may be undertaken before the analysis/material type determining logic 2054 is used to analyze the determined optical characteristic(s) or indication(s) thereof and the indication(s) 2000 of force to determine the type of the material in the region 506.

(112) In some embodiments, the kernel discriminant analysis performed by the analysis/material type determining logic 2054 may also include determining a confidence value associated with the determined type of the material in the region. The determined confidence value may indicate a percentage or degree of likelihood that the determined type of the material in the region 506 is correct, and may vary with the force(s) applied by the at least one optical fiber 300 to the material in the region 506 as indicated by the at least one force sensor 1900. In particular, the determined confidence value may increase as the force(s) applied by the at least one optical fiber 300 to the material in the region 506 increase(s). That is, as the applied force(s) increase, the changes in optical characteristic(s) of the reflected light, such as diffuse absorbance spectra, may be smaller relative to changes in the applied force(s).

(113) In some embodiments, a minimum confidence value or value(s) of the applied force(s) may be determined as the minimum value(s) at which closed-loop control of a laser ablation process and/or a continuing diagnostic (e.g., material type identification) process in the region 506 may be performed. For example, it may be determined that if the confidence value or value(s) of the applied force(s) is/are below the minimum, closed-loop control (e.g., without human input) during an ablation procedure (and/or during a diagnostic procedure) may be unsafe.

(114) In the event that closed-loop control is determined to be permitted, the controller 180 may, for example, cause the at least one optical fiber 300 to supply light from the laser source 500 to ablate the material in the region 506 based on the determination of the type of the material, without human input. For example, control of the ablation may be robotic. Additionally or alternatively, control of further diagnostic procedures may be robotically performed without human input. In another implementation, the analysis/material type determining logic 2054, upon determining the type of the material and the confidence value(s), may cause the laser device output logic 514 to control ablation by controlling the laser source 500 accordingly, or to control diagnostics by controlling the diagnostic light source 502 appropriately. When the confidence value(s) is/are determined to be too low for control without human input, human input may be used in the control of ablation and/or diagnostic procedures.

(115) By using one or more of the at least one optical fiber 300 as both a source and return fiber, diagnostics and/or treatment (e.g., ablation) may be performed using a single fiber. Additionally, it will be appreciated that in cases where the number of force sensors 1900 is the same as the number of optical fibers 300, and/or in cases where some optical fibers 300 have a force sensor 1900 coupled directly thereto, for example, each single optical fiber 300 may be used to determine a type of the material in the region 506, including by way of using force measurements. Among other advantages, the number of optical fibers 300 may be reduced, and with reference to the preceding discussion, each of the optical fibers 300 may thus more easily be selectively used to diagnose and/or treat the material in the region 506. For example, the optical fibers 300 may be selectively switched on and off on an individualized basis, and/or may be selectively oriented or configured to perform ablation in a different direction on an individualized basis. Additionally, the use of one or more small optical fiber 300 for diagnosis of material type and for treatment, including for diagnosis based on force measurements, may allow the optical fiber(s) 300 to be used for diagnosis and/or treatment in very small regions of the vasculature of a patient, such as within capillaries. This advantage allows, among other applications, the use of the optical fiber(s) 300 in procedures such as those in the brain. Furthermore, in some embodiments, different ones of the optical fibers 300 may be used for treatment in the region 506 as compared to ones of the optical fibers 300 used for diagnosis of material type in the region 506.

(116) In some embodiments, the controller 180 may cause one or more of the at least one optical fiber 300 to emit a differentiating substance, such as a material that may affect the spectra of the reflected light from the material in the region 506. In particular, the emitted material may adhere to at least a portion of the material in the region 506, and the emitted material may cause the spectra of the reflected light from the material in the region 506 to have a more noticeable difference from similar spectra that would be associated with light reflected with a different type of material in the region 506. Stated another way, the emitted material may be used to make the spectra of the reflected light more distinctly indicative that the material in the region 506 is of a certain type, where the spectra of the reflected light would otherwise (e.g., without the emitted material adhering to the material in the region 506) be less distinguishable from spectra of light reflected from a different type of material. In this manner, determination of the type of the material in the region 506 by the analysis/material type determining logic 2054 may be more accurately performed. In some embodiments, the material emitted from the one or more of the at least one optical fiber 300 may comprise a solution containing gold nanoparticles. The gold nanoparticles may be ejected from the one or more optical fibers 300 and, if desired, the material in the region 506 may be washed, e.g., with a saline solution ejected from one or more of the at least one optical fiber 300, in a way that leaves the material in the region 506 still able to reflect light that is more distinctly indicative of the type of the material in the region 506.

(117) FIG. 21A illustrates an example lead locking device 2100 that may be used in some embodiments of the present disclosure. The lead locking device 2100 includes a radiopaque marker end 2102, a distal loop 2104, a proximal loop 2106, a mandrel 2108, and a proximal connector 2110. In a lead extraction procedure, a clinician (or, in some cases, a robot) may control the lead locking device 2100 by gripping the lead locking device 2100 at the distal loop 2104 and applying a pull force concurrent with applying a push force on an outer sheath (not shown in FIG. 21A, but shown below). As shown in FIG. 21B, which is an example close-up view of a portion of the example lead locking device 2100 of FIG. 21A, a force sensor 2120 may be mounted on a flat portion of the lead locking device 2100 at the distal loop 2104. In particular, the flat portion at the distal loop 2104 may be made flat, instead of having the small circular form factor that other portions of the lead locking device 2100 may have, in order to accommodate a flat strain gage as the force sensor 2120.

(118) FIG. 21C illustrates an example environment 2150 in which the lead locking device 2100 may be used in a lead extraction procedure and in which various principles described herein may be incorporated. A lead 2152 to be extracted is shown with a lead locking device 2154, which may be the lead locking device 2100 discussed above, disposed therein. A sheath 2156 having a magnetic sheath tip 2158, where the sheath 2156 may contain the laser catheter 170 and/or the at least one optical fiber 300, may be advanced over the lead 2152 and lead locking device 2154. Magnetic markers 2160 may be spaced along the lead locking device 2154 for use in determining, together with the magnetic sheath tip 2158, a position of the sheath 2156. The sheath 2156 may thus be advanced to a position of interest, such as an apex 2162 of a heart, which may be the region 506 as discussed above. In some embodiments, it may be the force sensor 2120 that provides the aforementioned indication of the force applied by one or more of the at least one optical fiber 300 to the material in the region 506 (e.g., the apex 2162 of the heart). In some examples, the force sensor 2120 may be one of several force sensors used, with additional force sensors being similar to the force sensor 2120 or similar to the force sensor(s) 1900 discussed above.

(119) FIG. 22 is a flowchart of an example method for diagnosis and/or treatment of material in a region within a vascular system of a patient. It will be understood upon review of the following disclosure that one or more of the acts associated with the method illustrated in FIG. 22 may, in some examples, be used in conjunction with aspects of the method(s) illustrated in one or more of FIGS. 9, 10, and 18.

(120) As shown in block 2200, the method may include supplying light from a light source, such as the diagnostic light source 502, to the region 506 containing unwanted blockage/deposits using at least one optical fiber 300 of the laser catheter 170.

(121) As shown in block 2202, the method may include receiving light reflected from the region 506 using the at least one optical fiber 300.

(122) As shown in block 2204, the method may include receiving at least one indication of a force applied by one or more of the at least one optical fiber 300 to material in the region 506, such as receiving at least one indication from the at least force sensor 1900 and/or the force sensor 2120.

(123) As shown in block 2206, the method may include determining a type of the material in the region 506 based on an analysis of the light reflected from the region 506 and of the received at least one indication of the force applied to the material in the region 506.

(124) As shown in block 2208, the method may include determining a confidence value associated with the determined type of the material.

(125) As shown in block 2210, the method may include controlling diagnostic and/or treatment procedure(s) in a closed-loop or manual manner based on the determined type of the material in the region 506 and based on the determined confidence value, as discussed above with respect to, for example, FIGS. 20A and 20B. The method may then end and be repeated as needed or desired.

(126) It will be appreciated that various modifications of the embodiments herein may be made after review of and understanding of the present disclosure. For example, different fiber tip geometries may be used to change the treatment and/or diagnostic areas as desired, and/or to control the gathering of reflected light. Diagnostic light source intensity may also be varied to more accurately reveal geometric features of vascular material in some cases. Fluorescence and/or mitochondrial markers may be employed to discriminate vascular material types, such as using mitochondrial markers to distinguish between live tissue and scar tissue. Force/strain measurements may be made using a diffraction grating (e.g., a Bragg diffraction grating) along the laser catheter 170 or its tip, or using interferometry-based microelectromechanical systems (MEMS) sensors. Force sensors may also be used to infer or determine vascular material type, including whether vascular material is comprised of biological material or non-biological material.

(127) Additional modifications of the embodiments herein may also be made after review of and understanding of the present disclosure, such as but not limited to the use of magnetic and/or robotic actuation of the tip of the laser catheter 170, balloon actuation of the tip of the laser catheter 170, balloon-actuated therapeutic delivery, and/or the use of optical fibers embedded in balloons. Other possible modifications of the embodiments herein may include the use of micro needles and arrays for sensing electrical impedance and electrical impedance tomography, and the use of a micro needle arrangement to infer additional depth of or to material in electrical impedance tomography. In other modifications, ablation may be vacuum-based. In still other modifications, an end of one or more optical fibers (e.g., one or more emitters) may be mechanically driven, e.g., using a push-pull mechanism, towards a vessel wall. Other suitable modifications are also possible based on review of and understanding of the present disclosure.

(128) It will be further appreciated upon review of the disclosure that the example features and methods described herein thus allow ablation of unwanted blockage, deposits, etc. in, for example, a peripheral artery.

(129) A number of variations and modifications of the disclosure can be used. It would be possible to provide for some features of the disclosure without providing others. Furthermore, embodiments of systems and methods according to the present disclosure may include and/or be used in conjunction with any of the systems, devices, structures, and/or methods described in U.S. patent application Ser. Nos. 13/800,651, 13/800,675, 13/800,700, and/or 13/800,728, all of which were filed on Mar. 13, 2013, the disclosures of which are hereby incorporated by reference in their entireties.

(130) The present disclosure, in various aspects, embodiments, and configurations, includes components, methods, processes, systems and/or apparatus substantially as depicted and described herein, including various aspects, embodiments, configurations, sub-combinations, and subsets thereof. Those of skill in the art will understand how to make and use the various aspects, aspects, embodiments, and configurations, after understanding the present disclosure. The present disclosure, in various aspects, embodiments, and configurations, includes providing devices and processes in the absence of items not depicted and/or described herein or in various aspects, embodiments, and configurations hereof, including in the absence of such items as may have been used in previous devices or processes, e.g., for improving performance, achieving ease and/or reducing cost of implementation.

(131) The foregoing discussion of the disclosure has been presented for purposes of illustration and description. The foregoing is not intended to limit the disclosure to the form or forms disclosed herein. In the foregoing Detailed Description for example, various features of the disclosure are grouped together in one or more, aspects, embodiments, and configurations for the purpose of streamlining the disclosure. The features of the aspects, embodiments, and configurations of the disclosure may be combined in alternate aspects, embodiments, and configurations other than those discussed above. This method of disclosure is not to be interpreted as reflecting an intention that the claimed disclosure requires more features than are expressly recited in each claim. Rather, as the following claims reflect, inventive aspects lie in less than all features of a single foregoing disclosed aspects, embodiments, and configurations. Thus, the following claims are hereby incorporated into this Detailed Description, with each claim standing on its own as a separate preferred embodiment of the disclosure.

(132) Moreover, though the description of the disclosure has included description of one or more aspects, embodiments, or configurations and certain variations and modifications, other variations, combinations, and modifications are within the scope of the disclosure, e.g., as may be within the skill and knowledge of those in the art, after understanding the present disclosure. It is intended to obtain rights which include alternative aspects, embodiments, and configurations to the extent permitted, including alternate, interchangeable and/or equivalent structures, functions, ranges or steps to those claimed, whether or not such alternate, interchangeable and/or equivalent structures, functions, ranges or steps are disclosed herein, and without intending to publicly dedicate any patentable subject matter.