text:
|Número de publicación
|Tipo de publicación
|Número de solicitud
|Fecha de publicación
|7 Sep 1999
|Fecha de presentación
|14 Mar 1997
|Fecha de prioridad
|1 Jun 1995
|También publicado como
|Número de publicación
|Todd J. Mortier, James R. Pray, Robert M. Vidlund, David A. Kusz, Cyril J. Schweich, Jr.
|Cesionario original
|Scimed Life Systems, Inc.
|Exportar cita
|BiBTeX, EndNote, RefMan
|Citas de patentes (100), Otras citas (15), Citada por (64), Clasificaciones (15), Eventos legales (4)
|Enlaces externos: USPTO, Cesión de USPTO, Espacenet
This is a continuation of application Ser. No. 08/456,787, filed Jun. 1, 1995, now abandoned.
The present invention deals with medical tubes. More particularly, the present invention deals with medical tubes, such as catheters.
Flow directed or flow assisted catheters are catheters which are used to access extremely tortuous vasculature, such as neuro vasculature. Conventional, over-the-wire catheters can also be used, but exhibit limitations in their ability to reach and maneuver within such intricate vasculature. Therefore, the flow assisted catheter is used.
Flow assisted catheters typically have a distal portion which is extremely flexible. Some flow assisted catheters also typically have an inflatable balloon or bulbous member at their distal ends. The flow assisted catheter is inserted into a vessel to be accessed through a guide catheter, and fluid may typically be pulsed through the guide catheter to carry the flow assisted catheter into the desired vessel. Once in the vessel, the flow assisted catheter is drawn through the vessel (primarily by blood flow) and is fed into the vessel by the physician. If the catheter has a balloon, the balloon is inflated to increase the drag between the blood flowing in the vessel and the distal end of the flow assisted catheter. The balloon is essentially carried by the flow through the vasculature to a target site. This draws the catheter along to the target site.
If the distal tip of the catheter becomes frictionally engaged with a vessel wall, or becomes "hung up" at a vessel branch, slack develops in the catheter. The physician then slightly withdraws the catheter until the catheter has moved away from the vessel wall or branch and is again free to move within the vessel. Once flow has taken up all the slack, the physician then feeds additional catheter length into the vessel.
In addition, some prior flow directed catheters included bent (typically steam formed) tips at the distal end of the flow directed catheter. This has been done in an effort to provide some selective tracking of the flow directed catheter into a desired vessel branch.
Current flow directed catheters suffer from a number of disadvantages. The distal portion of the flow directed catheter must be extremely flexible so that it is capable of tracking the intricate vasculature to the site to be accessed under the influence of flow in the vessel. Consequently, conventional flow directed catheters have had distal portions formed of material which is extremely flexible, and which is also quite soft. Typically, the softer the material, the lower the burst pressure. Thus, some conventional flow assisted catheters are formed with distal shaft portions with undesirably low burst pressure. This can cause the catheter to burst when injectate is introduced through the catheter.
Further, soft materials commonly have undesirably low tensile strength and also tend to stick to the vessel wall. This can cause the catheter to hang up in the vessel more often. When withdrawing the catheter to disengage it from the vessel wall, or when removing the catheter from tortuous vasculature, a catheter with such low tensile strength is susceptible to breakage.
In addition, when the physician is feeding the catheter into the vessel, the highly flexible distal portion of the conventional flow directed catheter can accumulate slack and loop. Then, when the treating physician withdraws the flow directed catheter, it can easily kink.
Further, the flexible nature of the distal portion of conventional flow directed catheters makes it virtually non-torquable by the treating physician. In other words, if the treating physician rotates or torques the proximal end of the flow directed catheter, the distal portion of the flow directed catheter is so flexible, and has such low torsional rigidity, that the torque does not transfer to the distal end. The physician must over-rotate the proximal end of the catheter, withdraw the catheter a short distance, allow the catheter to advance in the vessel and hope for some unpredictable amount of torque at its distal end. This makes selective tracking very difficult and cumbersome, even when the catheter includes a shaped tip.
The inability to transfer torque, in itself, leads to another significant problem as well. When the flow directed catheter hangs up in the vessel, the attending physician cannot break the friction between the catheter and the vessel wall by simply torquing the catheter. Rather, as described above, the physician must withdraw the flow directed catheter to some extent so it disengages from the vessel wall. Repeatedly withdrawing and advancing the flow directed catheter causes the treating physician to take an undesirable amount of time in accessing the target vasculature.
Also, in order to make the catheters highly flexible, they are often made with a very small diameter. This results in very low flow rates of injectate through the catheter and also makes it particularly difficult, if not impossible, to use such catheters to deliver large particles or coils. Finally, the soft materials used with such catheters are not typically compatible with some agents, such as alcohol. This is undesirable since a physician may wish to deliver alcohol with such a catheter.
A catheter includes a manifold and a proximal shaft portion coupled to the manifold. A distal shaft portion is coupled to a distal end of the proximal shaft portion and is flexible relative to the proximal shaft portion. A fiber reinforcement layer is disposed about the distal shaft portion.
FIG. 1A is a side view of a flow directed catheter according to the present invention.
FIGS. 1B and 1C are cross-sectional views of the catheter shown in FIG. 1.
FIG. 2A is a side view of a portion of a braid according to the present invention.
FIG. 2B is a cross-sectional view of the braid shown in FIG. 2A.
FIG. 3A is a side view of a second embodiment of a flow directed catheter according to the present invention.
FIGS. 3B, 3C, 3D, 3E and 3F are cross-sectional views of the catheter shown in FIG. 3A.
FIG. 4 illustrates one embodiment of a tip portion of a catheter according to the present invention.
FIG. 5 shows a second embodiment of a tip portion of a catheter according to the present invention.
FIG. 6 shows a third embodiment of a tip portion of a catheter according to the present invention.
FIG. 7 is another embodiment of a tip portion of a catheter according to the present invention.
FIG. 8 is another embodiment of a tip portion of a catheter according to the present invention.
FIG. 8A shows another embodiment of a tip portion of a catheter according to the present invention.
FIG. 8B shows a contoured surface of a catheter according to the present invention.
FIGS. 9A and 9B show a portion of a conventional braiding machine.
FIG. 9C illustrates a modified assembly mounted on the braiding machine shown in FIGS. 9A and 9B.
FIG. 1A is a side view of one preferred embodiment of a flow directed catheter 10 according to the present invention. Catheter 10 includes manifold 12 and shaft 14. Shaft 14 includes proximal shaft portion 16 and distal shaft portion 18. Distal shaft portion 18, has, at its distal end, tip 20. Catheter 10 also includes marker band 22 which is formed of radiopaque material that can be observed under fluoroscopy.
In a preferred embodiment, catheter 10, from manifold 12 to tip 20 is roughly 160-165 cm in length. In addition, distal shaft portion 18 is preferably approximately 45 cm in length.
Proximal shaft portion 16 is formed to be rigid relative to distal shaft portion 18. Distal shaft portion 18, on the other hand, is extremely flexible and suitable for being assisted or directed through a vessel in the human body by blood flow. Bulbous tip 20 is provided to increase the drag between the blood flowing in the vessel and catheter 10. While catheter 10 can be used without tip 20, the increased drag provided by tip 20 allows the blood flow to assist in tracking the catheter to the vascular site to be accessed.
It is also desirable (although not necessary) that proximal shaft 16 have relatively high torsional rigidity so that it transmits a large portion of torque applied by the administering physician to distal shaft portion 18. Also, it is preferred that proximal shaft portion 16 be relatively stiff or rigid in the axial direction so that the treating physician can insert shaft portion 16 into a guide catheter simply by pushing on shaft portion 16.
It is important that distal shaft portion 18 be extremely flexible so that it can be carried through tortuous vasculature. However, it is also very important that distal shaft portion 18 be strong in both tensile strength and burst pressure. Further, it is desirable that distal shaft portion 18 have relatively high torsional rigidity (also referred to as torsional stiffness) to transmit torque applied by a treating physician through manifold 12 or proximal shaft portion 16.
FIG. 1B is a cross-section of shaft portion 16 taken along section lines 1B--1B in FIG. 1A. The outer diameter of proximal shaft portion 16 is approximately 2.8 French. FIG. 1B shows that proximal shaft portion 16 is formed of a number of layers. Proximal shaft portion 16 has an undercoat layer 24 which defines the inner lumen of catheter 10. Undercoat layer 24 is preferably urethane, PVC, polyamide, or silicon. Proximal shaft portion 16 also includes a reinforcement layer shown in FIG. 1B as braid layer 26. The braid layer 26 is described in more detail with respect to FIGS. 2A and 2B. Briefly, however, braid layer 26 is formed of fibers braided about layer 24 to add strength to, and increase the torsional rigidity of, proximal shaft portion 16. After braid layer 26 is disposed about layer 24, overcoat layer 28, similar to layer 24, is coated onto braid layer 26. Layer 28 is also formed of urethane, PVC, polyamide, or silicon. Finally, a stiff jacketing layer 30 is provided over layer 28. Stiff jacketing layer 30 is formed of relatively stiff material (e.g., having an elastic modulus greater than 10,000 psi) such as polyimide, PVC, polyethylene or PET. Such a configuration provides proximal shaft portion 16 with a relatively stiff or rigid characteristic, and with a high degree of strength.
FIG. 1C is a cross-section of distal shaft portion 18 taken along section lines 1C--1C in FIG. 1A. FIG. 1C shows that distal shaft portion 18 is preferably formed of undercoat layer 24, braid layer 26 and overcoat layer 28 shown in FIG. 1B, which simply extend continuously from within stiff jacketing layer 30. In this way, distal shaft portion 18 is highly flexible, yet the braid layer 26 provides distal shaft portion 18 with very high burst pressure, tensile strength and torsional rigidity.
FIG. 2A illustrates a portion of braid layer 26 in greater detail. FIG. 2A illustrates that braid layer 26 is formed of a number of different fibers 32, each fiber comprising a plurality of individual filaments 34. In the preferred embodiment, braid layer 26 is formed of eight fibers 32, each comprising five filaments 34. Further, in one preferred embodiment, the filaments 34 are formed of a liquid crystal polymer material, such as a material commercially designated as Vectran sold by Hoechst Celanese Corporation of Charlotte, N.C. The filaments 34 are each approximately 20-25 microns in diameter. Five filaments 34 are assembled together to preferably form one 25 Denier fiber 32.
FIG. 2A also shows that, in braid layer 26, the fibers 32 overlap one another at areas referred to as pics 36. The number of pics per longitudinal inch of catheter 10 affect both the burst strength and torsional stiffness of catheter 10. In the preferred embodiment, braid layer 26 has approximately 70-120 pics per longitudinal inch of the catheter.
FIG. 2B is a cross-section of the portion of catheter 10 shown in FIG. 2A and taken along section lines 2B--2B in FIG. 2A. FIG. 2B shows layers 24, 26 and 28 in greater detail. In the preferred embodiment, layers 24 and 28 are formed of a product commercially designated as Desmopan sold by the Polymers Division of Miles Inc. which is located in Pittsburgh, Pa.
FIG. 2B also better illustrates the process of making catheter 10. FIG. 2B shows a copper mandrel or copper core 38 disposed within the inner lumen of catheter 10. In the preferred embodiment, undercoat layer 24 is extruded onto copper mandrel 38. Braid layer 26 is applied to layer 24 and that entire assembly is encased in overcoat layer 28 which is extruded over braid layer 26. To remove mandrel 38, the axial ends of mandrel 38 are pulled in opposite directions. This causes mandrel 38 to neck down to a smaller diameter and break free of undercoat layer 24. Once free, mandrel 38 is removed. On proximal shaft portion 16, stiff jacketing layer 30 is then placed over layer 28 to provide the desired stiffness. In order to place layer 30 over layer 28, the axial ends of the braided shaft are pulled in opposite directions. This causes the braid layer 26 to decrease in diameter. Jacketing layer 30 is then placed over braid layer 26 and the ends of the braid are released. This causes the braided shaft to increase in diameter frictionally engaging jacketing layer 30. Both ends of jacketing layer 30 are then glued to layer 28.
In another embodiment, layers 28 and 30 are coextruded on braid layer 26. The coextrusion runs substantially he entire length of the catheter. After the catheter has been cut to an appropriate length, the outer, stiffer layer 28 is removed from the distal portion of the catheter by grinding, scraping, or other suitable means. Thus, the catheter has a stiffer proximal portion and a more flexible distal portion with one continuous inner lumen. Manifold 12 is assembled onto proximal shaft portion 16 in any suitable, known manner.
The extrusion process used in forming the present invention preferably utilizes the above-described over core extrusion technique. The core material utilized for the shaft according to the present invention is preferably an annealed copper. The core may be preheated prior to the first extrusion pass. Preheating prior to the second extrusion pass may also be used to possibly improve adhesion between the layers.
FIG. 3A is a preferred embodiment of a catheter 40 according to the present invention. Catheter 40 includes manifold 42, proximal shaft portion 44, midshaft portion 46, distal shaft portion 48 and flexible tip portion 50. Flexible tip portion 50 is also provided with a radiopaque marker band 52 which is visible under fluoroscopy. As with catheter 10, catheter 40 is preferably approximately 160-165 cm in length from manifold 42 to marker band 52. Also, midshaft portion 46 and distal shaft portion 48, along with flexible tip portion 50, are approximately 45 cm in total length. The particular length of midshaft portion 46 and distal shaft portion 48 will vary depending on the particular application in which catheter 40 is used.
In the preferred embodiment, proximal shaft portion 44 is relatively rigid or stiff, midshaft portion 46 is a transition portion which is more flexible than proximal shaft portion 44, but less flexible than distal shaft portion 48. Distal shaft portion 48 is highly flexible, similar to distal shaft portion 18 of catheter 10 shown in FIG. 1A. Flexible tip portion 50 has even greater flexibility than distal shaft portion 48.
FIG. 3B is a cross-sectional view of catheter 40 taken along section lines 3B--3B in FIG. 3A. FIG. 3B shows that proximal shaft portion 44 is formed of a single, relatively stiff, material such as polyimide or polyurethane. In the preferred embodiment, the outer diameter of proximal shaft portion 44 is approximately 2.8 French.
FIG. 3C is a cross sectional view of catheter 40 taken along section lines 3C--3C in FIG. 3A. In the preferred embodiment, midshaft portion 46 has an inner diameter in a range of approximately 0.010 inches to 0.022 inches. Midshaft portion 46 preferably has approximately the same outer diameter as proximal shaft portion 44.
FIG. 3C shows that midshaft portion 46 is substantially formed of four layers. Layers 54, 56 and 58 are similar to layers 24, 26 and 28 shown in FIGS. 1B and 1C. In other words, an undercoat 54 of polyurethane (preferably Desmopan) is first extruded and then a braid layer 56 (preferably formed of strands of Vectran fiber) is braided onto layer 54. Then, an overcoat layer 58 (also preferably of polyurethane or Desmopan) is extruded over braid layer 56. FIG. 3C also shows that midshaft portion 46 has an outer layer 60 which provides midshaft portion 46 with a stiffness that is preferably intermediate that of proximal shaft portion 44 and distal shaft portion 48. Outer layer 60, in the preferred embodiment, is a polyurethane material commercially designated as Texin 5286 (or other suitable material) which is necked or drawn over layer 58. In other words, layer 60 is placed over layer 58 and drawn through a heated die. Texin is commercially available from the Polymers Division of Miles Inc. of Pittsburgh, Pa.
In another preferred embodiment, the layers of catheter 40 can be formed using the coextrusion and grinding process described above with respect to catheter 10.
FIG. 3D is a detailed cross-sectional view of a joint portion 62 between proximal shaft portion 44 and midshaft portion 46. Midshaft portion 46 has a proximal end 64 which includes only layers 54, 56 and 58 shown in FIG. 3C. In other words, outer layer 60 is removed. Distal end 68 of proximal shaft portion 44 has a portion removed from the inner diameter thereof to form an enlarged receiving aperture. The inner diameter of the enlarged receiving aperture in end 68 of proximal shaft portion 44 is sized just larger than the outer diameter of the proximal end portion 64 of midshaft portion 46. Therefore, end 64 of midshaft portion 46 fits snugly within end 68 of proximal shaft portion 44. Further, any suitable adhesive or fastening technique can be used to secure end 64 within end 68.
FIG. 3E is another preferred embodiment of joint portion 62 joining midshaft portion 46 to proximal shaft portion 44. In the embodiment shown in FIG. 3E, proximal shaft portion 44 has a tapered distal end 70 which reduces to a small outer diameter. Midshaft portion 46, by contrast, has an expanded proximal end portion 72 which expands to have an inner diameter just larger than the outer diameter of tapered end portion 70 of proximal shaft portion 44. Tapered end portion 70 fits snugly within the inner diameter of expanded end portion 72 and, as in the embodiment shown in FIG. 3D, any suitable, commercially available adhesive or fastening technique can be used to couple end 70 to end 72.
FIG. 3F is a cross-sectional view of distal shaft portion 48 taken along section lines 3E--3E in FIG. 3A. FIG. 3E shows that distal shaft portion 48 is formed of only layers 54, 56 and 58. Therefore, distal shaft portion 48 is extremely flexible, yet has high tensile strength and burst strength.
FIG. 4 is a cross-sectional view of one embodiment of a distal tip 18' suitable for use with either catheter 10 shown in FIG. 1A or catheter 40 shown in FIG. 3A. FIG. 4 shows that the tip portion is formed similarly to the distal shaft portion 18 shown in FIG. 1C. Radiopaque marker band 22 is provided at the very distal end of the shaft portion 18' and, in the embodiment shown in FIG. 4, the enlarged bulbous tip 22 is removed.
FIG. 5 shows a second embodiment of a distal tip 50' suitable for use as tip 50 shown in FIG. 3A. FIG. 5 shows that tip portion 50' has a tapered outer layer 58 to which marker band 52 is adhesively secured. The length of tapered tip 50' is, in one preferred embodiment, approximately 2-3 cm. Tip 50' has tapered overcoat layer 58 to provide even greater flexibility than the remainder of distal shaft portion 48.
FIG. 6 is a cross-sectional view of yet another embodiment of a distal tip 75 suitable for use with either catheter 10 or catheter 40. FIG. 6 shows tip 75 attached to shaft portion 48 of catheter 40. In FIG. 6, a platinum coil 70 is secured to the distal end of distal shaft portion 48. Coil 70 is preferably formed of 0.001-0.002 inch platinum wire and is therefore radiopaque. Coil 70 is preferably encased by placing it on undercoat layer 54 and dipping coil 70 into dissolved encasing material.
FIG. 7 shows another embodiment of a distal tip of a catheter 10, 40 according to the present invention. Tip 80 is provided in a curved shape and is preferably heat or steam shapeable, along with layers 26, 56. It should be noted that tip 80 can either be integrally formed with catheter 10, 40 simply as the distal end thereof, or it can be formed separately and connected to catheter 10, 40.
The curved shape improves tracking because tip 80 does not dive into the outer radius of a vessel bend as it approaches the bend. Rather, tip 80 reaches the outer curvature of the bend and, when properly oriented by the physician, slides along the bend. Bent tip 80 only provides this significant advantage if it can be oriented properly within the vessel. In conventional flow directed catheters, the torsional rigidity (and hence torque transfer) is very low and orientation of tip 80 was very difficult. Since braided layers 26 and 56 are provided in catheters 10, 40 according to the present invention, rotating the proximal shaft provides a very predictable rotation at the distal portion of the shaft. This significantly increases selective tracking of the flow directed catheter 10, 40 and improves catheter advancement.
Tip portion 80 also increases frictional drag within the vessel. In other words, since tip 80 is bent, the friction between tip 80 and the fluid flowing in the vessel is higher than if tip 80 were straight. This further assists in moving the catheter along the vessel.
It should be noted that tip 80 can also be provided in a spiral or squiggle configuration to orient tip 80 into the axis of flow through the vessel thereby increasing drag by increasing the surface area of the shaft exposed to the flow.
FIG. 8 shows a second embodiment of a distal tip portion 83 of shaft 10 or 40 according to the present invention which increases drag of the catheter 10, 40 relative to fluid flowing in the vessel. A plurality of bulbous or balloon members 82 are provided at the distal tip 83. This serves to increase the friction between the flowing fluid in the vessel and the catheter 10, 40. This further assists in catheter advancement. It should be noted that, as shown in FIG. 8A, either of the bulbous members 82, or additional bulbous members 82, can be attached to an extremely flexible thread 85 which is attached to, or run through, the catheter 10, 40. Since thread 85 is even more flexible than the distal portion of the shaft, it assists in tracking through tortuous vasculature and essentially drags the distal tip of the catheter along to the site to be accessed.
FIG. 8B shows yet another embodiment of the present invention utilized to increase drag of the catheter relative to the flow in the vessel. FIG. 8B shows that a contoured shape is provided on the outer surface 84 of the distal end portion of the shaft of catheters 10, 40. Such a contour can be cut into the outer surface of the shaft using appropriate tooling. Further, such an impression can be made in the outer surface of the shaft utilizing molding techniques.
Braid layers 26 and 56 are preferably applied to extruded layer 54 with commercially available braiding machines. Two such machines which have been used with satisfactory results are the Kokubun No. ST16 Braiding Machine commercially available from Toyota Tsusho America or Kokubun Ltd. from Hamatsu, Japan. A second commercially available system which has been used satisfactorily is one available from Wilhelm Steeger GmbH & Co. type no. K80/16-72/89 Braiding Machine. Wilhelm Steeger GmbH & Co. is located in Barmen, Germany.
Both machines are preferably somewhat modified in order to perform satisfactorily. The machines are typically designed to braid larger gauge fibers than those used with the present invention. The modifications to the machines for adaptation to the present invention focused on the carriers or totes that hold and dispense fiber as they circulate around the inner hub or braid point.
It is important in braiding layers 26 and 56 to have low tension on the fiber and to minimize sliding contact with any parts on the braiding machine which can damage the fibers. Minimizing damage and high tension in the fiber is also important when the fiber is wound on the spools of the braider. Further, ionized air is used in the system in a known manner to control and remove undesirable foreign material during the braiding process.
To better illustrate the modifications to both the Steeger and Kokubun machines, the modifications to a Steeger machine will now be described. FIG. 9A is a schematic view of the operation of the conventional, unmodified, Steeger machine identified above. The fiber is removed from a storage mechanism 59, travels through a first eyelet 61 and is threaded about a plurality of pulleys 63. The fiber is then threaded through a top eyelet 65 and then provided to the braid point or inner hub 90.
FIG. 9B is a side view of a portion of a standard Steeger fiber carrier used in the above-identified braiding machines. It will be noted that the Steeger machine provides a double pulley assembly with a top eyelet 67 through which the fiber travels to the braid point 90. It has been found that eyelet 67 was a source of problems in that it damaged the fiber due to friction and due to surface roughness.
FIG. 9C is one embodiment of a top carrier assembly 70 used in modifying both the Kokubun and Steeger machines. The machine carriers are originally provided with the top eyelet which, as discussed above, caused damage to the fibers. Therefore, assembly 70 is mounted on the top of the carriers to replace the eyelet. Assembly 70 includes mounting block 72, pulley 74 and conical spool 76. Mounting block 72 is assembled onto the top 77 of the carrier (shown in FIG. 9B). Pulley 74 is rotatable about axis of rotation 78 and conical spool 76 is rotatable about axis of rotation 80. The fiber 82 is threaded from the standard lower portion of the machine. However, instead of traveling through eyelet 67, the fiber travels up around pulley 74 and around conical spool 76 and then to the braid point or central hub 90 on the machine.
In the Kokubun machines, the carriers are commonly of nearly all metal construction. A similar combination of eyelets and pulleys are used to guide the fiber through the machine and to control timing during which more fiber is released from a storage spool. However, the eyelets on the Kokubun machine have also been observed to cause damage to the fibers from sliding friction, and breakage of the fibers from surface irregularities on the eyelet. Thus, the Kokubun machine was modified to replace the eyelets with Delrin or Teflon plastic rollers.
Further, the Kokubun machine is provided with only a single pulley system (as opposed to the double pulley system shown on the Steeger machine). This was replaced with a pair of pulleys to reduce the tension in the fiber. By replacing the metal contact portions with plastic parts, significant advantages are achieved. The parts move more quickly because they have smaller mass than the metal parts, and the plastic parts are not slowed down by lubricant which is required in metal part designs.
A spring (79 in FIG. 9B) is provided in the carriers of both Steeger and Kokubun machines which provides the tension for fiber take-up. The take-up spring 79 must provide low enough force to keep tension as low as possible on the fiber, but must be high enough to have a quick response as the carrier weaves in and out along its path around the braid point 90. A preferred tension (the force measured to pull the fiber off of the carrier) is in a range of approximately 20-90 grams.
The pulleys provided with the Steeger machine had observable surface roughness. These pulleys were replaced with pulleys made from ultra high molecular weight polyethylene.
The number of pics per inch provided by the braid, and the number of elements in the braid, affect both flexibility and strength. In other words, the higher the pic count, the stronger the catheter (with respect to both burst pressure and tensile strength), and the more torsional rigidity is exhibited by the catheter.
The present invention provides means by which a great deal of flexibility can be maintained in the catheter, without sacrificing torsional rigidity, burst pressure levels, or tensile strength. It has been found that, utilizing the present invention, a preferred ratio of burst pressure to flexibility is in a range greater than approximately 60,000. The present invention has been used to provide shafts with a ratio of burst pressure to flexibility in a range of approximately 130,000 to in excess of 500,000.
In these examples, burst pressure was measured using a commonly known technique. One end of the shaft to be measured was closed off and the interior of the shaft was pressurized with a measurable source, until a discontinuity or fault (such as a hole) developed in the shaft. The pressure was measured in pounds per square inch (psi).
Flexibility measurements are referred to in terms of the elastic modulus (E) and were taken using a cantilevered method. One end of the shaft was held in place and the other end was deflected. A measurement of the force required to deflect the sample beam (or cantilevered shaft) a certain distance was measured. The elastic modulus (E) was calculated as follows:
E=Fl3 /3Iz y
where F=force;
l=the length of cantilever;
Iz =the moment of inertia (for a tube Iz =π/64 d0 4 -di 4 !, where d0 is the outer diameter of the tube and di is the inner diameter); and
y=vertical deflection.
For a one half inch length of shaft, the flexibility measured was 0.0009 pounds per inch of deflection. Using these techniques, the ratio of burst pressure to flexibility in one preferred embodiment was measured at in excess of 400,000, and has been observed to be as high as 700,000. The shafts used had dimensions of 0.019 inch inner diameter and 0.029 inch outer diameter. Smaller shafts having an inner diameter of 0.012 inches and an outer diameter of 0.023 inches have also been successfully manufactured, and the ratios of burst pressure to flexibility are approximately in the same ranges as indicated above.
The shaft manufactured according to the present invention, including braid layer 26, has also been observed to have an elastic modulus in the range of approximately 400 psi to 4,000 psi using standard ASTM elastic modulus test procedures.
Torsional rigidity or torsional stiffness, as used herein, is determined as follows:
Torsional stiffness=M/.o slashed.=GIz /L
where M=moment;
.o slashed.=angle of twist (in radians);
G=shear modulus;
Iz =moment of inertia; and
L=length of sample.
To compare different tubes, independent of dimensions, the shear modulus (G) was first calculated using test results. The test included twisting the sample tube and measuring the moment. The shear modulus can be calculated using the following formula:
Shear modulus=G=ML/.o slashed.Iz
To express the relationship between torsional properties and flexibility, the ratio of the shear modulus to the elastic modulus (G/E) was used. The elastic modulus was calculated as set out above. The ratio of G/E for conventional flow assisted catheters is approximately 0.21. The ratio of G/E using the reinforced shaft according to the present invention yields a value in excess of 0.25, and has been observed to be in a preferred range of approximately 1.8-2.6. This is a significant enhancement over prior flow assisted devices.
Because incorporation of the braided fiber layers 26 and 56 in the shaft provide a significant increase in torsional rigidity (and thus torque transfer characteristics) the treating physician can break any friction which develops between the shaft and the vessel wall. This converts friction in the system from static friction to lower dynamic friction which results in further and more smooth tracking.
Because the braid fibers are formed of a number of filaments, the fibers lay down on the tubular surface over which they are braided to provide a thin braid band. This increases the surface coverage of the shaft over which the braids are disposed, but maintains the wall thickness of the shaft within desirable limits. This improves burst characteristics. Further, braiding provides the shaft with a relatively low elongation percent (relative to prior flow directed catheters) resulting in less ballooning or radial expansion of the shaft during use.
Also, since torsional rigidity and strength are significantly enhanced, without sacrificing flexibility, the catheter according to the present invention can be made with an inner diameter significantly larger than prior art catheters. The present invention allows satisfactory operation of catheters with an inner diameter of in excess of 0.015 inches and up to approximately 0.021 inches and preferably in a range of approximately 0.018 inches to 0.019 inches. This allows greater flexibility in the types of injectate, agents, or particles (including coils) which can be administered with the catheter.
Further, while the reinforcing layer according to the present invention has been disclosed in the form of a braided layer, it can also take the form of a tightly wound coil, a mesh sleeve, tapered longitudinal strands, or similar reinforcing configurations incorporated into the catheter.
Finally, it should also be noted that the shaft according to the present invention may be hydrophylically coated. Hydrophylic coating on the shaft reduces friction between the shaft and the vessel wall and thus significantly improves the ability of the shaft to flow in the vessel and track through tortuous vasculature. Placing the hydrophilic coating on the shaft also increases skin drag. Because the coating absorbs water from the blood, it creates a layer of fluid and blood around the outer surface of the shaft that has zero velocity. This increases skin drag and assists in catheter advancement.
Although the present invention has been described with reference to preferred embodiments, workers skilled in the art will recognize that changes may be made in form and detail without departing from the spirit and scope of the invention.
|Patente citada
|Fecha de presentación
|Fecha de publicación
|2 Abr 1956
|28 Oct 1958
|Sheridan David S
|X-ray catheter
|24 Dic 1962
|11 Ene 1966
|Us Catheter & Instr Corp
|Fluorocarbon tungsten members
|17 Jul 1962
|27 Feb 1968
|Fernando R. Vizcarra
|Method of introducing a catheter into a body vessel
|13 Abr 1966
|23 Dic 1969
|Cordis Corp
|Tubular products and method of making same
|31 Dic 1968
|28 Sep 1971
|Chemplast Inc
|Radio opaque and optically transparent tubing
|3 Feb 1969
|12 Oct 1971
|Becton Dickinson Co
|Preformable catheter package assembly and method of preforming
|6 May 1969
|9 Nov 1971
|Scient Tube Products Inc
|Nontoxic radiopaque multiwall medical-surgical tubings
|23 Sep 1971
|17 Jul 1973
|American Hospital Supply Corp
|Multi-lumen balloon catheter
|10 Mar 1971
|24 Jul 1973
|Staley Mfg Co A E
|Treatment of frostable light sensitive organic layers with water vapor after exposure for obtaining frosted images in unexposed areas
|21 Ene 1972
|18 Feb 1975
|Univ Washington
|Fiberoptic catheter
|1 Mar 1974
|24 Jun 1975
|Bruce C Wilson
|Kinetic memory electrodes, catheters and cannulae
|31 Jul 1974
|3 Feb 1976
|Co Eddy D
|Cardiac catheter
|11 Feb 1976
|7 Dic 1976
|American Hospital Supply Corporation
|Multipurpose flow-directed catheter
|14 Oct 1975
|5 Abr 1977
|General Atomic Company
|Blood access device
|24 May 1976
|24 May 1977
|Becton, Dickinson And Company
|Balloon catheter assembly
|8 Mar 1976
|14 Jun 1977
|Kerber Charles W
|Calibrated leak balloon micro-catheter
|1 Jun 1976
|11 Jul 1978
|Samuel Moore And Company
|Method of making push-pull cable conduit and product
|23 Jun 1976
|3 Oct 1978
|Siemens-Elema Ab
|Catheter for selective coronary arteriography of the left coronary artery
|16 Dic 1977
|2 Oct 1979
|Cordis Corporation
|Catheter for selective catheterization of aortic branches
|26 Ago 1977
|22 Ene 1980
|University Of Utah
|Peritoneal dialysis catheter
|17 Mar 1978
|8 Abr 1980
|Baxter Travenol Laboratories, Inc.
|Silicone-containing thermoplastic polymers for medical uses
|10 Ene 1980
|5 May 1981
|Toray Industries, Inc.
|Plastic tube having a crosslinked thin layer on the surface
|15 Nov 1978
|7 Jul 1981
|Datascope Corp.
|Elongatable balloon catheter
|24 Ago 1979
|21 Jul 1981
|Martin Michael T
|X-ray scaling catheter
|29 May 1980
|22 Dic 1981
|Gesco International, Inc.
|Cholangiogram catheter
|18 Jun 1980
|18 May 1982
|American Hospital Supply Corporation
|Catheter with trans-luminal electrical conductor
|29 Ene 1980
|24 Ago 1982
|Toray Monofilament Company Limited
|Medical vascular guide wire and self-guilding type catheter
|5 May 1980
|30 Nov 1982
|The Kendall Company
|28 Mar 1979
|7 Dic 1982
|Eduard Fresenius Chem.-Pharm. Industrie Kg Apparatebau Kg
|Stiffening core for catheters
|12 Feb 1981
|18 Ene 1983
|Nigel Sharrock
|Intravenous catheter
|15 May 1981
|31 May 1983
|Ruiz Oscar F
|Angiographic catheter with soft tip end
|27 Jul 1981
|17 Ene 1984
|Raychem Corporation
|Torque transmitting catheter apparatus
|4 Jun 1982
|7 Ago 1984
|Mallinckrodt, Inc.
|Blood vessel catheter for medicine delivery and method of manufacture
|2 Nov 1982
|12 Mar 1985
|Intermedicate Gmbh
|Stiffening core for a catheter tube
|5 Abr 1984
|15 Oct 1985
|Angiomedics Incorporated
|Catheter having embedded multi-apertured film
|12 Ago 1983
|18 Feb 1986
|Advanced Cardiovascular Systems, Inc.
|Catheter having encapsulated tip marker
|18 Ago 1983
|25 Mar 1986
|American Hospital Supply Corporation
|Construction of a monolithic reinforced catheter with flexible portions
|8 Mar 1984
|24 Jun 1986
|Cordis Corporation
|Thin-walled multi-layered catheter having a fuseless tip
|29 Ago 1985
|9 Sep 1986
|Terumo Kabushi Kaisha
|Catheter introducing instrument
|30 Oct 1985
|9 Dic 1986
|High Voltage Engineering Corporation
|Tri-layer tubing
|9 Sep 1985
|27 Ene 1987
|Animal Healthcare Products
|23 Ene 1985
|22 Sep 1987
|Mallinckrodt, Inc.
|Loop coronary catheter
|23 Abr 1986
|29 Sep 1987
|Thomas J. Fogarty
|Thermodilution flow-directed catheter assembly and method
|27 Feb 1986
|26 Ene 1988
|Cardiac Pacemakers, Inc.
|Diagnostic catheter for monitoring cardiac output
|4 Feb 1987
|12 Abr 1988
|Kuraray Co., Ltd.
|Reinforced therapeutic tube
|2 Jun 1986
|26 Abr 1988
|Target Therapeutics
|Catheter for guide-wire tracking
|17 Sep 1986
|31 May 1988
|Ladika Joseph E
|Selective pulmonary arteriograph catheter
|18 Feb 1986
|19 Jul 1988
|St. Louis University
|Catheter with a tip manipulation feature
|15 Ene 1987
|9 Ago 1988
|Thomas J. Fogarty
|Catheter with corkscrew-like balloon
|2 Sep 1986
|4 Oct 1988
|Advanced Cardiovascular Systems, Inc.
|Stiffened dilatation catheter and method of manufacture
|13 Jul 1987
|4 Abr 1989
|Devices For Vascular Intervention, Inc.
|Guiding catheter
|6 Oct 1987
|20 Jun 1989
|Menlo Care, Inc.
|Kink resistant catheter
|2 Jun 1988
|27 Jun 1989
|Terumo Kabushiki Kaisha
|Catheter and method for making
|6 Ene 1988
|28 Nov 1989
|Sherwood Medical Company
|Right coronary angiographic method
|18 Abr 1988
|5 Dic 1989
|Target Therapeutics
|Catheter guide wire
|9 Ago 1988
|6 Feb 1990
|Mallinckrodt, Inc.
|Nylon-PEBA copolymer catheter
|31 Mar 1989
|2 Oct 1990
|Cordis Corporation
|Flexible tubular member for catheter construction
|14 Jul 1988
|16 Oct 1990
|Novoste Corporation
|Method for making fuseless soft tip angiographic catheter
|23 Nov 1988
|15 Ene 1991
|Med Institute, Inc.
|Catheter having durable and flexible segments
|2 Nov 1988
|19 Feb 1991
|Target Therapeutics
|Vaso-occlusion coil and method
|23 Oct 1989
|28 May 1991
|Cordis Corporation
|Catheter having reinforcing strands
|14 Nov 1988
|6 Ago 1991
|Cordis Corporation
|Catheter having sections of variable torsion characteristics
|4 Abr 1990
|15 Oct 1991
|Webster Wilton W Jr
|Braided catheter with low modulus warp
|7 Feb 1990
|3 Dic 1991
|Cordis Corporation
|Catheter with double step-down bore
|29 Dic 1989
|3 Dic 1991
|Medical Engineering And Development Institute, Inc.
|Flexible, kink-resistant catheter
|25 Mar 1988
|7 Ene 1992
|Baxter International Inc.
|Soft tip catheters
|21 Nov 1990
|4 Feb 1992
|Flynn Vincent J
|Torque controlled tubing
|26 Feb 1990
|18 Feb 1992
|Novoste Corporation
|Fuseless soft tip angiographic catheter
|13 Oct 1989
|26 May 1992
|Abbott Laboratories
|Kink-resistant medical tubing and catheters
|10 Jul 1991
|20 Oct 1992
|Cordis Corporation
|Extruded tubing and catheters having increased rotational stiffness
|12 Jul 1991
|15 Dic 1992
|Cordis Corporation
|Catheter having highly radiopaque, flexible tip
|16 Oct 1991
|22 Jun 1993
|Mahurkar Sakharam D
|Reinforced multiple lumen catheter
|28 Jun 1991
|22 Jun 1993
|Cook Incorporated
|Soft tip guiding catheter
|6 Jun 1991
|10 Ago 1993
|Advanced Cardiovascular Systems, Inc.
|Intravascular catheter with a nontraumatic distal tip
|24 Ago 1992
|28 Sep 1993
|Cordis Corporation
|Extruded tubing and catheters having helical liquid crystal fibrils
|23 Sep 1992
|19 Oct 1993
|Cordis Corporation
|Catheter having extended braid reinforced transitional tip
|25 Jun 1992
|18 Ene 1994
|Cordis Corporation
|Intravascular catheter with kink resistant tip
|18 Feb 1992
|15 Feb 1994
|Diagnostic Devices Group Limited
|Dual-diameter multifunction catheter
|11 May 1992
|1 Mar 1994
|Advanced Cardiovascular Systems, Inc.
|Intraluminal catheter with a composite shaft
|9 Jul 1992
|15 Mar 1994
|World Precision Instruments, Inc.
|Miniaturized fluid conveying device and methods of use thereof
|10 Feb 1993
|26 Abr 1994
|Namic Caribe, Inc.
|Coronary catheter
|7 Ago 1991
|3 May 1994
|Target Therapeutics, Inc.
|Variable stiffness catheter
|9 Sep 1993
|24 May 1994
|Toyo Boseki Kabushiki Kaisha
|11 May 1992
|2 Ago 1994
|American Interventional Technologies, Inc.
|Reinforced catheter with thin monolithic walls
|25 Feb 1993
|9 Ago 1994
|Target Therapeutics, Inc.
|Flow directed catheter
|26 Oct 1992
|30 Ago 1994
|Cordis Corporation
|Catheter with multiple flexibilities along the shaft
|2 Ago 1993
|20 Sep 1994
|Quinton Instrument Company
|Coextruded catheter and method of forming
|22 Sep 1992
|18 Oct 1994
|Target Therapeutics, Inc.
|Perfusion catheter system
|23 Feb 1993
|10 Ene 1995
|Cook Incorporated
|Flexible, kink-resistant, introducer sheath and method of manufacture
|23 Nov 1993
|14 Mar 1995
|Terumo Kabushiki Kaisha
|Título no disponible
|21 May 1993
|5 Dic 1995
|Navarre Biomedical, Ltd.
|Drainage catheter
|8 Jun 1993
|16 Ene 1996
|Namic Caribe, Inc.
|Method for making a medical catheter
|10 Ene 1986
|26 Ago 1992
|Toray Industries, Inc.
|Medical guiding micro-tube
|31 Ago 1989
|31 May 1995
|Advanced Cardiovascular Systems, Inc.
|Composite vascular catheter
|28 Dic 1990
|2 Oct 1991
|Becton Dickinson and Company
|Catheter tubing of controlled in vivo softening
|26 May 1992
|9 Dic 1992
|Advanced Cardiovascular Systems, Inc.
|Intravascular catheter with a nontraumatic distal tip
|22 Oct 1993
|27 Abr 1994
|Terumo Kabushiki Kaisha
|Catheter tube and method of manufacturing the tube
|22 Ago 1994
|22 Mar 1995
|Cordis Europa N.V.
|27 Feb 1992
|17 Sep 1992
|Baxter International Inc.
|Cardiovascular catheter having discrete regions of varying flexibility
|"Injectable Flow-Guided Coaxial Catheters for Selective Angiography and Controled Vascular Occlusion", by Charles T. Dotter, M.D., Josef Rosch, M.D., Paul C. Lakin, M.D., Robert C. Lakin, B.A., and Jack E. Pegg, R.T., Work in Progress, pp. 421-423, Aug. 1972.
|"Magic Catheter 3F/1.8F", Balt, published prior to Jun. 1995.
|"Progressive Suppleness Pursil Catheter: A New Tool For Superselective Angiography and Embolization", by Jacques E. Dion, Gary R. Duckwiler, Pedro Lytyk, Fernando Vinuela, and John Bentson, American Journal of Neuroradiology, Sep./Oct. 1989, pp. 1068-2070.
|"The Balt Extrusion Family of Magic Infusion Catheters", Target Therapeutics, Jul. 1993.
|"Zephyr Flow-Assisted Infusion Catheter", Target Therapeutics, Apr. 1993.
|"Zephyr Flow-Assisted Infusion Catheter", Target Therapeutics, Jul. 1991.
|Balt Magic Standard & 1.5F Shaft Configurations data sheet, by Target Therapeutics, 47201 Lakeview Blvd., Fremont, CA 94538, Apr. 1993.
|Injectable Flow Guided Coaxial Catheters for Selective Angiography and Controled Vascular Occlusion , by Charles T. Dotter, M.D., Josef Rosch, M.D., Paul C. Lakin, M.D., Robert C. Lakin, B.A., and Jack E. Pegg, R.T., Work in Progress , pp. 421 423, Aug. 1972.
|Magic Catheter 3F/1.8F , Balt, published prior to Jun. 1995.
|Mallincrodt Medical brochure, in Japanese language, published prior to Jun., 1995.
|Pediatric Magic 3F/1.5F Catheter, Balt, published prior to Jun. 1995.
|Progressive Suppleness Pursil Catheter: A New Tool For Superselective Angiography and Embolization , by Jacques E. Dion, Gary R. Duckwiler, Pedro Lytyk, Fernando Vinuela, and John Bentson, American Journal of Neuroradiology , Sep./Oct. 1989, pp. 1068 2070.
|The Balt Extrusion Family of Magic Infusion Catheters , Target Therapeutics, Jul. 1993.
|Zephyr Flow Assisted Infusion Catheter , Target Therapeutics, Apr. 1993.
|Zephyr Flow Assisted Infusion Catheter , Target Therapeutics, Jul. 1991.
|Patente citante
|Fecha de presentación
|Fecha de publicación
|11 Sep 1998
|26 Dic 2000
|Advanced Cardiovascular Systems, Inc.
|Catheter with a flexible tip and taper and method of manufacture
|23 Feb 1999
|28 Ago 2001
|Scimed Life Systems, Inc.
|High flow rate dialysis catheters and related methods
|13 Sep 1999
|3 Sep 2002
|Advanced Cardiovascular Systems, Inc.
|Balloon catheter shaft formed of liquid crystal polymeric material blend
|2 Dic 1999
|22 Oct 2002
|Embol-X, Inc.
|Buoyant tip aspiration catheter and methods of use
|18 Oct 2000
|25 Mar 2003
|Advanced Cardiovascular Systems, Inc.
|Method of manufacturing a catheter with a flexible tip and taper
|16 May 2001
|22 Jul 2003
|Scimed Life Systems, Inc.
|High flow rate dialysis catheters and related methods
|16 Oct 2001
|16 Sep 2003
|Scimed Life Systems, Inc.
|Medical stent with variable coil and related methods
|24 Oct 2001
|13 Abr 2004
|Scimed Life Systems, Inc.
|Medical stent and related methods
|19 Sep 2001
|8 Mar 2005
|Advanced Cardiovascular Systems, Inc.
|Catheter with a multilayered shaft section having a polyimide layer
|7 Jul 2009
|Advanced Cardiovascular Systems, Inc.
|Catheter with a multilayered shaft section having a polyimide layer
|13 Abr 2010
|Beisel Robert F
|Stylet free flexible-tip epidural catheter and method of making
|13 Abr 2004
|27 Abr 2010
|Cook Incorporated
|Large diameter delivery catheter/sheath
|2 Jul 2004
|27 Jul 2010
|Bolton Medical, Inc.
|Self-aligning stent graft delivery system, kit, and method
|20 Ago 2003
|2 Nov 2010
|Boston Scientific Scimed, Inc.
|Catheter with thin-walled braid
|2 Nov 2007
|30 Nov 2010
|Boston Scientific Scimed, Inc.
|Medical device for crossing an occlusion in a vessel
|30 Jun 2006
|15 Mar 2011
|Abbott Cardiovascular Systems, Inc.
|Method of making a balloon catheter shaft having high strength and flexibility
|5 Nov 2007
|31 May 2011
|Boston Scientific Scimed, Inc.
|Medical stent
|7 Jun 2011
|Boston Scientific Scimed, Inc.
|Composite catheter braid
|8 Mar 2010
|28 Jun 2011
|Cook Medical Technologies Llc
|Large diameter delivery catheter/sheath
|30 Ago 2011
|Bolton Medical, Inc.
|Method of forming a non-circular stent
|26 Jul 2007
|22 Nov 2011
|Bolton Medical, Inc.
|Delivery systems for delivering and deploying stent grafts
|22 Nov 2011
|Bolton Medical, Inc.
|Method for aligning a stent graft delivery system
|13 Feb 2006
|6 Dic 2011
|Bolton Medical, Inc.
|Capture device for stent graft delivery
|28 Ago 2012
|Boston Scientific Scimed, Inc.
|Medical device incorporating a polymer blend
|23 Oct 2012
|Bolton Medical, Inc.
|Stent graft with longitudinal support member
|6 Feb 2006
|13 Nov 2012
|Bolton Medical, Inc.
|Two-part expanding stent graft delivery system
|10 Mar 2011
|27 Nov 2012
|Target Therapeutics, Inc.
|Catheter with composite stiffener
|17 Ene 2003
|19 Feb 2013
|Boston Scientific Scimed, Inc.
|Unbalanced reinforcement members for medical device
|15 Jun 2007
|26 Feb 2013
|Abbott Cardiovascular Systems, Inc.
|Balloon catheter tapered shaft having high strength and flexibility and method of making same
|5 Mar 2013
|Abbott Cardiovascular Systems Inc.
|Balloon catheter shaft having high strength and flexibility
|17 Dic 2007
|26 Mar 2013
|Abbott Cardiovascular Systems Inc.
|Catheter having transitioning shaft segments
|21 May 2013
|Abbott Cardivascular Systems, Inc.
|Robust catheter tubing
|14 Nov 2011
|28 May 2013
|Bolton Medical, Inc.
|Delivery systems for delivering and deploying stent grafts
|31 Mar 2009
|6 Ago 2013
|Bolton Medical, Inc.
|Dual capture device for stent graft delivery system and method for capturing a stent graft
|22 Sep 2011
|24 Dic 2013
|Abbott Cardiovascular Systems, Inc.
|Robust multi-layer balloon
|3 Ago 2012
|28 Ene 2014
|Bolton Medical, Inc.
|Methods of implanting a prosthesis
|31 Jul 2012
|25 Feb 2014
|Abbott Cardiovascular Systems, Inc.
|Catheter having transitioning shaft segments
|5 Jul 2012
|1 Abr 2014
|Abbott Cardiovascular Systems Inc.
|Catheter with a dual lumen monolithic shaft
|25 Feb 2013
|13 May 2014
|Abbott Cardiovascular Systems Inc.
|Balloon catheter shaft having high strength and flexibility
|8 Jun 2006
|3 Jun 2014
|Bolton Medical, Inc.
|Methods of implanting a prosthesis and treating an aneurysm
|12 Nov 2012
|5 Ago 2014
|Boston Scientific Scimed, Inc.
|Catheter with composite stiffener
|14 Mar 2013
|7 Abr 2015
|Bolton Medical, Inc.
|Vascular prosthetic delivery device and method of use
|25 Feb 2013
|16 Jun 2015
|Abbott Cardiovascular Systems Inc.
|Balloon catheter tapered shaft having high strength and flexibility and method of making same
|12 Mar 2010
|11 Ago 2015
|Bolton Medical, Inc.
|System and method for deploying an endoluminal prosthesis at a surgical site
|18 Ago 2006
|20 Oct 2015
|David M. Hoganson
|Flow directed guidewire
|5 Dic 2011
|3 Nov 2015
|Bolton Medical, Inc.
|Vascular repair devices
|1 Feb 2007
|1 Dic 2015
|Bolton Medical, Inc.
|Lumen repair device with capture structure
|31 Mar 2014
|8 Dic 2015
|Abbott Cardiovascular Systems Inc
|Balloon catheter shaft having high strength and flexibility
|14 Feb 2014
|22 Dic 2015
|Abbott Cardiovascular Systems Inc.
|Catheter having transitioning shaft segments
|10 Jun 2014
|29 Dic 2015
|Bolton Medical, Inc.
|Dual capture device for stent graft delivery system and method for capturing a stent graft
|2 Abr 2014
|12 Abr 2016
|Smh Device Corp.
|Tunneled catheter with hemostasis mechanism
|31 Ene 2007
|26 Abr 2016
|Bolton Medical, Inc.
|Aligning device for stent graft delivery system
|22 Oct 2002
|8 May 2003
|Embol-X, Inc.
|Buoyant tip aspiration catheter and methods of use
|5 Abr 2002
|9 Oct 2003
|Kevin Gilmartin
|Reinforced catheter system
|16 May 2002
|20 Nov 2003
|Pepin Henry J.
|Radiopaque and MRI compatible catheter braid
|17 Dic 2003
|23 Jun 2005
|Scimed Life Systems, Inc.
|Composite catheter braid
|18 Ene 2005
|27 Oct 2005
|Lee Jeong S
|Catheter with a multilayered shaft section having a polyimide layer
|12 May 2006
|15 Nov 2007
|Aga Medical Corporation
|Anchoring and tethering system
|14 Jul 2006
|17 Ene 2008
|Beisel Robert F
|Stylet free flexible-tip epidural catheter and method of making
|18 Ago 2006
|24 Abr 2008
|Hoganson David M
|Flow directed guidewire
|3 Jun 2009
|1 Oct 2009
|Advanced Cardiovascular Systems, Inc.
|Catheter with a multilayered shaft section having a polyimide layer
|14 Jul 2011
|Target Therapeutics, Inc.
|Catheter with Composite Stiffener
|11 Ago 2011
|Boston Scientific Scimed, Inc.
|Medical stent and related methods
|2 Abr 2014
|4 Dic 2014
|Smh Device Corp.
|Tunneled Catheter with Hemostasis Mechanism
|Clasificación de EE.UU.
|604/523, 600/435, 604/264
|Clasificación internacional
|Clasificación cooperativa
|Clasificación europea
|30 Dic 2002
|Fee payment
Year of fee payment: 4
|6 Nov 2006
Owner name: BOSTON SCIENTIFIC SCIMED, INC., MINNESOTA
Free format text: CHANGE OF NAME;ASSIGNOR:SCIMED LIFE SYSTEMS, INC.;REEL/FRAME:018505/0868
Effective date: 20050101
Owner name: BOSTON SCIENTIFIC SCIMED, INC.,MINNESOTA
Free format text: CHANGE OF NAME;ASSIGNOR:SCIMED LIFE SYSTEMS, INC.;REEL/FRAME:018505/0868
Effective date: 20050101
|20 Feb 2007
|Fee payment
Year of fee payment: 8
|18 Feb 2011
|Fee payment
Year of fee payment: 12


text:
- ParaguayRetailFunding via Fundación Paraguaya
Kuña Katupy...ParaguayRetailFunding via Fundación Paraguaya
8 De Diciem...ParaguayServicesFunding via Fundación Paraguaya
San Jose Group
Sofia is part of this group; she has a small stand where she sells all types of products like food, drinks, candy, and more. She works every day in her small business in order to get an income with which she can help her loved ones. She is a very hard-working person who, with sacrifice, is getting ahead in life.
She asks for this loan so that she can invest in the purchase of candy, juices, cookies, and other products that will allow her to continue with her sales and to give her clients what they ask for. She is grateful for the help that she is receiving to improve.
Sofia es parte de este grupo, ella tiene un pequeño copetín donde vende todo tipo de productos, como ser comestibles, bebidas, golosinas y demás. En su pequeño negocio trabaja todos los días para poder tener un ingreso con el cual poder ayudar a sus seres queridos. Ella es una persona muy trabajadora, que con sacrificio esta saliendo adelante.
Ella pide este préstamo para poder invertirlo en la compra de golosinas, jugos, galletitas y demás productos, que le permitirá poder seguir con sus ventas, y dando a sus clientes lo que piden. Agradece por esta ayuda que está recibiendo de ir mejorando.
Additional Information
About Fundación ParaguayaFundación Paraguaya is a financially self-sustaining social enterprise that promotes entrepreneurship in urban and rural areas through microfinance, education programs, and more. Its focus on agriculture has helped many farmers boost their crop yields. And a number of other borrowers have taken out loans to start and grow social businesses that have helped deliver eyeglasses, medicines and other helpful services in their local communities.
This is a Group Loan
In a group loan, each member of the group receives an individual loan but is part of a larger group of individuals. The group is there to provide support to the members and to provide a system of peer pressure, but groups may or may not be formally bound by a group guarantee. In cases where there is a group guarantee, members of the group are responsible for paying back the loans of their fellow group members in the case of delinquency or default.
Kiva's Field Partners typically feature one borrower from a group. The loan description, sector, and other attributes for a group loan profile are determined by the featured borrower's loan. The other members of the group are not required to use their loans for the same purpose.
About Paraguay
33View loans »
Success!! The loan was 100% repaid
- Repayment Term
- 9 months (Additional Information)
- Repayment Schedule
- Monthly
- Pre-Disbursed:
- Feb 20, 2014
- Listed
- Apr 11, 2014
- Currency Exchange Loss:
- Possible
- Ended:
- Oct 17, 2014

subset: commoncrawl


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Key things you need to know aboutDr. Derderian:
Dr. Derderian's Experience
Research training, expertise and qualifications
Dr. Derderian's Specialties
- General Surgery
- View all 2 Specialties and 2 board certifications
Conditions Dr. Derderian Treats
- Carotid Artery Disease
- Coronary Artery Disease (CAD)
- See all 4 conditions
More About Dr. Derderian's Background
Patient Satisfaction
Patients' feedback on their experience with Dr. Derderian
Likelihood of recommending Dr. Derderian to family and friends is 3 out of 5 5 1 2
See More Survey Results
8 Facts About Patient Satisfaction Surveys
Patient satisfaction surveys provide a standardized way of reporting about healthcare experiences. But there can be more than meets the eye when reviewing scores. Here's what you should know
Appointments & Offices
Check insurance plans, locations and make an appointment
- Michigan Vascular Insititute
- Michigan Vascular Insititute
- 700 N Old Woodward Ave Ste 100
- Birmingham, MI 48009
- (248) 594-3067
- Directions
- 6770 Dixie Hwy Ste 106A
- Clarkston, MI 48346
- (248) 922-9374
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7 Tips to Prepare for Your Appointment
The key to a successful appointment is communication. To get the most out of your visit, prepare ahead of time so you can lead the conversation with your doctor. These 7 tips will get you ready
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text:
Quotes From The Cast of Les Miserables
Quotes From The Cast of Les Miserables
Recently, I had the pleasure of sitting down with the phenomenal cast of Les Miserables. They discussed their roles in the film and the biggest challenges they had to face filming. Les Miserables is a musical that cuts into your emotions and forces you to reflect on broken dreams, love, sacrifice and redemption.
Les Miserables has been seen by more than 60 million people in 42 countries. The musical can be seen in 21 languages around the world and is in its 28th year.
Here is what the cast had to say about their masterpiece.
page 1 of 9
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Mar 27, 2012
Abu Dhabi sovereign wealth fund Mubadala Development Company has agreed to pay $2bn for a 5.63% stake in Brazil's EBX group, underscoring the growing trend of big-ticket Mideast equity investments in LatAm. Bankers say they are spending more and more time pitching sovereign wealth funds with investment opportunities in a diversifying number of LatAm sectors, with the caveat that the Middle Easterners need size. "We are talking a lot to these investors to pitch them private transactions. There has been an increased interest since the end of last year," says a Sao Paulo-based ECM banker, referring to investments with structures similar to EBX and...
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text:
Mylan Announces $1 Million Gift To The Pittsburgh Promise Scholarship Fund
PITTSBURGH, April 22, 2013 /PRNewswire/ -- Mylan Inc. (Nasdaq: MYL) today announced that it has contributed $1 million to The Pittsburgh Promise Scholarship Fund, a scholarship program for Pittsburgh Public School students that advocates for improving the quality of education and increasing the preparedness and diversity of the region's workforce. The donation will help The Pittsburgh Promise to complete phase II of their $250 million fundraising campaign nearly three years ahead of the fund's original 2018 target. Mylan Executive Chairman Robert J. Coury said, "Mylan has and will continue to play an active role in Pittsburgh, as we believe strongly in the importance of giving back to our community. Pittsburgh has long served as an important hub to Mylan and we anticipate it will continue to play a key role in our business for many years, as we look forward the opening of our new Global Center later this year."With this donation to The Pittsburgh Promise, we are proud to invest in the future of the region's children through enhanced educational opportunities and believe this contribution will only further build on the strength of our community and its people in the future." Mylan CEO Heather Bresch commented, "Our pledge supports the hope that students in our own backyard receive an education after high school and helps break down the financial barriers that could keep them from making their dreams come true. We are pleased to support one of the country's leading scholarship programs that advances public education reform, while preparing our young people for jobs in science and business." Pittsburgh Promise scholars have enrolled in 91 different post-secondary public and private colleges and universities, career training companies, and vocational and trade programs throughout the Commonwealth of Pennsylvania. Pittsburgh has the largest Promise program in the United States. Reaching the program's financial goals sooner than previously expected will help to ensure that the Promise can continue making progress on its mission to advance the lives of young people for many years to come. Since the Pittsburgh Promise was launched in 2007, $160 million has been raised in gifts and pledges from more than 100 corporations and foundations, and more than 2,000 individual donors. The Promise has provided $32 million in scholarships to 3,800 graduates from the Pittsburgh Public Schools classes of 2008 – 2012. Mylan is a global pharmaceutical company committed to setting new standards in health care. Working together around the world to provide 7 billion people access to high quality medicine, we innovate to satisfy unmet needs; make reliability and service excellence a habit; do what's right, not what's easy; and impact the future through passionate global leadership. We offer a growing portfolio of approximately 1,100 generic pharmaceuticals and several brand medications. In addition, we offer a wide range of antiretroviral therapies, upon which approximately 40% of HIV/AIDS patients in developing countries depend. We also operate one of the largest active pharmaceutical ingredient manufacturers and currently market products in approximately 140 countries and territories. Our workforce of more than 20,000 people is dedicated to improving the customer experience and increasing pharmaceutical access to consumers around the world. But don't take our word for it. See for yourself. See inside. mylan.com
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317 Dundas St. W. (McCaul St.) Send to Phone
416-979-6688 | Make Restaurant Reservations | Menu
OpenLunch Tues.-Fri., Dinner Tues.-Sat., Brunch Sat.-Sun.
- Dress code: Casual dressy
- Full bar
- Private room(s)
* Click here for rating key
FRANK Restaurant Review: Located within the Art Gallery of Ontario (AGO), which was redesigned by famed architect Frank Gehry, this multi-story dining room is also a showcase for art, with sculptures by Frank Stella and works by Canadian painters Paterson Ewen and Joyce Wieland. Chef Ryan Wilson-Lall has created a menu using locally sourced ingredients and a global theme. For example, black cod, pickled vegetables and soba noodles come together in a dashi broth, while braised octopus is flavored with achiote alongside a Peruvian potato salad. Also sample the roasted butternut squash salad with spicy maple vinaigrette, beets and goat cheese, and the duck with smoked tomato confit and black olive salt. Conclude your meal with shareable chocolate charcuterie, including chocolate salami, banana passion fruit cream, and fruit preserves. The approachable, well-organized wine list focuses exclusively on Ontario selections.
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13406 E. Philadelphia St. Whittier, CA 90608
For the first time in Whittier College's history, Poet Athletics earned three conference championships in one school year. The men's and women's water polo teams dominated the pool in the 2014-2015 season, bringing home two conference trophies.... More
The rain and soggy weather did not dampen the festive atmosphere of Whittier College's 112th Commencement ceremony held indoors at the Graham Athletic Center for the first time in the history of the College. More than 400 members of the class of... More
Los Angeles Mayor Eric Garcetti will serve as Commencement Speaker at Whittier College's 112th Commencement Ceremony on Friday, May 15, 2015. The celebration will take place at Memorial Stadium on the Whittier College campus. During the event,... More
President Sharon Herzberger visited Washington D.C. in early February to attend NAICU's (National Association of Independent Colleges and Universities) Annual Meeting. NAICU serves as the unified national voice of private nonprofit higher... More
Dr. Joel Pérez has been appointed Vice President and Dean of Students at Whittier College, following a national search. He will officially join the College in March 2015. Pérez comes to Whittier College from Seattle Pacific University, where he... More
More than 1,000 Poets including alumni, families, and friends, participated in this year's Whittier Weekend festivities between October 17 and 19. The three-day celebration opened with an intimate Golden Anniversary brunch in honor of the... More
Once again, Whittier College has been named one of the top national liberal arts colleges by U.S. News and World Report and the Washington Monthly, among others, in the annual college rankings roundtable. Of note, the U.S. News' 2015 Best Colleges... More
Whittier College has named 229 undergraduate students to the Spring 2014 Dean's List. Undergraduate students are awarded Dean's List honors if he or she earns a 3.70 grade point average (GPA) while completing a full-time course load (12 units) in... More
Seated under a brilliantly sunny sky in Whittier College's Memorial Stadium, the nearly 450 members of the class of 2014 listened attentively as humanitarian Jesuit Priest Father Gregory J. Boyle entreated them to not only "promote" justice with... More
Whittier College social work students traveled to Sacramento in early April to participate in the 2014 Legislative Lobby Days, a two-day event that educates approximately 1000 students and professionals about important legislation affecting clients... More


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This profile was last updated on 2/21/01 and contains information from public web pages and contributions from the ZoomInfo community.
Dr. Khalid HaqueWrong Dr. Khalid Haque?
Consultant Neonatologist
Phone: +44 **********Email: k***@***.uk
St Helier Hospital
Wrythe Lane
Carshalton , Surrey SM5 1AA
United Kingdom
Company Description: We have been a training practice for 10 years and are situated in close proximity to both St. Helier and St. George's hospitals. In addition to standard primary... more
ProPub_Iteration_NT.402[02] SEIDXWK-19


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The Missouri Tigers are at home again this Saturday against Kentucky. The Tigers are coming off a 24-14 home victory over Vanderbilt this past Saturday.
High School Soccer...
Class 2 District 7 at Winfield...
Borgia 4 Winfield 0
Elsberry 2 Christian 1
The World Series is down to one final game. The Kansas City Royals and San Francisco Giants will meet in Game Seven of the Fall Classic... more
The St. Louis Rams are adding safety Mark Barron to their roster.
Vladimir Tarasenko completed a hat trick with a game-winning power play goal in overtime to lift the Blues to a 4-3 win over the Stars at American Airlines Center.
Class 3 District 9 at Union...
Camdenton 2 Union 1 in overtime
Helias 2 Rolla 1
Camdenton and Helias will meet in the... more
St. Louis Cardinals manager Mike Matheny says he couldn't find the right words to express his feelings on the death of 22-year-old outfielder Oscar Taveras.
Bench coach Mike Aldrete is leaving the Cardinals for the same position with the Oakland Athletics. Aldrete worked as the bench coach for the Cards for the last three seasons... more
The Rams hit the practice field tomorrow to gear up for their Week Nine contest against the San Francisco 49ers. St. Louis will travel to Levi's Stadium in Santa Clara for the contest.
The KLPW Radio Athlete of the Week is Junior Baseball Player Gus Kleekamp from St. Francis Borgia Regional High School in Washington.


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I want to make a sketch of Saturn tonight and I would like to use one of those templates with the accurate tilt of the rings. Does anyone know where to find this? On the net I can only find older templates which have a wider ring configuration.
Looking for a Saturn sketch template
Started by Roel , Feb 18 2009 06:00 AM
3 replies to this topic
Posted 18 February 2009 - 06:00 AM
Posted 18 February 2009 - 06:48 AM
Here's one.
Attached Files
Posted 18 February 2009 - 08:23 PM
Thanks Sol, i bet a lot of folks on the forum appreciate an up to date template of Saturn.
Posted 19 February 2009 - 02:55 PM
Well I hope it can be of some help. North is up in this template's orientation.


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For a discussion of some of the risks and important factors that could affect the firm's future results, see Risk Factors in the company's latest Annual Report on Form 20-F filed with the Securities and Exchange Commission on April 13, 2012. AB InBev assumes no obligation to update or revise any forward-looking information provided during the conference call and shall not be liable for any action taken in reliance upon such information.It is now my pleasure to turn the floor over to Mr. Carlos Brito. Sir, you may now begin.
Anheuser-Busch InBev SA/NV Management Discusses Q2 2012 Results - Earnings Call Transcript
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tag: architecture
Lake View Residence1 comment
This home, located on a small lot near a lake, captures great views throughout the house. The contrast on both the interior and exterior of the home communicates strongly with the many unique structural shapes and features.view details
Converting a Closet into a ¾ Bathroom full of Craftsmanship & Architectural Design
In need of another bathroom, this 1927 Built duplex bungalow had a closet on an exterior wall that had the room to be expanded making is possible to add a much needed extra bathroom. With the...view details
Building A Modern Craftsman Staircase4 comments
Building an exposed stringer staircase with reclaimed Long Leaf Pine is the job for a Master Carpenter. See my carpenter Darryl build this modern detailed staircase in a 1920's house my company remodeled.view details
Smart Design Advice for Hot & Humid Climates (i.e. The South)
Architect Peter Pfeiffer talks about how to utilize smart design for a house in a hot climate zone. His green building advice is practical and following his advice will result in a house that's well designed for the rigors of a hot climate. If you want a comfortable, efficient, durable house and you live in the South then this video will give you tons to think about.view details
National Architecture Week2 comments
Celebrating the Power of Design with a Beautiful Bungalow Remodel by Moore Architectsview details
Mountain Porch Retreat1 comment
Our region has an extended outdoor season that the homeowners wanted to take full advantage of. The existing deck was not adequate for hosting large parties and had no covered space for protection...view details
Our New Design Blog2 comments
Welcome to Fine Homebuilding's new blog, where we'll help you design inspiring homes.view details
From Playhouse to Shed
Every time we visited Costco, our twins would marvel at the large play structures on display. By the time they were 6, they had made a pretty compelling argument that a play structure of their own was a "necessity".view details
Total Seattle Gut-Second Story Addition7 comments
Bought by my wife and myself as an investment, this is the 'house next door'...literally. When our neighbor of 20 years passed on, we decided to buy and renovate the property. We designed it to keep...view details
Ultimate Deck Build 2016: Critical Connections Part 1: Ledger
The primary connection between deck and house read more


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View more product details
Fill out the form below and select your desired product options - we will notify you when it is back in stock.
We respect your privacy and the information you provide will NOT be sold, shared, or disseminated in any way. Please review our Privacy & Security Policy to learn more about our commitment to your privacy.
Paula's Choice will provide a full refund or credit (including tax where applicable) for merchandise returned within 60 days of your purchase date. We're sorry, but shipping fees are not refundable.
Step 1. Fill out the Return/Exchange Form located on the back of your invoice. If you don't have your invoice you can print the Return/Exchange Form here.
Step 2. Package the items for return in any box and enclose the completed Return/Exchange Form.
Step 3. Mail your items to:
Paula's Choice Returns
23215 66th Ave South, Bldg 1
Kent, WA 98032
Please note that you are responsible for shipping costs and the safe return of merchandise.
Step 4. Most returns are processed within 3-5 business days of receipt. You will receive an email confirmation once your return or exchange has been processed.
Bring on skin that's dry, oily or somewhere in between. Give us the wrinkles, rosacea, acne, blackheads, and big pores. Paula's Choice Skincare treats them all. Without irritation. No added dyes. 100% fragrance free. Our products are based on our unique combination of research, reviews, and results-driven product development. Finally, products that really work.
Animal testing is not okay with us. Never has been. We don't fund any independent source to do it for us, either. In fact we're members of the Leaping Bunny Program, which means not only have we eliminated animal testing from our company, but also from our ingredient suppliers. We love animals so much; our employees bring their dogs to work. Keeps things real.
Looking for animal-derived product information?
At Paula's Choice Skincare we believe our products will work as claimed. In fact, if you are not completely satisfied with your purchase for any reason we will give you a full refund or credit (including tax if applicable) for products returned within 60 days of your purchase date. As usual for online purchases, shipping fees are non-refundable.
How to make a return or exchange →
(based on 254 reviews)
Ratings Distribution
5 Stars
4 Stars
3 Stars
2 Stars
1 Stars
of respondents would recommend this to a friend.
Best Uses
Reviewed by 254 customers
Displaying reviews 26-50
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(5 of 6 customers found this review helpful)
Best body sunscreen
By Lola
from Vancouver
Comments about Extra Care Non-Greasy SPF 50 - 5 oz:
I love this sunscreen. Perfect texture, and doesn't have that smell you sometimes get with sunscreens. You run it on, and it disappears. I find it stings my eyes, Soni don't use it on my face, which is the downside. I think this needs to be offered in a larger size, in a container that sits on my counter with a pump top.
Bottom Line Yes, I would recommend this to a friend
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(6 of 7 customers found this review helpful)
By Ann L.
from Undisclosed
I have extremely fair, sensitive, and oily skin, and I've struggled to find something that really works well without being extremely greasy or wearing off in two hours. This sh*t lasts for hours, non-greasy (if you really rub it in) and I'm leaving Aruba after 7 days with absolutely no burn (compare this to my shoulders, where I used cheapo SPF50 and fried, despite frequent reapplication.) I will be buying this stuff for life.
(0 of 2 customers found this review helpful)
Disappointed with
By Rana A.
I used another sun block before and I have never had these pores and breakout even my skin really oily like I am sweating. It is really the worst product ever I used from paula choice and I dislike. Also, the worst thing is I bought two of them!!
Customer Service Response: Hello, and thank you for sharing your experience with us - we're sorry to hear this didn't work as expected for you! Please contact a member of our Customer Care team, who can assist you with a possible exchange or refund.
(0 of 1 customers found this review helpful)
Non-Greasy, Absorbs Fast, and Effective
By Megan C.
I have never been able to use sunscreens for my body because they tend to be oily sprays or thick lotions, which never absorb into my skin. I wanted to give this a try because it is specifically formulated for oily/combo skin (and because PC has not failed me yet) and it works great. It absorbs within a couple of minutes, dries to a barely-there finish, and prevents all tanning/burning on my easily-tanned skin.
By Hannah U.
My husband and I love this sunscreen. I like it for my body (I have a different SPF moisturizer for my face) and my husband likes it for his face when he rides his motorcycle. It's really effective at sun protection and it isnt greasy at all compared to most other sunscreens out there. I just bought a second backup bottle during the sunscreen sale. If they made a bigger bottle then I would definitely get it.
(1 of 1 customers found this review helpful)
Great! But water resistant mineral sunscreen for face?
By Sarah P.
Used a sample of this and ordered a full size. Non-sticky and non-greasy with no white cast. Price is very reasonable. This is great for the body, but chemical sunscreens tend to sting my eyes, so I'm afraid to use this on my face if I perspire/go swimming. Please come out with a mineral based water resistant face sunscreen. It would be great if you could make something similar to the Hydralight sunscreen that was water resistant. Thank you!
(1 of 2 customers found this review helpful)
Love this! & potential fix for product use problems
By Anonymous
First, I love this product for my combination, acne prone skin. Before Paula's Choice, I refused to wear sunscreen on my face for fear that my acne would worsen. I have used this for many years with wonderful results. Secondly, I read in a previous review that a product user was having difficulty squeezing product out of the tube. I, too, had the problem until I discovered my error. When I removed the foil safety seal, I failed to entirely remove the clear, plastic liner.
Non-Greasey = great for body hair
By JZ
This is the only sunscreen I use anymore. The non-greasy formula is the best I've found and I'm able to rub it into my arms and legs with no problem while other brands leave me feeling like i've got a coat of nastiness on me and it gets all tangled you've got hairy arms and legs. This product has very little odor, goes on smooth, and dries without much of any feeling there is a product on you at all.
Very efficient
By Max
I went in Mexico for vacation and I have a pretty sensitive and pale skin. I applied it every 2 hours like recommanded and I did not burn a bit neither did I tan! That is the best sunscreen I've tried in a long time and it dries pretty fast and does not feel too greasy!
(3 of 3 customers found this review helpful)
No-sting No tears
I've tried many brands over the 30 years I've been wearing sunblock, I find this product t perfect It absorbs well, is a good base for makeup, and most important for me, it does not sting my eyes and make me tear, which has been the biggest problem for all the brands I've tried. Thank you, Paula.
Dries completely, feels like nothing!
The most lightweight, fast drying, and dry to the touch sunscreen I have ever used. After a few minutes it feels like you put NOTHING on. Sunscreen hating man in my life approves. A miracle! Wish I could find a physical sunblock that felt as good as this but that doesn't appear to exist yet. PAULAS CHOICE: Could you pleeease make a formula as lightweight and quick drying as RESIST Super Light Wrinkle Defense in a larger tube for body? It would be the answer to all my hopes and dreams in life.
Repeated buyer
By Norma
Been using this for two summers and am coming back to buy more for this summer. Powerful protection without the heaviness of other sunscreens, this is not greasy yet moisturizing, good price for a large tube too. I used it mainly for hiking when I sweat a lot but do not need to get into water so I can't speak for its waterproof effectiveness. I like the liquid-y texture which is quite unusual for sunscreens. It also performs well on my face under makeup.
(2 of 2 customers found this review helpful)
By Dori
It makes make face shiny and greasy for the whole day;/ Make up looks awful on the top of it. disappointed:(
(4 of 4 customers found this review helpful)
True to its name, it's non-greasy yet smooth as silk. Plu...
By Steve
While applying this to my face, I felt a tingling sensation, that slowly dissipated in about 5 minutes or so. No redness or acne. ( I use only mineral based sunscreens around the eye area so that I won't feel any tingling sensation.) I believe the advantages of the product far outweigh the disadvantages. Paula, please let this wonderful product come out forever for the sake of those who love high spf synthetic sunscreens and want to use super-sized inexpensive ones without any greasy feeling~!!
Not for me
By Betty C.
I was really hoping that I could use this but unfortunately I break out in an itchy rash whenever I used this. I'll have to keep looking.
Great Product & Miss the Spray
By BRANDIE D.
Always buy this, it's pricy as I'm Canadian but we still do. My Dad who is very fair and bald has had numerous bouts of skin cancer and I always stock him with this product. BUT, we do miss the ease sometimes of the spray - particularly for the kids! I'd like to see it make a comeback.
Great for the body
By matt h.
I found this great for the body and neck. I didn't really try it for the face as I love the fluid spf 50 from paula's resist line, but this is great for everything else. You get a generous amount compared to the other smaller versions and it wasn't greasy at all. Also, the spf 50 is a def ++
Not for sensitive skin!
By Kathleen T.
I really wanted to love this product- the texture is wonderful, perfect for acne prone skin. However, when I used this on my face it immediately caused a burning sensation and after a few days of using it I broke out in a painful rash underneath my eyes and on my eyelids.
Customer Service Response: Hello, and thanks for sharing your experience with us - we're sorry to hear this didn't work as expected for you! Please contact a member of our Customer Care team for information about a possible exchange or refund.
Ouch! this is not for your face, neither waterproof
I didn't like this product at all. I put it on my face and it gave me a reaction right away. Then used on my body then as soon start sweating it melts away, I could actually see dripping white from my skin. No I don't recommend this product.
Customer Service Response: We're so sorry this product didn't work for you! Please contact us to arrange for a refund or exchange.
Not non-greasy...
By Sophia S.
I have combination skin (not that oily) and large pores in T zone. I tried it for 2 weeks. It's so greasy that I had to use oil blotting papers before I applied makeup (I use mineral powder foundation). The rest of my day is a bit more greasy. It left a few white dots in pores. I had to use exfoliating masks more frequently (every 2 days instead of 3). My eyes also felt stinging. Since I only paid $8 for it, I use it on the rest of my body. It works well for my arms.
Customer Service Response: Hello, and thanks for your comments! We're sorry to hear this didn't work for you - you might find out new RESIST Youth-Extending Daily Fluid SPF 50 is a better fit, as it offers great SPF protection in a water-light formula.
Great Product
By Valerie W.
I love this sunscreen. It's very light weight and non-greasy, but it does the job. I apply this to my face 2-3 times a day, so I appreciate the generous size. So far no break-outs and the sun protection is great. I can wear this under make-up because the finish is matte. I'm going to order another tube while it's on sale!
Best sunscreen for acne!
By Yazmin K
After searching a lifetime for a sunscreen for oily acne prone skin, I finally found my HG its a amazing sunscreen that works well to protect you from sun damage while not causing additional breakouts, it's a lightweight lotion that quickly sinks in, it's not matte but not greasy either! I love this sunscreen, try if traditional sunscreens cause acne.
Best sunscreen for acne
By Yasmin
Very good sunscreen for those struggling with oily skin and breakouts, does not cause or worsen acne, non greasy and hydrates perfectly without feeling oily, lasts for ages and gives excellent sun protection. A must to try for those with acne that struggle to find a sunscreen that does not cause or worsen outbreaks.
Great Product, but Packaging Has Become Frustrating
By Kathi jr
This is a high quality sunscreen for the price and it comes in a large enough container to last for a while (I use sunscreen on my face and many areas of my body three times a day.) However, the last two tubes have been a little frustrating. The product refuses to come out (and this happened with a brand new tube that I just opened.) I can understand where the hole needs to be small enough so that too much product doesn't come out, but this is just the opposite.
Customer Service Response: Thanks for your commenrs! How unusual this is happening. We will be sure to pass this comment on to our packaging team.
Get answers from our staff experts by clicking "Ask a Question" or click here
to send an email to our customer service team.
Be the first to ask us a question about this product.
What makes this product unique?Extra Care Non-Greasy Sunscreen SPF 50 offers reliable broad-spectrum sun protection without feeling thick or oily. In fact, you may be surprised by it silky texture and smooth matte finish that's so unlike many high-SPF sunscreens. This antioxidant-rich sunscreen is suitable for the face and body; it may be worn under makeup. Its very water-resistant formula is ideal for outdoor activities.
This product is 100% fragrance- and colorant-free.
Who is this product for?Extra Care Non-Greasy Sunscreen SPF 50 is recommended for normal to oily/combination skin. It is also suitable for blemish-prone skin.
Future Oncology, December 2008, pages 841–856; Clinics in Dermatology, November-December 2008, pages 614–626; Skin Therapy Letter, September 2008, pages 5–9; Journal of Drugs in Dermatology, July 2008, pages S7–S12; Dermatologic Therapy, September-October 2007, pages 314-321; Journal of Pathology, January 2007, 241–251; International Journal of Immunopathology and Pharmacology, July-September 2005, pages 497-502; Experimental Dermatology, September 2005, pages 684-691; Journal of the American Academy of Dermatology, June 2005, pages 937–958; Photodermatology, Photoimmunology, and Photomedicine, August 2004, pages 200–204; Cutis, September 2003, pages 11–15; Journal of Investigative Dermatology, January 2002, pages 117–125; and Clinical Experimental Dermatology, October 2001, pages 573–577.
Key Ingredients:
vitamin C, vitamin A, silica, bentonite, Aloe barbadensis, vitamin E, avobenzone
Active Ingredients: Homosalate 10%, Oxybenzone 6%, Octisalate 5%, Avobenzone 3%, Octocrylene 2% (all FDA-approved sunscreen ingredients). Other Ingredients: Water (Aqua), Butylene Glycol (slip agent), PEG-8 (thickeners), Polyethylene (thickeners), Silica (dry finish slip agent), Dimethicone (silicone slip agent), Picea Excelsa Wood Extract (anti-inflammatory agent), Sodium Ascorbyl Phosphate (vitamin-based antioxidants), Retinyl Palmitate (vitamin-based antioxidants), Tocopherol (vitamin E/antioxidants), Tocopheryl Acetate (vitamin E/antioxidants), Titanium Dioxide (thickener/opacifying agent), Aloe Barbadensis Leaf Juice (water-binding agent), Bentonite (absorbent), Methyl Glucose Sesquistearate (emulsifier), Acrylates/C10-30 Alkyl Acrylate Crosspolymer (film-forming/waterproofing agents), Sodium Polyacrylate (film-forming/waterproofing agents), Kaolin (thickener/absorbent), Ethylhexylglycerin (water-binding agent), Disodium EDTA (chelating agent), Sodium Hydroxide (pH adjuster), Phenoxyethanol (preservatives), Chlorphenesin (preservatives).
DIRECTIONS: Apply liberally prior to sun or daylight and as needed after swimming and/or perspiring. Can be used over any Paula's Choice skincare product.
Detailed instructions on how/when to apply your Paula's Choice products can be found in our How to Put Together Your Own Skincare Routine article.
Is Extra Care Non-Greasy Sunscreen SPF 50 suitable for blemish-prone skin?
I thought Paula said sunscreens rated above SPF 30 weren't needed—SPF 30 is enough, right?
Although Paula has spoken out against the fact that other companies offer sunscreens with oftentimes ridiculously high SPF ratings (such as SPF 70 or 100), the issue has always been that such products tend to give consumers a false sense of security. They erroneously believe that a higher SPF only needs to be applied once as they spend the day in the sun. That is not the case for any sunscreen number. A sunscreen rated SPF 30 or above provides longer but not better protection. That means you can stay in the sun longer before your skin shows signs of turning color, but does not negate the need to reapply every two hours after periods of swimming, perspiring, or toweling off. We suggest our Extra Care Non-Greasy Sunscreen SPF 50 for those who will be spending several hours outdoors and/or engaging in water-based activities. Liberal application and routine re-application is necessary in order to maintain the high level of sun protection.
How come this sunscreen's SPF rating changed from SPF 45 to SPF 50? Did the formula change, too?
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Check BNN and Bulbanews for up-to-date Pokémon news and discuss it on the forums or in our IRC channel #bulbagarden on irc.systemnet.info.
Check BNN and Bulbanews for up-to-date Pokémon news and discuss it on the forums or in our IRC channel #bulbagarden on irc.systemnet.info.
Changes related to "Lance's Gyarados (VS 98)"
From Bulbapedia, the community-driven Pokémon encyclopedia.
This is a list of changes made recently to pages linked from a specified page (or to members of a specified category). Pages on your watchlist are bold.
6 May 2016
|m 06:40
|Pokémon games (diff | hist) . . (+20) . . Chosen (Talk | contribs) (→On Bulbagarden forums)
30 April 2016
|Lance (2 changes | history) . . (0) . . [Nmurthy; Pumpkinking0192]
|05:44 (cur | prev) . . (-126) . . Pumpkinking0192 (Talk | contribs) (Undo revision 2435491 by Nmurthy (talk) This doesn't seem that special or noteworthy to me — tons of Pokemon are part of a three-stage family.)
|04:41 (cur | prev) . . (+126) . . Nmurthy (Talk | contribs) (All of Lance's Pokemon on his team have evolved twice from their base forms.)
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