초록 ▼

Methods and apparatus for delivery of substances or apparatus to target sites located outside blood vessels within the body of a human or animal patient. A vessel wall penetrating catheter is inserted into the vasculature, positioned and oriented within a blood vessel near the target extravascular s

Methods and apparatus for delivery of substances or apparatus to target sites located outside blood vessels within the body of a human or animal patient. A vessel wall penetrating catheter is inserted into the vasculature, positioned and oriented within a blood vessel near the target extravascular site and a penetrator is advanced from the catheter so as to penetrate outwardly through the wall of the blood vessel in the direction of the target site. Thereafter, a delivery catheter is passed through a lumen of the penetrator to the target site. A desired substance or apparatus is then delivered to or obtained from the target site. In some applications, the penetrator may be retracted into the vessel wall penetrating catheter and the vessel wall penetrating catheter may be removed, leaving the delivery catheter in place for chronic or continuous delivery of substance(s) to and/or obtaining of information or samples from the target site. Alternatively, a delivery catheter having an occlusion member or balloon may be advanced into a vein or venule and the occlusion member or balloon may be used to occlude the lumen of the vein or venule during and after injection of a substance through the catheter, such that the substance will not be carried away by normal venous blood flow and will remain in the vein or venule for a sufficient period of time to have its intended effect (e.g. to enter adjacent tissues through capillary beds drained by that vein or venule).

대표청구항 ▼

What is claimed is: 1. A system for delivering substances or apparatus to an extravascular target site within the body of a human or veterinary patient, said system comprising: a. a vessel wall penetrating catheter that comprises i) a flexible catheter body that is insertable into the vasculature o

What is claimed is: 1. A system for delivering substances or apparatus to an extravascular target site within the body of a human or veterinary patient, said system comprising: a. a vessel wall penetrating catheter that comprises i) a flexible catheter body that is insertable into the vasculature of the patient and ii) a vessel wall penetrating member that is advanceable laterally from the catheter body, said vessel wall penetrating member having a lumen extending longitudinally therethrough, said penetrating member being sufficiently long to advance through the full thickness of the wall of a blood vessel in which the catheter body is positioned to an extravascular target site located beyond that blood vessel wall; and, b. a delivery catheter having a lumen extending longitudinally therethrough, said delivery catheter being advanceable through the lumen of the vessel wall penetrating member to said extravascular target site; said vessel wall penetrating member being retractable into the catheter body of the vessel wall penetrating catheter and the vessel wall penetrating catheter being removable from the patient's body such that the delivery catheter remains indwelling with the distal end of the delivery catheter located at the extravascular target site. 2. A system according to claim 1 wherein the vessel wall penetrating catheter further comprises iii) a guidance element useable by the operator to position the vessel wall penetrating catheter body within the vasculature of the patient such that when the vessel wall penetrating member is passed from the catheter body it will penetrate through the wall of the blood vessel in the direction of the intended extravascular target site. 3. A system according to claim 2 wherein the guidance element comprises an imaging apparatus. 4. A system according to claim 3 wherein the imaging apparatus is an ultrasound imaging apparatus. 5. A system according to claim 2 wherein the guidance element comprises an imageable marker on the vessel wall penetrating catheter body. 6. A system according to claim 2 wherein the guidance element comprises the combination of an imaging apparatus and at least one imageable marker that is imageable by the imaging apparatus. 7. A system according to claim 2 wherein the guidance element comprises an emitter located on or in the catheter body, said emitter emitting a signal that is received by an extracorporeally situated signal-receiving apparatus. 8. A system according to claim 1 wherein the delivery catheter further comprises a matter blocking member for preventing cellular ingrowth and other matter from obstructing the lumen of the delivery catheter. 9. A system according to claim 8 wherein the delivery catheter has an outflow opening though which substances may pass out of the lumen of the delivery catheter and into the target location and wherein the matter blocking member comprises a selectively permeable barrier that allows desired substances to be infused in the distal direction through the outflow opening and to the target location but prevents cellular ingrowth and other matter from entering the lumen of the delivery catheter through said outflow opening. 10. A system according to claim 9 wherein the selectively permeable barrier is a balloon attached to the delivery catheter such that substances infused though the lumen of the delivery catheter collect within the balloon and subsequently diffuse outwardly though the balloon. 11. A system according to claim 8 wherein the matter blocking member comprises a stylet that is insertable into the lumen of the delivery catheter to block the entry of extraneous matter thereinto. 12. A system according to claim 11 wherein the stylet is removable from the lumen of the delivery catheter to permit delivery of a substance or apparatus through the delivery catheter. 13. A system according to claim 1 wherein the delivery catheter comprises: a first tube having a lumen and a sidewall in which an outflow aperture is formed; and, a second tube rotatably disposed in a coaxial position within the first tube, said second tube having a lumen, a closed distal end and a sidewall in which an opening is formed; the second tube being rotatably moveable between i) a blocking position wherein the side wall of the second tube substantially blocks the outflow aperture of the first tube to prevent cellular ingrowth and other matter from entering the lumen of the second tube and ii) an infusion position wherein the opening of the second tube is aligned with the outflow opening of the first tube such that a substance that is injected into the lumen of the second tube will flow through the opening of the second tube and through the outflow opening of the first tube. 14. A system according to claim 12 wherein a plurality of outflow apertures are formed in the sidewall of the first tube. 15. A system according to claim 1 wherein the delivery catheter comprises: a tube having a lumen and a sidewall in which an outflow aperture is formed; and, an obturator member disposed at least partially within the lumen of the tube, said obturator member being alternately disposable in i) a blocking position wherein the obturator substantially blocks the outflow aperture of the tube to prevent cellular ingrowth and other matter from entering the lumen of the tube and ii) an infusion position wherein the obturator does not substantially block the outflow apertures such that fluid may be injected through the lumen of the tube and out of the outflow aperture. 16. A system according to claim 15 wherein a plurality of outflow apertures are formed in the sidewall of the tube. 17. A system according to claim 15 wherein the obturator member is an inflatable balloon that assumes said blocking position when inflated and said infusion position when deflated. 18. A system according to claim 1 wherein the delivery catheter comprises a plurality of high pressure outflow openings. 19. A system according to claim 18 wherein said high pressure outflow openings are formed in the side wall of the delivery catheter. 20. A system according to claim 1 wherein the delivery catheter further comprises an anchoring member for anchoring the catheter in a substantially fixed position within the patient's body. 21. A system according to claim 20 wherein the anchoring member is selected from the group of anchoring members consisting of: a hook; a barb; a permeable surface into which tissue may grow; and an adhesive. 22. A system according to claim 1 wherein the delivery catheter further comprises a backflow deterrent member for blocking backflow of substances that have been injected through the delivery catheter. 23. A system according to claim 22 wherein said backflow deterrent member comprises a backflow barrier rib formed on the delivery catheter. 24. A system according to claim 23 wherein said backflow barrier comprises an inflatable balloon on the delivery catheter. 25. A system according to claim 23 wherein said backflow barrier comprises a raised projection formed on the exterior of the delivery catheter. 26. A system according to claim 25 wherein the raised projection comprises an annular rib formed about the outer surface of the delivery catheter. 27. A system according to claim 22 wherein the backflow deterrent comprises a sealant that is implanted prior to or concurrently with removal of the delivery catheter so as to prevent the injected substance from backflowing through the tract from which the delivery catheter is removed. 28. A system according to claim 27 wherein the sealant comprises a quantity of a flowable sealant injected into the tract upon removal of the delivery catheter. 29. A system according to claim 27 wherein the sealant comprises a detachable sealing member. 30. A system according to claim 29 wherein the detachable sealing member is formed of biodegradable material. 31. A system according to claim 30 wherein the sealing member is a collagen sponge. 32. A system according to claim 30 wherein the sealing member is a hydrogel sponge. 33. A system according to claim 1 wherein at least a portion of the delivery catheter is coated with an adhesive. 34. A system according to claim 1 wherein an anti-microbial substance is disposed on at least a portion of the delivery catheter. 35. A system according to claim 1 wherein an anti-coagulant substance is disposed on at least a portion of the delivery catheter. 36. A system according to claim 1 further comprising apparatus for creating a pocket within tissue adjacent to the delivery catheter such that when a substance or apparatus is introduced though the delivery catheter it will be received within said pocket. 37. A system according to claim 36 wherein the apparatus for creating a pocket comprises an energy emitting member that emits energy into adjacent tissue to create said pocket. 38. A system according to claim 37 wherein the energy emitting apparatus is a radiofrequency electrode. 39. A system according to claim 37 wherein the energy emitting apparatus is a laser. 40. A system according to claim 36 wherein the apparatus for creating a pocket comprises a nozzle though which a stream of fluid may be injected to create the pocket in adjacent tissue. 41. A system according to claim 36 wherein the apparatus for creating a pocket comprises an expandable cage which, when expanded, creates said pocket. 42. A system according to claim 1 further in combination with an infusion apparatus for infusing a substance through the delivery catheter. 43. A system according to claim 42 wherein said infusion apparatus is a syringe. 44. A system according to claim 42 wherein said infusion apparatus further comprises a quantity of a substance for infusion through the delivery catheter. 45. A system according to claim 44 wherein the substance is a drug. 46. A system according to claim 45 wherein the drug is selected from the group consisting of: thrombolytics, platelet inhibitors, anti-restenotic agents, beta adrenergic blockers, ion channel antagonists, positive or negative ionotropic agents and anti-arrhythmics. 47. A system according to claim 44 wherein the substance is a protein. 48. A system according to claim 44 wherein the substance is an angiogenic substance. 49. A system according to claim 47 wherein the angiogenic substance is selected from the group consisting of vascular endothelial growth factor (VEGF), fibroblast growth factors (FGF), epidermal growth factor (EGF), platelet-derived growth factor (PDGF), hepatocyte growth factor (HGF) or scatter factor and heparin combined with an adenosine receptor agonist. 50. A system according to claim 44 wherein the substance comprises cells. 51. A system according to claim 50 wherein the substance comprises progenator cells for a type of cell that is desired to be formed at the target site. 52. A system according to claim 51 wherein said substance comprises myoblasts to form cardiac muscle cells. 53. A system according to claim 52 wherein said cells are selected from the group consisting of stem cells, progenator cells, myoblasts, myocytes, secretory cells, pancreatic islet cells, dopamine secreting cells, endothelial cells, hepatocytes, cloned cells, cells grown in cell culture and genetically modified cells. 54. A system according to claim 44 wherein the substance is a gene. 55. A system according to claim 44 wherein the substance comprises a gene and a vector for facilitating entry of the gene into locations within cells at which the gene will have a desired effect on the cells. 56. A system according to claim 55 wherein the vector is a virus. 57. A system according to claims 1 or 51 wherein the delivery catheter further comprises a position indicator for indicating the position of the delivery catheter within tissue. 58. A system according to claim 57 wherein the position indicator comprises a radiographically visible marker. 59. A system for delivery of a substance to a target site located a spaced distance from a blood vessel within the body of a human or animal patient, said system comprising: a vessel wall penetrating catheter that has a flexible catheter body and a vessel wall penetrator advanceable laterally therefrom, said vessel wall penetrating catheter being insertable into the vasculature and positionable in the blood vessel near the target site and said penetrator being thereafter advanceable from the catheter, trough the full thickness of the wall of the blood vessel, and through tissue that is located beyond the blood vessel wall in the direction of the target site; a delivery catheter that is advanceable through the penetrator and to the target site, said delivery catheter being of sufficient length and constructed such that, after the delivery catheter has been advanced through the penetrator and to the target site, the penetrator is retractable into the vessel wall penetrating catheter and the vessel wall penetrating catheter is removable, leaving the delivery catheter in place such that the delivery catheter extends through the patients vasculature into the blood vessel near the target site, outwardly through the wall of the blood vessel and to the target site. 60. A system according to claim 59 wherein the delivery catheter comprises a hub member that is a) not attached to the proximal end of the delivery catheter while the vessel wall penetrating catheter is being withdrawn and removed and b) attached to the proximal end of the delivery catheter after the vessel wall penetrating catheter has been withdrawn and removed. 61. A system according to claim 59 wherein the delivery catheter further comprises at least one anchoring element for holding the delivery at the target site. 62. A system according to claim 60 wherein the delivery catheter further comprises a baffler for deterring substances injected through the delivery catheter from backflowing around the delivery catheter through the tissue tract through which the delivery catheter extends from the blood vessel to the target site. 63. A system according to claim 59 wherein the delivery catheter further comprises apparatus for preventing cellular ingrowth and other matter from obstructing the lumen of the delivery catheter. 64. A system according to claim 59 wherein the vessel wall penetrating catheter further comprises a guidance element that facilitates positioning and orientation of the vessel wall penetrating catheter within the blood vessel such that, then the penetrator is subsequently advanced from the vessel wall penetrating catheter, the penetrator will travel substantially toward the target site. 65. A method for delivery of substances or apparatus to a target site located a spaced distance from a blood vessel within the body of a human or animal patient, said method comprising the steps of: (A) inserting a vessel wall penetrating catheter into the vasculature of the patient, said vessel wall penetrating catheter having a flexible catheter body and a penetrator that is advanceable laterally therefrom; (B) positioning the vessel wall penetrating catheter in the blood vessel near the target site; (C) advancing the penetrator laterally from the vessel wall penetrating catheter and though the entire wall of the blood in the direction of the target site; (D) advancing a delivery catheter though the penetrator and to the target site; (E) retracting the penetrator into the vessel wall penetrating catheter; and, (F) withdrawing and removing the vessel wall penetrating catheter, leaving the delivery catheter indwelling such that it extends though the patient's vasculature into the blood vessel near the target site, outwardly though the wall of the blood vessel and to the target site. 66. A method according to claim 65 wherein the delivery catheter comprises a hub member that is a) not attached to the proximal end of the delivery catheter while the vessel wall penetrating catheter is being withdrawn and removed and b) attached to the proximal end of the delivery catheter after the vessel wall penetrating catheter has been withdrawn and removed, and wherein the method further comprises the steps of: causing the hub member to be detached from the delivery catheter while the vessel wall penetrating catheter is being withdrawn and removed in Step F; and, causing the hub member to be attached to the proximal end of the delivery catheter after the vessel wall penetrating catheter has been withdrawn and removed in Step F. 67. A method according to claim 65 wherein the delivery catheter further comprises at least one anchoring element for holding the delivery at the target site and wherein the method further comprises: causing the anchoring element to hold the delivery catheter at the target site at least after Step F has been performed. 68. A method according to claim 65 wherein the delivery catheter further comprises a barrier for deterring substances injected though the delivery catheter from backflowing around the delivery catheter though the tissue tract though which the delivery catheter extends from the blood vessel to the target site and wherein the method further comprises: causing the barrier to deter substances injected though the delivery catheter from backflowing around the delivery catheter though the tissue tract though which the delivery catheter extends from the blood vessel to the target site. 69. A system according to claim 65 wherein the delivery catheter further comprises apparatus for preventing cellular ingrowth and other matter from obstructing the lumen of the delivery catheter and wherein the method further comprises the step of: causing the apparatus for preventing cellular ingrowth and other matter from obstructing the lumen of the delivery catheter to prevent cellular ingrowth or other matter from obstructing the lumen of the delivery catheter. 70. A system according to claim 59 wherein the vessel wall penetrating catheter further comprises a guidance element that facilitates positioning and orientation of the vessel wall penetrating catheter within the blood vessel such that, then the penetrator is subsequently advanced from the vessel wall penetrating catheter, the penetrator will travel substantially toward the target site and wherein the method further comprises the step of: using the guidance element to position and orient the vessel wall penetrating catheter in the blood vessel prior to performance of Step C such that when Step C is subsequently performed, the penetrator will travel though the blood vessel wall substantially in the direction of the target site. 71. A system for delivery of a substance or article to an intramyocardial location in the heart of a mammalian patient, said system comprising: a tissue penetrating catheter that is advanceable though the vasculature to a position within a chamber of the heart, said tissue penetrating catheter comprising a flexible catheter body having a distal end and a penetrator outlet port located in the distal end of the catheter body; a tissue penetrator having a hollow bore extending therethrough, the penetrator being advancable from the penetrator outlet port, through the endocardial surface of the heart and into the myocardium; and, a delivery catheter that is advanceable through the bore of the penetrator and into the myocardial tissue; the substance or article being thereby deliverable through the delivery catheter and into at least one intramyocardial site. 72. A system according to claim 71 wherein the tissue penetrating catheter comprises a flexible catheter body having a side wall and a penetrator outlet port located in the side wall of the catheter body. 73. A system according to claim 71 wherein, after the penetrator has been advanced into the myocardium and as the delivery catheter is being advanced through the bore of the penetrator, the configuration and position of the penetrator will cause the delivery catheter to advance through myocardial tissue on a path which does not result in the delivery catheter a) entering any chamber of the heart, b) passing outwardly through the epicardial surface of the heart and/or c) perforating a substantially sized coronary blood vessel in a manner that causes clinically significant bleeding or other clinically significant complications. 74. A system according to claim 71 wherein the vessel wall penetrating catheter further comprises iii) a guidance element useable by the operator to position the vessel wall penetrating catheter body within the vasculature of the patient such that when the vessel wall penetrating member is passed from the catheter body it will penetrate through the wall of the blood vessel in the direction of the intended extravascular target site. 75. A system according to claim 74 wherein the guidance element comprises an imaging apparatus. 76. A system according to claim 75 wherein the imaging apparatus is an ultrasound imaging apparatus. 77. A system according to claim 74 wherein the guidance element comprises an imageable marker on the vessel wall penetrating catheter body. 78. A system according to claim 74 wherein the guidance element comprises the combination of an imaging apparatus and at least one imageable marker that is imageable by the imaging apparatus. 79. A system according to claim 74 wherein the guidance element comprises an emitter located on or in the catheter body, said emitter emitting a signal that is received by an extracorporeally situated signal-receiving apparatus. 80. A system according to claim 71 wherein the delivery catheter further comprises a matter blocking member for preventing cellular ingrowth and other matter from obstructing the lumen of the delivery catheter. 81. A system according to claim 80 wherein the delivery catheter has an outflow opening through which substances may pass out of the lumen of the delivery catheter and into the target location and wherein the matter blocking member comprises a selectively permeable barrier that allows desired substances to be infused in the distal direction through the outflow opening and to the target location but prevents cellular ingrowth and other matter from entering the lumen of the delivery catheter through said outflow opening. 82. A system according to claim 81 wherein the selectively permeable barrier is a balloon attached to the delivery catheter such that substances infused through the lumen of the delivery catheter collect within the balloon and subsequently diffuse outwardly through the balloon. 83. A system according to claim 80 wherein the matter blocking member comprises a stylet that is insertable into the lumen of the delivery catheter to block the entry of extraneous matter thereinto. 84. A system according to claim 83 wherein the stylet is removable from the lumen of the delivery catheter to permit delivery of a substance or apparatus through the delivery catheter. 85. A system according to claim 71 wherein the delivery catheter comprises: a first tube having a lumen and a sidewall in which an outflow aperture is formed; and, a second tube rotatably disposed in a coaxial position within the first tube, said second tube having a lumen, a closed distal end and a sidewall in which an opening is formed; the second tube being rotatably moveable between i) a blocking position wherein the side wall of the second tube substantially blocks the outflow aperture of the first tube to prevent cellular ingrowth and other matter from entering the lumen of the second tube and ii) an infusion position wherein the opening of the second tube is aligned with the outflow opening of the first tube such that a substance that is injected into the lumen of the second tube will flow through the opening of the second tube and through the outflow opening of the first tube. 86. A system according to claim 84 wherein a plurality of outflow apertures are formed in the sidewall of the first tube. 87. A system according to claim 71 wherein the delivery catheter comprises: a tube having a lumen and a sidewall in which an outflow aperture is formed; and, an obturator member disposed at least partially within the lumen of the tube, said obturator member being alternately disposable in i) a blocking position wherein the obturator substantially blocks the outflow aperture of the tube to prevent cellular ingrowth and other matter from entering the lumen of the tube and ii) an infusion position wherein the obturator does not substantially block the outflow apertures such that fluid may be injected through the lumen of the tube and out of the outflow aperture. 88. A system according to claim 87 wherein a plurality of outflow apertures are formed in the sidewall of the tube. 89. A system according to claim 87 wherein the obturator member is an inflatable balloon that assumes said blocking position when inflated and said infusion position when deflated. 90. A system according to claim 71 wherein the delivery catheter comprises a pressure increasing outflow opening configured to cause an increase the pressure of fluids that are injected through the delivery catheter lumen and out of said pressure increasing outflow opening. 91. A system according to claim 90 wherein said pressure increasing outflow opening is formed in the side wall of the delivery catheter. 92. A system according to claim 91 wherein a plurality of pressure increasing outflow openings are formed in the side wall of the delivery catheter. 93. A system according to claim 91 wherein the delivery catheter further comprises an anchoring member for anchoring the catheter in a substantially fixed position within the patient's body. 94. A system according to claim 93 wherein the anchoring member is selected from the group of anchoring members consisting of: a hook; a barb; a permeable surface into which tissue may grow; an adhesive; and, combinations thereof. 95. A system according to claim 71 wherein the delivery catheter further comprises a backflow deterrent member for blocking backflow of substances that have been injected through the delivery catheter. 96. A system according to claim 95 wherein said backflow deterrent member comprises a backflow barrier rib formed on the delivery catheter. 97. A system according to claim 96 wherein said backflow barrier comprises an inflatable balloon on the delivery catheter. 98. A system according to claim 96 wherein said backflow barrier comprises a raised projection formed on the exterior of the delivery catheter. 99. A system according to claim 98 wherein the raised projection comprises an annular rib formed about the outer surface of the delivery catheter. 100. A system according to claim 95 wherein the backflow deterrent comprises a sealant that is implanted prior to or concurrently with removal of the delivery catheter so as to prevent the injected substance from backflowing though the tract from which the delivery catheter is removed. 101. A system according to claim 100 wherein the sealant comprises a quantity of a flowable sealant injected into the tract upon removal of the delivery catheter. 102. A system according to claim 100 wherein the sealant comprises a detachable sealing member. 103. A system according to claim 102 wherein the detachable sealing member is formed of biodegradable material. 104. A system according to claim 103 wherein the sealing member is a collagen sponge. 105. A system according to claim 103 wherein the sealing member is a hydrogel sponge. 106. A system according to claim 71 wherein at least a portion of the delivery catheter is coated with an adhesive. 107. A system according to claim 71 wherein an anti-microbial substance is disposed on at least a portion of the delivery catheter. 108. A system according to claim 71 wherein an anti-coagulant substance is disposed on at least a portion of the delivery catheter. 109. A system according to claim 71 further comprising apparatus for creating a pocket within tissue adjacent to the delivery catheter such that when a substance or apparatus is introduced through the delivery catheter it will be received within said pocket. 110. A system according to claim 109 wherein the apparatus for creating a pocket comprises an energy emitting member that emits energy into adjacent tissue to create said pocket. 111. A system according to claim 110 wherein the energy emitting apparatus is a radiofrequency electrode. 112. A system according to claim 110 wherein the energy emitting apparatus is a laser. 113. A system according to claim 71 further in combination with an infusion apparatus for infusing a substance through the delivery catheter. 114. A system according to claim 113 wherein said infusion apparatus is a syringe. 115. A system according to claim 113 wherein said infusion apparatus further comprises a quantity of a substance for infusion through the delivery catheter. 116. A system according to claim 115 wherein the substance is a drug. 117. A system according to claim 116 wherein the drug is selected from the group consisting of: thrombolytics, platelet inhibitors, anti-restenotic agents, beta adrenergic blockers, ion channel antagonists, positive or negative ionotropic agents, anti-arrhythmics and combinations thereof. 118. A system according to claim 115 wherein the substance is a protein. 119. A system according to claim 115 wherein the substance is an angiogenic substance. 120. A system according to claim 118 wherein the angiogenic substance is selected from the group consisting of vascular endothelial growth factor (VEGF), fibroblast growth factors (FGF), epidermal growth factor (EGF), platelet-derived growth factor (PDGF), hepatocyte growth factor (HGF) or scatter factor, heparin combined with an adenosine receptor agonist, and combinations thereof. 121. A system according to claim 115 wherein the substance comprises cells. 122. A system according to claim 121 wherein the substance comprises progenator cells for a type of cell that is desired to be formed at the target site. 123. A system according to claim 122 wherein said substance comprises myoblasts to form cardiac muscle cells. 124. A system according to claim 123 wherein said cells are selected from the group consisting of stem cells, progenator cells, myoblasts, myocytes, secretory cells, pancreatic islet cells, dopamine secreting cells, endothelial cells, hepatocytes, cloned cells, cells grown in cell culture, genetically modified cells, and combinations thereof. 125. A system according to claim 115 wherein the substance is a gene. 126. A system according to claim 125 wherein the substance comprises a gene and a vector for facilitating entry of the gene into locations within cells at which the gene will have a desired effect on the cells. 127. A system according to claim 126 wherein the vector is a virus. 128. A system according to claim 71 wherein the penetrator is of a helical configuration and is capable of being rotated as it is advanced into the myocardial tissue.