Methods and apparatus for crossing vascular occlusions
First Claim
1. A guidewire deflection system comprising:
- a catheter body having a proximal end, a distal end, a longitudinal axis, and at least one lumen extending along the catheter body;
a nosecone formed at the distal end of the catheter body having a distal opening in communication with the catheter body lumen, a lateral opening spaced relatively proximal to the distal opening that is in communication with the catheter body lumen, and an inclined surface formed proximally adjacent to the lateral opening; and
a cannula having a proximal end, a distal end, and at least one passageway extending through at least a distal portion of the cannula, wherein the distal end of the cannula is configured to deflect away from the longitudinal axis of the catheter body when the distal end thereof engages the inclined surface adjacent to the lateral opening.
6 Assignments
0 Petitions
Accused Products
Abstract
Methods and apparatus for crossing totally to substantially occluded blood vessels by passing a redirectable wire such as a guidewire from a relatively proximal point past the occlusion within a subintimal space formed between the intimal layer and the adventitial layer of a blood vessel wall. The wire may be advanced to a point distal to the occlusion, and thereafter deflected back into the blood vessel lumen, typically using a deflecting catheter which is advanced over the guidewire after it has been positioned within the subintimal space. The deflecting catheter may include a flapper valve assembly or preformed actuator wire for redirecting the guidewire. After the guidewire is returned to the blood vessel lumen, the deflecting catheter may be withdrawn, and the guidewire may be available for introduction of other interventional and diagnostic catheters for performing procedures such as stenting.
355 Citations
60 Claims
-
1. A guidewire deflection system comprising:
-
a catheter body having a proximal end, a distal end, a longitudinal axis, and at least one lumen extending along the catheter body;
a nosecone formed at the distal end of the catheter body having a distal opening in communication with the catheter body lumen, a lateral opening spaced relatively proximal to the distal opening that is in communication with the catheter body lumen, and an inclined surface formed proximally adjacent to the lateral opening; and
a cannula having a proximal end, a distal end, and at least one passageway extending through at least a distal portion of the cannula, wherein the distal end of the cannula is configured to deflect away from the longitudinal axis of the catheter body when the distal end thereof engages the inclined surface adjacent to the lateral opening. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19)
-
-
20. An intravascular catheter comprising:
-
a catheter shaft having a distal end and a longitudinal lumen;
a nosecone positioned at the distal end of the catheter shaft having a first port in communication with the longitudinal lumen formed with a first transverse cross-sectional area, and a second port in communication with the longitudinal lumen formed with a second transverse cross-sectional area relatively smaller than the first transverse cross-sectional area;
a cannula having a passageway that is slidably positioned within at least a portion of the longitudinal lumen of the catheter shaft, and is configured for passage through the first port but not through the second port of the nosecone; and
a guidewire that is slidably disposed within at least part of the cannula passageway and is configured for passage through the second port. - View Dependent Claims (21, 22, 23, 24, 25)
-
-
26. A redirectable intravascular guidewire catheter comprising:
-
a catheter shaft having a distal end, a proximal end, a longitudinal axis, and at least one lumen extending along at least a portion of catheter shaft; and
a guidewire deflector formed at the distal end of the catheter shaft having a distal end port, a lateral port, and a flapper assembly with a deflectable extension having a first position that directs a guidewire tip through the distal end port when the guidewire tip is positioned relatively distal to the deflectable extension, and a second position that directs the guidewire tip through the lateral port when the tip is positioned relatively proximal to the deflectable extension and advanced thereafter in a relatively distal direction. - View Dependent Claims (27, 28, 29, 30, 31, 32, 33)
-
-
34. A redirectable guidewire catheter comprising:
-
a catheter shaft formed with a distal end, and having a first lumen and a second lumen each extending along the catheter shaft respectively to a first distal opening and a second distal opening;
an actuator wire slidably positioned within the first lumen of the catheter shaft, wherein the actuator wire is formed with a preformed distal end to provide an actuated position that is biased towards the second distal opening when advanced relatively distal through the first distal opening; and
a guidewire slidably positioned within the second lumen of the catheter shaft that may be deflected when advanced relatively distal through the second distal opening and when the actuator wire is placed in its actuated position. - View Dependent Claims (35, 36, 37)
-
-
38. A redirectable guidewire catheter comprising:
-
a catheter shaft formed with a distal portion and a longitudinal axis, and wherein the catheter shaft has a first lumen and a second lumen each extending within the distal portion of the catheter shaft;
a nosecone formed at the distal portion of the catheter shaft, wherein the nosecone includes a distal orifice and an interior region, and wherein the interior region of the nosecone is formed with a tapered surface and is in communication with the first and second lumens;
an actuator wire formed with a distal tip that is slidably positioned within the first lumen of the catheter shaft, wherein the distal tip of the actuator wire is redirected substantially away from the longitudinal axis of the catheter shaft when advanced relatively distal along the tapered surface of the nosecone and through the nosecone orifice; and
a guidewire slidably positioned within the second lumen of the catheter shaft that may be deflected away from the longitudinal axis of the catheter shaft by contacting the redirected actuator wire when the guidewire is advanced relatively distal through the distal orifice. - View Dependent Claims (39, 40, 41)
-
-
42. An intravascular catheter for selectively deflecting a guidewire comprising:
-
a catheter body formed with a distal end and a longitudinal lumen formed along at least a portion of the catheter body;
a support tube having a distal tube end, a proximal tube end, a tube port formed at the distal tube end, and a conduit formed within the support tube in communication with the tube port, wherein the distal tube end is formed with a cut-out portion, and wherein the support tube is slidably and rotatably positioned within the longitudinal lumen of the catheter body; and
a cannula having a distal cannula end, a cannula port formed at the distal cannula end, and at least one passageway extending through at least a distal end portion of the cannula that is in communication with the cannula port, wherein the distal portion of the cannula has a pre-formed shape resilient curve, and wherein the cannula is slidably positioned within the conduit of the support tube. - View Dependent Claims (43, 44, 45)
-
-
46. An intravascular catheter for selectively deflecting a guidewire comprising:
-
a catheter body formed with a distal end, a catheter port formed at the distal end of the catheter body, a longitudinal axis, and a longitudinal lumen extending within at least a distal portion of the catheter body in communication with the catheter port;
a cannula having a distal cannula end, a cannula port formed at the distal cannula end, and at least one passageway formed within at least a distal portion of the cannula in communication with the cannula port, wherein the cannula is slidably positioned within the longitudinal lumen of the catheter body; and
a support tube connected to the distal cannula end, wherein the support tube is formed with a distal tube end section, a proximal tube end section, and a backbone connecting the distal and the proximal tube end sections. - View Dependent Claims (47, 48, 49, 50)
-
-
51. A redirectable intravascular guidewire catheter comprising:
-
a catheter shaft having a distal end, a proximal end, a longitudinal axis, a first port formed at the distal end of the shaft, a second port spaced relatively proximal to the distal end of the shaft, and at least one lumen extending along at least a portion of the longitudinal axis of the catheter shaft in communication with the first and second ports; and
a guidewire deflector formed within a distal extremity of the catheter shaft having a first surface that directs an end portion of a guidewire between the catheter shaft lumen and the first port, and a second surface that directs the end portion of the guidewire between the catheter shaft lumen and the second port. - View Dependent Claims (52)
-
-
53. A method for crossing a substantially occluded blood vessel, said method comprising:
-
selecting a guidewire with a deflectable distal tip configured for advancement within a lumen of a blood vessel wall;
creating a longitudinal dissection plane within a wall the blood vessel by inserting the guidewire into blood vessel wall from within the blood vessel lumen at a proximal location relative to a vascular occlusion;
forming a channel along the dissection plane within the blood vessel wall by advancing the guidewire within the blood vessel wall in a relatively distal direction; and
selectively deflecting the distal tip of the guidewire at a relatively distal location relative to the proximal location back into the blood vessel lumen. - View Dependent Claims (54, 55, 56, 57, 58, 59, 60)
-
Specification