System and method for percutaneous coronary artery bypass

• US 20030195457A1
• Filed: 05/13/2003
• Published: 10/16/2003
• Est. Priority Date: 03/06/1997
• Status: Active Grant

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: Scimed Life Systems Incorporated (Boston Scientific Corporation)
• Inventors: LaFontaine, Daniel M., Wang, Lixiao, Hastings, Roger N., Harrison, Kent D., Euteneuer, Charles L.
• Granted Patent: US 7,004,175 B2
• Time in Patent Office: Days
• US Class Current: 604/8
• CPC Class Codes: A61B 17/32053 Punch like cutting instruments, e.g. using a cylindrical or oval knife A61B17/326 takes precedence; trepans A61B17/1695; for use on the cornea A61F9/007
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00252 for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel
• CPC Class Codes: A61B 2017/1135 End-to-side connections, e.g. T- or Y-connections Y-shaped blood vessel prostheses A61F2002/065
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2090/3929 Active markers
• CPC Class Codes: A61B 2090/3945 Active visible markers, e.g. light emitting diodes
• CPC Class Codes: A61B 2090/3958 emitting a signal
• CPC Class Codes: A61F 2/06 Blood vessels
• CPC Class Codes: A61F 2/064 with special features to facilitate anastomotic coupling anastomosis of natural blood vessels A61B17/11
• CPC Class Codes: A61F 2/82 Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents stent-grafts for tubular structures of the body other than blood vessels A61F2/04; stent-grafts for blood vessels A61F2/07; instruments specially adapted for placement or removal of stents or stent-grafts A61F2/95; for closing wounds, or holding wounds closed A61B17/04 - A61B17/115; dilators A61M29/00
• CPC Class Codes: A61F 2/90 characterised by a net-like or mesh-like structure
• CPC Class Codes: A61F 2/958 Inflatable balloons for placing stents or stent-grafts
• CPC Class Codes: A61F 2250/0098 radio-opaque, e.g. radio-opaque markers
• CPC Class Codes: Y10S 623/902 Method of implanting

Abstract

A percutaneous system for bypassing a restriction in a native vessel of a mammal having an aorta includes providing a graft having a body portion with a first end, a second end and a lumen therebetween. An aperture is formed in the aorta. The graft is inserted into the aorta and the first end of the graft is connected to the aorta about the aperture in the aorta. An aperture is then formed in the native vessel distal of the restriction. The second end of the graft is connected to the native vessel about the aperture therein such that the lumen in the graft communicates with the aorta and the native vessel.

Claims

1. A method of bypassing a restriction in a native vessel of a mammal having an aorta, the method comprising:

providing a graft having a body portion with a first end, a second end and a lumen therebetween;

forming an aperture in the aorta;

inserting the graft into the aorta;

connecting the first end of the graft to the aorta about the aperture in the aorta;

advancing the body portion of the graft through the aperture in the aorta;

forming an aperture in the native vessel distal of the restriction; and

connecting the second end of the graft to the native vessel about the aperture therein such that the lumen in the graft communicates with the aorta and the native vessel.

2. The method of claim 1 wherein inserting the graft into the aorta comprises:

inserting the graft into the aorta in an inverted position and wherein advancing the body portion of the graft through the aperture in the aorta comprises;

advancing the graft through the aperture in the aorta after the first end of the graft is attached to the aorta such that the graft becomes non-inverted.

3. The method of claim 1 wherein forming an aperture in the aorta comprises:

isolating a region of the aorta from blood flow through the aorta; and

forming the aperture in the isolated region.

4. The method of claim 3 wherein isolating a region of the aorta comprises:

positioning a catheter with a distal end thereof against the region to be isolated; and

drawing a vacuum through the catheter causing the distal end of the catheter to abut against the region to be isolated.

5. The method of claim 1 wherein forming an aperture in the native vessel comprises:

positioning the second end of the graft proximate a region of the native vessel distal of the restriction;

inserting a cutting device through the aorta and through the lumen in the graft; and

cutting the aperture in the native vessel with the cutting device.

6. The method of claim 1 wherein forming an aperture in the native vessel comprises:

advancing a cutting device through the native vessel across the restriction to a region distal of the restriction; and

cutting the aperture in the native vessel with the cutting device.

7. The method of claim 1 wherein connecting the second end of the graft to the native vessel, comprises:

advancing a suturing catheter through the aorta and through the lumen of the graft; and

suturing the second end of the graft to the native vessel with the suturing catheter.

8. The method of claim 1 wherein providing a graft comprises:

providing the graft having a coupler connected to the first end of the body portion, the coupler having an insertion end and a shoulder portion with a lumen running through the insertion end and the shoulder portion, the lumen in the coupler communicating with the lumen in the body portion; and

wherein connecting the first end of the graft to the aorta includes inserting the insertion end of the coupler into the aperture in the aorta such that the shoulder portion abuts an inner surface of the aorta proximate the aperture in the aorta.

9. The method of claim 8 wherein advancing the body portion of the graft through the aperture in the aorta comprises:

advancing the body portion of the graft through the lumen of the coupler.

10. The method of claim 1 wherein providing a graft comprises:

providing a first expandable stent in the second end of the graft; and

wherein connecting the second end of the graft to the native vessel includes inserting at least a portion of the first stent through the aperture in the native vessel and deploying the first stent to connect the second end of the graft within the native vessel.

11. The method of claim 10 wherein providing a graft includes providing a second stent in the first end of the graft and wherein connecting the first end of the graft to the aorta comprises:

positioning the second stent such that a first expandable portion is outside the aorta and a second expandable portion is within the aorta; and

expanding the first and second expandable portions of the second stent to have outer diameters at least as large as the aperture in the aorta to anchor the first end of the graft in the aorta.

12. The method of claim 11 wherein expanding the first and second expandable portions comprises:

expanding the second expandable portion such that it deploys radially outwardly to lie against an interior wall of the aorta about the aperture in the aorta.

13. The method of claim 1 and further comprising, before connecting the second end of the graft to the native vessel, positioning the second end of the graft proximate a region of the native vessel distal of the restriction.

14. The method of claim 13 wherein positioning the second end of the graft comprises:

injecting contrast medium through the graft and through the region of the native vessel distal of the restriction; and

moving the second end of the graft based on observation of the contrast medium.

15. The method of claim 13 wherein positioning the second end of the graft comprises:

providing radiopaque markers proximate the second end of the graft and distal of the restriction in the native vessel; and

moving the radiopaque markers toward one another under fluoroscopic observation.

16. The method of claim 13 wherein positioning the second end of the graft comprises:

placing an emitter in one of the region of the native vessel distal of the restriction and the second end of the graft, the emitter emitting location signals;

placing a sensor in another of the region of the native vessel distal of the restriction and the second end of the graft, the sensor sensing the location signals and providing an output indicative of the location signals sensed; and

moving the second end of the graft based on the output from the sensor.

17. The method of claim 16 wherein placing an emitter comprises:

placing a light emitter in one of the region of the native vessel distal of the restriction and the second end of the graft; and

wherein placing a sensor comprises placing a fiber optic bundle in another of the region of the native vessel distal of the restriction and the second end of the graft, the fiber optic bundle sensing light emitted by the light emitter and providing the output indicative of the light sensed.

18. The method of claim 16 wherein placing an emitter comprises:

placing an ultrasound emitter in one of the region of the native vessel distal of the restriction and the second end of the graft; and

wherein placing a sensor comprises placing an ultrasound imager in another of the region of the native vessel distal of the restriction and the second end of the graft, the ultrasound imager sensing ultrasound signals emitted by the ultrasound emitter and providing the output as an ultrasound image indicative of the ultrasound signals sensed.

19. The method of claim 16 wherein placing an emitter comprises:

placing an electromagnetic signal emitter in one of the region of the native vessel distal of the restriction and the second end of the graft; and

wherein placing a sensor comprises placing an electromagnetic sensing array in another of the region of the native vessel distal of the restriction and the second end of the graft, the electromagnetic sensing array sensing electromagnetic signals emitted by the electromagnetic signal emitter and providing the output indicative of the electromagnetic signals sensed.

20. The method of claim 16 wherein placing an emitter comprises:

placing a radio frequency (RF) signal emitter in one of the region of the native vessel distal of the restriction and the second end of the graft; and

wherein placing a sensor comprises placing an RF sensor in another of the region of the native vessel distal of the restriction and the second end of the graft, the RF sensor sensing RF signals emitted by the RF signal emitter and providing the output indicative of the RF signals sensed.

21. The method of claim 13 wherein positioning the second end of the graft comprises:

placing a first emitter in the region of the native vessel distal of the restriction and a second emitter in the second end of the graft, the first and second emitters emitting location signals;

sensing the location signals and providing an operator perceptible output indicative of the relative location of the region of the native vessel distal to the restriction and the second end of the graft; and

moving the second end of the graft based on the operator perceptible output from the sensor.

22. The method of claim 1 wherein forming an aperture in the aorta comprises:

cutting the aperture in the aorta and advancing a snare through the aperture in the aorta; and

wherein forming an aperture in the native vessel comprises;

advancing across the restriction a wire and forming the aperture in the native vessel with the wire.

23. The method of claim 22 and further comprising:

capturing a distal end of the wire with the snare;

moving the distal end of the wire into the aorta with the snare; and

advancing the graft over the wire between the aorta and the native vessel.

24. The method of claim 10 wherein providing a first expandable stent includes:

providing a sleeve on the first expandable stent, the sleeve having a chemical carrying region carrying chemicals; and

wherein deploying the first expandable stent includes dispensing the chemicals from the chemical carrying region.

25. The method of claim 24 wherein dispensing the chemicals comprises:

dispensing biological adhesive.

26. The method of claim 24 wherein dispensing the chemicals comprises:

dispensing growth factors.

27. The method of claim 24 wherein dispensing the chemicals comprises:

dispensing a drug.

28. A method of bypassing a restriction in a native vessel of a mammal having an aorta, the method comprising:

providing a graft having a body portion with a first end, a second end and a lumen therebetween;

forming an aperture in the aorta;

advancing a snare through the aperture in the aorta;

advancing across the restriction in the native vessel a wire and forming an aperture in the native vessel with the wire distal of the restriction;

.

capturing a distal end of the wire with the snare;

moving the distal end of the wire into the aorta with the snare; and

advancing the graft over the wire between the aorta and the native vessel.

29. The method of claim 28 and further comprising:

connecting the first end of the graft to the aorta about the aperture in the aorta; and

connecting the second end of the graft to the native vessel about the aperture therein such that the lumen in the graft communicates with the aorta and the native vessel.

30. A method of bypassing a restriction in a native vessel of a mammal having an aorta, the method comprising:

providing a graft having a body portion with a first end, a second end and a lumen therebetween;

providing a first expandable stent at the first end of the graft;

providing a second expandable stent at the second end of the graft;

forming an aperture in the aorta;

forming an aperture in the native vessel distal of the restriction;

inserting the graft between the aperture in the aorta and the aperture in the native vessel;

inserting at least a portion of the first stent through the aperture in the native vessel and deploying the first stent to connect the first end of the graft within the native vessel;

positioning the second stent such that a first expandable portion is outside the aorta and a second expandable portion is within the aorta; and

expanding the first and second expandable portions of the second stent- to have outer diameters at least as large as the aperture in the aorta to anchor the first end of the graft in the aorta such that the lumen in the graft communicates with the aorta and the native vessel.

31. The method of claim 30 wherein expanding the first and second expandable portions comprises:

expanding the second expandable portion such that it deploys radially outwardly to lie against an interior wall of the aorta about the aperture in the aorta.

32. The method of claim 30 and further comprising:

providing a sleeve on at least one of the first and second expandable stents, the sleeve having a chemical carrying region carrying chemicals; and

wherein deploying the at least one of the first and second expandable stents includes dispensing the chemicals from the chemical carrying region.

33. The method of claim 30 wherein providing a second expandable stent comprises providing two separate stents and wherein expanding the first and second expandable portions includes expanding the two separate stents.