Catheter systems for crossing total occlusions in vasculature

• US 20060276749A1
• Filed: 03/30/2006
• Published: 12/07/2006
• Est. Priority Date: 01/13/1998
• Status: Abandoned Application

• Current Assignee: Cordis Corporation (Cardinal Health, Inc.)
• Original Assignee: Cordis Corporation (Cardinal Health, Inc.)
• Inventors: Thai, Erik, Betelia, Ray, Sparks, Kurt, Selmon, Matthew R., Clark, Ben, Deckman, Rob, Kaiser, Jason
• Application Number:
  US11/393,623
• Publication Number:
  US 20060276749A1
• Time in Patent Office: Days
• US Class Current: 604/164.10
• CPC Class Codes: A61B 17/3207 Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions A61B17/32037 takes precedence; endoscopic cutting instruments A61B17/320016
• CPC Class Codes: A61B 17/3415 for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters A61B17/3417 takes precedence; body piercing catheter guide needles A61M25/06
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• 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 2017/22077 with a part piercing the tissue A61B2017/22044 takes precedence
• CPC Class Codes: A61B 2017/22094 for crossing total occlusions, i.e. piercing
• CPC Class Codes: A61B 2017/22095 accessing a blood vessel true lumen from the sub-intimal space
• CPC Class Codes: A61B 2090/3925 ultrasonic
• CPC Class Codes: A61B 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/485 involving fluorescence X-ray imaging
• CPC Class Codes: A61M 2025/018 Catheters having a lateral opening for guiding elongated means lateral to the catheter
• CPC Class Codes: A61M 2025/0197 for creating an artificial passage within the body, e.g. in order to go around occlusions
• CPC Class Codes: A61M 25/001 Forming the tip of a catheter, e.g. bevelling process, join or taper
• CPC Class Codes: A61M 25/0023 by the form of the lumen, e.g. cross-section, variable diameter

Abstract

Medical devices and methods are described that include catheter systems for use in vasculature. The catheter systems include a re-entry catheter for use with numerous guide wires to direct the guide wire from the extraluminal or subintimal space back into a true lumen after the guide wire has entered the subintimal space. An example of the re-entry catheter is a single lumen catheter configured to facilitate placement and positioning of guide wires and catheters within vasculature. An embodiment places and positions guide wires and catheters within peripheral vasculature. More specifically, the re-entry catheter provides for re-entry of a guide wire back into the true lumen of peripheral vasculature from a subintimal space.

Claims

1. A catheter system for use in vasculature, comprising:

a catheter body including a body lumen;

a nosecone coupled to a distal end of the catheter body, the nosecone including a nosecone lumen, a lateral port, and a distal port, wherein a proximal section of the nosecone lumen is in communication with the body lumen, a middle section of the nosecone lumen is configured to include a passive deflection region in communication with the lateral port and the proximal section, and a distal section of the nosecone lumen is in communication with the distal port and the proximal section; and

a marker in the nosecone configured to present as a plurality of symbols that indicate relative orientation of the lateral port to a target site in the vasculature.

2. The catheter system of claim 1, wherein a cross-sectional area of the distal section is relatively smaller than the cross-sectional area of the proximal section and the middle section.

3. The catheter system of claim 1, wherein the middle section is configured for passage of a cannula to the lateral port.

4. The catheter system of claim 1, wherein the distal section is configured for passage of a guide wire to the distal port.

5. The catheter system of claim 1, wherein the marker is located distal to the lateral port, wherein the plurality of symbols include a first symbol and a second symbol.

6. The catheter system of claim 1, further comprising a working element having a distal end configured to deploy through the lateral port for delivery from a first vascular location within a subintimal space to a second vascular location within a true lumen of the vasculature when the working element is advanced distally through the lateral port.

7. The catheter system of claim 6, wherein the working element is keyed to the catheter body.

8. The catheter system of claim 6, wherein the working element includes a cannula having at least one lumen.

9. The catheter system of claim 6, wherein the working element includes a cannula and at least one guide wire slidably disposed within the cannula.

10. The catheter system of claim 6, wherein the distal end of the working element includes a preformed resilient tip.

11. The catheter system of claim 6, wherein the distal end of the working element assumes a first configuration when the working element is retracted into the catheter body and a second configuration when the working element is extended through the lateral port.

12. A method for re-entering a true lumen of vasculature from a subintimal space, comprising:

advancing a catheter over a wire into the subintimal space and retracting the wire;

locating and positioning a lateral port of the catheter approximately adjacent a target re-entry site of the true lumen using information of a plurality of symbols presented by a marker in a distal region of the catheter during visualization; and

advancing the wire through the lateral port in to the true lumen, wherein the true lumen is re-entered by the wire.

13. The method of claim 12, wherein locating and positioning includes positioning the lateral port approximately adjacent the true lumen by rotating the catheter to a position that presents a first symbol.

14. The method of claim 13, wherein locating and positioning includes tuning the positioning of the lateral port by rotating the catheter to a position that presents a second symbol.

15. The method of claim 14, wherein a position of an imager during visualization resulting in presentation of the second symbol is approximately orthogonal to the position of the imager during visualization resulting in presentation of the first symbol.

16. The method of claim 12, further comprising advancing a cannula through the lateral port toward the target re-entry site.

17. The method of claim 16, wherein advancing comprises deflecting the cannula from the catheter.

18. The method of claim 16, wherein advancing comprises advancing the wire through the cannula.

19. The method of claim 12, wherein the visualization includes fluoroscopy.

20. The method of claim 12, wherein the subintimal space is located within diffuse disease of the vasculature.

21. The method of claim 12, wherein the subintimal space is located between an adventitial layer and an intimal layer of the vasculature.