Endovascular devices and methods

• US 20070093783A1
• Filed: 09/11/2006
• Published: 04/26/2007
• Est. Priority Date: 09/12/2005
• Status: Active Grant

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: BridgePoint Medical, Inc. (Boston Scientific Corporation)
• Inventors: Atkinson, Robert, Kugler, Chad
• Granted Patent: US 7,918,870 B2
• Time in Patent Office: Days
• US Class Current: 604/510
• CPC Class Codes: A61B 2017/22095 accessing a blood vessel true lumen from the sub-intimal space
• CPC Class Codes: A61M 2025/09083 having a coil around a core
• CPC Class Codes: A61M 2025/09133 having specific material compositions or coatings; Materials with specific mechanical behaviours, e.g. stiffness, strength to transmit torque
• CPC Class Codes: A61M 2025/09175 having specific characteristics at the distal tip
• CPC Class Codes: A61M 2025/09191 made of twisted wires
• CPC Class Codes: A61M 25/09 Guide wires
• CPC Class Codes: A61M 25/104 used for angioplasty

Abstract

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion with a lumen extending therein; inserting the device into the vascular lumen; positioning the distal portion in the vascular wall; and directing the distal portion within the vascular wall.

Claims

1. A method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein, the method comprising:

providing an intravascular device having a distal portion;

inserting the device into the vascular lumen;

positioning the distal portion in the vascular wall; and

directing the distal portion within the vascular wall such that the distal portion moves in a circumferential direction.

2. The method of claim 1, wherein providing an intravascular device comprises providing a wire having a helical shape, and wherein directing the distal portion of the intravascular device comprises rotating the intravascular device such that the wire moves in a circumferential direction.

3. The method of claim 1, wherein inserting the device into the vascular lumen comprises providing an intravascular device lumen and directing the intravascular device lumen toward the vascular wall at an orientation that facilitates penetration of the intravascular device within the vascular wall.

4. The method of claim 2, wherein rotating the intravascular device advances the wire concentrically around the occlusion.

5. The method of claim 4, wherein upon advancement of the wire around the occlusion, a shape of the wire approximates the inside diameter of the vascular lumen.

6. A method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein, the method comprising:

providing a first intravascular device having a distal radiopaque portion;

inserting the first device into the vascular lumen;

positioning the distal portion in the vascular wall;

directing the distal portion within the vascular wall such that the distal portion moves at least partially laterally;

providing a second intravascular device; and

using angiographic visualization, positioning the second device in the vascular lumen as a function of the position of the radiopaque distal portion of the first device in the vascular wall.

7. The method of claim 6, wherein directing the distal portion of the first intravascular device comprises locating the distal portion at least partially coextensive with the occlusion.

8. The method of claim 7, wherein upon advancement of the distal portion at least partially coextensive with the occlusion, a shape of the distal portion approximates the inside diameter of the vascular lumen.

9. The method of claim 6, wherein positioning the second device in the vascular lumen comprises traversing the occlusion with the second device.

10. The method of claim 7, wherein positioning the second device in the vascular lumen comprises traversing the occlusion with the second device.

11. The method of claim 6, wherein providing a second intravascular device comprises providing one or more of a guidewire, a laser device, an ultrasonic energy device, a mechanical dissection device, and an atherectomy device.

12. A method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein, the method comprising:

providing a first intravascular device having a distal radiopaque portion;

inserting the first device into the vascular lumen;

positioning the distal portion in the vascular wall;

directing the distal portion within the vascular wall such that the distal portion moves at least partially laterally;

providing a second intravascular device;

placing the second device in the vascular lumen; and

advancing the second device adjacent the distal portion of the first device disposed in the vascular wall such that the distal portion of the first device guards against perforation of the second device through the vascular wall.

13. The method of claim 12, wherein directing the distal portion of the first intravascular device comprises locating the distal portion at least partially coextensive with the occlusion.

14. The method of claim 13, wherein upon advancement of the distal portion at least partially coextensive with the occlusion, a shape of the distal portion approximates the inside diameter of the vascular lumen.

15. The method of claim 13, wherein advancing the second device in the vascular lumen comprises traversing the occlusion with the second device.

16. The method of claim 15, wherein providing a second intravascular device comprises providing a device having an atraumatic tip.

17. The method of claim 16, wherein providing an atraumatic tip comprises providing one of a ball tip, a looped tip, or a directional tip.

18. A method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein, the method comprising:

providing a intravascular device having a distal portion with a lumen extending therein;

inserting the device into the vascular lumen;

positioning the distal portion in the vascular wall; and

deflecting the distal portion within the vascular wall.

19. The method of claim 18, wherein the distal portion of the intravascular device has a curve formed at a distal end suitable for device advancement.

20. A method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein, the method comprising:

providing an intravascular device having a distal portion with external threads;

inserting the device into the vascular lumen;

positioning the distal portion in the vascular wall; and

rotating the distal portion within the vascular wall such that the threads engage the wall to advance or retract the device therein.

21. The method of claim 20, further comprising advancing the distal portion of the intravascular device to extend at least partially coextensive with the occlusion.

22. The method of claim 21, wherein upon advancement of the distal portion at least partially coextensive with the occlusion, a shape of the distal portion approximates the inside diameter of the vascular lumen.

23. The method of claim 20, wherein the external threads comprise one or more round members concentrically wound on an exterior surface of the intravascular device.

24. The method of claim 20, wherein a plurality of coils are wound on an external surface of the intravascular device, and wherein one external coil has a larger cross sectional area than adjacent coils, thereby forming the external threads.

25. The method of claim 20, wherein the external threads comprise one or more members concentrically wound on an exterior surface of the intravascular device, the members having a triangular or rectangular shaped cross-section.

26. A method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein, the method comprising:

providing an intravascular device having a distal portion with layers of oppositely wound coil turns;

inserting the device into the vascular lumen;

positioning the distal portion in the vascular wall; and

rotating the distal portion within the vascular wall.

27. The method of claim 26, further comprising advancing the distal portion of the intravascular device to extend at least partially coextensive with the occlusion.

28. The method of claim 27, wherein upon advancement of the distal portion at least partially coextensive with the occlusion, a shape of the distal portion approximates the inside diameter of the vascular lumen.

29. A method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein, the method comprising:

providing an intravascular device having a distal portion with interlocking coil turns;

inserting the device into the vascular lumen;

positioning the distal portion in the vascular wall; and

rotating the distal portion within the vascular wall.

30. The method of claim 29, further comprising providing adjacent coil turns with complementary engagement surfaces such that an applied torsional load is at least partially transmitted through the engagement of the complementary surfaces.

31. The method of claim 29, further comprising providing adjacent coil turns with complementary engagement surfaces such that during the application of a torsional load, relative translation of wire surfaces of the adjacent coil turns is resisted.

32. A method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein, the method comprising:

providing a first intravascular device having a distal portion;

providing a second intravascular device having a distal lumen;

inserting the second device into the vascular lumen such that the distal lumen is directed toward the vascular wall;

inserting the distal portion of the first device in the distal lumen of the second device; and

advancing the distal portion of the first device into the vascular wall.

33. The method of claim 32, wherein advancing the distal portion of first intravascular device comprises locating the distal portion at least partially coextensive with the occlusion.

34. The method of claim 33, wherein upon advancement of the distal portion at least partially coextensive with the occlusion, a shape of the distal portion approximates the inside diameter of the vascular lumen.

35. The method of claim 33, further comprising providing a third intravascular device, and positioning the third device in the vascular lumen such that a distal portion of the third intravascular device traverses the occlusion.

36. The method of claim 35, wherein providing a third intravascular device comprises providing one or more of a guidewire, a laser device, an ultrasonic energy device, a mechanical dissection device, and an atherectomy device.

37. The method of claim 33, wherein the second device includes a distal expandable member and wherein inserting the second device into the vascular lumen comprises expanding the expandable member to orient the distal lumen toward the vascular wall.

38. The method of claim 37, wherein the distal lumen extends in a helical path around an exterior surface of the expandable member.

39. An intravascular device sized and configured for intravascular navigation comprising:

an elongate shaft having a lumen extending therethrough, the shaft including at least one coil winding with adjacent coil edges including a plurality of engaging elements that limit translational movement therebetween.

40. The device of claim 39, wherein adjacent turns of the coil winding include complementary engagement surfaces such that an applied torsional load is at least partially transmitted through the engagement of the complementary surfaces.

41. The device of claim 39, wherein adjacent turns of the coil winding include complementary engagement surfaces such that during the application of a torsional load, relative translation of wire surfaces of the adjacent turns is resisted.

42. The device of claim 39, wherein the coil edges form a repeating pattern of peaks and valleys, and wherein the peaks of a coil turn fall within the valleys of an adjacent coil turn.