Telescoping balloon catheter and method of use

• US 5,591,194 A
• Filed: 06/07/1995
• Issued: 01/07/1997
• Est. Priority Date: 02/18/1994
• Status: Expired due to Fees

• Current Assignee: Medtronic Ave Incorporated (Medtronic Plc)
• Original Assignee: C.R. Bard, Inc. (Becton, Dickinson & Co)
• Inventors: Berthiaume, William A.
• Primary Examiner(s): Buiz, Michael Powell
• Assistant Examiner(s): TRUONG, KEVIN THAO
• Application Number:
  US08/485,655
• Time in Patent Office: 580 Days
• Field of Search: 606/191, 606/193, 606/194, 606/195, 606/197, 606/198, 606/192, 604/96, 604/99, 604/97, 604/101, 604/103, 604/102
• US Class Current: 606/192
• CPC Class Codes: A61F 2250/0065 telescopic
• CPC Class Codes: A61M 2025/0175 having telescopic features, interengaging nestable members movable in relations to one another
• CPC Class Codes: A61M 25/00 Catheters; Hollow probes dilators A61M29/00; peritoneal catheters A61M1/285; tracheal tubes A61M16/04; for drainage A61M27/00; for uterus, vagina or rectum A61M31/00 ; for measuring or testing A61B; materials for catheters A61L29/00
• CPC Class Codes: A61M 25/0169 Exchanging a catheter while keeping the guidewire in place
• CPC Class Codes: A61M 25/10 Balloon catheters A61M25/0125 takes precedence; embolectomy A61B17/22032; retractors A61B17/02; inflatable balloons for placing stents or stent-grafts A61F2/958 ; stomach balloons for treatment of obesity A61F5/0003; oesophagal tubes A61J15/00

Abstract

A catheter wherein the "effective over-the-wire" length is adjustable. The catheter includes an elongated inflation shaft having a longitudinal inflation lumen, an extension shaft disposed distal to the inflation shaft and through which the inflation lumen is continued, a balloon element disposed at the distal end of the extension shaft and in fluid communication with the inflation lumen, a guidewire shaft having a longitudinal guidewire lumen which extends from the distal end of the balloon member, through the balloon member and the extension shaft, to the proximal end of the extension shaft, and a telescoping portion. The telescoping portion comprising first and second telescoping tubes which are slidably mounted on the inflation shaft and the extension shaft. The first and second telescoping tubes are sized so that the first telescoping tube can be retracted into the second telescoping tube. The extension shaft is sized so that it can be retracted into the first telescoping tube. The effective "over-the-wire length" of the telescoping balloon catheter can be reduced by retracting the first telescoping tube and the extension tube into the second telescoping tube. In another embodiment, the telescoping portion comprises three telescoping tubes, which results in a greater reduction of the effective "over-the-wire length."

Claims

1. A balloon dilatation catheter with a variable effective over-the-wire length, i.e. a variable guidewire lumen length, that is adapted to be utilized with a conventional length guidewire without resort to an exchange guidewire or a guidewire extension apparatus, comprising:

an elongated inflation shaft having open proximal and distal ends and a longitudinal inflation lumen extending therethrough;

an extension shaft disposed distal to said inflation shaft, said extension shaft having open proximal and distal ends and a lumen extending therethrough that is in fluid communication with and extends said inflation lumen through the extent of said extension shaft and, said proximal end of said extension shaft connected to said distal end of said inflation shaft;

a guidewire shaft having open proximal and distal ends and a guidewire lumen extending therethrough, said guidewire shaft being coextensive with said extension shaft over the length of said extension shaft, said proximal end of said guidewire shaft being adjacent to said proximal end of said extension shaft, said guidewire shaft distal end extending distal of said extension shaft distal end, and said guidewire lumen sized to slidably receive said conventional length guidewire;

an inflatable balloon having a distal end and a proximal end, said proximal end of said balloon sealingly affixed to said distal end of said extension shaft, said distal end of said balloon sealingly affixed to said guidewire shaft at about said guidewire shaft distal end, and the interior of said balloon in fluid communication with said inflation lumen; and

telescoping means slidably mounted on said inflation shaft and said extension shaft for adjustably extending the length of said guidewire lumen.

2. The balloon dilatation catheter defined in claim 1 wherein said telescoping means comprises a first telescoping tube having distal and proximal ends, and a second telescoping tube having distal and proximal ends, said second telescoping tube having an inner diameter sized to permit said first telescoping tube to be retracted into said second telescoping tube, and said first telescoping tube having an inner diameter sized to permit said extension shaft to be retracted into said first telescoping tube but smaller than said balloon when deflated thereby preventing the retration of said balloon into said first telescoping tube, the length of said guidewire lumen is determined by the extent that said first telescoping tube is retracted into said second telescoping tube such that when said distal end of said second telescoping tube is positioned at said proximal end of said first telescoping tube and said distal end of said first telescoping tube is positioned at said proximal end of said extension shaft the length of said guidewire lumen is at a maximum value and when said extension shaft and first telescoping tube are fully retracted into said second telescoping tube the length of said guidewire lumen is at a minimum value.

3. The balloon dilatation catheter defined in claim 2 which further comprises an anti-backbleed hub disposed at said proximal end of said second telescoping tube, said anti-backbleed hub has a central port so that said inflation shaft and said guidewire can be extended through said anti-backbleed hub.

4. The balloon dilatation catheter defined in claim 3 which further comprises a first stopping means associated with said first telescoping tube for preventing the maneuvering of said distal end of said second telescoping tube distal to said distal end of said first telescoping tube.

5. The balloon dilatation catheter defined in claim 4 which further comprises a second stopping means associated with said first and second telescoping tubes for preventing the maneuvering of said proximal end of said first telescoping tube distal to said distal end of said second telescoping tube.

6. The balloon dilatation catheter defined in claim 5 wherein said inflation shaft is formed from hypotube.

7. The balloon dilatation catheter defined in claim 1 wherein said telescoping means comprises a first telescoping tube having distal and proximal ends, a second telescoping tube having proximal and distal ends, and a third telescoping tube having proximal and distal ends, said third tube having an inner diameter sized to permit said second telescoping tube to be retracted into said third telescoping tube, said second telescoping tube having an inner diameter sized to permit said first telescoping tube to be retracted into said second telescoping tube, and said first telescoping tube having an inner diameter sized to permit said extension shaft to be retracted into said first telescoping tube but smaller than said balloon when deflated thereby preventing the retraction of said balloon into said first telescoping tube, the extent of the retraction of said first telescoping tube into said second telescoping tube and of said second telescoping tube into said third telescoping tube determines the length of said guidewire lumen such that when said distal end of said third telescoping tube is positioned at said proximal end of said second telescoping tube, said distal end of said second telescoping tube is positioned at said proximal end of said first telescoping tube and said distal end of said first telescoping tube is positioned at said proximal end of said extension shaft the length of said guidewire lumen is at a maximum value and when said extension shaft, first telescoping tube and second telescoping tube are fully retracted into said third telescoping tube the length of said guidewire lumen is at a minimum value.

8. The balloon dilatation catheter defined in claim 7 which further comprises an anti-backbleed hub disposed at said proximal end of said third telescoping tube, said anti-backbleed hub having a central port so that said inflation shaft and said guidewire can be extended through said anti-backbleed hub.

9. The balloon dilatation catheter defined in claim 8 wherein said inflation shaft is formed from hypotube.

10. A balloon dilatation catheter with a variable effective over-the-wire length, i.e. a variable guidewire lumen length, that is adapted to be utilized with a conventional length guidewire without resort to an exchange wire or a guidewire extension apparatus, comprising:

an elongated inflation shaft having open proximal and distal ends and a longitudinal inflation lumen extending therethrough;

an extension shaft disposed distal to said inflation shaft, said extension shaft having open proximal and distal ends and a lumen extending therethrough that is in fluid communication with and extends said inflation lumen through the extent of said extension shaft, and said proximal end of said extension shaft connected to said distal end of said inflation shaft;

a guidewire shaft having open proximal and distal ends and a guidewire lumen extending therethrough, said guidewire shaft being coextensive with said extension shaft over the length of said extension shaft, said proximal end of said guidewire shaft being adjacent to said proximal end of said extension shaft, said guidewire shaft distal end extending distal of said extension shaft distal end, and said guidewire lumen sized to slidably receive said conventional length guidewire;

an inflatable balloon having a distal end and a proximal end, said proximal end of said balloon sealingly affixed to said distal end of said extension shaft, said distal end of said balloon sealingly affixed to said guidewire shaft at about said guidewire shaft distal end and the interior of said balloon in fluid communication with said inflation lumen;

a first telescoping tube having distal and proximal ends, said first telescoping tube slidably mounted on said inflation shaft and said extension shaft so as to be extendable over at least a portion of a guidewire extending proximally from said guidewire lumen extending through said guidewire shaft so as to extend the length of said guidewire lumen, said first telescoping tube having an inner diameter sized to permit said extension shaft to be retracted into said first telescoping tube as said inflation shaft is withdrawn from a patient'"'"'s body but smaller than said balloon when deflated so that said balloon cannot be retracted into said first telescoping tube; and

a second telescoping tube having distal and proximal ends, said first telescoping tube slidably mounted on said inflation shaft and said extension shaft so as to be extendable over at least a portion of a guidewire extending proximally from said guidewire lumen extending through said guidewire shaft and said first telescoping tube so as to extend the length of said guidewire lumen, said second telescoping tube having an inner diameter sized to permit said first telescoping tube and said extension shaft to be retracted into second telescoping tube as said inflation shaft continues to be withdrawn from a patient'"'"'s body, and said second telescoping tube operatively associated with said first telescoping tube so that the length of said guidewire lumen will be reduced as a result of the withdrawal of said inflation shaft from a patient'"'"'s body.

11. The balloon dilatation catheter defined in claim 10 which further comprises an anti-backbleed hub disposed at said proximal end of said second telescoping tube, said anti-backbleed hub has a central port so that said inflation shaft and said guidewire can be extended through said anti-backbleed hub.

12. The balloon dilatation catheter defined in claim 11 which further comprises a first stopping means associated with said first telescoping tube for preventing the maneuvering of said distal end of said second telescoping tube distal to said distal end of said first telescoping tube.

13. The balloon dilatation catheter defined in claim 12 which further comprises a second stopping means associated with said first and second telescoping tubes for preventing the maneuvering of said proximal end of said first telescoping tube distal to said distal end of said second telescoping tube.

14. The balloon dilatation catheter defined in claim 13 wherein said inflation shaft is formed from hypotube.

15. A balloon dilatation catheter with a variable effective over-the-wire length, i.e. a variable guidewire lumen length, that is adapted to be utilized with a conventional length guidewire without resort to an exchange guidewire or a guidewire extension apparatus, comprising:

an elongated inflation shaft formed from hypotube having open proximal and distal ends and a longitudinal inflation lumen extending therethrough;

an extension tube having open proximal and distal ends and a lumen extending therethrough, said extension tube proximal end connected to said distal end of said inflation shaft, and said lumen is in fluid communication with and extends said inflation lumen through the extent of said extension tube,

an extension shaft having open proximal and distal ends and an extension lumen extending therethrough, said proximal end of said extension shaft connected to said distal end of said extension tube, and said extension lumen is in fluid communication with and extends said inflation lumen through the extent of said extension shaft,

a guidewire shaft having open proximal and distal ends and a guidewire lumen extending therethrough, said guidewire shaft being coextensive with said extension shaft over the length of said extension shaft, said proximal end of said guidewire shaft being adjacent to said proximal end of said extension shaft, said guidewire shaft distal end extending distal of said extension shaft distal end, and said guidewire lumen sized to slidably receive said conventional length guidewire;

an inflatable balloon having a distal end and a proximal end, said proximal end of said balloon sealingly affixed to said distal end of said extension shaft, said distal end of said balloon sealingly affixed to said guidewire shaft about said guidewire shaft distal end and the interior of said balloon in fluid communication with said inflation lumen;

a first telescoping tube having distal and proximal ends, said first telescoping tube slidably mounted on said inflation shaft, extension tube and extension shaft so as to be extendable over at least a portion of a guidewire extending proximally from said guidewire lumen extending through said guidewire shaft so as to extend the length of said guidewire lumen, said first telescoping tube having an inner diameter sized to permit said extension shaft to be retracted into said first telescoping tube as said inflation shaft is withdrawn from a patient'"'"'s body but smaller than said balloon when deflated so that said balloon cannot be retracted into said first telescoping tube; and

a second telescoping tube having distal and proximal ends, said first telescoping tube slidably mounted on said inflation shaft, extension tube and extension shaft so as to be extendable over at least a portion of a guidewire extending proximally from said guidewire lumen extending through said guidewire shaft and said first telescoping tube so as to extend the length of said guidewire lumen, said second telescoping tube having an inner diameter sized to permit said first telescoping tube and said extension shaft to be retracted into said second telescoping tube as said inflation shaft continues to be withdrawn from a patient'"'"'s body, and said second telescoping tube operatively associated with said first telescoping tube so that the length of said guidewire lumen will be reduced as a result of the withdrawal of said inflation shaft from a patient'"'"'s body.

16. The balloon dilatation catheter defined in claim 15 which further comprises a first stopping means associated with said first telescoping tube for preventing the maneuvering of said distal end of said second telescoping tube distal to said distal end of said first telescoping tube.

17. The balloon dilatation catheter defined in claim 16 which further comprises a second stopping means associated with said first and second telescoping tubes for preventing the maneuvering of said proximal end of said first telescoping tube distal to said distal end of said second telescoping tube.

18. A balloon dilatation catheter with a variable effective over-the-wire, i.e. a variable guidewire lumen length, length that is adapted to be utilized with a conventional length guidewire without resort to an exchange guidewire or a guidewire extension apparatus, comprising:

an elongated inflation shaft having open proximal and distal ends and a longitudinal inflation lumen extending therethrough;

an extension shaft disposed distal to said inflation shaft, said extension shaft having open proximal and distal ends and a lumen extending therethrough that is in fluid communication with and extends said inflation lumen through the extent of said extension shaft, and said proximal end of said extension shaft connected to said distal end of said inflation shaft;

a guidewire shaft having open proximal and distal ends and a guidewire lumen extending therethrough, said guidewire shaft being coextensive with said extension shaft over the length of said extension shaft, said proximal end of said guidewire shaft being adjacent to said proximal end of said extension shaft, said guidewire shaft distal end extending distal of said extension shaft distal end, and said guidewire lumen sized to slidably receive said conventional length guidewire;

an inflatable balloon having a distal end and a proximal end, said proximal end of said balloon sealingly affixed to said distal end of said extension shaft, said distal end of said balloon sealingly affixed to said guidewire shaft at about said guidewire shaft distal end and the interior of said balloon in fluid communication with said inflation lumen;

a first telescoping tube having distal and proximal ends, said first telescoping tube slidably mounted on said inflation shaft and said extension shaft so as to be extendable over at least a portion of a guidewire extending proximally from said guidewire lumen extending through said guidewire shaft so as to extend the length of said guidewire lumen, said first telescoping tube having an inner diameter sized to permit said extension shaft to be retracted into said first telescoping tube as said inflation shaft is withdrawn from a patient'"'"'s body but smaller than said balloon when deflated so that said balloon cannot be retracted into said first telescoping tube; and

a second telescoping tube having distal and proximal ends, said first telescoping tube slidably mounted on said inflation shaft and said extension shaft so as to be extendable over at least a portion of a guidewire extending proximally from said guidewire lumen extending through said guidewire shaft and first telescoping tube so as to extend the length of said guidewire lumen, said second telescoping tube having an inner diameter sized to permit said first telescoping tube and said extension shaft to be retracted into said second telescoping tube as said inflation shaft continues to be withdrawn from a patient'"'"'s body; and

a third telescoping tube having distal and proximal ends, said third telescoping tube slidably mounted on said inflation shaft and said extension shaft so as to be extendable over at least a portion of a guidewire extending proximally from said guidewire lumen extending through said guidewire shaft, said first telescoping tube and said second telescoping tube so as to extend the length of said guidewire lumen, said third telescoping tube having an inner diameter sized to permit said second telescoping tube, said first telescoping tube and said extension shaft to be retracted into said third telescoping tube as said inflation shaft continues to be withdrawn from a patient'"'"'s body, and said third telescoping tube operatively associated with said first and second telescoping tubes so that the length of said guidewire lumen will be reduced as a result of the withdrawal of said inflation shaft from a patient'"'"'s body.

19. A method for advancing a balloon dilatation catheter with a variable effective over-the-wire length, i.e. a variable guidewire lumen length, to the stenosis site where the catheter is an over-the-wire catheter over the full extent of its length and rapidly exchanging said catheter without making use of an exchange guidewire or a guidewire extension apparatus by reducing the effective over-the-wire length of said catheter, said balloon dilatation catheter having an elongated inflation shaft having open proximal end distal ends and a longitudinal inflation lumen extending therethrough, an extension shaft disposed distal to said inflation shaft, said extension shaft having open proximal and distal ends and a lumen extending therethrough that is in fluid communication with and extends said inflation lumen through the extent of said extension shaft, a guidewire shaft having open proximal end, distal ends and a guidewire lumen extending therethrough, said proximal end of said guidewire shaft being adjacent to said proximal end of said extension shaft, said guidewire shaft being coextensive with said extension shaft over the length of said extension shaft said guidewire shaft distal end extending distal of said extension shaft distal end, an inflatable balloon having a distal end and a proximal end, said balloon proximal end sealingly affixed to said distal end of said extension shaft, said balloon distal end sealingly affixed to said guidewire shaft about said guidewire shaft distal end and the interior of said balloon in fluid communication with said inflation lumen, a first telescoping tube slidably mounted on said inflation shaft and said extension shaft so as to be extendable over at least a portion of a guidewire extending proximally from said guidewire lumen extending through said guidewire shaft so as to extend the length of said guidewire lumen, said first telescoping tube having an inner diameter sized to permit said extension shaft to be retracted into said first telescoping tube as said inflation shaft is withdrawn from a patient'"'"'s body but smaller than said balloon when deflated so that said balloon cannot be retracted into said first telescoping tube, a second telescoping tube slidably mounted on said inflation shaft and said extension shaft so as to be extendable over at least a portion of a guidewire extending proximally from said guidewire lumen extending through said guidewire shaft and said first telescoping tube so as to extend the length of said guidewire lumen, said second telescoping tube having an inner diameter sized to permit said first telescoping tube to be retracted into second telescoping tube, and said second telescoping tube operatively associated with said first telescoping tube so that the effective over-the-wire length of said balloon dilatation catheter will be reduced as a result of a withdrawal of said inflation shaft from a patient'"'"'s body, and an anti-backbleed hub disposed at said proximal end of said second telescoping tube, said anti-backbleed hub has a central port so that said inflation shaft and said guidewire can be extended through said anti-backbleed hub, said method comprising the steps of:

(a) maneuvering said first and second telescoping tubes to substantially the fully extended position such that said proximal end of said first telescoping tube is located at about said distal end of said second telescoping tube;

(b) introducing a conventional length guidewire, which has a distal end and a proximal end, into said balloon dilatation catheter through said guidewire lumen and rearwardly advancing said guidewire through said first and second telescoping tubes until said guidewire proximal end protrudes from said anti-backbleed hub;

(c) pulling said proximal end of said guidewire until said guidewire distal end is at about said distal end of said balloon dilatation catheter;

(d) inserting said balloon dilatation catheter and guidewire into a guiding catheter that has been inserted in a patient'"'"'s vasculature;

(e) advancing said guidewire and said balloon dilatation catheter to a stenosis site;

(f) holding said guidewire in position at said stenosis site by gripping said guidewire at a position just proximal of said anti-backbleed hub;

(g) gripping said inflation shaft and withdrawing said inflation shaft through said anti-backbleed hub;

(h) continuing to withdraw said inflation shaft so that said first telescoping tube is fully retracted into said second telescoping tube;

(i) continuing to withdraw said inflation shaft so that said extension shaft is fully retracted into said first telescoping tube;

(j) gripping said guidewire at a position proximal of said anti-backbleed hub with a first hand;

(k) gripping said inflation shaft with a second hand and rearwardly advancing said inflation shaft to said position of said first hand gripping said guidewire;

(l) repeating steps (j)-(k) until said balloon dilatation catheter distal end is withdrawn from said patient; and

(m) gripping said guidewire at a position distal of said balloon dilatation catheter distal end and pulling said balloon dilatation catheter off said proximal end of said guidewire.

20. A method for advancing a balloon dilatation catheter with a variable effective over-the-wire length, i.e. a variable guidewire lumen length, to the stenosis site where said catheter is an over-the-wire catheter over the full extent of its length and rapidly exchanging said catheter without making use of an exchange wire or a guidewire extension apparatus by reducing the effective over-the-wire length of said catheter, said balloon dilatation catheter having an elongated inflation shaft formed from hypotube having open proximal and distal ends and a longitudinal inflation lumen extending therethrough, an extension tube having open proximal and distal ends and a lumen extending therethrough, said extension tube proximal end connected to said distal end of said inflation shaft, and said lumen is in fluid communication with and extends said inflation lumen through the extent of said extension tube, an extension shaft having open proximal and distal ends and an extension lumen extending therethrough, said proximal end of said extension shaft connected to said distal end of said extension tube, and said extension lumen is in fluid communication with and extends said inflation lumen through the extent of said extension shaft, a guidewire shaft having open proximal and distal ends and a guidewire lumen extending therethrough, said proximal end of said guidewire shaft being adjacent to said proximal end of said extension shaft, said guidewire shaft being coextensive with said extension shaft over the length of said extension shaft, said guidewire shaft distal end extending distal of said extension shaft distal end, an inflatable balloon having a distal end and a proximal end, said proximal end of said balloon sealingly affixed to said distal end of said extension shaft, said distal end of said balloon sealingly affixed to said guidewire shaft about said guidewire shaft distal end and the interior of said balloon in fluid communication with said inflation lumen, a first telescoping tube having distal and proximal ends, said first telescoping tube slidably mounted on said inflation shaft, extension tube and said extension shaft so as to be extendable over at least a portion of a guidewire extending proximally from said guidewire lumen extending through said guidewire shaft so as to extend the length of said guidewire lumen, said first telescoping tube having an inner diameter sized to permit said extension shaft to be retracted into said first telescoping tube as said inflation shaft is withdrawn from a patient'"'"'s body but smaller than said balloon when deflated so that said balloon cannot be retracted into said first telescoping tube, a second telescoping tube having distal and proximal ends, said second telescoping tube slidably mounted on said inflation shaft, extension tube and extension shaft so as to be extendable over at least a portion of a guidewire extending proximally from said guidewire lumen extending through said guidewire shaft and said first telescoping tube so as to extend the length of said guidewire lumen, said second telescoping tube having an inner diameter sized to permit said first telescoping tube to be retracted into second telescoping tube, said second telescoping tube operatively associated with said first telescoping tube so that the effective over-the-wire length of said balloon dilatation catheter will be reduced as a result of a withdrawal of said inflation shaft from a patient'"'"'s body, and an anti-backbleed hub disposed at said proximal end of said second telescoping tube, said anti-backbleed hub has a central port so that said inflation shaft and said guidewire can be extended through said anti-backbleed hub, said method comprising the steps of:

(a) maneuvering said first and second telescoping tubes to substantially the fully extended position such that said proximal end of said first telescoping tube is located at about said distal end of said second telescoping tube;

(b) introducing a conventional length guidewire, which has a distal end and a proximal end, into said balloon dilatation catheter through said guidewire lumen and rearwardly advancing said guidewire through said first and second telescoping tubes until said guidewire proximal end protrudes from said anti-backbleed hub;

(c) pulling said proximal end of said guidewire until said guidewire distal end is at about said distal end of said balloon dilatation catheter;

(d) inserting said balloon dilatation catheter and guidewire into a guiding catheter that has been inserted in a patient'"'"'s vasculature;

(e) advancing said guidewire and said balloon dilatation catheter to a stenosis site;

(f) holding said guidewire in position at said stenosis site by gripping said guidewire at a position just proximal of said anti-backbleed hub;

(g) gripping said inflation shaft and withdrawing said inflation shaft through said anti-backbleed hub;

(h) continuing to withdraw said inflation shaft so that said first telescoping tube is fully retracted into said second telescoping tube;

(i) continuing to withdraw said inflation shaft so that said extension shaft is fully retracted into said first telescoping tube;

(j) gripping said guidewire at a position proximal of said anti-backbleed hub with a first hand;

(k) gripping said inflation shaft with a second hand and rearwardly advancing said inflation shaft to said position of said first hand gripping said guidewire;

(l) repeating steps (j)-(k) until said balloon dilatation catheter distal end is withdrawn from said patient; and

(m) gripping said guidewire at a position distal of said balloon dilatation catheter distal end and pulling said balloon dilatation catheter off said proximal end of said guidewire.

21. A method for advancing a balloon dilatation catheter with a variable effective over-the-wire length, i.e. a variable guidewire lumen length, to the stenosis site where the catheter is an over-the-wire catheter over the full extent of its length and rapidly exchanging said catheter without making use of an exchange guidewire or a guidewire extension apparatus by reducing the effective over-the-wire length of said catheter, said balloon dilatation catheter having an elongated inflation shaft having open proximal and distal ends and a longitudinal inflation lumen extending therethrough, an extension shaft disposed distal to said inflation shaft, said extension shaft having open proximal and distal ends and a lumen extending therethrough that is in fluid communication with and extends said inflation lumen through the extent of said extension shaft, a guidewire shaft having open proximal and distal ends and a guidewire lumen extending therethrough, said proximal end of said guidewire shaft being adjacent to said proximal end of said extension shaft, said guidewire shaft being coextensive with said extension shaft over the length of said extension shaft said guidewire shaft distal end extending distal of said extension shaft distal end, an inflatable balloon having a distal end and a proximal end, said balloon proximal end sealingly affixed to said distal end of said extension shaft, said balloon distal end sealingly affixed to said guidewire shaft about said guidewire shaft distal end and the interior of said balloon in fluid communication with said inflation lumen, a first telescoping tube slidably mounted on said inflation shaft and said extension shaft so as to be extendable over at least a portion of a guidewire extending proximally from said guidewire lumen extending through said guidewire shaft so as to extend the length of said guidewire lumen, said first telescoping tube having an inner diameter sized to permit said extension shaft to be retracted into said first telescoping tube as said inflation shaft is withdrawn from a patient'"'"'s body but smaller than said balloon when deflated so that said balloon cannot be retracted into said first telescoping tube, a second telescoping tube slidably mounted on said inflation shaft and said extension shaft so as to be extendable over at least a portion of a guidewire extending proximally from said guidewire lumen extending through said guidewire shaft and said first telescoping tube so as to extend the length of said guidewire lumen, said second telescoping tube having an inner diameter sized to permit said first telescoping tube to be retracted into said second telescoping tube, a third telescoping tube slidably mounted on said inflation shaft and said extension shaft so as to be extendable over at least a portion of a guidewire extending proximally from said guidewire lumen extending through said guidewire shaft, said first telescoping and said second telescoping tube so as to extend the length of said guidewire lumen, said third telescoping tube having an inner diameter sized to permit said second telescoping tube to be retracted into said third telescoping tube, and said third telescoping tube operatively associated with said first and second telescoping tubes so that the effective over-the-wire length of said balloon dilatation catheter will be reduced as a result of a withdrawal of said inflation shaft from a patient'"'"'s body, and an anti-backbleed hub disposed at said proximal end of said second telescoping tube, said anti-backbleed hub has a central port so that said inflation shaft and said guidewire can be extended through said anti-backbleed hub, said method comprising the steps of:

(a) maneuvering said first, second and third telescoping tubes to substantially the fully extended position such that said proximal end of said first telescoping tube is located at about said distal end of said second telescoping tube and the proximal end of said second telescoping tube is located at about said distal end of said third telescoping tube;

(b) introducing a conventional length guidewire, which has a distal end and a proximal end, into said balloon dilatation catheter through said guidewire lumen and rearwardly advancing said guidewire through said first, second and third telescoping tubes until said guidewire proximal end protrudes from said anti-backbleed hub;

(c) pulling said proximal end of said guidewire until said guidewire distal end is at about said distal end of said balloon dilatation catheter;

(d) inserting said balloon dilatation catheter and guidewire into a guiding catheter that has been inserted in a patient'"'"'s vasculature;

(e) advancing said guidewire and said balloon dilatation catheter to a stenosis site;

(f) holding said guidewire in position at said stenosis site by gripping said guidewire at a position just proximal of said anti-backbleed hub;

(g) gripping said inflation shaft and withdrawing said inflation shaft through said anti-backbleed hub;

(h) continuing to withdraw said inflation shaft so that said first telescoping tube is fully retracted into said second telescoping tube;

(i) continuing to withdraw said inflation shaft so that said second telescoping tube is fully retracted into said third telescoping tube;

(j) continuing to withdraw said inflation shaft so that said extension shaft is fully retracted into said first telescoping tube;

(k) gripping said guidewire at a position of said anti-backbleed hub with a first hand;

(l) gripping said inflation shaft with a second hand and rearwardly advancing said inflation shaft to said position of said first hand gripping said guidewire;

(m) repeating steps (k)-(l) until said balloon dilatation catheter distal end is withdrawn from said patient; and

(n) gripping said guidewire at a position distal of said balloon dilatation catheter distal end and pulling said balloon dilatation catheter off said proximal end of said guidewire.

22. A telescoping catheter comprising:

a first elongated catheter member having a proximal end and a distal end; and

a second tubular catheter member having a proximal end and a distal end and an inner diameter sized so that said first elongated catheter member is slidably received within said second tubular catheter member, said second tubular catheter member comprising a first telescoping tube having distal and proximal ends, and a second telescoping tube having distal and proximal ends, said second telescoping tube having an inner diameter sized to permit said first telescoping tube to be retracted into said second telescoping tube, and said first elongated catheter member extending from said distal end of said first telescoping tube to beyond said proximal end of said second telescoping tube, said distal end of said first elongated catheter member engageable with said distal end of said first telescoping tube so that withdrawal of said first elongated catheter member through said proximal end of said second tubular catheter member will cause said first telescoping tube to be retracted into said second telescoping tube.

23. A telescoping catheter comprising:

a first elongated catheter member having a proximal end and a distal end; and

a second catheter member having a proximal end and a distal end and an inner diameter sized so that said first elongated catheter member is slidably received within said second tubular catheter member, said second tubular catheter member comprising a first telescoping tube having distal and proximal ends, a second telescoping tube having distal and proximal ends and a third telescoping tube having distal and proximal ends, said second telescoping tube having an inner diameter sized to permit said first telescoping tube to be retracted into said second telescoping tube, said third telescoping tube having an inner diameter sized to permit said second telescoping tube to be retracted into said third telescoping tube, and said first elongated catheter member extending from said distal end of said first telescoping tube to beyond said proximal end of said third telescoping tube, said distal end of said first elongated catheter member engageable with said distal end of said first telescoping tube and said first telescoping tube engageable with said second telescoping tube so that withdrawal of said first elongated catheter member through the proximal end of said second tubular catheter member will cause said first telescoping tube to be retracted into said second telescoping tube and said second telescoping tube to be retracted into said third telescoping tube.

24. A method for using a telescoping catheter, said telescoping catheter having a first elongated catheter member having a proximal end and a distal end, and a second tubular catheter member having a proximal end and a distal end and an inner diameter sized so that said first catheter member is slidably received within said second tubular catheter member, said second tubular catheter member comprising a first telescoping tube having distal and proximal ends, and a second telescoping tube having distal and proximal ends, said second telescoping tube having an inner diameter sized to permit said first telescoping tube to be retracted into said second telescoping tube, and said first elongated catheter member extending from said distal end of said first telescoping tube to beyond said proximal end of said second telescoping tube, said distal end of said first elongated catheter member engageable with said distal end of said first telescoping tube so that withdrawal of said first elongated catheter member through said proximal end of said second tubular catheter member will cause said first telescoping tube to be retracted into said second telescoping tube, said method comprising the steps of:

(a) maneuvering said first and second telescoping tubes to a substantially fully extended position such that said proximal end of said first telescoping tube is located at about said distal end of said second telescoping tube;

(b) inserting said telescoping catheter into a patient'"'"'s vasculature;

(c) advancing said catheter to a predetermined location within said patient'"'"'s vasculature;

(d) gripping said proximal end of said first catheter member and withdrawing said first catheter member through said second tubular catheter member;

(e) continuing to withdraw said first catheter member so that said first telescoping tube is fully retracted into said second telescoping tube; and

(f) gripping said proximal end of said second tubular catheter member and removing said telescoping catheter from said patient'"'"'s vasculature.

25. A method for using a telescoping catheter, said telescoping catheter having a first elongated catheter member having a proximal end and a distal end, and a second tubular catheter member having a proximal end and a distal end and an inner diameter sized so that said first catheter member is slidably received within said second tubular catheter member, said second tubular catheter member comprising a first telescoping tube having distal and proximal ends, a second telescoping tube having distal and proximal ends and a third telescoping tube having distal and proximal ends, said second telescoping tube having an inner diameter sized to permit said first telescoping tube to be retracted into said second telescoping tube, said third telescoping tube having an inner diameter sized to permit said second telescoping tube to be retracted into said third telescoping tube, and said first elongated catheter member extending from said distal end of said first telescoping tube to beyond said proximal end of said third telescoping tube, said distal end of said first elongated catheter member engageable with said distal end of said first telescoping tube and said first telescoping tube engageable with said second telescoping tube so that withdrawal of said first elongated catheter member through the proximal end of said second tubular catheter member will cause said first telescoping tube to be retracted into said second telescoping tube and said second telescoping tube to be retracted into said third telescoping tube, said method comprising the steps of:

(a) maneuvering said first, second and third telescoping tubes to a substantially fully extended position such that said proximal end of said first telescoping tube is located at about said distal end of said second telescoping tube and the proximal end of said second telescoping tube is located at about the distal end of said third telescoping tube;

(b) inserting said telescoping catheter into a patient'"'"'s vasculature;

(c) advancing said telescoping catheter to a predetermined location within said patient'"'"'s vasculature;

(d) gripping the proximal end of said first catheter member and withdrawing said first catheter member through said second tubular catheter member;

(e) continuing to withdraw said first catheter member so that said first telescoping tube is fully retracted into said second telescoping tube;

(f) continuing to withdraw said first catheter member so that said second telescoping tube is fully retracted into said third telescoping tube; and

(g) gripping said proximal end of said second tubular catheter member and removing said telescoping catheter from said patient'"'"'s vasculature.

26. A method for using a telescoping catheter, said telescoping catheter having a first elongated catheter member having a proximal end and a distal end, and a second tubular catheter member having a proximal end and a distal end and an inner diameter sized so that said first catheter member is slidably received within said second tubular catheter member, said second tubular catheter member comprising a first telescoping tube having distal and proximal ends, and a second telescoping tube having distal and proximal ends, said second telescoping tube having an inner diameter sized to permit said first telescoping tube to be retracted into said second telescoping tube, and said first elongated catheter member extending from said distal end of said first telescoping tube to beyond said proximal end of said second telescoping tube, said distal end of said first elongated catheter member engageable with said distal end of said first telescoping tube so that withdrawal of said first elongated catheter member through said proximal end of said second tubular catheter member will cause said first telescoping tube to be retracted into said second telescoping tube, said method comprising the steps of:

(a) inserting said telescoping catheter into a patient'"'"'s vasculature;

(b) advancing said catheter to a predetermined location within said patient'"'"'s vasculature while maneuvering said first and second telescoping tubes to a substantially fully extended position such that said proximal end of said first telescoping tube is located at about said distal end of said second telescoping tube;

(c) gripping said proximal end of said first catheter member and withdrawing said first catheter member through said second tubular catheter member;

(d) continuing to withdraw said first catheter member so that said first telescoping tube is fully retracted into said second telescoping tube; and

(e) gripping said proximal end of said second tubular catheter member and removing said telescoping catheter from said patient'"'"'s vasculature.

27. A method for using a telescoping catheter, said telescoping catheter having a first elongated catheter member having a proximal end and a distal end, and a second tubular catheter member having a proximal end and a distal end and an inner diameter sized so that said first catheter member is slidably received within said second tubular catheter member, said second tubular catheter member comprising a first telescoping tube having distal and proximal ends, a second telescoping tube having distal and proximal ends and a third telescoping tube having distal and proximal ends, said second telescoping tube having an inner diameter sized to permit said first telescoping tube to be retracted into said second telescoping tube, said third telescoping tube having an inner diameter sized to permit said second telescoping tube to be retracted into said third telescoping tube, and said first elongated catheter member extending from said distal end of said first telescoping tube to beyond said proximal end of said third telescoping tube, said distal end of said first elongated catheter member engageable with said distal end of said first telescoping tube and said first telescoping tube engageable with said second telescoping tube so that withdrawal of said first elongated catheter member through the proximal end of said second tubular catheter member will cause said first telescoping tube to be retracted into said second telescoping tube and said second telescoping tube to be retracted into said third telescoping tube, said method comprising the steps of:

(a) inserting said telescoping catheter into a patient'"'"'s vasculature;

(b) advancing said telescoping catheter to a predetermined location within said patient'"'"'s vasculature while maneuvering said first, second and third telescoping tubes to a substantially fully extended position such that said proximal end of said first telescoping tube is located at about said distal end of said second telescoping tube and the proximal end of said second telescoping tube is located at about the distal end of said third telescoping tube;

(c) gripping the proximal end of said first catheter member and withdrawing said first catheter member through said second tubular catheter member;

(d) continuing to withdraw said first catheter member so that said first telescoping tube is fully retracted into said second telescoping tube;

(e) continuing to withdraw said first catheter member so that said second telescoping tube is fully retracted into said third telescoping tube; and

(f) gripping said proximal end of said second tubular catheter member and removing said telescoping catheter from said patient'"'"'s vasculature.