Systems and methods for directing and snaring guidewires

• US 6,379,319 B1
• Filed: 10/27/1998
• Issued: 04/30/2002
• Est. Priority Date: 10/11/1996
• Status: Expired due to Term

• Current Assignee: Medtronic Vascular, Inc. (Medtronic Plc)
• Original Assignee: TransVascular, Inc. (Medtronic Plc)
• Inventors: Chang, John, Whitt, Jason, Garibotto, John, Hayase, Motoya, Flaherty, J. Christopher, Makower, Joshua, Kim, Steven W.
• Primary Examiner(s): Shaver, Kevin
• Assistant Examiner(s): SZMAL, BRIAN SCOTT
• Application Number:
  US09/179,737
• Time in Patent Office: 1,281 Days
• Field of Search: 600/585, 600/137, 606/191, 606/192, 606/194, 604/101, 604/95-100, 604/102, 604/103, 604/523, 604/284, 604/528
• US Class Current: 600/585
• CPC Class Codes: A61B 17/00491 Surgical glue applicators surgical adhesives A61L24/00; two-component delivery syringes A61M5/19
• CPC Class Codes: A61B 17/0643 with separate closing member, e.g. for interlocking with staple
• CPC Class Codes: A61B 17/11 for performing anastomosis; Buttons for anastomosis
• CPC Class Codes: A61B 17/12022 Occluding by internal devices, e.g. balloons or releasable wires plugging an opening in the wall of an organ A61B17/0057; occluders for the cervical canal A61F6/146; vas deferens occluders A61F6/20
• CPC Class Codes: A61B 17/12109 in a blood vessel
• CPC Class Codes: A61B 17/12136 Balloons
• CPC Class Codes: A61B 17/221 Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions surgical snare instruments A61B17/32056
• CPC Class Codes: A61B 17/32056 Surgical snare instruments for removing or smashing calculi A61B2017/2212; tonsillotomes A61B17/26
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 18/00 Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body eye surgery A61F9/007; ear surgery A61F11/00
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• 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 2017/00504 Tissue welding
• CPC Class Codes: A61B 2017/1107 for blood vessels
• CPC Class Codes: A61B 2017/1139 Side-to-side connections, e.g. shunt or X-connections
• CPC Class Codes: A61B 2017/22035 for retrieving or repositioning foreign objects
• CPC Class Codes: A61B 2017/22094 for crossing total occlusions, i.e. piercing
• CPC Class Codes: A61B 2017/2212 having a closed distal end, e.g. a loop
• CPC Class Codes: A61B 2017/306 : holding by means of suction
• CPC Class Codes: A61B 2017/347 : Locking means, e.g. for locking instrument in cannula
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 90/39 : Markers, e.g. radio-opaque or breast lesions markers
• CPC Class Codes: A61B 90/40 : Apparatus fixed or close to patients specially adapted for providing an aseptic surgical environment
• CPC Class Codes: A61F 2/064 : with special features to facilitate anastomotic coupling anastomosis of natural blood vessels A61B17/11
• CPC Class Codes: A61F 2/07 : Stent-grafts
• CPC Class Codes: A61F 2/90 : characterised by a net-like or mesh-like structure
• CPC Class Codes: A61F 2002/061 : provided with means for allowing access to secondary lumens
• CPC Class Codes: A61F 2002/30079 : magnetic
• CPC Class Codes: A61F 2002/825 : having longitudinal struts
• CPC Class Codes: A61F 2210/009 : magnetic
• CPC Class Codes: A61M 2025/0076 : Unidirectional valves
• CPC Class Codes: A61M 2025/0161 : wherein the distal tips have two or more deflection regions
• CPC Class Codes: A61M 2025/1052 : for temporarily occluding a vessel for isolating a sector
• CPC Class Codes: A61M 25/0105 : Steering means as part of the catheter or advancing means; Markers for positioning systems for detection of markers A61B
• CPC Class Codes: A61M 25/0133 : Tip steering devices

Abstract

Devices and methods for achieving directed placement of guidewires or other flexible rails over which other catheters or other devices may be introduced to a targeted location. A guidewire directing device includes a lumen extending between a proximal end and a distal peripheral opening for directing a guidewire laterally from the device, and may have a deflecting member with a predetermined deflection angle in the lumen adjacent the peripheral opening. A snaring device is also provided that includes one or more lumens through which a snare or other grasping member is directed for releasably capturing or coupling to a guidewire. The snaring and target guidewire devices may include cooperating end effectors for releasably coupling or securing the devices together. The devices may be used for directing, snaring and/or manipulating one or more guidewires between two blood vessels connected by an interstitial channel, for example, to “floss” a guidewire through the coronary arterial and venous systems between two percutaneous entry sites and/or to bypass a lesion in a vessel using proximal and distal interstitial channels communicating with an adjacent vessel.

Claims

1. A method for manipulating a guidewire device within a body, comprising the steps of:

introducing a distal portion of a guidewire device into a first location in the body;

introducing a distal end of a directing member into the body until it is adjacent to the distal end of the guidewire device;

capturing the distal portion of the guidewire device with a grasping mechanism on the distal end of the directing member;

directing the directing member to a second location in the body with the distal portion of the guidewire device captured by the grasping mechanism; and

releasing the distal portion of the guidewire device from the grasping mechanism at the second location.

2. The method of claim 1, wherein the distal portion of the guidewire device is magnetically coupled to the grasping mechanism during the capturing step.

3. The method of claim 1, wherein the distal portion of the guidewire device is snared within a loop on the grasping mechanism during the capturing step.

4. The method of claim 1, wherein the distal portion of the guidewire device is secured to an outer surface of the directing member by the grasping mechanism during the capturing step.

5. The method of claim 1, wherein the first location is within a first body passage connected by an interstitial channel to a second body channel, and wherein the directing member comprises a catheter having a distal portion including a weakened region proximate to a distal tip of the catheter, the distal portion of the catheter being introduced into the second body channel proximate the interstitial channel.

6. The method of claim 5, wherein the capturing step comprises securing the distal portion of the guidewire device and the distal tip of the catheter together through the interstitial channel;

and wherein the directing step comprises directing the distal portion of the catheter, with the guidewire device secured thereto, distally within the second passage, thereby causing the distal portion of the catheter to prolapse at the weakened region.

7. The method of claim 6, wherein the step of securing the distal end of the guidewire device and the distal tip of the catheter comprises the steps of:

directing the distal tip of the catheter through the interstitial channel into the first body passage; and

deploying a snaring device from the catheter to capture the distal end of the guidewire device.

8. The method of claim 7, comprising the additional step of withdrawing the distal portion of the catheter back into the second body passage, thereby pulling the guidewire device into the second body passage.

9. A method for manipulating a guidewire device within a body passage, comprising:

introducing a distal portion of a guidewire device into a first location in a first body passage;

introducing a distal end of a directing member into a second body passage adjacent the first location until the distal end of the directing member is adjacent to the distal end of the guidewire device;

advancing a snaring member substantially laterally from the directing device into the first body passage;

capturing the distal portion of the guidewire device in the first body passage with the grasping mechanism on the snaring member; and

directing the directing member to a second location with the distal portion of the guidewire device captured by the grasping mechanism.

10. The method of claim 9, wherein the directing step comprises withdrawing the snaring member into the second body passage, with the guidewire device captured by the grasping mechanism.

11. The method of claim 10, wherein the directing device is directed through a channel between the first body passage and the second body passage when the guidewire directing member is directed to the second location.

12. The method of claim 10, wherein the first location comprises a location adjacent to a portion of the first body passage upstream of a lesion in the first body passage.

13. The method of claim 12, wherein the second location comprises a location downstream of the lesion in the first body passage.

14. The method of claim 10, wherein the directing member is introduced over a first guidewire placed between the first location and the second location.

15. The method of claim 10, wherein the snaring member is directed over a second guidewire placed between the first location and the second body passage.

16. The method of claim 10, wherein the first and second body passages comprise adjacent blood vessels within the coronary system.

17. A method for manipulating a guidewire device within a body passage, comprising:

introducing a distal portion of a guidewire device into a first location within a first blood vessel connected by an interstitial channel to a second blood vessel;

introducing a distal end of a directing member into the second blood vessel proximate the interstitial channel until it is adjacent to the distal portion of the guidewire device;

advancing the distal end of the directing member through the interstitial channel into the first blood vessel;

capturing the distal portion of the guidewire device with a grasping mechanism on the distal end of the directing member; and

directing the directing member to a second location with the distal portion of the guidewire device captured by the grasping mechanism.

18. The method of claim 17, wherein the directing step comprises withdrawing the distal end of the directing member through the interstitial channel back into the second vessel, thereby pulling the distal portion of the guidewire device into the second vessel.

19. The method of claim 18, wherein the directing step further comprises releasing the distal portion of the guidewire device from the directing member within the second vessel.

20. The method of claim 19, wherein the directing step further comprises directing the directing member along the second vessel to the second location before releasing the distal portion of the guidewire device.

21. The method of claim 18, wherein the directing step further comprises withdrawing the directing member completely from the second vessel to outside the body, thereby pulling the distal portion of the guidewire device through the second vessel to outside the body, the second location being located outside the body.

22. The method of claim 17, wherein the guidewire device comprises a guidewire or a micro-catheter.

23. The method of claim 17, wherein the distal portion of the guidewire device and the distal end of the directing member include cooperating end effectors for detachably securing the distal portion of the guidewire device and the directing member together.

24. The method of claim 23, wherein the end effectors comprise a magnet.

25. The method of claim 23, wherein the end effectors comprise a loop and pin on the distal end of the directing member and a recess in the distal portion of the guidewire device, and wherein the distal portion is received through the loop and the recess is engaged by the pin when the guidewire device is captured by the directing member.

26. A method for manipulating a guidewire device within a body passage, comprising:

advancing a distal portion of a first guidewire distally from a first percutaneous entry site into a first vessel to a first location, the first location being located adjacent to a second vessel; and

advancing a distal end of a snaring member from a second percutaneous entry site distally into the second vessel adjacent to the first location;

capturing the distal portion of the first guidewire with a grasping mechanism on the distal end of the snaring member, and

directing the snaring member to a second location with the distal portion of the first guidewire captured by the grasping mechanism.

27. The method of claim 26, wherein the capturing step comprises:

advancing one of the distal portion of the guidewire and the snaring member between the first and second vessels; and

snaring the distal portion of the first guidewire with the snaring member.

28. The method of claim 27, wherein the first location is adjacent a proximal channel extending between the first and second vessels.

29. The method of claim 27, wherein the first vessel comprises a vein, and the second vessel comprises an artery.

30. The method of claim 29, wherein the first vessel comprises a coronary vein and the second vessel comprises a coronary artery.

31. The method of claim 27, wherein the snaring member is advanced over a second guidewire into the second vessel.

32. The method of claim 27, comprising the additional step of withdrawing the snaring member proximally from the second vessel and out the second entry site, thereby flossing the first guidewire through the first and second vessels between the first and second entry sites.

33. The method of claim 32, comprising the additional steps of:

advancing a catheter from the second entry site over the flossed first guidewire into the second vessel adjacent to the first selected location;

advancing a snaring member from the first entry site into the first vessel;

deploying a second guidewire from the catheter;

advancing the catheter, the second guidewire or the snaring member between the first and second vessels;

snaring a distal end of the second guidewire with the snaring member;

directing the snaring member distally along the first vessel to a second selected location; and

releasing the distal end of the second guidewire from the snaring member at the second selected location.

34. The method of claim 33, wherein the catheter is directed through the channel into the first vessel prior to the deployment of the second guidewire.

35. The method of claim 33, wherein:

a third guidewire is advanced from the first entry site into the first vessel prior to the snaring member being advanced from the first entry site into the first vessel; and

the snaring member is advanced into the first vessel over the third guidewire.

36. The method of claim 33, wherein the second location is a distal location in the second vessel, and wherein the snaring member is advanced through a distal channel from the first vessel into the second vessel to advance the second guidewire into the distal location in the second vessel.

37. The method of claim 36, wherein the snaring member is advanced through the distal channel over a fourth guidewire previously placed from the first entry site through the first vessel and the distal channel into the distal location in the second vessel.

38. The method of claim 33, wherein the second vessel comprises an artery, and wherein the artery includes a lesion at a location between the first and second locations.

39. A method for manipulating a guidewire device within a body passage, comprising:

creating an interstitial opening between a first blood vessel and a second blood vessel;

introducing a distal portion of a guidewire device into a first location within the first blood vessel;

introducing a distal end of a directing member into the second blood vessel proximate the interstitial channel;

advancing the distal end of the directing member through the interstitial channel into the first blood vessel; and

capturing the distal portion of the guidewire device with a grasping mechanism on the distal end of the directing member.

40. The method of claim 39, further comprising directing the directing member to a second location with the distal portion of the guidewire device captured by the grasping mechanism.

41. The method of claim 40, wherein the directing step comprises withdrawing the distal end of the directing member through the interstitial channel back into the second vessel, thereby pulling the distal portion of the guidewire device into the second vessel.

42. The method of claim 41, wherein the directing step further comprises releasing the distal portion of the guidewire device from the directing member within the second vessel.

43. The method of claim 41, wherein the directing step further comprises directing the directing member along the second vessel to the second location before releasing the distal portion of the guidewire device.

44. The method of claim 41, wherein the directing step further comprises withdrawing the directing member completely from the second vessel to outside the body, thereby pulling the distal portion of the guidewire device through the second vessel to outside the body, the second location being located outside the body.