Delivery methods for left ventricular conduit

• US 6,387,119 B2
• Filed: 03/02/2001
• Issued: 05/14/2002
• Est. Priority Date: 09/10/1998
• Status: Expired due to Fees

• Current Assignee: WILK Patent Development Corporation
• Original Assignee: Percardia, Inc.
• Inventors: Wilk, Peter J., Wolf, Scott J., Pompili, Vincent
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US09/796,590
• Publication Number:
  US 20010034547A1
• Time in Patent Office: 438 Days
• Field of Search: 606/108, 606/194, 606/195, 606/191, 606/192, 606/198, 600/434, 600/585, 604/96.01, 604/264, 604/164.13, 604/528, 604/530, 623/1.11, 623/1.24, 623/1.37, 623/12.11, 128/898
• US Class Current: 606/108
• 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 2017/22054 with two balloons
• CPC Class Codes: A61B 2017/22071 Steering
• CPC Class Codes: A61B 2017/22095 accessing a blood vessel true lumen from the sub-intimal space
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61F 2/2493 Transmyocardial revascularisation [TMR] devices
• CPC Class Codes: A61F 2/86 Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
• CPC Class Codes: A61F 2/95 Instruments specially adapted for placement or removal of stents or stent-grafts
• CPC Class Codes: A61F 2/958 Inflatable balloons for placing stents or stent-grafts
• CPC Class Codes: A61M 2025/0096 being laterally outward extensions or tools, e.g. hooks or fibres
• 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 2025/1095 with perfusion means for enabling blood circulation while the balloon is in an inflated state or in a deflated state, e.g. permanent by-pass within catheter shaft
• CPC Class Codes: A61M 2025/1097 with perfusion means for enabling blood circulation only while the balloon is in an inflated state, e.g. temporary by-pass within balloon
• CPC Class Codes: A61M 2210/125 Heart
• CPC Class Codes: A61M 25/0147 with movable mechanical means, e.g. pull wires
• CPC Class Codes: A61M 25/0152 with pre-shaped mechanisms, e.g. pre-shaped stylets or pre-shaped outer tubes
• CPC Class Codes: A61M 25/0155 with hydraulic or pneumatic means, e.g. balloons or inflatable compartments
• CPC Class Codes: A61M 25/0194 Tunnelling catheters
• 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
• CPC Class Codes: A61M 25/1006 : Balloons formed between concentric tubes
• CPC Class Codes: A61M 25/1011 : Multiple balloon catheters

Abstract

Described herein are various methods and apparatuses for delivering stents or conduits and other devices into the myocardium of a patient. One preferred stent delivery system provides access to the insertion site in the myocardium by advancing a delivery catheter through a blockage in a coronary artery, or around the blockage through a coronary vein or through a channel or tunnel formed around the blockage. In one embodiment, once the distal end of the delivery catheter is adjacent the myocardium, an angled bend is created in the catheter by actuating expandable steering guides mounted to the catheter which cooperate with the walls of the blood vessel to cause the catheter to turn. Then, a guidewire is advanced through the delivery catheter and into the myocardium. In another embodiment, a tip-deflecting pull wire extends from the distal end of the delivery catheter which may be actuated to turn towards and then inserted into the myocardium. In another embodiment, an exit port facing the insertion site is provided within the catheter or a balloon mounted on the catheter so that a guidewire may be directed through a lumen and out the exit port into the:.myocardium. Once the guidewire punctures into the myocardium, the guidewire is anchored using barbs, balloons or other actuatable members to secure the guidewire to the myocardium. Subsequently, using a push-pull mechanism, stents and other medical devices can be advanced over the guidewire into the myocardium.

Claims

1. A method of bypassing a blockage in a coronary vessel, comprising:

delivering an instrument within the coronary vessel to a point proximal to the blockage;

extending the instrument through an anterior wall of the coronary vessel and into a pericardial space;

extending the instrument through the anterior wall of the coronary vessel and into the coronary vessel at a point distal to the blockage; and

delivering a shunt through the coronary vessel and along the instrument so that a first end of the shunt is in the coronary vessel proximal to the blockage, a second end of the shunt is in the coronary vessel distal to the blockage, and a lumen of the shunt between the first and second ends extends within the pericardial space.

2. The method of claim 1, further comprising advancing a catheter through the coronary vessel to the point proximal to the blockage.

3. The method of claim 2, wherein delivering the instrument includes advancing the instrument through the catheter.

4. The method of claim 3, further comprising turning a distal end of the catheter toward the anterior wall of the coronary vessel.

5. The method of claim 1, further comprising navigating the instrument through the pericardial space after extending the instrument into the pericardial space.

6. The method of claim 5, wherein the instrument is a guidewire.

7. The method of claim 5, wherein the instrument includes a shape memory alloy material.

8. The method of claim 5, wherein the instrument includes a pre-established curved shape.

9. The method of claim 1, wherein delivering the shunt includes delivering the shunt over the instrument.

10. The method of claim 9, wherein the instrument is a guidewire.

11. The method of claim 1, further comprising removing the instrument after delivering the shunt.

12. The method of claim 1, wherein the coronary vessel is a coronary artery.

13. The method of claim 1, wherein the blockage is a partial blockage of the coronary vessel.

14. The method of claim 1, wherein the instrument is inserted percutaneously to the point proximal to the blockage.

15. A method of bypassing a blockage in a coronary vessel, comprising:

advancing a delivery catheter through the coronary vessel to a point proximal to the blockage;

advancing a guidewire through the delivery catheter to the point proximal to the blockage;

extending the guidewire through an anterior wall of the coronary vessel and into a pericardial space;

navigating the guidewire through the pericardial space and around the blockage;

extending the guidewire through the anterior wall of the coronary vessel and into the coronary vessel at a point distal to the blockage; and

delivering a shunt through the delivery catheter and over the guidewire until a first end of the shunt is within the coronary vessel proximal to the blockage, a second end of the shunt is in the coronary vessel distal to the blockage, and a lumen of the shunt between the first and second ends extends within the pericardial space.

16. The method of claim 15, further comprising turning a distal end of the delivery catheter toward the anterior wall of the coronary vessel.

17. The method of claim 15, wherein the guidewire includes a shape memory alloy material.

18. The method of claim 15, wherein the guidewire includes a preestablished curved shape.

19. The method of claim 15, further comprising removing the guidewire after delivering the shunt.

20. The method of claim 15, wherein the coronary vessel is a coronary artery.

21. The method of claim 15, wherein the blockage is a partial blockage of the coronary vessel.

22. The method of claim 15, wherein the guidewire is inserted percutaneously to the point proximal to the blockage.

23. A method of bypassing a blockage in a coronary vessel, comprising:

creating a path from a first position proximal to the blockage to a second position distal to the blockage; and

advancing a shunt to the path so that a first end of the shunt is in the coronary vessel proximate the first position, a second end of the shunt is in the coronary vessel proximate the second position, and a lumen of the shunt between the first and second ends extends within a pericardial space.

24. The method of claim 23, wherein creating the path includes delivering an instrument within the coronary vessel to a point proximal to the blockage, extending the instrument through an anterior wall of the coronary vessel and into a pericardial space, and extending the instrument through the anterior wall of the coronary vessel and into the coronary vessel at a point distal to the blockage.

25. The method of claim 24, further comprising advancing a catheter through the coronary vessel to the point proximal to the blockage.

26. The method of claim 25, wherein delivering the instrument includes advancing the instrument through the catheter.

27. The method of claim 26, further comprising turning a distal end of the catheter toward the anterior wall of the coronary vessel.

28. The method of claim 24, further comprising navigating the instrument through the pericardial space after extending the instrument into the pericardial space.

29. The method of claim 28, wherein the instrument is a guidewire.

30. The method of claim 28, wherein the instrument includes a shape memory alloy material.

31. The method of claim 28, wherein the instrument includes a pre-established curved shape.

32. The method of claim 24, wherein advancing the shunt includes advancing the shunt over the instrument.

33. The method of claim 24, further comprising removing the instrument after delivering the shunt.

34. The method of claim 23, wherein the coronary vessel is a coronary artery.

35. The method of claim 23, wherein the blockage is a partial blockage of the coronary vessel.

36. The method of claim 24, wherein the instrument is inserted percutaneously to the point proximal to the blockage.