Vascular re-entry catheter

• US 6,511,458 B2
• Filed: 01/19/2001
• Issued: 01/28/2003
• Est. Priority Date: 01/13/1998
• Status: Expired due to Term

• Current Assignee: Cardinal Health Switzerland 515 GmbH (Cardinal Health, Inc.)
• Original Assignee: LuMend, Inc. (Cardinal Health, Inc.)
• Inventors: French, Ronald G., Co, Fred H., Hill, Richard E., Milo, Charles F., Selmon, Matthew R.
• Primary Examiner(s): KENNEDY, SHARON E
• Application Number:
  US09/765,777
• Publication Number:
  US 20010012924A1
• Time in Patent Office: 739 Days
• Field of Search: 604/158-161, 604/164.01, 604/164.07, 604/164.09, 604/164.11, 604/164.13, 604/165.01, 604/165.02, 604/165.04, 604/170.03, 604/264, 604/272, 604/500, 604/523, 604/508
• US Class Current: 604/164.13
• 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 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 2017/003 Steerable
• CPC Class Codes: A61B 2017/22044 with a pointed tip
• CPC Class Codes: A61B 2017/22077 with a part piercing the tissue A61B2017/22044 takes precedence
• 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: A61B 2090/3925 ultrasonic
• CPC Class Codes: A61M 2025/0096 being laterally outward extensions or tools, e.g. hooks or fibres
• CPC Class Codes: A61M 25/01 Introducing, guiding, advancing, emplacing or holding catheters A61M25/10 takes precedence

Abstract

Total occlusions are crossed by passing a guidewire or other penetrating wire from a point proximal to the occlusion into a subintimal space between the intimal layer and adventitial layer of the blood vessel wall. The wire is advanced to a point distal to the occlusion and thereafter deflected back into the blood vessel lumen, typically using a deflecting catheter which is advanced over the guidewire after it has been positioned within the subintimal space. After the guidewire is returned to the blood vessel lumen, the deflecting catheter may be withdrawn and the guidewire is available for introduction of other interventional and diagnostic catheters.

Claims

1. A method for forming a pathway between an extraluminal space within a blood vessel and a lumen of the blood vessel, comprising:

advancing a wire into the extraluminal space of a wall of the blood vessel;

advancing a catheter system over the wire into the extraluminal space;

retracting the wire into the catheter system; and

advancing the wire through a lateral port in the catheter system, wherein the pathway is formed from the extraluminal space into the lumen.

2. The method of claim 1, wherein advancing comprises deflecting.

3. A method for forming a pathway between an extraluminal space within a blood vessel and a lumen of the blood vessel, comprising:

advancing a wire into the extraluminal space of a wall of the blood vessel;

advancing a catheter system into the extraluminal space;

positioning the wire in the catheter system; and

advancing the wire through a lateral port in the catheter system, wherein the pathway is formed from the extraluminal space into the lumen.

4. A method for forming a pathway between an extraluminal space within a blood vessel and a lumen of the blood vessel, comprising:

advancing a catheter system into the extraluminal space of a wall of the blood vessel;

positioning a wire in the catheter system;

positioning a port of the catheter system towards the lumen using a visualization subsystem of the catheter system; and

advancing the wire through the port to form the pathway from the extraluminal space into the lumen.

5. The method of claim 4, wherein the visualization subsystem includes at least one system selected from among ultrasound system, an intravascular ultrasonic imaging system (IVUS), an optical coherence tomography (OCT) system, and a fluoroscopic system.

6. The method of claim 4, wherein the wire includes the visualization subsystem.

7. A method for forming a pathway between an extraluminal space within a blood vessel and a lumen of the blood vessel, comprising:

advancing a catheter system into the extraluminal space of a wall of the blood vessel;

positioning a working element in the catheter system;

positioning a port of the catheter system towards the lumen using a visualization subsystem of the catheter system; and

advancing the working element through the port to form the pathway from the extraluminal space into the lumen.

8. The method of claim 7, further comprising advancing a guide wire into the extraluminal space, wherein advancing the catheter system includes tracking the catheter system over the guide wire to a target location.

9. The method of claim 7, wherein the working element is a cannula.

10. The method of claim 7, wherein the working element is a cannula having a pre-shaped distal tip.

11. The method of claim 7, wherein die working element is a needle cannula having a pre-shaped distal tip.

12. A method for forming a pathway between an extraluminal space within a blood vessel and a lumen of the blood vessel, comprising:

advancing a catheter system into the extraluminal space of a wall of the blood vessel;

positioning a wire in the catheter system, wherein the wire includes a visualization subsystem;

positioning a port of the catheter system towards the lumen using a visualization subsystem; and

advancing the wire through the port to form the pathway from the extraluminal space into the lumen.