System and method for percutaneous coronary artery bypass

• US 6,575,168 B2
• Filed: 01/12/2001
• Issued: 06/10/2003
• Est. Priority Date: 03/06/1997
• Status: Expired due to Term

• Current Assignee: Boston Scientific Scimed, Inc. (Boston Scientific Corporation)
• Original Assignee: Scimed Life Systems Incorporated (Boston Scientific Corporation)
• Inventors: LaFontaine, Daniel M., Harrison, Kent D., Wang, Lixiao, Hastings, Roger N., Euteneuer, Charles L.
• Primary Examiner(s): McDermott, Corrine
• Assistant Examiner(s): BARRETT, THOMAS C
• Application Number:
  US09/759,996
• Publication Number:
  US 20010003985A1
• Time in Patent Office: 879 Days
• Field of Search: 128/898, 606/27, 606/78, 606/191-200, 600/36, 623/1.1
• US Class Current: 128/898
• CPC Class Codes: A61B 17/32053 Punch like cutting instruments, e.g. using a cylindrical or oval knife A61B17/326 takes precedence; trepans A61B17/1695; for use on the cornea A61F9/007
• CPC Class Codes: A61B 2017/00243 cardiac
• 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 2017/1135 End-to-side connections, e.g. T- or Y-connections
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2090/3929 Active markers
• CPC Class Codes: A61B 2090/3945 Active visible markers, e.g. light emitting diodes
• CPC Class Codes: A61B 2090/3958 emitting a signal
• CPC Class Codes: A61F 2/06 Blood vessels
• CPC Class Codes: A61F 2/064 with special features to facilitate anastomotic coupling anastomosis of natural blood vessels A61B17/11
• CPC Class Codes: A61F 2/82 Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents stent-grafts for tubular structures of the body other than blood vessels A61F2/04; stent-grafts for blood vessels A61F2/07; instruments specially adapted for placement or removal of stents or stent-grafts A61F2/95; for closing wounds, or holding wounds closed A61B17/04 - A61B17/115; dilators A61M29/00
• CPC Class Codes: A61F 2/90 characterised by a net-like or mesh-like structure
• CPC Class Codes: A61F 2/958 Inflatable balloons for placing stents or stent-grafts
• CPC Class Codes: A61F 2250/0098 radio-opaque, e.g. radio-opaque markers
• CPC Class Codes: Y10S 623/902 Method of implanting

Abstract

A percutaneous system for bypassing a restriction in a native vessel of a mammal having an aorta includes providing a graft having a body portion with a first end, a second end and a lumen therebetween. An aperture is formed in the aorta. The graft is inserted into the aorta and the first end of the graft is connected to the aorta about the aperture in the aorta. An aperture is then formed in the native vessel distal of the restriction. The second end of the graft is connected to the native vessel about the aperture therein such that the lumen in the graft communicates with the aorta and the native vessel.

Claims

1. A method of percutaneously bypassing a restriction in an artery of a mammal having an aorta, the artery having an artery wall defining an artery lumen and the aorta having an aorta wall defining an aorta lumen, the method comprising:

providing a conduit having a body portion with a first end and a second end;

forming an aperture in the aorta wall;

connecting the first end of the conduit to the aorta wall about the aperture in the aorta wall;

advancing the body portion of the conduit through the aperture in the aorta wall after connecting the first end of the conduit to the aorta wall;

forming an aperture in the artery wall distal of the restriction; and

connecting the second end of the conduit to the artery wall about the aperture therein such that the conduit communicates with the aorta lumen and the artery lumen.

2. The method of claim 1 wherein the conduit includes a normal inner conduit wall which constitutes the inner wall of the conduit when the conduit is in its normal, non-inverted, configuration and a normal outer wall which constitutes the outer wall of the conduit when the conduit is in its normal, non-inverted, configuration, wherein connecting the first end of the conduit comprises:

connecting the first end of the conduit to the aorta wall in an inverted position such that the normal inner conduit wall forms the outer wall of the conduit and the normal outer wall forms the inner wall of the conduit;

and wherein advancing the body portion of the conduit through the aperture in the aorta wall comprises;

advancing the conduit through the aperture in the aorta wall such that the conduit becomes non-inverted.

3. The method of claim 1 wherein the aorta wall comprises an inner aorta wall and an outer aorta wall, and wherein forming an aperture in the aorta wall comprises:

isolating a region of the inner aorta wall from blood flow while allowing blood flow through the remainder of the aorta lumen; and

forming the aperture in the isolated region.

4. The method of claim 3 wherein isolating a region of the inner aorta wall comprises:

positioning a distal end of a catheter such that the distal end of the catheter encompasses the region of the inner aorta wall to be isolated; and

drawing a vacuum through the catheter causing the distal end of the catheter to abut against the region of the inner aorta wall to be isolated.

5. The method of claim 1 wherein forming an aperture in the artery wall comprises:

positioning the second end of the conduit proximate a region of the artery distal of the restriction;

inserting a cutting device through the aorta lumen and through the conduit; and

cutting the aperture in the artery wall with the cutting device.

6. The method of claim 1 wherein forming an aperture in the artery wall comprises:

advancing a cutting device through the artery lumen across the restriction to a region distal of the restriction; and

cutting the aperture in the artery wall with the cutting device.

7. The method of claim 1 wherein connecting the second end of the conduit to the artery wall comprises:

advancing a suturing catheter through the aorta lumen and through the conduit; and

suturing the second end of the conduit to the artery wall with the suturing catheter.

8. The method of claim 1 wherein the conduit provided in the providing step includes a coupler connected to the first end of the body portion, the coupler having a lumen running therethrough, an insertion end and a shoulder portion of greater width than the insertion end, the lumen in the coupler communicating with the conduit, and wherein connecting the first end of the conduit to the aorta wall comprises:

inserting the insertion end of the coupler into the aperture in the aorta wall such that the shoulder portion abuts an inner surface of the aorta wall proximate the aperture in the aorta wall.

9. The method of claim 8 wherein advancing the body portion of the conduit through the aperture in the aorta wall comprises:

advancing the body portion of the conduit through the lumen of the coupler.

10. The method of claim 1 and further comprising:

before connecting the second end of the conduit to the artery wall, positioning the second end of the conduit proximate a region of the artery distal of the restriction.

11. The method of claim 10 wherein positioning the second end of the conduit comprises:

injecting contrast medium through the conduit and through a region of the artery lumen distal of the restriction; and

moving the second end of the conduit based on observation of the contrast medium.

12. The method of claim 10 wherein positioning the second end of the conduit comprises:

providing radiopaque markers proximate the second end of the conduit and distal of the restriction in the artery; and

moving the radiopaque markers toward one another under fluoroscopic observation.

13. The method of claim 10 wherein positioning the second end of the conduit comprises:

placing an emitter in one of the artery lumen distal of the restriction and the second end of the conduit, the emitter emitting location signals;

placing a sensor in another of the artery lumen distal of the restriction and the second end of the conduit, the sensor sensing the location signals and providing an output indicative of the location signals sensed; and

moving the second end of the conduit based on the output from the sensor.

14. The method of claim 13 wherein placing an emitter comprises:

placing a light emitter in one of the region of the artery distal of the restriction and the second end of the conduit; and

wherein placing a sensor comprises placing a fiber optic bundle in another of the region of the artery distal of the restriction and the second end of the conduit, the fiber optic bundle sensing light emitted by the light emitter and providing the output indicative of the light sensed.

15. The method of claim 13 wherein placing an emitter comprises:

placing an ultrasound emitter in one of the region of the artery distal of the restriction and the second end of the conduit; and

wherein placing a sensor comprises placing an ultrasound imager in another of the region of the artery distal of the restriction and the second end of the conduit, the ultrasound imager sensing ultrasound signals emitted by the ultrasound emitter and providing the output as an ultrasound image indicative of the ultrasound signals sensed.

16. The method of claim 13 wherein placing an emitter comprises:

placing an electromagnetic signal emitter in one of the region of the artery distal of the restriction and the second end of the conduit; and

wherein placing a sensor comprises placing an electromagnetic sensing array in another of the region of the artery distal of the restriction and the second end of the conduit, the electromagnetic sensing array sensing electromagnetic signals emitted by the electromagnetic signal emitter and providing the output indicative of the electromagnetic signals sensed.

17. The method of claim 13 wherein placing an emitter comprises:

placing a radio frequency (RE) signal emitter in one of the artery lumen distal of the restriction and the second end of the conduit; and

wherein placing a sensor comprises placing an RE sensor in another of the artery lumen distal of the restriction and the second end of the conduit, the RE sensor sensing RE signals emitted by the RE signal emitter and providing the output indicative of the RF signals sensed.

18. The method of claim 10 wherein positioning the second end of the conduit comprises:

placing a first emitter in the region of the artery distal of the restriction and a second emitter in the second end of the conduit, the first and second emitters emitting location signals;

sensing the location signals and providing an operator perceptible output indicative of the relative location of the region of the artery distal to the restriction and the second end of the conduit; and

moving the second end of the conduit based on the operator perceptible output from the sensor.

19. The method of claim 1 wherein providing a conduit comprises:

providing a first expandable stent in the second end of the conduit; and

wherein connecting the second end of the conduit to the artery wall includes inserting at least a portion of the first stent through the aperture in the artery wall and deploying the first stent to connect the second end of the conduit within the artery.

20. The method of claim 19 wherein providing a first expandable stent includes:

providing a sleeve on the first expandable stent, the sleeve having a chemical carrying region carrying chemicals; and

wherein deploying the first expandable stent includes dispensing the chemicals from the chemical carrying region.

21. The method of claim 20 wherein dispensing the chemicals comprises:

dispensing biological adhesive.

22. The method of claim 20 wherein dispensing the chemicals comprises:

dispensing growth factors.

23. The method of claim 20 wherein dispensing the chemicals comprises:

dispensing a drug.