Delivery methods for left ventricular conduit

• US 6,694,983 B2
• Filed: 03/08/2002
• Issued: 02/24/2004
• Est. Priority Date: 09/10/1998
• Status: Expired due to Fees

• Current Assignee: Horizon Technology Funding Co. LLC (Horizon Technology Finance Management LLC)
• Original Assignee: Percardia, Inc.
• Inventors: Wilk, Peter J., Wolf, Scott J., Pompili, Vincent
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US10/092,916
• Publication Number:
  US 20020100484A1
• Time in Patent Office: 718 Days
• Field of Search: 128/898, 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
• US Class Current: 128/898
• 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 blood vessel, comprising:

delivering a guidewire along a path in a heart wall between a location in the blood vessel proximal to the blockage and a location in the blood vessel distal to the blockage; and

forming a passage along the path formed by the guidewire.

2. The method of claim 1, wherein forming the passage includes dilating the heart wall along the path.

3. The method of claim 2, wherein dilating the heart wall along the path includes inserting a catheter over the guidewire.

4. The method of claim 2, wherein dilating the heart wall along the path includes dilating the heart wall via at least one of a catheter, a balloon, radiation, drilling, and a laser.

5. The method of claim 1, wherein delivering the guidewire includes delivering the guidewire through a catheter and extending the guidewire from the catheter such that the guidewire does not extend in a vessel other than the vessel being bypassed.

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

7. The method of claim 6, wherein delivering the guidewire includes advancing the guidewire through the catheter.

8. The method of claim 6, further comprising turning a distal end of the catheter toward an anterior wall of the blood vessel.

9. The method of claim 1, wherein the guidewire is made of a shape memory alloy material.

10. The method of claim 1, wherein the guidewire has a curved shape.

11. The method of claim 1, further comprising delivering a conduit to the passage over the guidewire.

12. The method of claim 11, further comprising removing the guidewire after delivering the conduit.

13. The method of claim 11, further comprising dilating the heart wall along the path prior to delivering the conduit.

14. The method of claim 11, wherein delivering the conduit includes delivering the conduit such that at least one end of the conduit extends into a flow path of the coronary vessel.

15. The method of claim 14, wherein delivering the conduit includes delivering the conduit such that a first end of the conduit extends into the flow path of the coronary vessel at the location proximal to the blockage and a second end of the conduit extends into the flow path of the coronary vessel at the location distal to the blockage.

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

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

18. The method of claim 1, wherein delivering the guidewire includes delivering the guidewire percutaneously to the location in the blood vessel proximal to the blockage.

19. The method of claim 1, wherein the path extends in tissue of the heart wall located between the blood vessel and a heart chamber.