Methods and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures

• US 7,134,438 B2
• Filed: 04/29/2003
• Issued: 11/14/2006
• Est. Priority Date: 10/13/1995
• Status: Expired due to Fees

• Current Assignee: Medtronic Vascular, Inc. (Medtronic Plc)
• Original Assignee: Medtronic Vascular, Inc. (Medtronic Plc)
• Inventors: Machold, Timothy R., Banks, Thomas, Redmond, Russell J., Flaherty, J. Christopher, Makower, Joshua, Vidal, Claude A., Evard, Philip Christopher, Whitt, Jason Brian, Macaulay, Patrick Edward, Garibotto, John Thomas
• Primary Examiner(s): Isabella, David J
• Application Number:
  US10/425,543
• Publication Number:
  US 20040059280A1
• Time in Patent Office: 1,295 Days
• Field of Search: 128/898, 604/7, 604/49, 604/53, 604/89, 604/96, 604/101, 604/104, 604191-194, 604/16
• US Class Current: 128/898
• CPC Class Codes: A61B 1/3137 for examination of the interior of blood vessels
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/00491 Surgical glue applicators surgical adhesives A61L24/00; two-component delivery syringes A61M5/19
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• 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 17/12045 double occlusion, e.g. during anastomosis
• CPC Class Codes: A61B 17/12109 in a blood vessel
• CPC Class Codes: A61B 17/12131 characterised by the type of occluding device
• CPC Class Codes: A61B 17/12136 Balloons
• CPC Class Codes: A61B 17/320725 with radially expandable cutting or abrading elements A61B17/32075 takes precedence
• 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 17/3496 Protecting sleeves or inner probes; Retractable tips for protecting body piercing guide needles A61M25/0612
• 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 18/1445 at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
• CPC Class Codes: A61B 18/1477 Needle-like probes
• 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 18/24 with a catheter A61B18/26, A61B18/28 take 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 2017/003 : Steerable
• CPC Class Codes: A61B 2017/00331 : with preformed bends
• CPC Class Codes: A61B 2017/00504 : Tissue welding
• CPC Class Codes: A61B 2017/00637 : for sealing trocar wounds through abdominal wall
• CPC Class Codes: A61B 2017/00668 : the implement being a tack or a staple
• CPC Class Codes: A61B 2017/0641 : having at least three legs as part of one single body
• 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 2017/12127 : Double occlusion, e.g. for creating blood-free anastomosis site
• CPC Class Codes: A61B 2017/22038 : with a guide wire
• 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 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 2017/3488 : Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00404 : Blood vessels other than those in or around the heart
• CPC Class Codes: A61B 2018/00869 : Phase
• CPC Class Codes: A61B 2018/1425 : Needle
• CPC Class Codes: A61B 2018/1475 : Electrodes retractable in or deployable from a housing
• CPC Class Codes: A61B 2090/378 : using ultrasound
• CPC Class Codes: A61B 2090/3925 : ultrasonic
• CPC Class Codes: A61B 2090/3929 : Active markers
• CPC Class Codes: A61B 2090/3958 : emitting a signal
• CPC Class Codes: A61B 90/361 : Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61B 90/40 : Apparatus fixed or close to patients specially adapted for providing an aseptic surgical environment
• CPC Class Codes: A61F 2/07 : Stent-grafts
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices
• CPC Class Codes: A61F 2/90 : 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 2002/30079 : magnetic
• CPC Class Codes: A61F 2002/8486 : provided on at least one of the ends
• CPC Class Codes: A61F 2210/009 : magnetic
• CPC Class Codes: A61M 2025/0076 : Unidirectional valves
• CPC Class Codes: A61M 2025/0096 : being laterally outward extensions or tools, e.g. hooks or fibres
• CPC Class Codes: A61M 2025/018 : Catheters having a lateral opening for guiding elongated means lateral to the catheter
• CPC Class Codes: A61M 2025/1052 : for temporarily occluding a vessel for isolating a sector

Abstract

Methods, devices, and systems for a) revascularization and/or b) performing other medical procedures at vascular or non-vascular intracorporeal locations within a mammalian body. The methods generally comprise the formation of at least one extravascular passageway from a blood vessel to a vascular or non-vascular target location. In the revascularization methods the extravascular passageway is utilized for blood flow. In the medical procedure methods the extravascular passageway is utilized as a conduit for accessing or performing procedures at the vascular or non-vascular target location. Also disclosed are catheter devices and systems which are useable to form the extravascular passageways of the invention, as well as apparatus for modifying, maintaining and/or closing such extravascular passageways.

Claims

1. A method coronary revascularization in a mammalian heart having arteries and veins formed therein, said method comprising the steps of:

providing a passageway-forming catheter adapted to form an extravascular passageway between two blood vessels;

inserting said catheter into a peripheral blood vessel and advancing said catheter into a blood vessel of the heart;

utilizing said catheter to form at least one primary extravascular passageway between the blood vessel of the heart in which said catheter is positioned and another blood vessel of the heart, such that blood will flow from one of the blood vessels, through the extravascular passageway, and into the other blood vessel.

2. The method of claim 1 wherein said at least one passageway is formed between an artery of the heart and a vein of the heart such that blood from the artery will flow through at least one of said extravascular passageway(s) into the vein of the heart.

3. The method of claim 2 wherein arterial blood which as flowed from the artery of the heart into the vein of the heart is subsequently caused to flow through the vein so as to retroperfuse cardiac tissues through the cardiac venous vasculature.

4. The method of claim 3 wherein said arterial blood is caused to flow through the vein so as to retroperfuse cardiac tissue through the cardiac venous vasculature by blocking flow through the vein in an opposite direction, at a location adjacent an extravascular passageway.

5. The method of claim 2 wherein the method further comprises:

utilizing said catheter to form at least one secondary extravascular passageway from said vein of the heart to an artery of the heart such that arterial blood which has entered said vein of the heart will subsequently flow through said at least one secondary extravascular passageway and into an artery of the heart, so as to profuse cardiac tissues through the cardiac arterial vasculature.

6. The method of claim 1 wherein said method is carried out for the purpose of bypassing an obstructed, injured or disease-affected segment of an artery of the heart.

7. The method of claim 6 wherein said revascularization is performed in the heart of a mammal having a Circumflex Artery, a Great Cardiac Vein, an Anterior Interventricular Vein and a Left Anterior Descending Artery for the purpose of bypassing an obstructed, injured or disease-affected segment of the Circumflex Artery, wherein said method further comprises:

i. forming a primary extravascular passageway between the Left Anterior Descending Artery and the Anterior Interventricular Vein;

ii. forming a secondary extravascular passageway between the Great Cardiac Vein and the Circumflex Artery at a location downstream of the obstructed, injured or disease-affected segment thereof; and

,

iii. causing blood to flow from the Left Anterior Descending Artery through the primary extravascular passageway, through the Anterior Interventricular Vein into the Great Cardiac Vein, and through the secondary extravascular passageway into the Circumflex Artery, downstream of the obstructed, injured or disease-affected segment thereof.

8. The method of claim 7 wherein step iii is accomplished by blocking the lumen of the Anterior Interventricular Vein at a location adjacent the primary extravascular passageway.

9. The method of claim 8 wherein step iii is further accomplished by blocking the lumen of the Great Cardiac Vein at a location adjacent the secondary extravascular passageway.

10. The method of claim 6 wherein said revascularization is performed in the heart of a mammal having a Circumflex Artery, a Great Cardiac Vein, an Anterior Interventricular Vein, and a Left Anterior Descending Artery for the purpose of bypassing an obstructed, injured or disease-affected segment of the Left Anterior Descending Artery, wherein said method further comprises:

i. forming a primary extravascular passageway between the Circumflex Artery and the Great Cardiac Vein;

ii. forming a secondary extravascular passageway between the Anterior Interventricular Vein and the Left Anterior Descending Artery at a location downstream of the obstructed, injured or diseased-affected segment thereof; and

,

iii. causing blood to flow from the Circumflex Artery, through the primary extravascular passageway, through the Great Cardiac Vein into the Anterior Interventricular Vein, and through the secondary extravascular passageway into the Left Anterior Descending Artery downstream of the obstructed, injured or disease-affected segment thereof.

11. The method of claim 10 wherein step iii is accomplished by blocking the lumen of the Great Cardiac Vein at a location adjacent the primary extravascular passageway.

12. The method of claim 11 wherein step iii is further accomplished be blocking the lumen of the Anterior Interventricular Vein at a location adjacent the secondary extravascular passageway.