Systems and methods for directing and snaring guidewires

• US 7,316,655 B2
• Filed: 04/30/2002
• Issued: 01/08/2008
• Est. Priority Date: 10/11/1996
• Status: Expired due to Term

• Current Assignee: Medtronic Vascular, Inc. (Medtronic Plc)
• Original Assignee: Medtronic Vascular, Inc. (Medtronic Plc)
• Inventors: Kim, Steven W., Hayase, Motoya, Chang, John, Flaherty, J. Christopher, Makower, Joshua, Whitt, Jason, Garibotto, John
• Primary Examiner(s): Hindenburg; Max F.
• Assistant Examiner(s): SZMAL, BRIAN SCOTT
• Application Number:
  US10/136,929
• Publication Number:
  US 20020123698A1
• Time in Patent Office: 2,079 Days
• Field of Search: 600/585, 600/107, 600/434, 604/506, 604/104, 604/164.13, 604/264, 604/523, 604/272, 604/102.02, 604/9.5, 604/164.08, 604/535, 623/1.11, 623/1.35, 606/195, 606/194
• US Class Current: 600/585
• CPC Class Codes: A61B 17/00491 Surgical glue applicators surgical adhesives A61L24/00; two-component delivery syringes A61M5/19
• 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 17/12109 in a blood vessel
• CPC Class Codes: A61B 17/12136 Balloons
• CPC Class Codes: A61B 17/221 Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions surgical snare instruments A61B17/32056
• CPC Class Codes: A61B 17/32056 Surgical snare instruments for removing or smashing calculi A61B2017/2212; tonsillotomes A61B17/26
• 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 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 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes 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 2017/00504 Tissue welding
• 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 2017/22035 for retrieving or repositioning foreign objects
• CPC Class Codes: A61B 2017/22094 for crossing total occlusions, i.e. piercing
• CPC Class Codes: A61B 2017/2212 having a closed distal end, e.g. a loop
• 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 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 90/39 : Markers, e.g. radio-opaque or breast lesions markers
• CPC Class Codes: A61B 90/40 : Apparatus fixed or close to patients specially adapted for providing an aseptic surgical environment
• CPC Class Codes: A61F 2/064 : with special features to facilitate anastomotic coupling anastomosis of natural blood vessels A61B17/11
• CPC Class Codes: A61F 2/07 : Stent-grafts
• CPC Class Codes: A61F 2/90 : characterised by a net-like or mesh-like structure
• CPC Class Codes: A61F 2002/061 : provided with means for allowing access to secondary lumens
• CPC Class Codes: A61F 2002/30079 : magnetic
• CPC Class Codes: A61F 2002/825 : having longitudinal struts
• CPC Class Codes: A61F 2210/009 : magnetic
• CPC Class Codes: A61M 2025/0076 : Unidirectional valves
• CPC Class Codes: A61M 2025/0161 : wherein the distal tips have two or more deflection regions
• CPC Class Codes: A61M 2025/1052 : for temporarily occluding a vessel for isolating a sector
• CPC Class Codes: A61M 25/0105 : Steering means as part of the catheter or advancing means; Markers for positioning systems for detection of markers A61B
• CPC Class Codes: A61M 25/0133 : Tip steering devices

Abstract

Devices and methods for achieving directed placement of guidewires or other flexible rails over which other catheters or other devices may be introduced to a targeted location. A guidewire directing device includes a lumen extending between a proximal end and a distal peripheral opening for directing a guidewire laterally from the device, and may have a deflecting member with a predetermined deflection angle in the lumen adjacent the peripheral opening. A snaring device is also provided that includes one or more lumens through which a snare or other grasping member is directed for releasably capturing or coupling to a guidewire. The snaring and target guidewire devices may include cooperating end effectors for releasably coupling or securing the devices together. The devices may be used for directing, snaring and/or manipulating one or more guidewires between two blood vessels connected by an interstitial channel, for example, to “floss” a guidewire through the coronary arterial and venous systems between two percutaneous entry sites and/or to bypass a lesion in a vessel using proximal and distal interstitial channels communicating with an adjacent vessel.

Claims

1. A catheter for directing a guidewire substantially laterally with respect to a body passage within which the catheter is introduced, comprising:

an elongate member having proximal and distal ends, having a distal portion adapted for insertion within a body passage, and defining a longitudinal axis and an outer peripheral surface;

a first lumen extending proximally from a first axial opening in the distal end; and

a second lumen extending between the proximal end of the elongate member and a second lumen lateral opening in the distal portion proximate the distal end;

wherein the distal portion comprises an angled step tapering to a distal tip, the second lumen lateral opening being located on the angled step; and

a snaring member deployable from the second lumen lateral opening, said snaring member comprising a loop extending distally from the second lumen lateral opening and surrounding the distal portion of the elongate member such that as the snaring member is directed proximally and distally, the loop substantially engages and disengages, respectively, the outer surface of the elongate member.

2. The catheter of claim 1, wherein the second lumen lateral opening is located on the peripheral surface of the elongate member.

3. The catheter of claim 1, wherein the second lumen includes a deflection ramp adjacent the second lumen lateral opening.

4. The catheter of claim 1, wherein the first lumen has a peripheral opening proximate the first axial opening.

5. A system comprising a catheter according to claim 1, further in combination with a snaring member that is deployable from the second lumen lateral opening.

6. The system of claim 5, wherein the snaring member comprises a loop that is advanceable out of the second lumen lateral opening so as to surround the distal portion of the elongate member such that, as the snaring member is directed proximally and distally, the loop substantially engages and disengages, respectively, the outer surface of the elongate member.

7. A catheter for directing a device substantially laterally with respect to a body passage within which the catheter is introduced, comprising:

an elongate member having proximal and distal ends, having a distal portion adapted for insertion within a body passage, and defining a longitudinal axis and an outer peripheral surface;

first lumen extending between the proximal end of the elongate member and a lateral opening in the distal portion proximate the distal end; and

a snaring member comprising a loop extending distally from the lateral opening and surrounding the distal portion of the elongate member such that as the snaring member is directed proximally and distally, the loop substantially engages and disengages, respectively, the outer surface of the elongate member.

8. The catheter of claim 7, wherein the lateral opening is located on the peripheral surface of the elongate member.

9. The catheter of claim 7, wherein the lumen includes a deflection ramp adjacent the lateral opening.

10. The catheter of claim 7, wherein the distal portion comprises an angled step tapering to a distal tip, the lateral opening being located on the angled step.

11. The catheter of claim 7, further comprising a second lumen extending proximally from an axial opening in the distal end.

12. The catheter of claim 11, wherein the second lumen has a peripheral opening proximate the first axial opening.

13. The catheter of claim 11, wherein the snaring member comprises a looped wire having first and second ends extending proximally through the first and second lumens, respectively, to define the loop.

14. The catheter of claim 7, wherein the device comprises a guidewire, the snaring member configured for capturing the guidewire when the loop engages the outer surface of the elongate member.

15. The catheter of claim 7, wherein the loop is biased to assume an enlarged substantially circular configuration.

16. The catheter of claim 15, wherein the substantially circular configuration defines a predetermined diameter corresponding to a diameter of a lumen of a blood vessel, and wherein the distal portion of the elongate member has a diameter substantially smaller than the predetermined diameter.

17. The catheter of claim 7, wherein the distal portion comprises an angled step tapering to a distal tip, the lateral opening being located on the angled step.

18. A catheter for directing a guidewire substantially laterally with respect to a body passage within which the catheter is introduced, said catheter comprising:

an elongate member having proximal and distal ends, having a distal portion adapted for insertion within a body passage, and defining a longitudinal axis and an outer peripheral surface;

a first lumen extending proximally from a first axial opening in the distal end; and

a second lumen extending between the proximal end of the elongate member and a second lumen lateral opening in the distal portion proximate the distal end; and

a snaring member deployable from the second lumen lateral opening, said snaring member comprising a loop that is advanceable distally from the second lumen lateral opening so as to surround the distal portion of the elongate member such that, as the snaring member is directed proximally and distally, the loop substantially engages and disengages, respectively, the outer surface of the elongate member.

19. The catheter of claim 18, wherein the second lumen lateral opening is located on the peripheral surface of the elongate member.

20. The catheter of claim 18, wherein the second lumen includes a deflection ramp adjacent the second lumen lateral opening.

21. A catheter system for directing a guidewire substantially laterally with respect to a body passage within which the catheter is introduced, said catheter comprising:

an elongate member having proximal and distal ends, a distal portion adapted for insertion within a body passage, a longitudinal axis, an outer peripheral surface, a first lumen extending proximally from an axial opening in the distal end and a second lumen extending between the proximal end of the elongate member and an unobstructed second lumen lateral opening in the distal portion proximate the distal end;

wherein the first lumen also has a peripheral opening proximate the axial opening;

wherein a deflection ramp is located within the second lumen adjacent the second lumen lateral opening;

a guidewire having a distal end, the guidewire being advanceable through the second lumen such that the distal end of the guidewire will be deflected by the deflection ramp and will then advance out of the second lumen lateral opening; and

an orientation element located on a distal portion of the catheter, said orientation element being usable in conjunction with an imaging device to enable the user to adjust the rotational orientation of the catheter within the body such that the guidewire will advance toward an intended target location as the guidewire exits the second lumen lateral opening.

22. The catheter system of claim 21, wherein the second lumen lateral opening is located on the peripheral surface of the elongate member.