Methods for deploying stents in bifurcations

• US 8,771,342 B2
• Filed: 09/08/2009
• Issued: 07/08/2014
• Est. Priority Date: 11/04/1996
• Status: Expired due to Fees

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Inventors: Vardi, Gil
• Primary Examiner(s): Erezo, Darwin
• Assistant Examiner(s): STRANSKY, KATRINA MARIE
• Application Number:
  US12/555,501
• Publication Number:
  US 20090326634A1
• Time in Patent Office: 1,764 Days
• Field of Search: 623/1.11, 623/1.12, 623/1.19, 623/1.25, 623/1.3, 623/1.35, 623/1.49, 623/1.13, 623/1.14, 623/1.15, 623/1.23, 606191-198, 606/108
• US Class Current: 623/1.35
• CPC Class Codes: A61B 2017/00469 for insertion of instruments, e.g. guide wire, optical fibre
• CPC Class Codes: A61F 2/856 Single tubular stent with a side portal passage
• CPC Class Codes: A61F 2/954 for placing stents or stent-grafts in a bifurcation
• 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: A61M 2025/018 Catheters having a lateral opening for guiding elongated means lateral to the catheter
• CPC Class Codes: A61M 25/01 Introducing, guiding, advancing, emplacing or holding catheters A61M25/10 takes precedence
• CPC Class Codes: A61M 25/09 Guide wires
• CPC Class Codes: A61M 25/09041 Mechanisms for insertion of guide wires

Abstract

A method of deploying a stent in a bifurcation includes introducing two guidewires through the main vessel and using the two guidewires for guiding a dual lumen catheter carrying a stent first to an initial position proximal to the stent deployment position, retracting one wire, and projecting it from the catheter and through a side of the stent a branch guidewire into the second branch vessel, and then moving the catheter to the predetermined deployment position while guided by the main guidewire in the first branch vessel, and the branch guidewire in the second branch vessel. The stent is then expanded, and the catheter is removed with the stent remaining in its deployed position An alternative embodiment includes introducing one wire, advancing the system over the one wire and subsequently introducing the second wire.

Claims

1. A method of deploying a stent in a bifurcation of a main vessel which separates into first and second branch vessels, the method comprising:

first, inserting a first guidewire into the main vessel such that the first guidewire extends across the bifurcation and into the first branch vessel;

providing a stent delivery device including a main lumen for receiving the first guidewire, a branch lumen for receiving a second guidewire, and an expandable stent disposed thereon;

after inserting the first guidewire into the main vessel, inserting the second guidewire into the branch lumen of the stent delivery device such that a distal end of the second guidewire is adjacent to a distal end of the branch lumen;

after the second guidewire is inserted into the branch lumen, advancing the stent delivery device over the first guidewire through the main vessel to a position adjacent to the bifurcation;

without retracting the second guidewire, advancing the second guidewire through the distal end of the branch lumen and into the second branch vessel;

advancing the stent delivery device over the first guidewire and the second guidewire to a stent deployment position adjacent the bifurcation; and

radially expanding the stent with at least a proximal end of the stent extending into the main vessel.

2. The method of claim 1, wherein a distal end of said stent extends into the first branch vessel in the stent deployment position.

3. The method of claim 1, further comprising:

removing the stent delivery device.

4. The method of claim 3, wherein the stent delivery device further comprises an inflatable balloon around which the stent is positioned, and wherein the step of radially expanding the stent comprises inflating the balloon to radially expand the stent.

5. The method of claim 4, wherein the radial expansion of a proximal end and a distal end of the stent are done separately.

6. The method of claim 5, further comprising:

deflating the balloon; and

removing the balloon together with the stent delivery device.

15. The method of claim 1, wherein the second guidewire is not initially placed into the bifurcation, but is carried by the stent delivery device to the bifurcation during the step of advancing the stent delivery device over the first guidewire.

7. A method of deploying a stent in a bifurcation of a main vessel which separates into first and second branch vessels, the method comprising:

first, inserting a first guidewire into the main vessel such that the first guidewire extends across the bifurcation and into the first branch vessel;

providing a stent delivery device including a branch lumen for receiving the first guidewire, a main lumen for receiving a second guidewire, and an expandable stent disposed thereon, wherein the main lumen extends to a distal end of the stent delivery device;

after inserting the first guidewire into the main vessel, inserting the second guidewire into the main lumen of the stent delivery device such that a distal end of the second guidewire is adjacent to a distal end of the main lumen;

after the second guidewire is inserted into the main lumen, advancing the stent delivery device over the first guidewire through the main vessel to a position adjacent to the bifurcation; and

without retracting the second guidewire, advancing the second guidewire through the distal end of the main lumen and into the second branch vessel.

8. The method of claim 7 further comprising advancing the stent delivery device over the first guidewire and the second guidewire to a stent deployment position adjacent to the bifurcation.

9. The method of claim 8 wherein a distal end of said stent extends into the first branch vessel and a proximal end of the stent extends into the main vessel in the stent deployment position.

10. The method of claim 8 further comprising:

radially expanding the stent; and

removing the stent delivery device.

11. The method of claim 10, wherein the stent delivery device further comprises an inflatable balloon around which the stent is positioned, and wherein the step of radially expanding the stent comprises inflating the balloon to radially expand the stent.

12. The method of claim 11, wherein the radial expansion of a proximal end and a distal end of the stent are done separately.

13. The method of claim 12, further comprising:

deflating the balloon; and

removing the balloon together with the stent delivery device.

16. The method of claim 7, wherein the second guidewire is not initially placed into the bifurcation, but is carried by the stent delivery device to the bifurcation during the step of advancing the stent delivery device over the first guidewire.

14. A method of deploying a stent in a bifurcation of a main vessel which separates into first and second branch vessels, the method comprising:

first, inserting a first guidewire into the main vessel such that the first guidewire extends across the bifurcation and into one of the first branch vessel or the second branch vessel;

providing a stent delivery device including a main guidewire lumen, a branch guidewire lumen, and an expandable stent disposed thereon, wherein the main guidewire lumen extends to a distal end of the stent delivery device;

after inserting a first guidewire into the main vessel, inserting a second guidewire into either the main guidewire lumen or the branch guidewire lumen of the stent delivery device such that a distal end of the second guidewire is adjacent to a distal end of the respective lumen;

after the second guidewire is inserted into either the main guidewire lumen or the branch guidewire lumen, advancing the stent delivery device over the first guidewire through the main vessel to a position adjacent to the bifurcation;

without retracting the first guidewire or the second guidewire, advancing the second guidewire through the distal end of either the main guidewire lumen or the branch guidewire lumen and into the second branch vessel;

advancing the stent delivery device over the first guidewire and the second guidewire to a stent deployment position adjacent the bifurcation; and

radially expanding the stent with at least a proximal end of the stent extending into the main vessel.

17. The method of claim 14, wherein the second guidewire is not initially placed into the bifurcation, but is carried by the stent delivery device to the bifurcation during the step of advancing the stent delivery device over the first guidewire.