Endovascular devices and methods for exploiting intramural space

• US 9,308,019 B2
• Filed: 07/23/2013
• Issued: 04/12/2016
• Est. Priority Date: 09/12/2005
• Status: Active Grant

• Current Assignee: Boston Scientific Scimed, Inc. (Boston Scientific Corporation)
• Original Assignee: BridgePoint Medical, Inc. (Boston Scientific Corporation)
• Inventors: Kugler, Chad J., Olson, Matthew J., Atkinson, Robert E.
• Primary Examiner(s): Mehta, Bhisma
• Assistant Examiner(s): OSINSKI, BRADLEY JAMES
• Application Number:
  US13/948,646
• Publication Number:
  US 20130310868A1
• Time in Patent Office: 994 Days
• US Class Current: 1/1
• CPC Class Codes: A61B 17/00008 Vein tendon strippers tube strippers A61M1/83
• CPC Class Codes: A61B 17/22 Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for dilators A61M29/00
• CPC Class Codes: A61B 17/22031 Gripping instruments, e.g. forceps, for removing or smashing calculi A61B17/221 takes precedence
• 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 17/32037 for removing obstructions from inner organs or blood vessels, e.g. for atherectomy
• 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 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 2017/22034 for gripping the obstruction or the tissue part from inside
• CPC Class Codes: A61B 2017/22095 accessing a blood vessel true lumen from the sub-intimal space
• CPC Class Codes: A61B 2017/320044 Blunt dissectors
• CPC Class Codes: A61B 2017/320741 for stripping the intima or the internal plaque from a blood vessel, e.g. for endarterectomy
• CPC Class Codes: A61F 2/88 the wire-like elements formed as helical or spiral coils forming a net-like or mesh-like structure A61F2/90
• CPC Class Codes: A61M 2025/006 having a special surface topography or special surface properties, e.g. roughened or knurled surface
• 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 25/0032 characterized by at least one unconventionally shaped lumen, e.g. polygons, ellipsoids, wedges or shapes comprising concave and convex parts
• CPC Class Codes: A61M 25/0045 multi-layered, e.g. coated coating materials A61L29/08
• CPC Class Codes: A61M 25/0069 Tip not integral with tube
• CPC Class Codes: A61M 25/0152 with pre-shaped mechanisms, e.g. pre-shaped stylets or pre-shaped outer tubes
• CPC Class Codes: A61M 25/0194 Tunnelling catheters
• CPC Class Codes: A61M 25/104 : used for angioplasty

Abstract

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing a first intravascular device having a distal portion with a concave side, inserting the first device into the vascular lumen, positioning the distal portion in the vascular wall, and orienting the concave side of the distal portion toward the vascular lumen.

Claims

1. A method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein, the method comprising:

inserting a first intravascular device into the vascular lumen, the first intravascular device having a distal portion with a keying element;

positioning the distal portion of the first intravascular device in the vascular wall;

orienting the distal portion of the first intravascular device toward the vascular lumen; and

orienting a keyed distal portion of a re-entry device with respect to the keying element of the first device such that the re-entry device is oriented toward the vascular lumen;

wherein the keying element of the first intravascular device engages the keyed distal portion of the re-entry device to prevent relative rotation between the first intravascular device and the re-entry device.

2. The method of claim 1, wherein the distal portion of the first intravascular device includes a radial curve having a radius of curvature that is less than a radius of curvature of the vascular lumen.

3. The method of claim 2, wherein the keyed distal portion of the re-entry device includes a radial curve having a radius of curvature less than the radius of curvature of the vascular lumen.

4. The method of claim 1, wherein the distal portion of the first intravascular device includes a radial curve having a radius of curvature approximating a radius of curvature of the vascular lumen.

5. The method of claim 1, wherein positioning the distal portion of the first intravascular device comprises traversing the occlusion with the distal portion of the first intravascular device, and further comprising penetrating the vascular wall with the re-entry device toward the vascular lumen.

6. The method of claim 1, wherein the keyed distal portion of the re-entry device includes external surface features configured for engagement with surfaces along an internal lumen of the keying element.

7. The method of claim 1, wherein the keying element of the first intravascular device includes a non-circular lumen portion and the keyed distal portion of the re-entry device includes a non-circular portion configured to be positioned in the non-circular lumen.

8. The method of claim 1, further comprising:

advancing the re-entry device relative to the first intravascular device to penetrate the vascular wall with the re-entry device.

9. The method of claim 8, further comprising:

advancing the re-entry device into the vascular lumen distal of the first intravascular device.

10. A method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein, the method comprising:

inserting an intravascular device into the vascular lumen;

positioning a distal portion of the intravascular device in the vascular wall;

advancing the distal portion of the intravascular device distally within the vascular wall until the distal portion of the intravascular device is located beyond the occlusion;

advancing a re-entry device through a lumen of the intravascular device to penetrate the vascular wall with the re-entry device; and

advancing the re-entry device into the vascular lumen distal of the intravascular device;

wherein the intravascular device includes a keying element mating with a keyed distal portion of the re-entry device to prevent relative rotation between the intravascular device and the re-entry device.

11. The method of claim 10, wherein the keying element of the intravascular device includes a non-circular lumen portion and the keyed distal portion of the re-entry device includes a non-circular portion configured to be positioned in the non-circular lumen.

12. The method of claim 10, wherein the intravascular device includes an elongate tubular shaft and an enlarged distal tip secured to the elongate tubular shaft.

13. The method of claim 12, wherein the elongate tubular shaft defines a circular lumen portion of the lumen of the intravascular device and the enlarged distal tip defines a non-circular lumen portion of the lumen of the intravascular device in communication with the circular lumen portion of the elongate tubular shaft.

14. The method of claim 13, wherein the keying element of the intravascular device includes the non-circular lumen portion.

15. The method of claim 14, wherein the keyed distal portion of the re-entry device includes a non-circular portion configured to be positioned in the non-circular lumen.

16. A method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein, the method comprising:

inserting an intravascular device into the vascular lumen;

positioning a distal portion of the intravascular device in the vascular wall;

advancing the distal portion of the intravascular device distally within the vascular wall until the distal portion of the intravascular device is located beyond the occlusion;

mating a keyed distal portion of a re-entry device with a keying element of the intravascular device to prevent relative rotation between the intravascular device and the re-entry device; and

advancing the re-entry device out of the intravascular device to penetrate the vascular wall with the re-entry device with the keyed distal portion of the re-entry device mated with the keying element of the intravascular device.

17. The method of claim 16, wherein the keying element of the intravascular device includes a non-circular lumen portion and the keyed distal portion of the re-entry device includes a non-circular portion configured to be positioned in the non-circular lumen.

18. The method of claim 16, wherein rotational movement of the re-entry device relative to the intravascular device is prevented while advancing the re-entry device out of the intravascular device.

19. The method of claim 16, wherein the intravascular device includes an elongate tubular shaft having a circular lumen portion and a distal tip having a non-circular lumen portion in communication with the circular lumen portion of the elongate tubular shaft.