US20030023261A1 - Chronic total occlusion device with variable stiffness shaft - Google Patents

Abstract

The present invention relates generally to a device for adding stiffening support to a guidewire so as to enable the guidewire or device to pass through a chronic total occlusion. A method for passing a guidewire through a chronic total occlusion is also disclosed.

Description

FIELD OF THE INVENTION
• The present invention relates to devices for performing intravascular procedures. More particularly, the present invention relates to devices for adding support to a guidewire so that the guidewire may be passed through a chronic total occlusion.[0001]
BACKGROUND OF THE INVENTION
• The use of intravascular catheters has become an effective method for treating many types of vascular disease. In general, an intravascular catheter is inserted into the vascular system of the patient and navigated through the vasculature to a desired target site. Using this method, virtually any target site in the patient's vascular system may be accessed, including the coronary, cerebral, and peripheral vasculature. Examples of therapeutic purposes for intravascular catheters include percutaneous transluminal angioplasty (PTA) and percutaneous transluminal coronary angioplasty (PTCA).[0002]
• Intravascular catheters are commonly used in conjunction with a guidewire. A guidewire may be advanced through the patient's vasculature until it has reached a target location. Once in place, a catheter may be threaded onto the guidewire and urged distally until the distal end of the catheter reaches a target location.[0003]
• When in use, the guidewire enters the patient's vasculature at a convenient location and then is urged to a target region. The path taken by a catheter through the vascular system is often tortuous, requiring the guidewire to change direction frequently. In order for the guidewire to conform to a patient's tortuous vascular system, it is desirable that it be very flexible, particularly near the distal end.[0004]
• The guidewire will often confront a stenosis when passing through the vasculature. In addition, the stenosis may completely block the vessel as is the case with a chronic total occlusion. The success of the procedure often depends on the ability to insert the guidewire through the chronic total occlusion.[0005]
SUMMARY OF THE INVENTION
• The present invention pertains to a chronic total occlusion device that may add support to a guidewire so that the guidewire may pass through a chronic total occlusion. The chronic total occlusion device may comprise an outer tubular member having a proximal end, a distal end, and a lumen extending therethrough. The proximal end may be connectable to a manifold and the distal end may include a distal tip.[0006]
• An inner tubular member may be disposed within the lumen. The inner tubular member may comprise a proximal end, a distal end, and an inner lumen extending therethrough. The inner lumen may be adapted so that a guidewire may be disposed therein.[0007]
• An annular space may be formed between the outer tubular member and the inner tubular member. A stiffening member may be disposed within the annular space. The stiffening member may comprise a distal head and a proximal tail. The proximal tail may be more stiff than the distal head. In an exemplary embodiment, the stiffening member is movable relative to the outer tubular member. The manifold may comprise a means for controlling the stiffening member.[0008]
• The outer tubular member may further comprise an expandable region. The expandable region may further comprise a first region and a second region. The first region may include a first outside diameter. The second region may include a second outside diameter that, when expanded, is generally smaller than the outside diameter of a typical angioplasty balloon. According to this embodiment, the stiffening member may comprise inflation medium, liquid, or gas. Additionally, the manifold may include an inflation medium pump capable of pumping the inflation medium into the expandable region so that the chronic total occlusion device may add stiffness to the guidewire, dilate the vessel, anchor the device, or center the guidewire.[0009]
• The chronic total occlusion may further comprise a marker band. The marker band may be disposed proximal of the distal tip. Alternatively, the marker band may be disposed at the distal tip.[0010]
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a side view of a chronic total occlusion device according to a preferred embodiment of the invention disposed within a vessel;[0011]
• FIG. 2 is a cross sectional view of a chronic total occlusion device according to a preferred embodiment of the invention;[0012]
• FIG. 3 is a cross sectional view of an alternate embodiment of the chronic total occlusion device shown in FIG. 2;[0013]
• FIG. 4 is a cross sectional view of a second alternate embodiment of the chronic total occlusion device shown in FIG. 2;[0014]
• FIG. 5 is a cross sectional view of an alternate chronic total occlusion device according to a preferred embodiment of the invention;[0015]
• FIG. 6 is a cross sectional view of an alternate embodiment of the chronic total occlusion device shown in FIG. 5; and[0016]
• FIG. 7 is a cross sectional view of a second alternate embodiment of the chronic total occlusion device shown in FIG. 5.[0017]
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• The following description should be read with reference to the drawings wherein like reference numerals indicate like elements throughout the several views. The detailed description and drawings illustrate example embodiments.[0018]
• FIG. 1 is a side view of a chronic total occlusion device. Along the length of a[0019]blood vessel10, a chronictotal occlusion12 may be present. Chronictotal occlusion12 is understood to be a partial or complete blockage ofblood vessel10 and may comprise a calcified lesion, an atherosclerotic lesion, a stenosis, etc. Chronictotal occlusion12 may occludeblood vessel10 so as to substantially prevent the passage of aguidewire14 therethrough. In order forguidewire14 to pass chronictotal occlusion12, it may need added stiffening support. Stiffening support forguidewire14 may include a chronictotal occlusion device16.
• Chronic[0020]total occlusion device16 may be used to stiffenguidewire14 in conjunction with a number of medical procedures. Chronictotal occlusion device16 may be used with a device or method that utilizes an intravascular guidewire. For example, chronictotal occlusion device16 may be used during percutaneous transluminal angioplasty (PTA), percutaneous transluminal coronary angioplasty (PTCA), atherectomy, or other vascular procedures.
• FIG. 2 is a detailed view of chronic[0021]total occlusion device16. Chronictotal occlusion device16 may comprise an outertubular member18 having aproximal end20, adistal end22, and alumen24 extending therethrough. The length of chronictotal occlusion device16 may be about equal to a typical angioplasty catheter. For example, chronic total occlusion device may be about 50-200 cm long.
• Outer[0022]tubular member18 may be comprised of materials including, but not limited to, metals, stainless steel, nickel alloys, nickel-titanium alloys, nitinol, thermoplastics, high performance engineering resins, fluorinated ethylene propylene (FEP), polymer, polyethylene (PE), polypropylene (PP), polyvinylchloride (PVC), polyurethane, polytetrafluoroethylene (PTFE), polyether-ether ketone (PEEK), polyimide, polyamide, polyphenylene sulfide (PPS), polyphenylene oxide (PPO), polysufone, nylon, or perfluoro(propyl vinyl ether) (PFA), and combinations thereof.
• Outer[0023]tubular member18 may be subdivided into aproximal segment26 and adistal segment28. According to this embodiment,proximal segment26 may be comprised of CRISTAMID® 11200, which is a semi-aromatic co-polyamide polymer commercially available from Atochem and is the subject of U.S. Pat. No. 4,898,896, hereby incorporated by reference.Distal segment28 may be comprised of polyether block amide (PEBA). Polyether block amide is commercially available from Atochem Polymers of Birdsboro, Pa., under the trade name PEBAX.Distal segment28 may have increased flexibility relative toproximal segment26.
• [0024]Proximal end20 may be connectable to amanifold30.Proximal end20 may be bonded tomanifold30 with an adhesive. Alternatively,proximal end20 may further comprise a luer adapter that is connectable tomanifold30.Distal end22 may include adistal tip32 that may be tapered. In an exemplary embodiment,distal tip32 may be comprised of Grilamid® (ELY 2694), which is commercially available from EMS-Chemie.
• An[0025]inner tubular member34 may be disposed withinlumen24. Innertubular member34 may be generally coaxial with outertubular member18. Innertubular member34 may comprise aproximal end36, adistal end38, and aninner lumen40 extending therethrough. Innertubular member34 may comprise an inner layer of high density polyethylene (HDPE, namely Marlex HHM 4903, commercially available from Phillips Petroleum), an outer layer of polyether block amide (PEBAX 7233), and a tie-layer of Plexar 380 to adhere the layers. Plexar is a known tie layer material that is a modified low density polyethylene.Inner layer34 may be manufactured by coextrusion of the above materials. Alternatively,inner tubular member34 may be comprised of materials similar to those disclosed above for outertubular member18.
• [0026]Inner lumen40 may be adapted so thatguidewire14 may be disposed therein.Inner lumen40 has an inside diameter appropriate to accommodate multiple embodiments ofguidewire14 having differing outside diameters. For example,inner lumen40 may accommodateguidewire14 having an outside diameter less than about 0.038-0.008 inches. Alternatively,inner lumen40 may accommodateguidewire14 having an outside diameter less than about 0.014 inches.Inner lumen40 may further comprise a lubricious liner. The lubricious liner may comprise polytetrafluoroethylene.
• Although[0027]inner lumen40 may have an inside diameter of appropriate size for many embodiments ofguidewire14, alteration of the inside diameter ofinner lumen40 may occur while maintaining the generally small profile of chronictotal occlusion device16 and, thus, the ability of outertubular member18 to pass through tight stenotic vasculature. According to this embodiment, the outside diameter of outertubular member18 may be less than about 0.200-0.500 inches.
• An[0028]annular space42 may be formed between outertubular member18 and innertubular member34. A stiffeningmember44 may be disposed withinannular space42. Stiffeningmember44 may comprise a number of materials similar to those listed above including metals and polymers. In addition, stiffeningmember44 may comprise a wire or stiffening sleeve.
• Stiffening[0029]member44 may further include adistal head46 and aproximal tail48.Proximal tail48 may be more stiff thandistal head46. Stiffeningmember44 may be movable relative to outertubular member18. Actuation of stiffeningmember44 can, thus, vary the stiffness of chronictotal occlusion device16 along the length of outertubular member18. For example, actuation of stiffeningmember44 may comprise movingdistal head46 towarddistal end22. Actuation may result in increased stiffness of chronictotal occlusion device16 neardistal end22. Increased stiffness may enable chronictotal occlusion device16 to provide stiffness support to guidewire14 so thatguidewire14 may pass through chronictotal occlusion12.
• [0030]Manifold30 may further comprise means for controlling stiffeningmember44. Means for controlling stiffeningmember44 may include an access port toproximal tail48. According to this embodiment, manifold30 may comprise an opening that may allow a clinician to grasp and moveproximal tail48 relative to outertubular member18. Additional means for controlling stiffeningmember44 may include a handle assembly comprising an actuation button, wheel, lever, or slidable object wherein actuation of the means for controlling stiffeningmember44 substantially results in movement of stiffeningmember44 relative to outertubular member18. Moreover, the coupling ofproximal tail48 tomanifold30 may add further support along the length ofguidewire14 during, for example, exchange of catheters overguidewire14 and for exchange of guidewires.
• In use, chronic[0031]total occlusion device16 or alternates thereof may be used in multiple ways to add support to guidewire14. For example, chronic total occlusion device may be passed overguidewire14 if chronictotal occlusion12 is encountered while steeringguidewire14 throughblood vessel10. According to this embodiment, guidewire14 may be steered throughblood vessel10 until encountering chronictotal occlusion12, chronictotal occlusion device16 may be passed overguidewire14, and chronic total occlusion device16 (withguidewire14 disposed in inner lumen40) may pass chronictotal occlusion12. During the step of encountering or passing chronictotal occlusion12, chronictotal occlusion device12 may pre-dilateblood vessel10 which may aid further dilation, for example, by an angioplasty catheter or stent. If desired, chronictotal occlusion device14 may be withdrawn fromguidewire14 until a further chronic total occlusion is encountered. Further, an alternative embodiment of chronictotal occlusion device16 comprises a single-operator-exchange catheter including a proximal guidewire port proximatedistal end22. The inclusion of the port may facilitate easier exchange of catheters alongguidewire14.
• Alternatively, guidewire[0032]14 may be disposed withininner lumen40 while chronictotal occlusion device16 is steered throughblood vessel10. According to this embodiment, chronic total occlusion device16 (withguidewire14 disposed in inner lumen40) may be steered throughblood vessel10 so as to more easily pass chronictotal occlusion12 when encountered. Similar to what is stated above, this method may be used in accordance with the single-operator-exchange embodiment disclosed above.
• FIG. 3 is a cross sectional view of an alternate embodiment of chronic[0033]total occlusion device16 shown in FIG. 2. Chronictotal occlusion116 is essentially similar to chronictotal occlusion device16 except it further comprises amarker band150.Marker band150 may be disposed neardistal tip32.
• [0034]Marker band150 may produce a relatively bright image on a fluoroscopy screen during a medical procedure. This relatively bright image may aid the user of chronictotal occlusion device16 in determining the location ofdistal end22 of outertubular member18. Marker band50 may comprise a number of radiopaque materials including, but not limited to, gold, platinum, and plastic material loaded with a radiopaque filler. Chronictotal occlusion device16 may further comprise additional marker bands or may comprise a marker band disposed at a different location. For example, chronictotal occlusion device16 may comprise a first marker band (e.g., marker band150) a fixed distance fromdistal end22 of outertubular member18. A second marker band may be disposed on outertubular member18 proximally a distance that is approximately equal to the distance the first marker band is fromdistal end22.
• FIG. 4 is a cross sectional view of a second alternate embodiment of chronic[0035]total occlusion device16 shown in FIG. 2. Chronictotal occlusion216 is essentially similar to chronictotal occlusion device16 except it further comprisesmarker band250 disposed atdistal tip32.Marker band250 may comprise a radiopaque additive that may be impregnated withindistal tip32. This method of disposingmarker band250 atdistal tip32 may help prevent or avoid weeping of the radiopaque materials into the body of a patient.
• FIG. 5 is a detailed view of an alternate chronic total occlusion device. Chronic[0036]total occlusion device316 is essentially similar to chronictotal occlusion device16 except that outertubular member318 further comprises anexpandable region352 in addition toproximal end320,distal end322, andlumen324 extending therethrough.Expandable region352 may comprise a balloon.Expandable region352 may be formed by alternatively processing outertubular member318. For example, alternative processing of outertubular member318 may include blow molding, changing dimensions, chemically changing, forming of differing materials including materials capable of self-collapsing after inflation, etc.
• Expandable[0037]region352 may further comprise afirst region354 and asecond region356.First region354 may include a firstoutside diameter360.Second region356 may include a secondoutside diameter358 that, when expanded, may be generally smaller than the outside diameter of a typical angioplasty balloon. Moreover, first outsidediameter360 may be generally smaller than secondoutside diameter358. Maintaining a generally smaller profile than a typical angioplasty balloon may allow chronictotal occlusion device316 to be steered through stenotic vasculature.
• Stiffening[0038]member344 may be disposed withinexpandable region352. Stiffeningmember344 may comprise inflation medium, liquid, or gas. According to this embodiment, stiffeningmember344 can be moved along outertubular member318 toexpandable region352.
• [0039]Annular space342 may be in fluid communication withexpandable region352.Manifold30 may further comprise means for controlling stiffeningmember344. Means for controlling stiffeningmember344 may include an inflation medium pump capable of pumping stiffeningmember344 intoexpandable region352. For example, manifold30 may include an inflation medium pump suitable for pumping inflation fluid intoexpandable region352.
• In use, chronic[0040]total occlusion device316 may be used substantially similar to chronictotal occlusion device16. Actuation of stiffeningmember344 may comprise expandingexpandable region352 by passing stiffeningmember344 into expandable region whenguidewire14 is disposed withininner tubular member34. Actuation of stiffeningmember344 may provide stiffening support to guidewire14. Passing stiffeningmember344 into expandable region may result in little or no expansion ofexpandable region352. According to this embodiment, actuation of stiffeningmember344 is understood to stiffen chronictotal occlusion device316 by adding tension to outertubular member318.Expandable region352 may, thus, comprise materials that are substantially resistant to expansion.
• FIG. 6 is a detailed view of an alternate embodiment of the chronic total occlusion device shown in FIG. 5. Chronic[0041]total occlusion416 is essentially similar to chronictotal occlusion device316 except it further comprises a marker band450. Marker band450 may be disposed neardistal tip32 or may be disposed proximal ofdistal tip32.
• FIG. 7 is a detailed view of a second alternate embodiment of the chronic total occlusion device shown in FIG. 5. Chronic[0042]total occlusion516 is essentially similar to chronictotal occlusion device316 except it further comprisesmarker band550 disposed atdistal tip32. Similar to what is disclosed above,marker band550 may comprise a radiopaque additive that may be impregnated withindistal tip32.
• Numerous advantages of the invention covered by this document have been set forth in the foregoing description. It will be understood, however, that this disclosure is, in many respects, only illustrative. Changes may be made in details, particularly in matters of shape, size, and arrangement of steps without exceeding the scope of the invention. The invention's scope is, of course, defined in the language in which the appended claims are expressed.[0043]

Claims (37)

What is claimed is:

1. A chronic total occlusion device, comprising:

an outer tubular member including a proximal end, a distal end, and a lumen extending therethrough;

an inner tubular member disposed within the lumen, the inner tubular member having an inner lumen;

an annular space between the outer tubular member and the inner tubular member; and

a stiffening member disposed within the annular space.

2. The device in accordance withclaim 1, wherein a manifold is disposed at the proximal end of the outer tubular member.

3. The device in accordance withclaim 2, wherein the manifold includes means for controlling the stiffening member.

4. The device in accordance withclaim 1, wherein the stiffening member further comprises a distal head and a proximal tail.

5. The device in accordance withclaim 4, wherein the stiffening member is movable relative to the outer tubular member.

6. The device in accordance withclaim 1, wherein the outer tubular member further comprises an expandable region.

7. The device in accordance withclaim 6, wherein the expandable region comprises a balloon.

8. The device in accordance withclaim 7, wherein the annular space is in fluid communication with the balloon.

9. The device in accordance withclaim 6, wherein the expandable region further comprises a first region having a first outside diameter and a second region having a second outside diameter.

10. The device in accordance withclaim 9, wherein the first outside diameter is less than the second outside diameter.

11. The device in accordance withclaim 9, wherein the stiffening member comprises a liquid.

12. The device in accordance withclaim 9, wherein the stiffening member comprises a gas.

13. A chronic total occlusion device, comprising:

an outer tubular member including a proximal end, a distal end, a lumen extending therethrough, and an expandable region having a first region having a first outside diameter, and a second region having a second outside diameter;

an inner tubular member disposed within the lumen, the inner tubular member having an inner lumen;

an annular space between the outer tubular member and the inner tubular member; and

a stiffening member disposed within the annular space.

14. The device in accordance withclaim 13, wherein a manifold is disposed at the proximal end of the outer tubular member.

15. The device in accordance withclaim 14, wherein the manifold includes means for controlling the stiffening member.

16. The device in accordance withclaim 13, wherein the stiffening member further comprises a distal head and a proximal tail.

17. The device in accordance withclaim 16, wherein the stiffening member is movable relative to the outer tubular member.

18. The device in accordance withclaim 13, wherein the expandable region comprises a balloon.

19. The device in accordance withclaim 18, wherein the annular space lumen is in fluid communication with the balloon.

20. The device in accordance withclaim 13, wherein the first outside diameter is less than the second outside diameter.

21. The device in accordance withclaim 13, wherein the stiffening member comprises a liquid.

22. The device in accordance withclaim 13, wherein the stiffening member comprises a gas.

23. A method for passing a guidewire through a chronic total occlusion, the method comprising the steps of:

placing a guidewire in a blood vessel proximate a chronic total occlusion;

providing a chronic total occlusion device, the chronic total occlusion device including an outer tubular member having a proximal end, a distal end, and a lumen extending therethrough; an inner tubular member disposed within the lumen and having an inner lumen; and an annular space between the outer tubular member and the inner tubular member;

passing the chronic total occlusion device over the guidewire such that the guidewire is disposed within the inner lumen; and

passing the guidewire through the chronic total occlusion.

24. The method in accordance withclaim 23, wherein the chronic total occlusion device further comprise a stiffening member disposed within the annular space.

25. The method in accordance withclaim 24, wherein the stiffening member further comprises a distal head and a proximal tail.

26. The method in accordance withclaim 24, wherein the stiffening member comprises a liquid.

27. The method in accordance withclaim 24, wherein the stiffening member comprises a gas.

28. The method in accordance withclaim 24, further comprising the step of actuating the stiffening member.

29. The method in accordance withclaim 28, wherein the step of actuating the stiffening member includes moving the stiffening member toward the distal end of the outer tubular member.

30. The method in accordance withclaim 23, wherein the outer tubular member further comprises an expandable region.

31. The method in accordance withclaim 30, wherein the expandable region comprises a balloon.

32. The method in accordance withclaim 31, wherein the annular space is in fluid communication with the balloon.

33. The method in accordance withclaim 30, wherein the expandable region further comprises a first region having a first outside diameter and a second region having a second outside diameter.

34. The method in accordance withclaim 33, wherein the first outside diameter is less than the second outside diameter.

35. The method in accordance withclaim 23, wherein the chronic total occlusion comprises a calcified lesion.

36. The method in accordance withclaim 23, wherein the chronic total occlusion comprises a stenosis.

37. The method in accordance withclaim 23, wherein the chronic total occlusion comprises an atherosclerotic lesion.

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