US20040143286A1 - Catheter with disruptable guidewire channel - Google Patents

Abstract

The present invention is a catheter device that includes a disruptable guidewire channel. The guidewire channel is configured to provide necessary trackability of the catheter along the guidewire during introduction of the catheter to a treatment site. Once treatment is completed, the guidewire channel can then be disrupted so as to free the guidewire from the catheter in situ. The apparatus of the present invention provides distinct advantages over existing over-the-wire and rapid exchange catheter introduction methods, including the ability to achieve much faster treatment implement exchanges, the ability to rapidly deliver multiple treatment implements in series, and the ability to maintain multiple treatment implements simultaneously at a treatment site using a single guidewire.

Description

BACKGROUND OF THE INVENTION
• 1. Field of the Invention[0001]
• The present invention relates to catheter systems for delivery of medical devices into a patient, and particularly to medical devices that are delivered to a treatment site using a guidewire.[0002]
• 2. Description of Related Art[0003]
• Minimally invasive (or “interventional”) medical procedures are commonly employed today to avoid the substantial effort and trauma inherent in traditional surgery. Instead of directly accessing a treatment site through surgical procedures, a physician will make a small incision into a remote vessel (e.g., a femoral artery) and guide the necessary tools to the treatment site using fluoroscopy or other visualization techniques. Access to the treatment site is first achieved using very low profile devices that can be “steered” through the various branches of vessels to the correct treatment location. Typically these initial small diameter devices will be a steerable guidewire or a small-diameter guiding catheter that is followed by insertion of a guidewire. Once in the correct position, treatment devices can then be attached to the guidewire and advanced to the treatment site along the guidewire like a train traveling along a track. Following treatment, each treatment device is then pulled out of the patient along the same guidewire to allow, if needed, further treatment devices to be advanced along the guidewire to the treatment site.[0004]
• This basic approach is now used in a wide variety of medical procedures, including internal vessel repairs (e.g., repairing aneurysms in the aorta or other vessels using grafts or stent-graft devices) and treating blockages in vessels (e.g., performing balloon angioplasty or thrombectomy, and stent or stent-graft placements). All of these procedures tend to be much faster and far less traumatic than comparable surgical treatments. As a result, there are a host of benefits by using these procedures, including: fewer medical professionals need to attend the procedures; the procedures can be completed more rapidly; the patient may need far less extensive anesthesia and, where appropriate, can be awake and cooperative during the procedure; and since the trauma of open surgery is avoided overall hospital stays are dramatically reduced (e.g., for the repair of an abdominal aortic aneurysm hospital stays can be reduced from over a week including intensive care to only a couple of days or less).[0005]
• Two basic categories of techniques are commonly used today to advance treatment apparatus to a treatment site along a guidewire. First, “over the wire” (OTW) techniques employ a long guidewire that extends far out of the patient's body. In the OTW procedures, each treatment device is mounted on a catheter that includes a guidewire lumen extending the entire length of the catheter. The physician threads each catheter completely over the length of the guidewire extending out of the patient and, while an assistant controls the tail end of the guidewire, the physician feeds the catheter to the treatment site. Following treatment, the entire catheter is then removed along the guidewire, again with the assistant controlling the tail end of the guidewire to keep it from moving out of position or touching the floor or other non-sterile areas. The OTW techniques have been widely practiced and provide very good trackability for the devices along the guidewire. However, these techniques require that the long tail end of the guidewire be controlled at all times, requiring at least one additional assistant throughout the procedure. Further, the threading of the entire length of the catheter along the guidewire can be somewhat difficult and time consuming. Moreover, limiting the speed with which procedures can be completed and the types of procedures that can be easily performed, these techniques require each treatment device to be completely retracted along the guidewire before a further treatment device can be advanced along the same guidewire to the treatment site.[0006]
• The second common category of techniques for advancing treatment apparatus to a treatment site is commonly referred to as “rapid exchange” techniques. In rapid exchange procedures a guidewire lumen is provided over only a relatively short distal length of the treatment catheter, having a guidewire port exiting the catheter shaft next to or a short distance back from the treatment device. In this manner a relatively short guidewire can be employed that does not extend far from the patient's body. The physician advances the catheter over the guidewire (through the guidewire lumen) and gains control of the proximal end of the guidewire where it exits the catheter near the catheter's distal end. The physician can then guide the catheter into position without the need of an assistant controlling an extra long guidewire tail. Examples of such devices are described in U.S. Pat. No. 4,762,129 to Bonzel and U.S. Pat. No. 5,040,548 to Yock. Although the rapid exchange techniques may sacrifice some trackability in use, these techniques can allow for faster threading of each treatment device and cost savings in the elimination of extra long guidewires and one assistant to control the guidewire tail during the procedure. However, in practice these techniques also require each treatment device to be completely retracted along the guidewire before a further treatment implement can be advanced along the guidewire to the treatment site.[0007]
• Other apparatus have been developed to provide some of the same benefits provided by the rapid exchange catheter techniques. For example, it has been suggested that the guidewire connect to the treatment catheter only at the distal tip of the guidewire, with a tube housing a guidewire lumen extending along the outside of the treatment device. Examples of these devices are described in U.S. Pat. No. 5,458,639 to Tsukashima et al. and U.S. Pat. No. 6,371,961 to Osborne et al. A similar device is taught in U.S. Pat. No. 6,394,995 to Solar et al. whereby an “advancement member” is provided attached to a treatment balloon; the advancement member includes a short tube at its far distal end forming a guidewire lumen. While these devices may deliver some of the same benefits of the conventional rapid exchange catheters, trackability may be a far greater problem since the guidewire is attached to the treatment catheter only at the very tip of the catheter. Additionally, depending upon the dimensions and stiffness of the tube housing the guidewire lumen (or, in the case of the Solar et al. device, of the “advancement member”), its presence on the outside of the treatment device may interfere with the proper operation of the treatment device. Finally, as was true with the other techniques discussed above, these devices would appear to require each treatment device to be completely retracted along the guidewire before a further treatment implement can be advanced along the guidewire to the treatment site.[0008]
• It is accordingly a purpose of the present invention to provide an improved apparatus for advancement of a catheter along a guidewire that can be loaded and operated on a relatively short guidewire by a single operator.[0009]
• It is a further purpose of the present invention for such an apparatus to provide a guidewire lumen that affords all necessary trackability while a treatment device is being advanced to a treatment site.[0010]
• It is still a further purpose of the present invention for such an apparatus to allow other treatment devices to be advanced along the same guidewire without prior removal of the first treatment device.[0011]
• These and other purposes of the present invention will become evident from review of the following description.[0012]
SUMMARY OF THE INVENTION
• The present invention is an improved catheter device that includes a disruptable guidewire channel. The guidewire channel is configured to provide necessary trackability of the catheter along the guidewire during introduction of the catheter to a treatment site. Once treatment is completed, the guidewire channel can then be disrupted so as to free the guidewire from the catheter in situ.[0013]
• In one embodiment of the present invention, it comprises a balloon and catheter assembly having an enlargeable balloon mounted on a catheter shaft. A sleeve is attached to the balloon forming a guidewire channel along at least a portion of the balloon. At an appropriate time, the sleeve may be disrupted to cause a guidewire placed within the sleeve to free from the balloon. The sleeve can be disrupted through a variety of means, including being formed from intentionally fragile material that will separate upon inflation of the balloon, having one or more separation lines (for example, perforations) pre-formed in the sleeve, having an attachment line between the sleeve and the balloon that is formed to split at an appropriate time, and having one of a variety of slots into which the guidewire can be placed and then remotely removed.[0014]
• The present invention may be further defined as a guidewire deliverable treatment implement comprising a sleeve attached to the implement forming a guidewire channel along at least a portion of the implement. Again, the sleeve is disruptable to cause a guidewire placed within the sleeve to free, in whole or in part, from the implement upon disruption of the sleeve. Treatment implements that may be employed with the present invention may include: fluid-inflatable balloons; mechanically expandable balloons; catheters; catheter systems; stent delivery systems; stent-graft delivery systems; embolic filters; occluders; and other such devices.[0015]
• The present invention may be still further defined as a medical device having a balloon configured for insertion within a patient's body directed along a guidewire and a guidewire channel attached to the balloon. The guidewire channel is formed from a material that maintains the guidewire close to the balloon during insertion and alters upon inflation of the balloon to separate the guidewire from the balloon upon subsequent deflation of the balloon. This separation of the guidewire from the balloon may take the form of various separation lines or other complete disruption means or may include a material that disrupts by distending away from the balloon so as to allow other devices to be advanced over the same guidewire past the balloon through the disrupted channel.[0016]
• The apparatus of the present invention provides distinct advantages over existing over-the-wire and rapid exchange catheter introduction methods, including the ability to achieve much faster treatment implement exchanges, the ability to rapidly deliver multiple treatment implements in series, and the ability to maintain multiple treatment implements simultaneously at a treatment site using a single guidewire. These advantages can be realized by the present invention because: the catheter does not have to be axially removed prior to advancement of another catheter on the same guidewire; the catheter can remain across an initial lesion for future touch up, while another catheter is advanced to treat a distal lesion; and the catheter allows treatment of multiple stenotic lesions at a bifurcation requiring only one guidewire, thus eliminating entanglement of guidewires that can occur when utilizing multiple guidewires.[0017]
DESCRIPTION OF THE DRAWINGS
• The operation of the present invention should become apparent from the following description when considered in conjunction with the accompanying drawings, in which:[0018]
• FIG. 1 is an isometric view of a balloon catheter incorporating one embodiment of a guidewire channel of the present invention;[0019]
• FIG. 2 is cross-section view of the balloon catheter and a guidewire channel along line[0020]2-2 of FIG. 1;
• FIG. 3 is an isometric view of the balloon catheter of FIG. 1, showing the balloon fully inflated and the guidewire channel disrupted;[0021]
• FIG. 4 is an isometric view of a balloon catheter incorporating a guidewire channel of the present invention with a stent mounted over the balloon catheter and guidewire channel;[0022]
• FIG. 5 is an isometric view of the balloon catheter and stent of FIG. 4, showing the balloon and stent fully expanded and the guidewire channel disrupted;[0023]
• FIG. 6 is a side view of the balloon catheter and stent of FIG. 4 positioned in a patient's body at the junction of two blood vessels shown in cross-section;[0024]
• FIG. 7 is a side view of the balloon catheter and stent positioned in the blood vessel as shown in FIG. 6, showing the balloon and stent fully expanded;[0025]
• FIG. 8 is a side view of the balloon catheter and stent positioned in the blood vessel as shown in FIG. 7, showing the balloon catheter deflated and the stent positioned fully expanded within the blood vessel;[0026]
• FIG. 9 is an isometric view of a second balloon catheter and stent being advanced along a guidewire following expansion of a first stent having been deployed on the same guidewire;[0027]
• FIG. 10 is an isometric view of a balloon catheter incorporating another embodiment of a guidewire channel of the present invention;[0028]
• FIG. 11 is an isometric view of the balloon catheter of FIG. 10, showing the balloon fully inflated and the guidewire channel disrupted;[0029]
• FIG. 12 is an isometric view of a balloon catheter incorporating still another embodiment of a guidewire channel of the present invention;[0030]
• FIG. 13 is an isometric view of the balloon catheter of FIG. 12, showing the balloon fully inflated and the guidewire channel disrupted through distension;[0031]
• FIG. 14 is an isometric view of the balloon catheter of FIG. 13, showing the balloon deflated and the guidewire channel remaining disrupted through distension;[0032]
• FIG. 15 is an isometric view of still another embodiment of the present invention comprising multiple separate guidewire channels;[0033]
• FIG. 16 is an isometric view of another embodiment of a balloon catheter of the present invention, employing a guidewire channel along with catheter tip including a guidewire centering groove;[0034]
• FIG. 17 is an isometric view of the balloon catheter of FIG. 16, showing the balloon fully inflated, the guidewire channel disrupted, and the guidewire separated from the centering groove in the catheter tip;[0035]
• FIG. 18 is an isometric view of a further embodiment of a balloon catheter of the present invention comprising a disruptable channel formed in the balloon itself and employing a catheter tip with a guidewire centering groove;[0036]
• FIG. 19 is an isometric view of the embodiment of FIG. 18, showing the balloon fully inflated, releasing the guidewire from the channel formed in the balloon, and the guidewire separated from the centering groove in the catheter tip;[0037]
• FIG. 20 is an isometric view of the embodiment of FIG. 18 including a stent mounted over the balloon;[0038]
• FIG. 21 is an isometric view of a further embodiment of the present invention employing a guidewire channel on a mechanical balloon;[0039]
• FIG. 22 is an isometric view of a still further embodiment of the present invention employing a guidewire channel with perforated tear release;[0040]
• FIG. 23 is an isometric view of another further embodiment of the present invention employing a guidewire channel with a slit release;[0041]
• FIG. 24 is an isometric view of still another embodiment of the present invention employing a guidewire channel that has a slot allowing for rotational release;[0042]
• FIG. 25 is a side view of a stent placement in a branched vessel following the procedure illustrated in FIGS. 6 through 8 with the guidewire repositioned into the branch vessel through the interstices of the stent;[0043]
• FIG. 26 is a side view of the stent placement of FIG. 25 showing a second balloon catheter of the present invention being advanced along the guidewire;[0044]
• FIG. 27 is a side view of the stent placement of FIG. 26 showing the stent and balloon catheter positioned within the branch vessel;[0045]
• FIG. 28 is a side view of the stent placement of FIG. 27 showing the stent and balloon catheter fully inflated within the branch vessel;[0046]
• FIG. 29 is a side view of the stent placement of FIG. 28 showing both the balloon in the main vessel and the balloon in the side vessel fully inflated;[0047]
• FIG. 30 is an isometric view of another embodiment of the present invention comprising a further example of a disruptable channel formed from the external surface of the balloon itself, having a guidewire retainer within the balloon, and employing a catheter tip with a guidewire centering groove;[0048]
• FIG. 31 is an isometric view of the embodiment of FIG. 18, showing the balloon fully inflated, releasing the guidewire from the channel formed in the balloon, and the guidewire separated from the centering groove in the catheter tip;[0049]
• FIG. 32 is a cross section view along line[0050]32-32 of FIG. 30;
• FIG. 33 is a cross section view along line[0051]33-33 of FIG. 31;
• FIG. 34 is an isometric view of one embodiment of a guidewire retainer for use in the embodiments of FIGS. 30 through 33;[0052]
• FIG. 35 is an isometric view of another embodiment of a guidewire retainer for use in the embodiments of FIGS. 30 through 33;[0053]
• FIG. 36 is an isometric view of still another embodiment of the present invention comprising another example of a disruptable channel formed in the balloon itself, having a guidewire retainer placed within the balloon, employing a catheter tip with a guidewire centering groove, and employing a disruptable channel in the catheter tube proximal to the balloon;[0054]
• FIG. 37 is an isometric view of the embodiment of FIG. 18, showing the balloon fully inflated, releasing the guidewire from each of the balloon, the centering groove in the catheter tip, and the disruptable channel in the catheter tube;[0055]
• FIG. 38 is a cross section view along line[0056]38-38 of FIG. 36;
• FIG. 39 is a cross section view along line[0057]39-39 of FIG. 37;
• FIG. 40 is an isometric view of a further embodiment of a catheter including a disruptable channel of the present invention;[0058]
• FIG. 41 is a side view of yet another guidewire channel of the present invention wherein the guidewire channel is formed in the wall of the balloon;[0059]
• FIG. 42 is a cross section view along line A-A of FIG. 41 showing one embodiment of a guidewire channel that can be formed in the wall of the balloon;[0060]
• FIG. 43 is an enlarged sectional view of the guidewire channel of FIG. 42;[0061]
• FIG. 44 is a cross section view along line A-A of FIG. 41 showing another embodiment of a guidewire channel that can be formed in the wall of the balloon;[0062]
• FIG. 45 is an enlarged sectional view of the guidewire channel of FIG. 44;[0063]
• FIG. 46 is a cross section view along line A-A of FIG. 41 showing still another embodiment of a guidewire channel that can be formed in the wall of the balloon; and[0064]
• FIG. 47 is an enlarged sectional view of the guidewire channel of FIG. 46.[0065]
DETAILED DESCRIPTION OF THE INVENTION
• The present invention is an improved apparatus for delivery of an interventional device along a guidewire to a remote treatment site in a patient's body.[0066]
• As the terms “interventional” or “minimally invasive” devices or procedures are used herein they are intended to encompass any device or procedure whereby a medical treatment implement is delivered to a treatment site by use of wires and/or tubes threaded through vessels or other body passageways accessed remotely. Such devices may include those employed in: balloon angioplasty; thrombectomy; stent, graft, or stent-graft placement; embolic filter device placement; remote diagnostic procedures, such as those employing fiber optic cameras, ultrasound monitoring, MRI monitoring, x-ray monitoring, etc.; remote therapeutic procedures, such as those employing cutting blades, lasers, heat application, cold application, radiation, drug delivery, etc.; and any other similar devices or procedures now known or later developed. Currently such interventional procedures are employed in large and small blood vessels, in other vessels in the body, such as in the bile duct, as well as in the respiratory, digestive, reproductive, and other body systems. As the term “patient” is used herein it is intended to encompass both humans and animals.[0067]
• As the term “guidewire” is used herein it is intended to encompass any device that provides a track for guiding medical implements to a treatment site in a minimally invasive procedure. Such devices may include straight, coiled, braided, coated, or other forms of wires, various tubular devices, such as catheter tubes and the like, or any other form of similar elongated device.[0068]
• Referring to the illustrations, FIGS. 1 and 2 show one embodiment of a[0069]guidewire channel30 of the present invention. Theguidewire channel30 comprises asleeve32 attached to a treatment implement34, in this case anexpandable balloon34, mounted on acatheter shaft36. Thecatheter shaft36 includes adistal end38 and a proximal end (not shown) extending out of the patient's body. Theguidewire channel30 is proportioned to slidably receive aguidewire40 therein. Thecatheter shaft36 should be stiff enough to allow theballoon34 to be advanced along theguidewire40 by the physician pushing on that portion of thecatheter shaft36 extending outside of the patient's body.
• If the catheter tube alone does not provide sufficient longitudinal stiffness, a[0070]reinforcement wire41 or similar support member may be incorporated into thecatheter shaft36 to aid in its pushability. The support member can be combined with the catheter in a variety of ways, including being attached distally to the catheter shaft distal to the balloon, being attached to the catheter shaft proximal to the balloon, or being unattached to the catheter shaft distally. In an unattached configuration, the support member can provide pushability when held by compressive forces of a stent mounted over the guidewire or similar constraining means. The support member can be attached proximally, such as to the catheter shaft or the hub.
• It is important that the treatment implement tracks closely along the guidewire while the catheter is being advanced to a treatment site in a body. This is particularly important when a treatment site is in small vessels, such as coronary arteries, that may have numerous branch vessels located nearby. As such, the guidewire channel should be proportioned to keep the treatment implement closely aligned with the guidewire during device advancement through the body while not overly constricting movement of the treatment implement along the guidewire. However, the present inventor has realized that once the treatment implement is correctly positioned within the treatment site and treatment has occurred, there is no reason why the treatment implement must remain on the guidewire for its subsequent removal from the body.[0071]
• As such, the[0072]guidewire channel30 of the present invention includes means to “disrupt” the channel at an appropriate time so as to separate the treatment implement34 from theguidewire40. In the embodiment illustrated in FIGS. 1 and 2, such means42 comprises a separation line comprising a line of perforations formed along the length of thesleeve32. As is shown in FIG. 3, when theballoon34 is expanded, thesleeve32 disrupts along the separation line, freeing theguidewire40 from the constraint of the guidewire channel. Thesleeve32 can occupy all or a portion of the balloon circumference.
• In this manner, the[0073]guidewire channel30 provides the necessary guidance while the treatment implement is being advanced into the body, but effectively disappears when guidance is no longer required so that the treatment implement can be removed independently of the guidewire. Unlike previous interfaces between catheters and guidewires, in situ separation of a first treatment implement from the guidewire immediately makes the guidewire available for the advancement of further treatment implements to the treatment site or to another adjacent or distal treatment site. This provides the physician with numerous options that are not currently available, such as allowing a second treatment implement to be advanced along the guidewire while a first treatment implement is either left in place or is being simultaneously removed, and/or allowing multiple treatment implements to be mounted in series on a single guidewire, with each advanced and used without the need to immediately and completely remove the previous treatment device.
• It should be evident that this construction circumvents the need for a long guidewire and extra medical personnel required with OTW catheters, while permitting far easier and quicker catheter exchanges than are possible with current so-called “rapid exchange” catheter systems.[0074]
• For most embodiments of the present invention, the[0075]sleeve32 should be formed from a relatively thin material that is selected and/or treated to disrupt at the appropriate time upon inflation of theballoon34. A sleeve of the present invention may be constructed from a wide variety of materials, including PTFE, expanded PTFE, polyamide, polyether block copolymers and other copolymers, polyurethane, ethylene vinyl acetate (EVA), polyvinylchloride (PVC), poly(ethylene terephthalate) (PET), PETG, polyethylene, silicone, latex, etc., as well as composites or various combinations thereof. The sleeve can be attached to virtually any form of balloon material, including balloons made from any of the above listed materials. The balloon material may be elastic or inelastic, and compliant, non-compliant, or semi-compliant. One suitable balloon material that may be used with the present invention comprises a composite balloon of expanded PTFE and elastomer, such as the balloons described in U.S. Pat. Nos. 5,752,934, 5,868,704, 6,120,477, all to Campbell et al.
• Attachment of the sleeve to the balloon may take any suitable form, such as through adhesive, heat welding, ultrasonic welding, or other bonding method. The sleeve material should be thermally compatible with the balloon material if heat bonding is the means of attachment. The preferred sleeve material should have minimal thickness of less than about 0.003 inches (about 0.08 mm), and more preferably a thickness of between about 0.001 to about 0.002 inches (about 0.02 to 0.05 mm). A minimal thickness of the sleeve is preferred in that it is desirable that the guidewire channel not interfere with the normal operation of the treatment implements.[0076]
• As the term “sleeve” is used herein, it is intended to encompass any configuration of material that forms a channel through which a guidewire will be retained in close proximity to a catheter shaft during device advancement through a body while allowing the catheter shaft to slide relative to the guidewire. A sleeve of the present invention may comprise one or more strips of material that is attached to a balloon or other treatment implement, or it may comprise one or more tubes of material that surrounds the balloon or other treatment implement, or it may comprise a guidewire retainer inside a balloon. Regardless of configuration, the sleeve of the present invention should provide a guidewire channel that is “disruptable.”[0077]
• As is explained and illustrated in greater detail below, as the terms “disrupt” or “disruptable” are used in reference to the guidewire channels of the present invention they are intended to encompass any guidewire channel that breaks, separates, distends, or otherwise releases the guidewire from a treatment implement to allow another treatment implement to be advanced along the same guidewire without removal of the prior treatment implement. Disruptable guidewire channels of the present invention may include ones that are attached to the balloon material, integral with the balloon material, or folded within the balloon material.[0078]
• FIGS. 4 and 5 illustrate how the above-described device may be used to deliver a deployable device, such as a stent. As is shown in FIG. 4, a[0079]stent44 may be mounted over the previously describedballoon34 andguidewire channel30 of the present invention. In this embodiment the guidewire40 passes through theguidewire channel30 under thestent44. FIG. 5 shows that upon inflation of theballoon34, thestent44 will expand to its deployed diameter while theguidewire channel30 disrupts beneath thestent44. Once theballoon34 is deflated, theguidewire40 will be separated from the balloon, allowing removal of thecatheter36 independent of the guidewire.
• FIGS. 6 through 8 demonstrate the procedure for deploying the construct of FIGS. 4 and 5 in a blood vessel. FIG. 6 shows the balloon catheter[0080]36 (incorporating theguidewire channel30 of the present invention) andstent44 of FIG. 4 positioned in a patient's body at the junction of amain vessel46 and abranch vessel48. FIG. 7 shows theballoon34 andstent44 fully expanded in themain vessel46, with theguidewire channel30 disrupted underneath thestent44. FIG. 8 shows theballoon34 fully deflated and thestent44 positioned fully expanded within themain vessel46. Theguidewire40 is now completely separated from theballoon34 andcatheter36.
• Once the[0081]guidewire40 is separated from theballoon34, additional devices can then be advanced on theguidewire40 in order to accomplish further treatments. For example, FIG. 9 shows a second balloon34bdevice of the present invention being advanced over theguidewire40 with the original balloon device34aleft in place to accomplish further treatments. In this instance, two stents44a,44bmay be deployed end-to-end (or overlapping) to address an extended defect in a vessel, with both balloons34a,34bkept in their original deployment positions to facilitate final “touch up” of stent placement prior to removal of the balloons.
• In another embodiment of the present invention, a second stent can be advanced even further distal to the first stent in order to treat another defect. This problem can present itself when fluoroscopy fails to detect the second distal defect prior to treatment of the first defect. Maintaining the first first implement across the first defect allows subsequent treatment (for instance, further distension of the first stent) to occur after treating the second distal defect.[0082]
• A further embodiment of the present invention is shown in FIGS. 10 and 11. In this embodiment the[0083]guidewire channel30 is formed from asleeve32 that has a separation line comprising an intentionallyloose attachment line50 to theballoon34. When the balloon is inflated, as is shown in FIG. 11, theloose attachment line50 will separate from theballoon34, freeing theguidewire40. Loose attachment of thesleeve32 to theballoon34 may be accomplished through a variety of means, including use of weak adhesive, discontinuously applied adhesion points, perforations, weak sleeve material along the attachment line, weak weld (e.g., weak heat bond), etc.
• A further variation on the present invention is illustrated in FIGS. 12 through 14. In this embodiment the[0084]guidewire channel30 comprises asleeve32 of distensible material that expands along with theballoon34 and then has little or no recoil to its originaldimensions following balloon34 deflation. Although this configuration does not completely separate the guidewire40 from theguidewire channel30 following deployment, theguidewire channel30 is still disrupted in that other devices can be advanced past the deflatedfirst balloon34 through the distended sleeve material. Suitable distensible material for use in this embodiment may include any material that can be distended beyond its elastic limit so as to present permanent plastic deformation.
• A further embodiment of the present invention is shown in FIG. 15. In this embodiment, multiple[0085]separate guidewire channels30a,30bare attached to the treatment implement34. Each of theguidewire channels30a,30bmay include one or more of the previously described disruption means so as to free the guidewire40 from the treatment implement34 at the appropriate time. This embodiment may be preferable under certain circumstances where it is desirable to further limit the amount of material comprising the guidewire channel. It should be evident that this embodiment may be practiced with two, three, four, five, or moreseparate guidewire channels30. Additionally, it should be understood that the separate guidewire channels of this embodiment may be of dimensions and properties identical to each other, or may differ from each other in dimensions, materials, attachment means, disruption means, and/or other properties.
• FIGS. 16 and 17 illustrate another embodiment of the present invention that employs both a[0086]disruptable guidewire channel30 attached to the treatment implement34 and aunique catheter tip56. Thedisruptable guidewire channel30 may be of any other forms described herein. Thecatheter tip56 includes aguidewire centering groove58 therein that is adapted to receive and retain aguidewire40 in sliding fit during device loading and advancement to a treatment site. The centeringgroove58 provides an additional anchorage for the guidewire to the treatment implement during device advancement and may be used to improve the trackability and crossability of the device. The centeringgroove58 is proportioned to release the guidewire40 from thetip56 when the treatment implement34 is expanded, as is shown in FIG. 17. Preferably thetip56 and centeringgroove58 are formed from the same or similar material as the balloon or catheter shaft material, such as thermoplastic material used in medical devices (e.g., polyamide, polyurethane, PTFE, polyethylene, EVA, PVC, etc.).
• A similar application of the present invention is shown in FIG. 18. In this embodiment, a[0087]disruptable channel60 is formed from the external surface of theballoon34 itself. Again, atip56 with a centeringgroove58 is employed to aid inguidewire40 attachment, trackability and crossability during device advancement. As is shown in FIG. 19, when theballoon34 is expanded, thedisruptable channel60 disappears, releasing theguidewire40 from attachment to theballoon34. Theguidewire40 will likewise separate from the centeringgroove58.
• FIG. 20 illustrates how the embodiment of FIGS. 18 and 19 can be used to deliver a[0088]deployable device44. Thedisruptable channel60 should be formed of sufficient dimensions and structural integrity so that thedeployable device44 can be adequately attached to theballoon34 without hindering the proper sliding motion of theguidewire40 through thedisruptable channel60 during device advancement.
• FIG. 21 shows how the present invention may be adapted to be used with other treatment apparatus beyond inflatable balloons. In this embodiment, a[0089]guidewire channel30 of the present invention is attached to amechanical expansion device62, adapted to expand upon mechanical actuation instead of introduction of fluid pressure. Other treatment implements that may benefit from use with a guidewire channel of the present invention may include, without limitation: other fluid-inflatable balloons; mechanically expandable balloons; catheters; catheter systems; stent delivery systems; stent-graft delivery systems; embolic filters; occluders; and other such devices.
• FIGS. 22 through 24 illustrate embodiments of the present invention that can release from the guidewire without need for an inflation device to disrupt the sleeve.[0090]
• FIG. 22 demonstrates that the[0091]guidewire channel30 of the present invention may be formed from atubular sleeve32 that completely surrounds the treatment implement34 and includes atear line42. In this embodiment, the sleeve is slidable relative to a coaxial underlying catheter shaft36 (for instance, thetubular sleeve32 may extend along the entire length of thecatheter36 to allow the sleeve and the catheter to be moved relative to one another). If an inflatable member is not employed, anenlarged bulb member63 can be mounted on thecatheter shaft36. By actuating thecatheter shaft36 relative to the tubular sleeve32 (by either pulling the catheter or pushing the tubular sleeve, or both), thebulb member63 can disrupt thetear line42, freeing theguidewire40 from theguidewire channel30. Additionally, this embodiment further demonstrates that theguidewire40 does not have to traverse the entire length of thesleeve32, but may be adapted to exit thesleeve32 through aport64 provided along its length. In this manner, thesleeve32 does not have to tear along its entire length in order to release theguidewire40.
• FIG. 23 illustrates another disruption means for use with the present invention. In this embodiment the[0092]guidewire channel30 comprises atubular sleeve32 formed from a resilient material with aresealable slit68 and anexit port70. An inner member contains a groove or passageway66 extending from the distal tip and terminating at an outermember exit port70. Aguidewire40 is fed through the passageway66 at the time of device introduction. At the time of deployment, the resilient material of thesleeve32 will part along theslit68, releasing the guidewire from the passageway66. Proximal displacement (pulling) of the outer member, or distal displacement (pushing) of the inner member, or some combination of the two, will release the guidewire.
• Still another embodiment of the present invention is shown in FIG. 24. In this embodiment, the[0093]guidewire channel30 is formed from asleeve32 having arotational slot72 formed therein. Theguidewire40 can be mounted into the channel by threading it through thesleeve32 within agroove75 of the inner member and outport74, or by positioning theguidewire40 along the length of theslot72 and then pressing the guidewire40 into the slot while thesleeve32 is rotated to align theguidewire40 within thesleeve32 and exit thesleeve32 throughport74. Thesleeve32 in this embodiment may be formed from a disruptable material, as previously described, or the guidewire can be released from theguidewire channel30 by rotating thesleeve32 at the appropriate time to align thegroove75 with theslot72 and allow the guidewire to “pop” free from theslot72.
• Embodiments of the present invention that can be utilized without a balloon, such as those illustrated in FIGS. 22 through 24, have numerous possible applications, including without limitation, use with self-expanding stents, embolic filter devices, septal defect occlusion devices, etc.[0094]
• As has been noted, among the advantages of the present invention is the fact that a physician is provided with unique treatment options not presently available using conventional catheter delivery devices. One such unique procedure is illustrates in FIGS. 25 through 29. FIG. 25 shows the stent placement in a[0095]main vessel46 illustrated in FIGS. 6 through 8, with theballoon34 left in place as shown in FIG. 8. If a physician would now like to likewise provide a stent in thebranch vessel48, under currently available procedures s/he would have to either remove thefirst balloon34 and then direct a second deployment device down thesame guidewire40, or laboriously thread a second guidewire into thebranch vessel48.
• With the present invention, however, since the[0096]guidewire40 has been released from theballoon34 in the procedure described in FIGS. 6 through 8, theguidewire40 is now free to be repositioned into thebranch vessel48, as is illustrated in FIG. 25, while leaving theballoon34 in position within themain vessel46. Asecond deployment apparatus76 can then be advanced along theguidewire40, as is shown in FIG. 26, and positioned into thebranch vessel48, as is shown in FIG. 27.
• Once the[0097]deployment apparatus76 is properly positioned in thebranch vessel48, asecond stent78 can then be deployed, as is shown in FIG. 28. Since thefirst balloon34 did not have to be removed to allow introduction of thesecond deployment apparatus76, the physician then has the option of immediately reinflating thefirst balloon34, as is shown in FIG. 29, in order to make sure bothstents44,78 are fully and properly deployed in the twovessels46,48. The ability to perform simultaneous ballooning of both of these stents using a single guidewire is believed to be particularly unique to the present invention. This allows this procedure to be completed faster and more efficiently than in any previously available stent deployment method.
• Still further embodiments of the present invention are illustrated in FIGS. 30 through 47.[0098]
• FIGS. 30 through 34 illustrate an embodiment of the present invention that improves on the embodiment illustrated in FIGS. 18 and 19. As was previously described, a[0099]disruptable guidewire channel60 can be formed from the external surface of theballoon34 itself. In this embodiment, aflexible guidewire retainer80 is contained within theballoon34 to aid in holding theguidewire40 within theguidewire channel60. When theballoon34 is inflated, as is shown in FIGS. 31 and 33, theballoon34 applies an outward force that causes theguidewire retainer80 to flex open releasing the portion of the balloon contained within the guidewire retainer, therefore releasing theguidewire40. The centering groove in the tip could be a continuation of the guidewire retainer inside the balloon or attached thereto. The guidewire retainer inside the balloon could be a continuation of the support member or attached thereto. The guidewire retainer could also be a continuation of the inflation lumen or attached thereto. The support member could be integral to the guidewire retainer. Anindentation82 can be formed in thecatheter shaft36 to assist in the transition of the guidewire into theguidewire channel60.
• One embodiment of a[0100]guidewire retainer80 is shown in FIG. 34. Theguidewire retainer80 comprises a cylinder with at least a semi-circular cross section.
• The retainer may comprise any form that provides some gripping of the guidewire, including a tube having a longitudinal slice down its length to the more longitudinally slotted constructions of FIGS. 34 and 35. One or[0101]more slits84 can be provided in theretainer80 to aid in its flexibility and adjust the pressure necessary to release the guidewire and a portion of the balloon from the retainer. Theguidewire retainer80 can be constructed from any suitably flexible and resilient material, including various plastics or metals. FIG. 35 illustrates that the width of theslits84 in theguidewire retainer80 can be altered to aid in its flexibility, adjust the release properties of the retainer relative to the particular materials used to create the retainer, as well as adjust the operating parameters of the balloon. It should be evident from this description that the shape, form, materials, and number of the guidewire retainer(s)80 used in any given application of the present invention may take a wide variety of forms.
• This embodiment of the present invention may be further improved by providing releasable retention means in the catheter proximal to the balloon, as is illustrated in FIGS. 36 through 39. As is shown, a[0102]channel86 is provided in thecatheter36 proximal to theballoon34 that is disruptable. The channel comprises alongitudinal slit88 in the catheter shaft and an guidewire port90. This proximal attachment of theguidewire40 may be beneficial in tracking the balloon into place in the body. Thechannel86 may be any suitable length, including a length of less than 5 cm to 25 cm or more from the balloon. When the balloon is inflated, as is shown in FIG. 37, theguidewire40 will actuate out of thedisruptable channel86 to become completely free from theballoon34 andcatheter36. In certain applications (e.g., when a longerdisruptable channels86 is employed), it may be desirable to include acollapsible inflation lumen92, as shown in FIG. 38 that will inflate when pressure is applied to the balloon. As is shown in FIG. 39, when thecollapsible lumen92 is inflated, thecollapsible lumen92 will fill thecatheter shaft36 to force theguidewire40 out of thechannel86.
• FIG. 40 illustrates another embodiment of the present invention wherein the[0103]catheter shaft36 includes apeelable sheath94 covering theguidewire channel96. Thesheath94 is disruptably attached to thecatheter shaft36, such as through use ofperforation lines98a,98b. Anactuation cord100 is attached to one end of thesheath94. In this embodiment theguidewire channel96 can be disrupted at any desired time simply by pulling on theactuation cord100 to remove thesheath94 and free theguidewire40.
• Other versions of the present invention are shown in FIGS. 41 through 47. In these embodiments, a[0104]guidewire channel102 is formed in thewall104 of theballoon34. As is shown in FIGS. 42 and 43, theguidewire channel102 may be integral with the balloon itself, with the lamina of theballoon wall104 fully surrounding thechannel102. FIGS. 44 and 45 demonstrate that theguidewire channel102 may alternatively comprise ininvagination106 formed into the balloon wall. Theinvagination106 may include acover108 to assist in maintaining theguidewire40 within thechannel102. FIGS. 46 and 47 illustrate that theguidewire channel102 may comprise aseparate component110 that is attached to theballoon34, such as through use of an adhesive or acover112. One skilled in the art will appreciate that similar constructs can be achieve through other means including direct extrusion of the balloon material. Likewise, one skilled in the art will further appreciate that one or moresuch channels102 may be provided in any given balloon and/or a single relatively wide channel can be provided in the balloon to allow passage of multiple guidewires.
• With respect to virtually all of the embodiments of the present invention, an additional benefit may be realized by the fact that the guidewire is positioned on the outside of the balloon. It is theorized that it can be beneficial under certain circumstances not to evenly balloon a plaque occlusion in a blood vessel. By applying a focused force at distinct areas around the circumference of the vessel during ballooning, it is believed that the plaque may more successfully be disrupted. Where focusing of expansion forces is desired, the presence of the guidewire on the outside of the balloon may provide a ready means to accomplish improved plaque treatment. In such instances it may be desirable to provide radiopaque markers on the guidewire channel to aid in positioning the balloon and guidewire and effectuating focused ballooning.[0105]
• Without intending to limit the scope of the present invention, the following example illustrates how the present invention may be made and used.[0106]
EXAMPLE
• One embodiment of the present invention can be constructed by modifying a commercially available balloon catheter device.[0107]
• A 4.0 mm×30 mm RX GEMINI Coronary Balloon Dilatation Catheter available from Guidant/ACS of Santa Clara, Calif., may be used as the starting catheter device and is modified in the following manner:[0108]
• 1. Insert a 0.36 mm diameter stainless steel wire in the tip and advance it proximally until it exits the RX port.[0109]
• 2. Measure the distance from the tip to RX port.[0110]
• 3. Remove and cut the 0.36 mm wire to the measured length.[0111]
• 4. Reinsert the 0.36 mm wire. Use the EFD dispensing tip to wick Loctite 4014 into the proximal RX channel and at the distal tip to secure the 0.36 mm wire.[0112]
• 5. A sleeve of the present invention is cut from a film or tube of expanded PTFE having the following dimensions: not longer than the balloon, but long enough to provide optimal trackability; the width should be at least as wide as the diameter of the guidewire and sufficient to attach across enough of the balloon so that the sleeve will disrupt when the balloon is inflated.[0113]
• 6. Perforations are formed in the sleeve by holes 0.64 mm in diameter on 1.02 mm centers along the entire length of the sleeve cutting using a CO[0114]₂laser.
• 7. The sleeve is permanently attached to the Guidant/ACS balloon by any suitable fashion, preferably adhesive such as Loctite 4014 cyanoacrylate.[0115]
• 8. Apply a bead of adhesive along the length of the balloon.[0116]
• 9. Place one side of the sleeve lengthwise onto the bead of adhesive, securing the sleeve to the balloon, ensuring that the other side of the sleeve is free.[0117]
• 10. Place an appropriate sized mandrel for the proper guidewire size along the balloon and under the sleeve flap.[0118]
• 11. Apply a bead of adhesive onto the balloon at an appropriate location to secure the free end of the sleeve. Wrap the sleeve over the mandrel and onto the adhesive bead, securing the sleeve to the balloon and creating a space to accommodate a future guidewire.[0119]
• A balloon catheter device of the present invention is created through this above described process. The catheter includes a guidewire channel attached to the exterior of the balloon that is disruptable upon inflation of the balloon so as to free the guidewire from the guidewire channel.[0120]
• While particular embodiments of the present invention have been illustrated and described herein, the present invention should not be limited to such illustrations and descriptions. It should be apparent that changes and modifications may be incorporated and embodied as part of the present invention within the scope of the following claims.[0121]

Claims (34)

The invention claimed is:

1. A balloon and catheter assembly comprising

an enlargeable balloon, having a length, mounted on a catheter shaft;

a sleeve attached to the balloon forming a guidewire channel along at least a portion of the balloon;

wherein the sleeve is disruptable to cause a guidewire placed within the sleeve to free from the balloon when the sleeve is disrupted.

2. The assembly ofclaim 1 wherein

the balloon has a compacted dimension and an enlarged dimension;

the assembly includes a guidewire within the guidewire channel;

the sleeve includes a separation line; and

the sleeve is disrupted by parting along the separation line when the balloon is enlarged, separating the guidewire from the balloon.

3. The assembly ofclaim 2 wherein the separation line comprises a line of perforations formed in the sleeve.

4. The assembly ofclaim 2 wherein the separation line comprises an attachment line between the balloon and the sleeve.

5. The assembly ofclaim 1 wherein the balloon includes a fluid inflatable structure.

6. The assembly ofclaim 1 wherein the balloon includes a mechanical expansion structure.

7. The assembly ofclaim 1 wherein the catheter shaft includes a support member.

8. The assembly ofclaim 1 wherein once the sleeve is disrupted the balloon is removable independently from other apparatus being advanced on the guidewire.

9. The assembly ofclaim 1 wherein once the sleeve is disrupted other apparatus may be advanced to a treatment site without removal of the balloon.

10. The assembly ofclaim 1 wherein multiple devices are loaded in series on the guidewire.

11. A guidewire deliverable implement comprising

a sleeve attached to the implement forming a guidewire channel along at least a portion of the implement;

wherein the sleeve is disruptable to cause a guidewire placed within the sleeve to free from the implement when the sleeve is disrupted.

12. The implement ofclaim 11 wherein the implement comprises a balloon.

13. The implement ofclaim 12 wherein

the balloon has a compacted dimension and an enlarged dimension, and a guidewire within the guidewire channel;

the sleeve includes a separation line; and

the sleeve is disrupted by parting along the separation line when the balloon is enlarged, separating the guidewire from the balloon.

14. The implement ofclaim 11 wherein the sleeve is disrupted by parting along a separation line.

15. The implement ofclaim 14 wherein the separation line comprises an attachment line between the implement and the sleeve.

16. The implement ofclaim 14 wherein comprises the separation line comprises line of perforations formed in the sleeve.

17. The implement ofclaim 11 wherein once the sleeve is disrupted the implement is removable independently from other apparatus being advanced on the guidewire.

18. The implement ofclaim 11 wherein once the sleeve is disrupted other apparatus may be advanced to a treatment site without removal of the implement.

19. The implement ofclaim 11 wherein multiple devices are loaded in series on the guidewire.

20. A temporary guidewire channel comprising

a sleeve having a separation line formed therein;

wherein the sleeve is adapted to receive a guidewire therein and serve as a guidewire channel to permit advancement of the sleeve over the guidewire; and

wherein the sleeve is disruptable along the separation line to cause a guidewire placed within the sleeve to separate from the sleeve when the sleeve is disrupted.

21. The guidewire channel ofclaim 20 wherein the sleeve is attached to a balloon to form a guidewire channel along at least a portion of the balloon.

22. The guidewire channel ofclaim 21 wherein the separation line comprises an attachment line between the balloon and the sleeve.

23. The guidewire channel ofclaim 21 wherein the separation line comprises a line of perforations formed in the sleeve.

24. The guidewire channel ofclaim 20 wherein the separation line comprises a line of perforations formed in the sleeve.

25. A medical device comprising

a balloon configured for insertion within a patient's body directed along a guidewire;

a guidewire channel exterior to the balloon;

the guidewire channel formed from a material that maintains the guidewire close to the balloon during insertion and alters upon inflation of the balloon to separate the guidewire from the balloon upon subsequent deflation of the balloon.

26. The medical device ofclaim 25 wherein the guidewire channel comprises a material that disrupts upon inflation of the balloon, freeing the guidewire from the balloon upon subsequent deflation of the balloon.

27. The medical device ofclaim 26 wherein the guidewire channel includes perforations therein to effectuate disruption of the guidewire channel upon inflation of the balloon.

28. The medical device ofclaim 25 wherein the guidewire channel comprises a material that distends upon inflation of the balloon.

29. The medical device ofclaim 28 wherein the material that distends upon inflation of the balloon undergoes minimal return to its original shape upon subsequent deflation of the balloon.

30. A medical treatment method comprising

providing a first catheter having a disruptable guidewire channel;

positioning a guidewire in a patient;

mounting the catheter on the guidewire through the guidewire channel;

advancing the catheter along the guidewire to a treatment site in the patient;

disrupting the guidewire channel to free the catheter from the guidewire at the treatment site.

31. The method ofclaim 30 wherein a second catheter is advanced along the guidewire prior to removal of the first catheter.

32. The method ofclaim 31 wherein the second catheter is advanced distal to the treatment site.

33. The method ofclaim 31 wherein the second catheter is advanced adjacent to the treatment site.

34. The method ofclaim 30 wherein a second catheter is mounted on the guidewire prior to the first catheter reaching the treatment site.

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