US20050171570A1 - Angioplasty apparatus facilitating rapid exchanges and method - Google Patents

Abstract

Apparatus for introduction into the vessel of a patient comprising a guiding catheter adapted to be inserted into the vessel of the patient and a device adapted to be inserted into the guiding catheter. The device includes a flexible elongate member and a sleeve carried by the flexible elongate member near the distal extremity thereof and extending from a region near the distal extremity to a region spaced from the distal extremity of the flexible elongate element. The device also includes a guide wire adapted to extend through the sleeve so that the guide wire extends rearwardly of the sleeve extending alongside of and exteriorally of the flexible elongate element into a region near the proximal extremity of the flexible elongate element.

Description

• This invention relates to angioplasty apparatus facilitating rapid exchanges and a method for making rapid exchanges of angioplasty devices.
• At the present time in practicing angioplasty, it is often necessary to exchange one dilatation catheter for another. In doing so, it has been necessary to utilize long exchange wires having a length of approximately 300 centimeters which typically requires two operators to perform the procedure. During this procedure, it is necessary that the operators communicate with each other which makes the procedure time consuming. In addition, since the exchange wire is so long it often is awkward to handle and for that reason may come in contact with the floor or become contaminated which necessitates removing the entire apparatus being utilized for the angioplasty procedure. There is therefore a need for a new and improved angioplasty apparatus which overcomes such difficulties.
• In general, it is an object of the present invention to provide an angioplasty apparatus and a method which facilitates rapid exchanges of various types of devices.
• Another object of the invention is to provide an angioplasty apparatus and method of the above character which greatly facilitates exchanges of dilatation catheters.
• Another object of the invention is to provide an angioplasty apparatus and method of the above character which can be utilized for the positioning of flexible elongate members.
• Another object of the invention is to provide an angioplasty apparatus and method of the above character which can be utilized with various types of devices utilizing flexible elongate members.
• Another object of the invention is to provide an angioplasty apparatus and method in which dye injection and pressure measurements can be made.
• Additional objects and features of the invention will appear from the following description in which the preferred embodiments are set forth in conjunction with the accompanying drawings.
• FIG. 1 is a side elevational view of an angioplasty apparatus incorporating the present invention.
• FIGS. 2A, 3A and4A are partial cross sectional views of the shaft, transition and balloon regions of the balloon dilatation catheter utilized in the embodiment of the invention shown inFIG. 1.
• FIGS. 2B, 3B and4B are cross sectional views taken along the lines2B-2B,3B-3B and4B-4B ofFIGS. 2A, 3A and4A respectively.
• FIGS. 5A, 6A and7A are cross sectional views corresponding toFIGS. 2A, 3A and4A of another embodiment of a balloon dilatation catheter incorporating the present invention.
• FIGS. 5B, 6B and7B are cross sectional views taken along the lines5B-5B,6B-6B and7B-7B ofFIGS. 5A, 6A and7A respectively.
• FIGS. 8A and 9 are cross sectional views of the transition and balloon regions of another balloon dilatation catheter incorporating the present invention.
• FIG. 8B is a cross sectional view taken along theline8B-8B ofFIG. 8A.
• FIG. 10 is a side elevational view of a dedicated dye injection/pressure measurement catheter incorporating the present invention.
• FIG. 11 is a side elevational view of a, fiber optic cable incorporating the present invention.
• FIG. 12 is a side elevational view of a dedicated dye injection/pressure measurement catheter incorporating the present invention and having specific guiding means for facilitating entering acute bends in arterial vessels.
• FIG. 13 is a side elevational view of a bail out catheter incorporating the present invention.
• FIG. 14 is a plan view of a holder utilized in connection with the present invention.
• In general, the angioplasty apparatus of the present invention is designed for introduction into the vessel of a patient. It consists of a guiding catheter which is adapted to be inserted into the vessel of the patient. It also consists of a device which is adapted to be inserted into the guiding catheter. The device includes a flexible elongate member, a sleeve is secured to the flexible elongate member near the distal extremity thereof and extends from the distal extremity into a region spaced from the distal extremity of the flexible elongate member. The device also includes a guide wire which is adapted to extend through the sleeve from the distal extremity of the flexible elongate element, through the sleeve and rearwardly of the sleeve alongside of and exteriorally of the flexible elongate element.
• More particularly as shown inFIGS. 1-4, theangioplasty apparatus16 for facilitating rapid exchanges of dilatation catheters consists of a conventional guidingcatheter17 which is provided with a rotatablehemostatic adapter18 mounted on a proximal end and a y or two-arm connector oradapter19 which is mounted on therotatable adapter18. The y-connector19 is provided with aknurled knob21 which carries a threadedvalve member22 that carries an O-ring23 which is adapted to be urged into sealing engagement with aballoon dilatation catheter26 and aguide wire27 extending through the y-adapter19, and through the guidingcatheter17 as shown inFIG. 1.
• Theballoon dilatation catheter26 is of a single lumen type and is provided with a flexible elongatetubular member29 which has alumen31 extending therethrough. The flexibletubular member29 can be formed of a suitable material such as plastic. A Luer-type fitting32 is mounted on the proximal extremity of the flexibletubular member29 and is adapted to be connected to a syringe or other type of instrument for introducing a radiographic contrast liquid into the flexibletubular member29. Aballoon33 is mounted on the distal extremity of another flexibletubular member36 also is formed of a suitable material such as plastic. The distal extremity of theballoon33 is bonded to the distal extremity of the flexibletubular member36 to form an air-tight and liquid-tight seal with respect to the same. Theballoon33 is coaxial with thetubular member36 or sleeve as shown inFIG. 4B. The flexibletubular member36 is provided with aguide wire lumen37 through which theguide wire27 carrying itsflexible tip28 can extend.
• Means is provided for forming aballoon inflation lumen41 substantially concentric with the flexibletubular member36 and extends toward the distal extremity of the flexibletubular member36. As can be seen fromFIGS. 3B and 4B, theballoon inflation lumen41 is formed by a flexibletubular member42 which can be formed integral with theballoon33. The flexibletubular member42 extends into atransition region44 which overlies the distal extremity of the flexibletubular member29 so that thelumen31 therein is in communication with theballoon inflation lumen41. As can be seen particularly fromFIG. 3A, the flexibletubular member36 makes a transition and extends out of thetubular member42 and provides anopening43. The proximal extremity of thetubular member36 overlies the flexibletubular member31. Theguide wire27 exits through theopening43 and extends alongside and exteriorally of the flexibletubular member29 from the proximal extremity of the flexibletubular member36 to the proximal extremity of the flexibletubular member29.
• Thetransition region44 should be positioned at least approximately 10-15 centimeters from the distal extremity of theballoon dilatation catheter26. This is important for two reasons. One is that the transition region be kept at a point where when theballoon dilatation catheter26 is utilized in a procedure, the transition region remains in the guidingcatheter27 and out of the coronary artery. The spacing from the distal extremity of the dilatation catheter for the transition region is also advantageous in that it permits the person performing the procedure to pull theballoon dilatation catheter26 out of the guidingcatheter17 until thetransition region44 clears the y-connector19 so that all of the portion of theguide wire27 which is exterior of theballoon dilatation catheter26 is proximal of the y-connector. While this is being done, the operator can then utilize theknurled nut21 to again close the o-ring to form a hemostatic seal between the y-connector and the balloon dilatation catheter to minimize the loss of blood from the patient.
• The flexibletubular member42 can be formed of a suitable material such as a heat shrinkable plastic so that it can be shrunk onto the distal extremity of the flexibletubular member29 and onto the proximal extremity of the flexibletubular member36 to form liquid-tight and air-tight seals with respect to the same. From the construction shown it can be seen that theguide wire27 exits from theballoon dilatation catheter26 in a region which is relatively close to the distal extremity of theballoon dilatation catheter26 and extends exteriorally of the balloon dilatation catheter to the proximal extremity of the same. As shown inFIG. 1, theguide wire27 and theballoon dilatation catheter26 extend outwardly from the y-connector19.
• Atorquer46 of a conventional construction is secured to theguide wire27 for rotating the guide wire as hereinafter described.
• Operation and use of the angioplasty apparatus shown inFIG. 1 may now be briefly described as follows. The guidingcatheter17 is inserted into the coronary artery in a conventional manner. The balloon dilatation catheter is prepared for insertion into the guidingcatheter17 in a conventional manner. Theballoon33 can be inflated outside the body by the use of a balloon flushing tube of the type described in U.S. Pat. No. 4,323,071 and inflated by introducing a radiopaque liquid through the fitting32 into thelumen31 and through thelumen41 into theballoon33 to flush all of the air in theballoon33 through the balloon flushing tube to fully inflate the balloon. After theballoon33 has been inflated, the balloon can be deflated by removing the radiopaque liquid from the balloon.
• Theguide wire27 is then introduced into theballoon dilatation catheter26 by a back loading technique. Without thetorquer46 on the guide wire, the proximal extremity of theguide wire27 is inserted backwardly through the tip of the balloon dilatation catheter through theguide wire lumen37. The guide wire is advanced rearwardly by holding the distal extremity of the balloon dilatation catheter in one hand and advancing theguide wire27 rearwardly with the other hand until theguide wire27 exits through theopening43 at thetransition region44 of the dilatation catheter. As soon as the guide wire has cleared theopening43, the guide wire can be grasped by the hand and pulled rearwardly paralleling theballoon dilatation catheter26 until its proximal extremity is near the proximal extremity of the dilatation catheter and so that the distal extremity of the guide wire,27 with its flexible orfloppy tip28 protrudes at least partially from the distal extremity of the balloon dilatation catheter.
• At this point in time, the O-ring23 in the y-connector19 is opened by operation of theknurled knob21. The distal extremity of theballoon dilatation catheter26 having the flexible tip protruding therefrom is then introduced to the y-connector past the opened o-ring23 and slid down the guidingcatheter17. Theballoon dilatation catheter26 and theguide wire27 are grasped between the fingers of a hand and are advanced parallel into the guidingcatheter17. This procedure is continued until a substantial portion of the balloon dilatation catheter is disposed in the guidingcatheter17.
• Thetorquer46 now can be attached to theguide wire27 near the proximal extremity of the same. Theguide wire27 is then advanced ahead of the balloon dilatation catheter until it enters the arterial vessel of the patient. Theballoon dilatation catheter26 is held stable by the fingers of the hand while theguide wire27 is being advanced. The positioning of the guide wire.27 in the desired arterial vessel can be observed under a fluoroscope by using x-ray techniques well known to those skilled in the art. As is well known to those skilled in the art, thetorquer46 can be utilized for rotating theguide wire27 to facilitate positioning of theflexible tip28 in the desired arterial vessel so that the distal extremity of the guide wire can be advanced into the stenosis which it is desired to open or enlarge.
• As soon as theguide wire27 is in the desired location, it can be held stationary by two fingers of the hand and at this point in time, theballoon dilatation catheter26 is advanced over the guide wire until the deflatedballoon33 is across the desired lesion or stenosis. If any difficulty is encountered by the person conducting the procedure in introducing the balloon dilatation catheter so that theballoon33 resists crossing the lesion or stenosis, theguide wire27 can be retracted slightly. The person then can observe under the fluoroscope to see that thetip28 of the guide wire is wiggling in the blood stream indicating that it is free to move in the blood stream. Then the person can grasp both the guide wire and the dilatation catheter in one hand and advance them as a unit so that they can cross the stenosis as a unit. It has been found by utilizing such a procedure, greater pushability can be obtained in advancing the balloon dilatation catheter across the stenosis. In other words, more force can be applied to the balloon to cause it to cross the stenosis or lesion in case the opening therein is very small.
• After theballoon33 has crossed the stenosis or lesion, theballoon33 can be inflated in a conventional manner by introducing a radiopaque contrast liquid through thelumen31. After the inflation has occurred and the desired operation has been performed by enlarging the opening in the stenosis, theballoon dilatation catheter26 can be removed very rapidly by the person performing the procedure by grasping theguide wire27 by two fingers immediately proximal of the y-connector19 after thetorquer46 has been removed. Theballoon dilatation catheter26 can be removed in several seconds in comparison with the much longer time required for removing the balloon dilatation catheter utilizing prior art exchange wire procedures. As soon as theballoon dilatation catheter26 has been removed from the guidingcatheter17, another injection of radiographic contrast liquid can be introduced through the guidingcatheter17 to observe whether or not the balloon dilatation procedure which has been performed on the lesion or stenosis has in fact opened the lesion or stenosis to the satisfaction of the person performing the procedure.
• If it is ascertained by the person performing the procedure that additional dilation of the stenosis is desired and that a larger balloon should be inserted into the stenosis, this can be accomplished very rapidly by selecting the desired size of balloon dilatation catheter.
• As theballoon dilatation catheter26 is being retracted out of the guidingcatheter17 and as soon as thetransition region44 has cleared the y-adapter19, the o-ring23 can be tightened down to form a seal over the balloon dilatation catheter to minimize the loss of blood of the patient. Thereafter, if desired, the remainder of theballoon dilatation catheter26 can be removed from the guidingcatheter17 until the proximal extremity of the guide wire passes through theopening43 and passes through the end of theballoon dilatation catheter26. As soon as this has been accomplished, a new balloon dilatation catheter can be loaded onto the guide wire in a rearward direction by introducing the proximal extremity of theguide wire27 into the tip of the balloon dilatation catheter. As this is being done, the index finger of the hand performing the procedure can be utilized for opening the o-ring by adjusting theknurled knob21. Theguide wire27 is grasped by the fingers of the hand and theballoon dilatation catheter26 can be advanced rapidly over the guide wire into the guidingcatheter17 and advanced across the lesion in a manner hereinbefore described with respect to the smaller balloon dilatation catheter which had been utilized. The balloon of the new dilatation catheter can be inflated in the same manner as hereinbefore described. If necessary even another exchange procedure can be readily accomplished in the same manner as hereinbefore described utilizing a still larger balloon dilatation catheter if that turns out to be necessary.
• It has been found that an exchange utilizing the present angioplasty apparatus can be performed in less than 10 to 15 seconds whereas in the past utilizing a prior art guide wire exchange procedure required an average of approximately two minutes.
• After the desired amount of dilation of the stenosis or lesion has been accomplished, theballoon dilatation catheter26 can be removed and thereafter, the guidingcatheter17 can be removed.
• Another embodiment of an angioplasty apparatus incorporating the present invention is shown inFIGS. 5A and 5B,6A and6B and7A and7B in which an additional dye/pressure lumen has been incorporated into the apparatus in order to enable an injection of a distal dye through the balloon dilatation catheter and also to enable the measurement of pressures at the tip of the balloon dilatation catheter. The construction which is utilized is very similar to that shown in theballoon dilatation catheter26 shown inFIG. 1. The corresponding parts of theballoon dilatation catheter26ashown inFIGS. 5-7 is very similar to that hereinbefore described and for that reason the corresponding parts have been given the same corresponding numbers with letters being added to the numerals where changes are present in the parts or components. Thus thetubular member29a,rather than having asingle lumen31 is provided withdual lumens31aand31bdisposed side by side in the shaft region of the balloon dilatation catheter as shown inFIGS. 5A and 5B. In the transition region44a,the twolumens31aand31bare still disposed side by side with thelumen37afor the guide wire being disposed above thelumens31aand31b.In the balloon region, thelumen31ahas been terminated and extends into theballoon lumen41a.At the transition region44a,theguide wire lumen37ainclines downwardly and sidewise and adjoins thelumen31bthrough the distal extremity of theballoon dilatation catheter26a.Thelumen31bextends to the distal extremity of the balloon dilatation catheter.
• The balloon dilatation catheter which is shown inFIGS. 5-7 can be utilized in the same manner as the balloon dilatation catheter shown inFIG. 1. It can be seen that theguide wire27 extends out of the opening43ain the transition region44cand parallels the balloon catheter to its proximal extremity. A balloon dilatation catheter of the type shown inFIGS. 5-7 can be utilized initially in an angioplasty procedure. However, it should be appreciated that if a very small opening is present in the stenosis or lesion, it may be desirable to utilize a balloon dilatation catheter of the type shown inFIG. 1 first because it can be constructed with a smaller diameter than a balloon dilatation catheter of the type shown inFIGS. 5-7 because of the additional lumen which is provided for dye injection and pressure measurements. After a smaller balloon dilatation catheter has been utilized, a balloon dilatation catheter of the type shown inFIGS. 5-7 can be used utilizing the exchange procedure hereinbefore described to make dye injection and/or pressure measurements through the use of theadditional lumen31b.It is particularly desirable to make such a pressure measurement before conclusion of the angioplasty procedure to be sure that the proper dilation of the lesion or stenosis has occurred and that there is adequate blood flow through the lesion or stenosis.
• Still another embodiment of the angioplasty apparatus incorporating the present invention is shown inFIGS. 8A and 8B and shows the transition region of aballoon dilatation catheter26bwhich incorporates avent tube51 which is utilized for venting air from the balloon during inflation of the balloon and before insertion into the patient with radiopaque liquid to ensure that all the air is exhausted from the balloon. As shown in thetransition region44binFIG. 8A, theguide wire27 extends through anopening43bprovided in the transition region and extends through aflexible tubular member36bout the end of the balloon dilatation catheter as shown inFIG. 9. Aballoon filling lumen31cis provided by theflexible tubular member29band terminates in thetransition region44bwhere it opens into the balloon filling lumen41bthat opens into the interior of theballoon33b.A relativelyshort sleeve52 formed of a suitable material such as plastic is also provided in thetransition region44band as shown inFIG. 8A underlies theflexible tubular member29band extends from a region forward of theflexible tubular member42band terminates distally within theballoon inflation lumen41 as shown inFIG. 8A.
• Thesleeve52 is provided with alumen53 through which thevent tube51 extends. Thevent tube51 can be formed of a suitable material such as metal and is also provided with alumen54 of a size so that gas can escape therethrough. The proximal extremity of thevent tube51 is provided with aportion51awhich is bent at right angles to the main portion of thevent tube51 to ensure that the vent tube will be removed from theballoon dilatation catheter26bprior to insertion into the guidingcatheter17. As shown inFIG. 9, thevent tube51 extends into theballoon33 into a region near the distal extremity of the same.
• Operation of theballoon dilatation catheter26bshown inFIGS. 8A, 8B and9 may now be briefly described as follows. With thevent tube51 in place in the balloon dilatation catheter, radiopaque contrast liquid is introduced through theballoon inflation lumen31 and through the balloon inflation lumen41bto introduce the liquid into the balloon. As the liquid is introduced into the balloon, any air in the balloon is discharged through thevent tube51. Pressure is maintained on the radiopaque contrast liquid introduced into the balloon untildroplets56 of the liquid exit from the proximal extremity of thevent tube51 which serves to indicate that the balloon has been completely filled with the radiopaque contrast liquid and that all of the air therein has been exhausted therefrom. As soon as this occurs, thevent tube51 can be withdrawn completely from the balloon dilatation catheter. Thesleeve52 which carries the vent tube collapses upon withdrawal of the vent tube and will remain collapsed to provide a valve to prevent the escape of any additional radiopaque contrast liquid from theballoon33b.Thesleeve52 remains collapsed because when a high pressure is being introduced through theballoon inflation lumen31c,theflexible tubular member29bwill force collapsing of thesleeve52. Alternatively, when a negative pressure is being applied to theballoon33bas, for example, when the balloon is being deflated, the positive atmospheric pressure on the exterior of theflexible tubular member42bwill again cause collapsing of thesleeve52. Thus in effect there is provided a double valve system in which positive pressures on the interior will collapse the sleeve and when there is negative internal pressure the positive exterior atmospheric pressure, will collapse the sleeve.
• In all other respects, theballoon dilatation catheter26bcan be utilized in the same manner as the balloon dilatation catheters hereinbefore described in connection with exchanges on theguide wire27.
• Still another embodiment of an angioplasty apparatus incorporating the present invention is shown inFIG. 10 in which there is disclosed a dedicated pressure/dye catheter61. The pressure/dye catheter61 consists of an elongate flexibletubular member62 formed of a suitable material such as plastic which is provided with apressure dye lumen63 extending therethrough. The proximal extremity of thetubular member62 is provided with a Luer-type fitting64 to which devices having Luer-type fittings can be attached. Asleeve66 formed of a suitable material such as plastic is secured to the exterior of theflexible tubular member62 by suitable means such as an adhesive. It is provided with aguide wire lumen67 extending therethrough. It should be appreciated that thesleeve66 can be formed integral with theflexible tubular member62 if desired. Thesleeve66 extends for a distance of at least 10 to 15 centimeters from the distal extremity of the catheter61 so that the transition region where it terminates at its proximal extremity is be within the guidingcatheter17 so that the transition region does not enter into the arterial vessel of the patient. Aguide wire68 is provided which extends through theguide wire lumen67. Theguide wire68 can be of the same type as theguide wire27. It is inserted into thesleeve66 by taking the proximal extremity of the guide wire which is relatively stiff and inserting it into the distal extremity of the sleeve and then pushing it backwardly or rearwardly through the sleeve until it clears theopening69 at the proximal extremity of thesleeve66. Theguide wire68 is then pulled so that it extends in a direction parallel to theflexible tubular member62 into a region near the proximal extremity of thetubular member62.
• It can be readily seen from the foregoing description that the pressure/dye catheter61 can be readily introduced into a guidingcatheter17 and that the distal extremity of the pressure/dye catheter can be positioned in a desired location in the arterial vessel by utilizing theguide wire68 to position the same. It also should be appreciated that a torquer of the type hereinbefore described such as thetorquer46 can be utilized on the proximal extremity of theguide wire68 to cause rotational movement of the guide wire to facilitate positioning of the guide wire in the desired arterial vessel and to thereafter have thetubular member62 follow the same. The desired picture and/or dye measurements can then be made by utilizing thelumen63 provided in thetubular member62. As can be seen fromFIG. 10 the distal extremity of thetubular member62 can be slanted and rounded as shown to facilitate entry into the stenosis in the arterial vessel. This is desirable because of the eccentricity created by the addition of thesleeve66.
• Another embodiment of an angioplasty apparatus is shown inFIG. 11 and takes the form of a fiber optic,device71. An encasedfiber optic bundle72 which is generally circular in cross section is provided. Asleeve73 of the type hereinbefore described formed of a suitable material such as plastic is secured to the distal extremity of thefiber optic bundle72 which is, adapted to receive aguide wire74. As in the previous embodiments, thesleeve73 extends from the distal extremity for a distance of approximately 10 to 15 centimeters after which the guide wire exits from the sleeve and extends alongside and exteriorally of thefiber optic bundle72 for substantially the entire length of the fiber optic bundle. As with the previous devices, theguide wire74 is threaded into the sleeve by taking the proximal extremity or stiff end of the guide wire and inserting it at the distal extremity of thesleeve73 and pushing it from the rear towards the forward extremity of the sleeve. Thefiber optic device71 can then be inserted into a guidingcatheter17 and advanced to the desired location through the use of the guide wire. The fiber optic bundle then can be utilized for angioscopy for looking directly at the blood vessel or alternatively, for delivering energy to plaque in the blood vessel to perform laser angioplasty. It should be appreciated that steerable systems can be utilized for directing the distal extremity of the fiber optic bundle if that is desired.
• It should be appreciated that the concept of using a relatively short sleeve extending from the distal extremity of the device to a region approximately 10 to 15 centimeters to the rear and then having the guide wire extend externally of the device is applicable for a number of medical devices as well as other applications. For example, ultrasonic catheters for imaging ultrasound and for measurement of Doppler velocity can be utilized to provide various types of dedicated devices having the guide sleeve with the guide wire therein for facilitating positioning of the same in arterial vessels. The apparatus of the present invention is particularly useful in devices where multiple re-entries are required in order to complete the procedure.
• InFIG. 12, there is disclosed another embodiment of an angioplasty apparatus to provide apressure dye catheter76 having additional steering capabilities. It consists of aflexible tubular member77 formed of a suitable material such as plastic which is provided with alumen78 extending through a slanted and curved end. A Luer-type fitting79 is provided on the proximal extremity. Asleeve81 formed of a suitable material such as plastic is secured to the distal extremity of the flexibleelongate member77. The sleeve is provided with a curved portion81awhich extends slightly beyond the distal extremity of the flexibleelongate member77 and curves over the end of the flexibleelongate member77. Theguide wire82 extends through thesleeve81 as shown. The catheter shown inFIG. 12 can be utilized in situations where there is an acute bend in the arterial vessel. By using the catheter shown inFIG. 11, the guide wire can be directed into the acute bend by rotation of thecatheter76 to help direct the guide wire into the acute bend. After the acute bend has been negotiated by the guide wire, the distal extremity of the catheter can follow the guide wire and negotiate the acute bend. The desired pressure and/or dye measurements can then be made. If by chance a guide wire should enter the wrong vessel, the guide wire can be retracted into the sleeve and then the catheter itself can be reoriented to have the distal extremity of thesleeve81 directed into the proper region so that the guide wire will enter the proper arterial vessel. Thecatheter76 shown inFIG. 12 can be introduced into the guidingcatheter17 in the same manner as the other catheters hereinbefore described.
• Still another embodiment of the angioplasty apparatus of the present invention is shown inFIG. 13 in the form of abailout catheter86. Thebailout catheter86 consists of aflexible tubular member87 formed of a suitable material such as plastic which is provided with alumen88 extending therethrough. A Luer-type fitting89 is secured to the proximal extremity of thetubular member87. The distal portion of thetubular member87 is provided with twosets91 and92 ofholes93 which are spaced circumferentially and apart longitudinally of the tubular member. Asleeve96 formed of a suitable material such as plastic is secured to the distal extremity of thetubular member87 and extends from the distal extremity of thetubular member87 into a region 10 to 15 centimeters from the distal extremity and is adapted to receive aguide wire97 which extends through the same. Theguide wire97 is inserted into the sleeve by taking the proximal extremity of the guide wire and inserting it into the distal extremity of the sleeve and pushing it rearwardly into the sleeve until it exits from the sleeve. Theguide wire97 is then pulled in a direction generally parallel to theflexible tubular member87 until it is adjacent the fitting89.
• Thebailout catheter86 is utilized in situations where an obstruction has occurred in a blood vessel and stops the flow of blood. In order to reestablish the flow of blood, the bailout device is inserted into the guidingcatheter17. If a guide wire is already in place, the bailout device can be placed on the guide wire by introducing the proximal extremity of the guide wire into the sleeve and then pushing the bailout catheter on the guide wire into the guidingcatheter17 until it passes through the obstruction in the arterial vessel. The distal extremity of the bailout device is so positioned so that the obstruction is disposed between the two sets ofholes91 and92. When the bailout catheter is positioned, blood can still flow through theholes93 past the obstruction which is held out of the way by the bailout catheter.
• Thus it can be seen that the same principle utilizing a guide tube and an external guide wire passing through the guide tube can be utilized for positioning the bailout device. As pointed out previously, the bailout device can be utilized for positioning other types of devices in arterial vessel, as for example, atherectomy devices particularly where multiple re-entries or reintroductions of the devices are required.
• InFIG. 14 there is disclosed additional angioplasty apparatus in which aholder101 is provided which serves as a support structure for a y-type connector19 of the type hereinbefore described in conjunction with the angioplasty apparatus shown inFIG. 1. Theholder101 consists of a rectangular member102 which is generally planar. The member102 can be formed of a suitable material such as plastic and is provided with a plurality ofrectangular openings103 extending longitudinally of the same to lighten the same.Posts104 are provided on the forward extremity of the member102 and are adapted to receive the y-type connector19 and to hold it in place on the member102. When positioned in theposts104, theknurled knob21 extends into one of theopenings103 so that it can be readily operated. A block107 is carried by the other end of the member102 and, if desired, can be formed intergal therewith. The block is provided with a plurality of spaced apartslots108 which are adapted to frictionally engage and receive theguide wire27. The friction block107 should be positioned a suitable distance as, for example, 15 to 20 centimeters from the o-ring carried by the y-connector19.
• Use of theholder101 shown inFIG. 14 may now be briefly described as follows. Theholder101 can be placed on the operating table near the region where the guidingcatheter17 has been inserted into the patient, as for example, in a femoral artery in the leg of a patient. After the guide wire has been inserted into the guiding catheter, the proximal end or, in other words, the stiff end of the guide wire can be placed in thefriction clamp108. When it is desired to utilize a dilatation catheter, the end of the guide wire which has been positioned in the clamp can be lifted out of theslot108 and inserted into the sleeve carried by the distal extremity of the dilatation catheter by taking the proximal end and advancing it from the tip rearwardly through the sleeve. As soon as the guide wire has been introduced through the sleeve, the proximal extremity of the guide wire can be repositioned in theslot108. Thereafter, the dilatation catheter can be advanced independently without the operator needing to pay any attention to the guide wire which is held in the desired position by theholder101. Similarly, the holder can be utilized to keep the guide wire in place while the dilatation catheter is being briskly withdrawn.
• More than one of theslots108 has been provided in theholder101 in order to make it possible to accommodate two wire or two balloon dilatation catheters in which one of theother slots108 can be utilized for accommodating the additional guide wire. This prevents the guide wires from becoming entangled with each other.
• It is apparent from the foregoing that there has been provided an angioplasty apparatus which greatly facilitates the exchange of devices which utilize flexible elongate elements as a part thereof. Rapid exchanges are possible with only one person being necessary to make the exchanges. The need for long exchange wires has been eliminated. One device can be readily substituted for another utilizing the same guide wire which has already been positioned. It can be seen from the foregoing that a relatively simple and expedient solution has been provided which eliminates the need for long exchange wires and the danger of those exchange wires becoming contaminated.
• Although the present invention has been described principally in conjunction with catheters having coaxial lumens, it should be appreciated that the invention is as applicable, if not more applicable, to catheters having side-by-side lumens.

Claims (17)

1. In an apparatus of the character described for introduction into the vessel of a patient, a guiding catheter adapted to be inserted into the vessel of the patient, and a device adapted to be inserted into the guiding catheter, the device including a flexible elongate member, a sleeve carried by the flexible elongate member near the distal extremity thereof and extending from a region near the distal extremity to a region spaced from the distal extremity of the flexible elongate element, the device also including a guide wire adapted to extend through the sleeve so that the guide wire can be positioned so that it extends from the distal extremity of the flexible elongate member, through the sleeve and rearwardly of the sleeve alongside of and exteriorally of the flexible elongate element into a region near the proximal extremity of the flexible elongate element.

2. Apparatus as inclaim 1 wherein said device includes a balloon dilatation catheter having said flexible elongate member forming a part thereof.

3. Apparatus as inclaim 2 wherein said balloon dilatation catheter includes a balloon near the distal extremity thereof and wherein the sleeve for the guide wire extends through the balloon.

4. Apparatus as inclaim 3 wherein said balloon is concentric with respect to said sleeve.

5. Apparatus as inclaim 3 wherein said balloon dilatation catheter includes a balloon inflation lumen extending through the flexible elongate element.

6. Apparatus as inclaim 5 wherein said balloon dilatation catheter includes a lumen for performing dye injection/pressure measurements.

7. Apparatus as inclaim 5 wherein said balloon dilatation catheter includes an additional sleeve carried by the flexible elongate element and extending into the balloon inflation lumen and extending out of the balloon inflation lumen together with a vent tube disposed in the additional sleeve for venting air from the balloon to the atmosphere when the balloon is being filled with a liquid.

8. Apparatus as inclaim 1 wherein said flexible elongate element is provided with a lumen extending the length thereof, said lumen being capable of being utilized for making pressure/dye measurements.

9. Apparatus as inclaim 8 wherein said sleeve carried by the flexible elongate element has its distal extremity extending in a curved manner over the distal extremity of the flexible elongate member.

10. Apparatus as inclaim 1 wherein said flexible elongate member is in the form of a fiber optic cable.

11. Apparatus as inclaim 1 wherein said flexible elongate element has a lumen extending therethrough and wherein said flexible elongate element is provided with spaced apart sets of holes extending through the flexible elongate element and being in communication with the lumen extending through the flexible elongate element.

12. Apparatus as inclaim 1 wherein said guiding catheter includes a y-connector having an O-ring fitting therein and wherein the guide wire is adapted to extend through the y connector together with a holder, said holder having means for supporting the y connector, and means for frictionally retaining the guide wire extending from the y connector.

13. In an angioplasty apparatus adapted to be inserted into the vessel of a patient, a guiding catheter, balloon dilatation catheter including a flexible elongate element having a balloon inflating lumen extending therethrough, a balloon, means for establishing a fluid-tight connection between the balloon inflating lumen and the balloon so that the balloon can be inflated and deflated, a sleeve extending through the balloon and extending rearwardly from the balloon and extending alongside and exteriorally of the flexible elongate element, said sleeve having a guide wire lumen extending therethrough and a guide wire extending through the sleeve and extending beyond the distal extremity of the flexible elongate element and extending rearwardly from the sleeve alongside and exteriorally of the flexible elongate element into a region adjacent the proximal extremity of the flexible elongate element.

14. Apparatus as inclaim 13 together with means forming a dye injection/pressure measurement lumen extending along the length of the flexible elongate element and extending through the balloon to the distal extremity of the dilatation catheter.

15. Apparatus as inclaim 13 together with an additional sleeve carried by the flexible elongate element and extending from the interior of the balloon to the exterior of the flexible elongate element and a vent tube removably disposed within the sleeve.

16. In a method for performing an angioplasty procedure in which a guiding catheter is disposed in the vessel of the patient and in which a device is to be inserted into the guiding catheter, the device including a flexible elongate element and a sleeve carried by the flexible elongate element extending from approximately the distal extremity thereof rearwardly of the flexible elongate element for a distance of approximately 10 centimeters, the device also including a guide wire, the method including the steps of taking the proximal extremity of the guide wire and inserting it in the distal extremity of the sleeve and pushing it rearwardly through the sleeve until it exits from the sleeve and then further advancing the guide wire so that the guide wire extends alongside and exteriorally substantially the entire length of the flexible elongate element, inserting the device into the guiding catheter with the guide wire thereon, advancing the guide wire ahead of the device to position the guide wire in the desired location in the vessel, and thereafter further advancing the device on the guide wire until the device is positioned in the desired location for performing an operation with the device, and removing device from the guide wire while the guide wire remains in place.

17. A method as inclaim 16 together with the step of selecting another device to be utilized in the patient and picking up the proximal extremity of the guide wire and inserting it into the tip of the sleeve and pushing the guide wire rearwardly of the sleeve and continuing to advance the flexible elongate element on the guide wire until the flexible elongate element is positioned in the desired location for performing the desired operation and thereafter removing the flexible elongate element and the guide wire from the guiding catheter and removing the guiding catheter.

Images