US20050273150A1 - Stent introducer system - Google Patents

Abstract

A stent delivery system for positioning a first and second stent the first and second branch lumens of a bifurcation. The stent delivery system includes stent introducers and a sheath or catheter having a frangible wall. A method of delivering stents to anatomies such as bifurcated ducts or vessels.

Description

RELATED APPLICATIONS
• This claims the benefit of U.S. Provisional Application Ser. No. 60/558,721, filed Mar. 31, 2004, entitled “Stent Introducer System,” which is incorporated by reference herein in its entirety.
TECHNICAL FIELD
• This invention generally relates to medical devices, and more particularly to devices for delivering stents to a target anatomy.
BACKGROUND
• Stents are elongate tubes that are used to prop open occluded or narrowed vessels or body lumens. Among other things, stents are often used to maintain the patency of the biliary tree, or common bile duct.FIG. 1 is a partial, cross-sectional view of abiliary system2 showing thecommon bile duct2a, the lefthepatic duct2b, the righthepatic duct2c, thegall bladder2d, thepancreas2eand theduodenum2f.
• Strictures or occlusions that develop in the upper common bile duct and/or the left and right hepatic ducts can interfere with the proper drainage of those ducts.FIG. 2 illustrates a partial cross-sectional view of thebiliary system2 havingstrictures3 within thecommon bile duct2a, the lefthepatic duct2band the righthepatic duct2c. One method of establishing proper drainage through the diseased ducts is to prop open the ducts by placing stents, such as self-expanding biliary stents, within the diseased ducts. Because of the branched configuration of the duct anatomy it is often necessary to place two or more stents in an overlying or side-by-side configuration.
• However, currently available stent and introducer geometries are such that placement of a first stent often impedes placement of a second stent.FIG. 3 illustrates the problems associated with the prior art method of placing stents in thecommon bile duct2aand the left and righthepatic ducts2b,2c. That is, placingstent16 within thecommon bile duct2aand the lefthepatic duct2bimpedes subsequent access to the stricture in the righthepatic duct2c. This prevents placement of a stent in the righthepatic duct2c.
• FIG. 3A illustrates one problem encountered in the prior art by placing two stents sequentially. That is, once the first stent is deployed, it impedes insertion of the second introducer20 used to deploy the second stent. An alternative to sequential deployment of the stents is simultaneous deployment. Simultaneous deployment, however, requires the side-by-side arrangement of two stent introducers within the working channel of an endoscope. Depending on the size of the stents to be placed and the limited size of the working channel of the endoscope, this option may be unworkable.
• Consequently, there is a need for a self-expanding stent delivery system which overcomes the problems associated with prior art delivery systems. Specifically, there is a need for a self-expanding stent delivery system which allows the physician to sequentially place a first and second stent in the side branches and main lumen of a bifurcation.
SUMMARY OF THE INVENTION
• Accordingly, it is an object of the present invention to provide a medical device, method, and kit having features that resolve or improvoe on one or more of the above-described drawbacks.
• The foregoing object is obtained by providing a stent delivery system having a first introducer used to deploy a first stent, and a sheath or catheter used to receive a second introducer, which in turn is used to deploy a second stent. The first introducer and the catheter can be simultaneously deployed, for example, in a staggered configuration, through the working channel of an endoscope. Once the first stent is deployed, the catheter facilitates delivery of the second introducer to the target anatomy. The catheter or sheath can be splittable.
• In another aspect, wire guides are used to guide the placement of the first introducer, the catheter, and the second introducer.
• In yet another aspect, the foregoing object is obtained by providing a method of placing at stents in the branches of a bifurcated target anatomy. The method includes placing a first and a second wire guide in a working channel of an endoscope. The first wire guide is inserted into the first branch lumen of the bifurcation. The second wire guide is inserted into the second branch lumen of the bifurcation. A first introducer and splittable catheter can then be advanced over the respective wire guides to the respective target anatomies. Once in place, the first stent can be deployed. A second introducer can then be introduced over the second guide wire, through the splittable catheter and to the proper target anatomy. Once the second introducer is in place, the second stent can be deployed.
• The method of the invention may further include any of the following steps: disposing the first introducer and the splittable catheter within the working channel of the endoscope such that the first introducer proximal portion is disposed adjacent to the splittable catheter and the first introducer distal portion is disposed distal to the splittable catheter while inside the working channel of the endoscope; deploying the first stent within the first branch lumen and the main lumen of the bifurcation and withdrawing the first introducer from the bifurcation; and/or splitting the splittable catheter and withdrawing the splittable catheter from the bifurcation.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a partial, cross-sectional view of a biliary system showing the common bile duct, the left hepatic duct, the right hepatic duct, the gall bladder, the pancreas and the duodenum.
• FIG. 2 is a partial, cross-sectional view of the biliary system ofFIG. 1 showing strictures within the common bile duct, the left hepatic duct and the right hepatic duct.
• FIG. 3 is a partial, cross-sectional view of the biliary system ofFIG. 2 illustrating a stent that has been placed in the common bile duct and the left hepatic duct.
• FIG. 3A is a partial, cross-sectional view of the biliary system ofFIG. 1 illustrating a first stent previously placed by a first introducer in the right hepatic duct and the common bile duct that obscures the access of a second introducer attempting to place a second stent in the left hepatic duct and common bile duct.
• FIG. 4 is a partial, cross-sectional view of the biliary system ofFIG. 2 illustrating the placement of first and second stents in the left and right hepatic ducts, respectively, and the common bile duct according to a preferred method of the present invention.
• FIG. 5 is a partial, cross-sectional view of a preferred embodiment of the stent delivery system of the present invention illustrating a first introducer placed within the right hepatic duct and the common bile duct and a splittable catheter placed in the right hepatic duct and the common bile duct.
• FIG. 6 is a partial, cross-sectional view of the preferred embodiment of the stent delivery system ofFIG. 5 illustrating a first stent deployed in the right hepatic duct and common bile duct after the first introducer has been removed and the splittable catheter placed in the right hepatic duct and the common bile duct.
• FIG. 7 is a partial, cross-sectional view of the preferred embodiment of the stent delivery system ofFIG. 6 illustrating a first stent deployed in the right hepatic duct and common bile duct and the splittable catheter shielding a second introducer as the second introducer is advanced over a second wire guide into the common bile duct and the left hepatic duct.
• FIG. 8 is a cross-sectional, end view of the stent delivery system of the present invention showing the first introducer and the splittable catheter within the working channel of an endoscope.
• FIG. 9 is a partial, cross sectional, side-view of a preferred embodiment of the stent delivery system of the present invention showing the first introducer and the splittable catheter within the working channel of an endoscope.
• FIG. 10 is a cross-sectional view of an embodiment of the first introducer of the stent delivery system of the present invention.
• FIG. 11 is a partial, cross-sectional view of a distal portion of the first introducer ofFIG. 5.
• FIG. 12 is a partial, cross-sectional view of an alternate embodiment of the distal portion of the first introducer ofFIG. 5.
• FIG. 13 is a partial, cross-sectional view of the distal portion of the first introducer ofFIG. 5 showing the wire guide and wire guide lumen.
• FIG. 14 is a partial, cross-sectional view of the distal portion of the first introducer ofFIG. 5 showing an alternate embodiment of the wire guide and the wire guide lumen.
• FIG. 15 is a partial, cross-sectional view of the distal portion of the first introducer ofFIG. 5 showing an alternate embodiment of the wire guide and the wire guide lumen.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• Referring now to the Figures wherein like numerals indicate the same element throughout the views, there is shown inFIGS. 1-2 and4 a bifurcation having a main lumen, a first branch lumen and a second branch lumen. In particular, these figures illustrate a bifurcation in the biliary system, wherein the main lumen comprises thecommon bile duct2aand the first and second branch lumens comprise the left and righthepatic ducts2b,2crespectively.FIG. 1 shows a normal, or healthy, biliary system without strictures.FIG. 2 shows the biliary system withstrictures3 residing in the main lumen and in both branch lumens of the bifurcation.FIG. 4 shows a pair of stents placed in the left and righthepatic ducts2b,2c, respectively, and thecommon bile duct2aaccording to a method of the present invention.
• Referring now toFIGS. 5-9, a stent delivery system made in accordance with the present disclosure is shown. The stent delivery system includes a first and second introducers configured to deliver two stents to a target anatomy, as well as a catheter used to facilitate delivery of the second introducer to a target anatomy. Thefirst introducer10 and thesplittable catheter50 are adapted to be disposed within the workingchannel8aof anendoscope8 as shown inFIGS. 5, 8 and9. As illustrated inFIG. 7, thesplittable catheter50 includes an interior passageway through which the second introducer can be advanced.
• As illustrated inFIG. 7, thesplittable catheter50 is an elongate, flexible tube adapted to allow thesecond introducer20 to advance unobstructed into the target anatomy. Thesplittable catheter50 can be formed from a frangible material, for example, a material that readily tears in a longitudinal direction along the length of the sheath. A non-limiting example of a splittable material is a molecularly oriented (non-isotropic) polytetrafluoroethylene (PTFE) such as that used in the PEEL-AWAY™ Sheath (Cook Incorporated, Bloomington, Ind.). Alternatively,splittable catheter50 can be formed from any suitable material known in the art including, but not limited to, PTFE, polyamide, polyurethane, polyethylene and nylon including multi-layer or single layer structures. Thesplittable catheter50 can also be provided with a groove, pre-score, a weakened area or a pre-slit end to facilitate splitting.
• Splittable catheter50 can ranges in size from about 5 Fr. to about 9 Fr. These sizes are provided for illustrative purposes only and are not intended to be construed as a limitation of the present invention. As one of ordinary skill in the art would appreciate in view of the present disclosure, the size of thesplittable catheter50 is related to the size of thesecond introducer20 that is advanced through it, which in turn is related to the size of thesecond stent26 in its compressed or unexpanded configuration. Thus, splittable catheters smaller than about 5 Fr. that may become available in the future are contemplated as being within the scope of the claims of the invention.
• With respect to the introducers used with the stent delivery system of the present disclosure, any introducer capable of introducing and deploying stents is contemplated. Non-limiting examples include biliary stent deployment delivery systems as well as the introducers described in co-pending provisional application Ser. No. 10/728,589 (Attorney docket number 10000/218), which is incorporated by reference in its entirety. The introducers can be of the same or different type and size.
• FIGS. 10-15 illustrate several, non-limiting, exemplary embodiments ofintroducer10. In one exemplary embodiment, illustrated inFIG. 10,introducer10 has a proximal end and a distal end having inner and outer coaxial tubes. The outer coaxial tube forms an outer sheath orcatheter11. The inner coaxial tube forms ashaft13.Shaft13 has aproximal end13a, adistal end13band astent retaining area15. Optionally,shaft13 may include apusher band17 attached to thestent retaining area15, adistal tip18 attached to the shaftdistal end13band awire guide lumen19.Shaft13 can be made from any suitable material known in the art including, but not limited to, polyethylene ether ketone (PEEK), polytetra-fluoroethylene (PTFE), polyamide, polyurethane, polyethylene and nylon, including multi-layer or single layer structures and may also include reinforcement wires, braid wires, coils and or filaments. Preferably,shaft13 comprises a proximal portion made of a relatively rigid material such as stainless steel or any other suitable material known in the art.
• Stent retaining area15 is preferably located on a distal portion of theshaft13. Thestent retaining area15 retains astent16 to be deployed in the bifurcation. Optionally,stent16 is a self-expanding stent.
• Pusher band17 helps to prevent the stent from proximally migrating as theouter catheter11 is withdrawn proximally to deploy the stent. Thepusher band17 is located proximal to thestent16 such that the proximal end of thestent16 abuts thepusher band17 as shown inFIGS. 10-15.
• Distal tip18 helps prevent fluids from entering theouter catheter11 as theintroducer10 is navigated through the body lumens. As shown inFIGS. 10-15,distal tip18 has aproximal end18aand adistal end18b. The distal tipproximal end18ahas a diameter that is less than the diameter of the distal outer catheterdistal end14band is received therein. Optionally, thedistal tip18 tapers to a smaller diameter towards itsdistal end18bas shown inFIG. 12.Distal tip18 can be made from any suitable material known in the art including, but not limited to, PEEK, PTFE, polyamide, polyurethane, polyethylene and nylon, including multi-layer or single layer structures.
• In the embodiment shown inFIGS. 10 and 13,wire guide lumen19 extends through theshaft13, from the shaftdistal end13bto the shaftproximal end13a. In this embodiment, the shaftproximal end13aoptionally includes a luer-lock fitting31 for releaseably fixing awire guide32 relative toshaft13 as shown inFIG. 10. In the embodiments shown inFIGS. 10 and 13, thestent delivery system1 of the present invention includes an over-the-wire type wire guide. Such wire guides are known in the art.
• Alternatively, thewire guide lumen19 may extend through theshaft13 from the shaftdistal end13bto the shaftproximal end13abut thewire guide32 exits through an aperture positioned along the length of theintroducer10. For example, as shown inFIG. 14, thewire guide32 extends through a portion of thedistal tip18 and exits through anaperture30 positioned along the length of thedistal tip18. In this embodiment, thewire guide32 extends through thedistal tip18 and exits theintroducer10 without passing throughstent16. For example,wire guide32 may extend proximally throughdistal tip18 for a distance of about 1 cm.
• In the alternate embodiment shown inFIG. 15, thewire guide lumen19 extends through the length of theshaft13 but thewire guide32 extends through a portion of theshaft13 and exits through anaperture30 positioned along the length ofouter catheter11. In this embodiment,wire guide32 extends through thedistal tip18, through a portion of theshaft13 and passes throughstent16 before exitingintroducer10. For example,wire guide32 may extend through thedistal tip18 and through thestent retaining area15 for a distance of about 20 cm.
• In yet other alternative embodiments, thewire guide lumen19 may extend through a portion ofshaft13 and may exit through anaperture30 positioned along the length of theintroducer10. Any number ofapertures30 positioned at any location along the length of theintroducer10 is contemplated. In addition, thewire guide lumen19 may also comprise a channel or split.
• Aperture30 provides the stent delivery system of the present invention with rapid-exchange capabilities. In particular, by extending thewire guide32 through only a distal portion of thewire guide lumen19, the delivery system can be removed from awire guide32 having a length substantially shorter than the length necessary if thewire guide32 were extended through the entire length of thewire guide lumen19.
• Referring toFIG. 10, the sheath orouter catheter11 has a proximal end11aand adistal end11b. Preferably, at least the distal portion ofouter catheter11 is made of any optically clear or imageable material. This allows thestent16 mounted on thestent retaining area15 of theshaft13 to be viewed.
• Theouter catheter11 further includes a proximalouter catheter12 having proximal and distal ends,12aand12b, respectively, and a distalouter catheter14 having proximal and distal ends,14aand14b, respectively. Thedistal end12bof the proximalouter catheter12 is attached to theproximal end14aof the distalouter catheter14 to formouter catheter11. Thedistal end12bof proximalouter catheter12 can be attached to theproximal end14aof distalouter catheter14 by any method known in the art including, but not limited to, heat fusing, adhesive bonding, chemical bonding or mechanical fitting. Alternatively, the proximalouter catheter12, and the distalouter catheter14 can be formed from of a single catheter or sheath.
• The introducer proximal outer diameter is between about 5 Fr. and about 6 Fr. The first introducer distal outer diameter is between about 6 Fr. and about 6.5 Fr. This allows placement of a stent having a compressed diameter between about 0.077 inches and about 0.78 inches. These sizes are provided for illustrative purposes only and are not intended to be construed as a limitation of the present invention. As one of ordinary skill in the art would appreciate, the size of the introducer required to place a stent is related to the size of the stent to be placed, and more particularly, to the size of the compressed configuration of the stent. Thus, introducers having distal outer diameters less than about 6 Fr. used to place stents having compressed configurations less than about 0.078 inches that may become available in the future are contemplated as being within the scope of the present disclosure.
• Thefirst introducer10 and thesplittable catheter50 are sized to be disposed next to each other in the workingchannel8aof anendoscope8. More particularly, the sum of thefirst introducer10 outer diameter, i.e. either the proximal outer diameter or the distal outer diameter, and the splittable catheter outer diameter is less than the inner diameter of the workingchannel8aof theendoscope8. For example, referring to the embodiment shown inFIG. 9, thefirst introducer10 and thesplittable catheter50 are disposed next to each other in a staggered configuration within the workingchannel8aof anendoscope8. That is, the introducer has an increased diameter portion (the stent retaining area) and a decreased diameter portion (the proximal outer catheter). When the introducer and catheter are positioned in an endoscope adjacent to one another and staggered the respective increased and decreased diameter portions are nested together. As can be seen inFIG. 9, the sum of the first introducer proximal outer diameter and thesplittable catheter50 is less than the inner diameter of the workingchannel8aof theendoscope8.
• In yet another alternate embodiment of thestent delivery system1 of the present invention, thefirst introducer10 and thesplittable catheter50 are sized to also accommodate at least onewire guide32 or42 within the workingchannel8aof theendoscope8. For this embodiment, the sum of the first introducer proximal outer diameter, the splittable catheter outer diameter and at least one of the first and second wire guides32,42 is less than the inner diameter of the workingchannel8aof theendoscope8.
• Thestent delivery system1 of the present invention is used to place first andsecond stents16,26 into abifurcation having strictures3 in themain lumen2aand the first andsecond branch lumens2b,2cas follows. Using an endoscope, a distal end of a first wire guide is advanced into the first branch lumen of the bifurcation. A distal end of a second wire guide is then advanced into the second branch lumen of the bifurcation. Thefirst introducer10 and thesplittable catheter50 are advanced over the wire guide into the workingchannel8aof theendoscope8. Thus, thefirst introducer10 is positioned within the first branch of the bifurcation and thesplittable catheter50 is positioned within the second branch lumen of the bifurcation, as shown inFIG. 5. Thefirst introducer10 andsplittable catheter50 may be positioned sequentially or simultaneously. Thefirst introducer10 is positioned such that thefirst stent16 is at least partially aligned within any occlusion of narrowing of the first branch of the bifurcation. Once aligned, the first stent is deployed within the first branch of the bifurcation and the first introducer is withdrawn as shown inFIG. 6. After thefirst introducer10 is removed, asecond introducer20 is passed through the workingchannel8aof theendoscope8 and advanced over thesecond wire guide42 through thesplittable catheter50.FIG. 7 shows that thesplittable catheter50 acts as a shield to protect thesecond introducer20 from being snagged, or otherwise blocked, by the deployedfirst stent16.FIG. 7 also shows thesplittable catheter50 splitting, or peeling away, as thesecond introducer20 is advanced through it and into thesecond branch lumen26. Once thesecond introducer20 is positioned in thesecond branch lumen2b, thesplittable catheter50 is removed and thesecond stent26 is deployed within thesecond branch lumen2band themain lumen2a. The resulting connfiguration is shown atFIG. 4.
• The above Figures and disclosure are intended to be illustrative and not exhaustive. This description will suggest many variations and alternatives to one of ordinary skill in the art. All such variations and alternatives are intended to be encompassed within the scope of the attached claims. Those familiar with the art may recognize other equivalents to the specific embodiments described herein which equivalents are also intended to be encompassed by the attached claims. For example, the invention has been described in the context of the biliary system for illustrative purposes only. Application of the principles of the invention to any other bifurcated lumens or vessels within the body of a patient, including areas within the digestive tract such as the pancreatic system, as well as areas outside the digestive tract such as other vascular systems, by way of non-limiting examples, are within the ordinary skill in the art and are intended to be encompassed within the scope of the attached claims.

Claims (20)

1. A stent delivery system comprising:

a first introducer comprising a first stent;

a second introducer comprising a second stent; and

a catheter having a passageway adapted to receive the second introducer.

2. The stent delivery system ofclaim 1 wherein the first introducer and the catheter are adapted to be disposed in a partly staggered configuration within the working channel of an endoscope.

3. The stent delivery system ofclaim 2, wherein the first introducer and the catheter have a combined outside diameter between about 3 mm and 4.5 mm.

4. The stent delivery system ofclaim 1, wherein the catheter further comprises a side wall having a frangible portion.

5. The stent delivery system ofclaim 4, wherein the first introducer comprises a distal portion having a stent retaining portion.

6. The stent delivery system ofclaim 4, wherein the second introducer comprises a distal portion having a stent retaining portion.

7. The stent delivery system ofclaim 4, wherein a proximal portion of the first introducer is positioned adjacent to the catheter and a distal portion of the first introducer is distal to the catheter when the first introducer and catheter are inside the working channel of the endoscope.

8. The stent delivery system ofclaim 1 further comprising a first wire guide, wherein the first introducer further comprises a wire guide lumen adapted to receive the first wire guide.

9. The stent delivery system ofclaim 8, wherein the wire guide lumen extends through at least a distal portion of the first introducer.

10. The stent delivery system ofclaim 8 further comprising a second wire guide, wherein the second introducer further comprises a second wire guide lumen adapted to receive the second wire guide.

11. The stent delivery system ofclaim 10, wherein the wire guide lumen of the second introducer extends through at least a distal portion of the second introducer introducer.

12. A kit for delivering first and second stents to a branched target anatomy, the kit comprising:

a first introducer comprising:

a tubular body having a proximal end, a distal end, and a stent carrying portion therebetween;

a second introducer comprising:

a tubular body having a proximal end, a distal end, and a stent carrying portion therebetween;

a catheter adapted to receive the second introducer, the catheter having a frangible wall; and

a sterile package adapted to receive the first introducer, the second introducer and the catheter.

13. The kit ofclaim 12, further comprising:

a first self-expanding stent positioned within the stent carrying portion of the first introducer; and

a second self-expanding stent positioned within the stent carrying portion of the second introducer.

14. The kit ofclaim 13, further comprising:

a first wire guide wherein the first wire guide is configured to receive the first introducer; and

a second wire guide wherein the second wire guide is configured to receive the second introducer; and

wherein the sterile package is adapted to receive the first and second wire guides.

15. The kit ofclaim 12, wherein the first introducer further comprises:

a passageway extending between the distal end and a port positioned proximal to the stent carrying portion, wherein the port is adapted to receive a wire guide.

16. The kit ofclaim 12, wherein the second introducer further comprises:

a passageway extending between the distal end and a port positioned proximal to the stent carrying portion, wherein the port is adapted to receive a wire guide.

17. The kit ofclaim 12, wherein the first introducer further comprises:

a passageway extending between the distal end and a port positioned distal to the stent carrying portion, wherein the port is adapted to receive a wire guide.

18. The kit ofclaim 12, wherein the second introducer further comprises:

a passageway extending between the distal end and a port positioned distal to the stent carrying portion, wherein the port is adapted to receive a wire guide.

19. A method for propping open a narrowed bifurcated anatomy having a main lumen and first and second branch lumens, the method comprising the steps of:

a) providing the kit ofclaim 19;

b) providing an endoscope having a working channel;

c) positioning the endoscope adjacent the bifurcated anatomy;

d) advancing the first wire guide through the working channel to the first branch lumen;

e) advancing the second wire guide through the working channel to the second branch lumen;

f) advancing the first introducer over the first wire guide to the first branch lumen of the bifurcation;

g) advancing the catheter over the second wire guide to the second branch lumen of the of the bifurcation; and

h) deploying the first stent within the first branch lumen.

20. The method ofclaim 19, wherein steps f) and g) further comprise advancing the first introducer and the catheter through the working channel in a staggered configuration; and further comprising the steps of:

i) advancing the second introducer over the second wire guide and through the catheter to the second branch lumen;

j) removing the catheter, thereby splitting the frangible wall;

k) deploying the second stent; and

l) withdrawing the second introducer.

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