WO2000018323A3 - Methods and apparatus for crossing vascular occlusions - Google Patents

Methods and apparatus for crossing vascular occlusions Download PDF

Info

Publication number
WO2000018323A3
WO2000018323A3 PCT/US1999/019831 US9919831W WO0018323A3 WO 2000018323 A3 WO2000018323 A3 WO 2000018323A3 US 9919831 W US9919831 W US 9919831W WO 0018323 A3 WO0018323 A3 WO 0018323A3
Authority
WO
WIPO (PCT)
Prior art keywords
guidewire
wire
methods
deflecting catheter
occlusion
Prior art date
Application number
PCT/US1999/019831
Other languages
French (fr)
Other versions
WO2000018323A2 (en
Inventor
Matthew R Selmon
Charles F Milo
Fred Co
Mark Campello
Ronald French
Amiel Aguilar
Original Assignee
Lumend Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Lumend Inc filed Critical Lumend Inc
Priority to EP99942548A priority Critical patent/EP1119387B1/en
Priority to BR9914165-5A priority patent/BR9914165A/en
Priority to JP2000571846A priority patent/JP4680386B2/en
Priority to AU55900/99A priority patent/AU5590099A/en
Priority to CA002341414A priority patent/CA2341414A1/en
Priority to DE69935149T priority patent/DE69935149T2/en
Publication of WO2000018323A2 publication Critical patent/WO2000018323A2/en
Publication of WO2000018323A3 publication Critical patent/WO2000018323A3/en

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
    • A61B2017/00252—Making holes in the wall of the heart, e.g. laser Myocardial revascularization for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A61B2017/22042—Details of the tip of the guide wire
    • A61B2017/22044—Details of the tip of the guide wire with a pointed tip
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22072—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other
    • A61B2017/22074—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel
    • A61B2017/22077—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel with a part piercing the tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22094—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for for crossing total occlusions, i.e. piercing
    • A61B2017/22095—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for for crossing total occlusions, i.e. piercing accessing a blood vessel true lumen from the sub-intimal space
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00351—Heart
    • A61B2018/00392—Transmyocardial revascularisation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3925—Markers, e.g. radio-opaque or breast lesions markers ultrasonic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M2025/018—Catheters having a lateral opening for guiding elongated means lateral to the catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0194—Tunnelling catheters
    • A61M2025/0197—Tunnelling catheters for creating an artificial passage within the body, e.g. in order to go around occlusions

Abstract

Methods and apparatus for crossing totally to substantially occluded blood vessels by passing a redirectable wire such as a guidewire from a relatively proximal point past the occlusion within a subintimal space formed between the intimal layer and the adventitial layer of a blood vessel wall. The wire may be advanced to a point distal to the occlusion, and thereafter deflected back into the blood vesel lumen, typically using a deflecting catheter which is advanced over the guidewire after it has been positioned within the subintimal space. The deflecting catheter may include a flapper valve assembly or preformed actuator wire for redirecting the guidewire. After the guidewire is returned to the blood vessel lumen, the deflecting catheter may be withdrawn, and the guidewire may be available for introduction of other inverventional and diagnostic catheters for performing procedures such as stenting.
PCT/US1999/019831 1998-09-30 1999-08-27 Methods and apparatus for crossing vascular occlusions WO2000018323A2 (en)

Priority Applications (6)

Application Number Priority Date Filing Date Title
EP99942548A EP1119387B1 (en) 1998-09-30 1999-08-27 Apparatus for crossing vascular occlusions
BR9914165-5A BR9914165A (en) 1998-09-30 1999-08-27 Guidewire deflection system, intravascular catheter, redirectable, redirectable intravascular guidewire, intravascular catheter to selectively deflect a guidewire, process for crossing a substantially occluded blood vessel
JP2000571846A JP4680386B2 (en) 1998-09-30 1999-08-27 Method and apparatus for traversing a vascular occlusion
AU55900/99A AU5590099A (en) 1998-09-30 1999-08-27 Methods and apparatus for crossing vascular occlusions
CA002341414A CA2341414A1 (en) 1998-09-30 1999-08-27 Methods and apparatus for crossing vascular occlusions
DE69935149T DE69935149T2 (en) 1998-09-30 1999-08-27 DEVICE FOR CROSSING VASCULAR OCCLUSIONS

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US09/163,854 1998-09-30
US09/163,854 US6217527B1 (en) 1998-09-30 1998-09-30 Methods and apparatus for crossing vascular occlusions

Publications (2)

Publication Number Publication Date
WO2000018323A2 WO2000018323A2 (en) 2000-04-06
WO2000018323A3 true WO2000018323A3 (en) 2000-07-13

Family

ID=22591864

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1999/019831 WO2000018323A2 (en) 1998-09-30 1999-08-27 Methods and apparatus for crossing vascular occlusions

Country Status (9)

Country Link
US (4) US6217527B1 (en)
EP (1) EP1119387B1 (en)
JP (1) JP4680386B2 (en)
AT (1) ATE353686T1 (en)
AU (1) AU5590099A (en)
BR (1) BR9914165A (en)
CA (1) CA2341414A1 (en)
DE (1) DE69935149T2 (en)
WO (1) WO2000018323A2 (en)

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JP4680386B2 (en) 2011-05-11
ATE353686T1 (en) 2007-03-15
AU5590099A (en) 2000-04-17
WO2000018323A2 (en) 2000-04-06
EP1119387A2 (en) 2001-08-01
JP2002525163A (en) 2002-08-13
US6221049B1 (en) 2001-04-24
BR9914165A (en) 2001-06-19
US20010000041A1 (en) 2001-03-15
DE69935149D1 (en) 2007-03-29
CA2341414A1 (en) 2000-04-06
US6514217B1 (en) 2003-02-04
EP1119387B1 (en) 2007-02-14
US6217527B1 (en) 2001-04-17
DE69935149T2 (en) 2007-10-25

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