CA2099579A1 - Method and device for exchanging cardiovascular guide catheter while a previously inserted angioplasty guide wire remains in place - Google Patents
Method and device for exchanging cardiovascular guide catheter while a previously inserted angioplasty guide wire remains in placeInfo
- Publication number
- CA2099579A1 CA2099579A1 CA002099579A CA2099579A CA2099579A1 CA 2099579 A1 CA2099579 A1 CA 2099579A1 CA 002099579 A CA002099579 A CA 002099579A CA 2099579 A CA2099579 A CA 2099579A CA 2099579 A1 CA2099579 A1 CA 2099579A1
- Authority
- CA
- Canada
- Prior art keywords
- guide wire
- catheter
- guide
- exchange catheter
- exchange
- Prior art date
- Legal status (The legal status 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 status listed.)
- Abandoned
Links
Classifications
-
- 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
- A61M25/0169—Exchanging a catheter while keeping the guidewire in place
-
- 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
- A61M25/10—Balloon catheters
- A61M25/104—Balloon catheters used for angioplasty
Abstract
A method and device for removing a first guide catheter (10) and replacing said first guide catheter with a second guide catheter (10a), without disturbing the placement of a flexible guide wire (32) which has previously been inserted through the first guide catheter. The device of the invention comprises an "exchange catheter" (58) which may be advanced over the outer surface of the pre-positioned guide wire to provide support and shielding of the guide wire during the catheter exchange procedure. A guide wire exit aperture (74) formed in the "exchange catheter" permits the guide wire to exit the exchange catheter at a location whereby the operator may hold and manipulate the guide wire to maintain its desired position during the catheter exchange procedure.
Description
1~ 2~99~79 1-- .
METHOD AND DEVIC~ FOR ~XCHANGING CAI~DIOVASCIJLA:R
GUIDE: CAT}IE~ER W~IILE A PREYIO~SLY INSER~ED ANGIOPLASTY
GUIDE WIRE RE~AINS IN P:~C}:
Field oP the In~entio~
The present invention relates yenerally to medical equipment and more particularly to a me~hod and device for xemoving a first cardiovascular guide catheter and replacing it with a second guide catheter while maintaining the operative position of a guide wire which has been previousl~v inserted through the first ~uide catheter.
Background o~ the Inv~tion Percutaneous transluminal angioplasty procedures have become commonly used in the trsatment of various obstructive disorders of the human circulatory system. To date, angioplasty procedures ha~e been utilized to treat stenotic lesions of the coronary arteries, iliac arterial obstructions, femoropopliteal arterial obstructions, renal arterial obstructions, cerebrovascular arteri~l obstructions, coarctations of the aorta, stenotic arteries in tran~planted organs, stenotic saphenous vain hypass grafts, stenotic dialysis ~istulas, stenotic portal ~ystemic shunts and other obstructive vascular lesions. ~;
In general, the usual ~echnique ~or per~orming percutaneous txansluminal angioplasty procedures requires the ini~ial placement of an elongate flexible angiocatheter known as a "guide catheter". The guide catheter is initially inserted into an appro~riate artery, such as the ;: . , , .,,: .
::' ', ~' ,. , '.' . . . . .
. : : :;: , . ... .
METHOD AND DEVIC~ FOR ~XCHANGING CAI~DIOVASCIJLA:R
GUIDE: CAT}IE~ER W~IILE A PREYIO~SLY INSER~ED ANGIOPLASTY
GUIDE WIRE RE~AINS IN P:~C}:
Field oP the In~entio~
The present invention relates yenerally to medical equipment and more particularly to a me~hod and device for xemoving a first cardiovascular guide catheter and replacing it with a second guide catheter while maintaining the operative position of a guide wire which has been previousl~v inserted through the first ~uide catheter.
Background o~ the Inv~tion Percutaneous transluminal angioplasty procedures have become commonly used in the trsatment of various obstructive disorders of the human circulatory system. To date, angioplasty procedures ha~e been utilized to treat stenotic lesions of the coronary arteries, iliac arterial obstructions, femoropopliteal arterial obstructions, renal arterial obstructions, cerebrovascular arteri~l obstructions, coarctations of the aorta, stenotic arteries in tran~planted organs, stenotic saphenous vain hypass grafts, stenotic dialysis ~istulas, stenotic portal ~ystemic shunts and other obstructive vascular lesions. ~;
In general, the usual ~echnique ~or per~orming percutaneous txansluminal angioplasty procedures requires the ini~ial placement of an elongate flexible angiocatheter known as a "guide catheter". The guide catheter is initially inserted into an appro~riate artery, such as the ;: . , , .,,: .
::' ', ~' ,. , '.' . . . . .
. : : :;: , . ... .
2~9~79 femoral artery or axillary artery, and subsequently advanced transluminally to a point where the distal tip o~
the guide catheter is positioned within a target blood vessel, near the obstructive lesion to be treated. A
flexible guide wire is then inserted through the lumen o~
the guide catheter such that the distal end of the guide wire emerges out of and extends beyond the distal tip of the guide catheter. The guide wire is then advanced under fluoroscopic guidance, to a point whereat the distal end o~
lo the wire has advanced ~ully through the stenotic lesion or obstruction to be treated. After the distal end o~ khe guide wire has been advanced through the stenotic lesion or obstruction, a small balloon catheter is then inserted and advanced over the guide wire, through the lumen of the guide ca~eter, to a point where the balloon of the balloon catheter lies adjacent the stenotic lesion or obstruction.
Therea~tar, the balloon is repeatedl~ infla~ed and deflated to bring about the desired dilatisn o~ the offending lesion andjor distention of the surrounding blood vessel wall.
After such dilatory treatment i5 completed, the balloon catheter, guide wire and guide catheter are withdrawn and removed from the patient's body.
Various types and ~izes of guide catheters are available. Care is generally taken, prior to the procedure, to pre-select a guide catheter o~ appropriate type and size for use in each particular patient. However, sometimes the pre-selected guide catheter proves to be inade~uate and it becomes ne~essary or desirable to '.:
: -: - , : :; - i. . .; , - 2~99~79 exchange one guide catheter ~or another during the course of the angioplasty procedureO If the de~ision to change a guide catheter is reached prior to insertion of the guide wire, the guide catheter may simply be extracted and replaced before the guide wire is inserted without any substantial risk o~ complication. However, if, as o~ten occurs, the decision to replace the guide catheter is not reached until after the guide wire has already b~en fully inserted through the gui~e catheter and advanced through the stenotic lesion, any attempt to replace the guide catheter at. that point .is complicated by the need to maintain the previously insert~.d guide wire in its operative position, without accidentally pulling the guide wire back through the stenotic lesion.
~In view o~ the foregoing problems in the prior art, there exists a need ~or a method and/or device to facilitate removal and replacement o~ a cardiovascular .-g~ide catheter ~hile a flexible guide wire, which has been previously inserted through the lumen of the original guide ~.
catheter,. remains in a substantially constant position without undue risk that the guide wixe will be inadvertently pulled in a distal direction or otherwise pulled, retracted or jerked from its previously attained operative position . The medical literature has previously reported two t2) techniques ~or removing an originally inserted guide catheter and replacing it with another guide catheter while maintaining the desired oper~tive . positioning of a .: , .
~ , . . . :
: .
2099~7~
previously inserted ~uide wire. One such technique is reported in: "Technique ~or Guiding Ca-theter Exchange During Coronary Angioplasty Wh.ile ~aintaining Guide Wire Access ~cross A Coronary Stenosis", by C. Mark Newton, M.D., Stephen Ao Lewis, M.D., and George W. Vetrovec, ~.D., Catheterizatlon_and Cardiovascular_ Dia~nosis, 15:173-175 (1988). The first technique of Newton et al. requires the insertion of a relatively thick exchange wire be inserted and advanced through the lumen of the guiding catheter, beside the originally placed angioplasty guide wire. In particular, Newton et al. discloses the use o~ 0.35 inch diameter exchange wire which, when inserted through the lumen of the .guiding catheter, lies adjacent to the . existing anyioplasty guide wire and provides ~ecessary support during extraction and exchange of the guiding catheter.. However, the passage o~ the exchange wire in immediate contact with the guide wire raises the possibility of inadvertent interference with and/or dislodgement of the guide wire. Moreover, the subsequent passage of the second guide catheter over the length af the existing guide wire ~ exchange wire may result in damage to or burring of the inner walls of the catheter.
The second techni~ue ~or exchan~ing a guide catheter is described in "Guiding Catheter Exchanged During Coronary Angioplasty", by Stephen G. Warren, M.D., and J. Craig Barnett, M.D., Catheterization _ and Cardiovascular Diaqnosls, 20:212-215 (1990). This second technique of Warren et al. is purely manipulative and relies solely upon , ;
- : . . . ... .
2~99~79 --5~
the skill of the practitioner. The technique o~ Warren et al. requires placement of an extension wire on the proximal end o~ the original guide wire and, thereafter, the guiding catheter is slowly and carefully withdrawn while simultaneously forming a slackened ar~a or "loop" in the guide wire within the ascending aorta. The slackened area or "loop" in the guide wire is formed to minimize khe likelihood of inadvertent withdrawal of the distal end of the guide wire from its trans-stenotic position. After the first yuide catheter has been withdrawn over the entire length of the extended guide wire, a second replacement guide catheter is then advanced over such extended guide wire and into a point where the distal end o~ the guide catheter is in the coronary ostium. Thereafter, the guide wire~ is gently retracted while the guide wire is simultaneously ~dvanced through the ostium. By this procedure, the "loop" in the guide wire is eliminated and the new guide catheter takes its desired position within the coronary artery.
This second guide catheter replacement kechni.que described by WARREN et al. is highly dependent upon the skill of the operator. ~oreover, the technique described by WARREN ~t al. fails to provide any sort of enhanced ~ support for the guide wire and, thus, allows the guide catheter to be moved over the thin guide wire w.ithout any protection or support ~or the guide wire.
one guida wire extension purported to facilitate exchange of a cardiovascular catheter with an existing 209~579 guide wire in place is described in U~ S. Patent No.
~,917,103 (Gambale et al.~..Anoth~r extendable guide wire for such procedures is described in U. S. Patent No. 4, 827,9al (Taylor et al.~.
Other U. S. patents which purport to describe devic~s usable in exchanging cardiovascular c~theters and/or guide wires are U. S. Patent No. 4,927,413 (Hess) and UO S.
Patent No. 4,932,413 (Shockey et: al.).
Because none of the prior art techniques or devices are truly optimal for effecting guide catheter exchange in all patientsj there remains a need in the art ~or improved methods and/or devices for facilitating such guide catheter exchange without dislodging or distur~ing the di~tal end positioning of a previously inserted guide wire.
~ Summary o~ the Invention The present invention overcomes some or all of the shortcomings of the prior art by providing a cardiovascul~r catheter exchange method and a .cardiovascular "exchange catheter" device which facilitates removal o~ a ~irst guide catheter and replacement thereof with a second guide catheter, without disturbing the operative placement of a guide wire which has previously been inserted through khe lumen of the first guide catheter.
In accordance with the invention, there is provided a method of supportiny and shielding a guide wire while removing and replacing a guide catheter through which said guide wire has been inserted, said method comprising the step of passing a tubular sheath m~ember over the guide wire , .
209~7~
to prokect and ~upport the guide wire while the guir7e catheter is removed and replaced.
In accordance with a more specific aspect of the method of the present invention, there is provided a method - 5 for removing a first guide catheter and replaclng said first guide catheter with a sacond guide catheter while maintaining the position of an elongate guide wire which has been previously been inserted through the first guide catheter, said method comprising the steps of:
lo (a) providing a flexible exchange catheter compri~ing a generally tubular body having an outer diameter which is smaller than the inner diameter of the first or second guide catheters, a proximal end, a distal end, at least one lumen extending longitudinally ther~through and a guide wire~exit aperture formed in the generally tubular body between the proximal and-distal ends thereof;
(b) p~sing the ~istal end o~ the exchange catheter onto the proximal end of the guide wire and advancing the exchange catheter over the guide wire in a distal direction to a point where the proximal end of the guide wire i~
adjacent the guide wir~ exit apertuxe of the exchange catheter;
(c~ causing the proximal end o~ the guide wire to emerge from the lumen of the exchanye catheter through the guide wire exit aperture;
~ d) further advancing the exchange catheter over the guide wire in a distal direction to a point where the 2099~79 ~ 8-distal end of the exchange catheter is proximate the distal end of the first gui~e cath~ter;
(e) extracting the first guide catheter in a proximal direction over the exchange catheter and over guide wire and thereby removing said first guide catheter from the patient;
(f) advancing a second guide catheter in a distal direction over the exchange ca~heter and over the guide wire to a point where the second guide catheter has reached its desired operative position within the patient; and (g) proximally withdrawing and removing the exchange catheter, leaving the second guide cathetex in its operati~e position with the guide wire extending therethrough.
15~Further in accordance with the method of the present invention, said method may further comprise the step of manual grasping, holding and manipulation o* the portion of the guide wire which is emergent from the guide wire exit - aperture, during at least portions of the time during which the original guide catheter, replacement guide catheter and/or exchange catheter device are being inserted and/or retractedO Such manual grasping, holdin~ and/or manipulation o~ the guide wire enables the operator to maintain the desired operative placement of the distal end 2$ o~ the guide wire and serves to prevent the guide wire from becoming substantially displaced or distally retracted during the catheter exchange procedure. Additionally, the proximal end of the guide wire m~y be shielded within the 20~ ~379 _9_ body of the exchange catheter device when the first and second guide catheters are passed thereover so as to prevent damage to the lumens of the first or second guide catheters by the cut proximal end of the guide wlre.
Further in accordance with the invention, there is provided an "exchange catheter" device comprising a flexible, generally tubular body having a proximal end, a distal end and at least one lumen extending longitudinally therethrough and at least o~e guide wire exit aperture formed therein between the proximal and distal ends thereof. An optional guide wire re-entry aperture may also be formed in the tubular body proximal to the guide wire exit aperture. A ramp mèmber may be formed within the lumen of the tubular body to urge the leading tip of the guide wire out of the guide wire exit aperture as the exchange catheter is advanced over the guide wire.
The b~dy o~ the exchange catheter device may be formed of any suitable material. Specifically, such exchange catheter device may be formed of tubular plastis, or, such exchange catheter device may be formed of an elongate coiled member such as a fine wire coiled about a hollow lumen to form a generally tubular sheath-like structure which may be passed ovex the outer surface o~ a guide wixe.
Still further in accordance with the inven~ion, there is provided a system for removing a first guide catheter and replacing it with a second guide catheter while a guide wire, previously inserted through the ~ixst guide~_atheter, remains in place. Such system c~mprises ta) a first guide ':
,'.''''.,"'''','''~, .''"';",''','':,,'.' '',,''',';''' "'',;" ~' ~, , ; , "
2~99~79 catheter, (b) a second guide catheter, (c) an elongate guide wire and (d) a generally tubular exchanye catheter.
Additionally, the system of the present inv~ntion may further include (e) an extensi.on wire attachable to the proximal end of the elonyate guide wixe to form a "guide wire assembly" which is suffic:iently long such that th~
portion o~ the guide wire assembly which extends outside o~
the patient's body will be at least as long as the longest of said first and second guide catheters.
~0These, as well as other elements, objects and advantages of the present invention will be more apparent from the following description and drawings. It is understood that changes in the specific structure shown and de~cribed may be made within the scope o~ the claims , 5 without departing ~rom the spirit of the invention.
8rie~ Descripition of the Drawings Figure 1 is an illustration of a prior art guide catheter inserted through the femoral artery of a human being in positioned for percutaneous transluminal angioplasty of the right coronary artery;
Figure 2 is an enlarged cross~sectional view of the ~distal end of the prior art guide catheter of Figure 1 disposed within the aortic arch;
Figure 3 is an enlarged view of the tip o~ the prior art guide catheter of Figure 2 showing the balloon catheter and guide wire extending there~rom with the guide wire extending through the lumen of the stenosis;
' .
209957~
~11--Figure 4 is an illustration of the prior art percutaneous transluminal angioplasty s~stem showing the guide catheter, balloon cathete!r, and guide wire;
Figure 5 is an illustration of the prior art guide catheter, balloon catheter, and guide wire as an attempt is made to extend the balloon into the lumen of th~ stenosis, resulting in displacement of the tip of the guide catheter and deformation or bending of the balloon catheter;
. Figure 6 is an enlarged view of the tip of the prior art guide catheter, balloon catheter, and guide wire of Figure 5;
Figure 7 is a top plan view of the exchange catheter .of the present învention;
.. ~:. .
Figure 8 is an illustration of the exchange catheter o~ Figure 7 after it has been i~s~rted into the femoral artery of a human being and al50 showing the guide wire extending therefrom;
Figure 9~is a sectional view of the exchange catheter of Figure 7 showing the guide wire extending therefrom and re-inserted therein;
- Figure 10 is an enla.rged cross-sectional view of the proximal end o~ the exchange catheter of Figure 7 showing the position of the proximal end of the guide wira extension disposed therein such that a new guide catheter 25 may be inse:rted over the exchange catheter without .
contactiny the proximal end of the guide wire extension; :.
Figure ~1 is a cross-sectional side view of the first aperture of the exchange cathete~ of Figures 7 and 9;
:.
2099~79 Figur~ 12 is a flow chart illustrating a preferred guide catheter exchange method of the present invention;
~ igures 13A-13H illustrate the steps of Figure 12 with corresponding letters indicat:ing the illustration o~
corresponding steps.
Detailed escription o~ the Preferred Embodiment The detailed description set forth below in conn~ction with the appended drawings is intended to describe and illustrate a presently preferred embodiment of the invention, and is not intended to represent the only form in which the present invention may be constructed or utilized. The description provided herein sets forth the functions and sequen~e of steps for constructing and operating the invention in connection with the illustrated embodiment. It is to be understood, howeYer, that the same or equivalent functions and sequences may be accomplished by different embodiments and it is intended that all such different embodiments be encompassed within the spirit and scope of the invention.
Broadly stated, the present invention comprises a flexible sheath-like member ox "exchange catheter" which may be passed over the outer surface of a pre-positioned guide wire to support and shield the guide wire while a surrounding guiding cathëter is extracted and replaced.
The preferred apparatus of the present invention incorporates specific elements and design attributes which enable the operator to carefully control and maintain the placement of the distal tip of~the guide wire across a . . , ;. , l ~ , ., ,., .. . . . . . ,, - . .: . :.
.: ~: . . . : . . . :: : : - . : . . : .
2099~79 ~13-~esired stenotic lesion, while the guide catheter is 'being exchanged, without undue risk of inadvertent disruption or movement of the guide wirP tip back through the stenotic lesion. Also, the present invention includes a method for exchanging a coronary guide catheter wherein a protective sheath or "exchange catheter" o* the above-described kype is utilized.
The preferred apparatus and methodology described in the presently preferred embodiment is notably applicab'le to coronary angioplasty procedures and is speci~ically described in such context. It is to be understood, -however, that the apparatus and methodology of the present-invention need not be limited to coronary artery procedure but, rather, may be utilized in a wide range of medical procedures wherein it is desirable to exch~nge one catheter for another while maintaining the operative location of a guide wire which has previously been inserted throu~h a lumen of the original catheter.
Figures 1-6 set forth schematic diagrams of typical 20 transluminal angioplasty procedures of the prior art and ' '' illustrations of problems which commonly occur during such procedures. The method and device of the present invention are illustrated in Figures 7-13H.
Re~erring now to Figure 1, the path followed by a ' flexible gu.ide cathe.ter, balloon catheter, and guide wire during percutaneous transluminal coronary angioplasty i5 illustrated. The guide catheter 10 enters the human being 14 through an opening 12 to the fe~oral artery at the thigh " ~
' :
. ~ ~
~099~7~
and travels upward and into the heart. The proximal end 16 of the guide catheter 10 remains outside of the body and may be manipulated to effect motion of the dist~l ~nd 18 within the heart. The guide wire and balloon catheter are insexted through the guide catheter 10 and thus follow the same path from the femoral artery to the heart.
Referring now to Figures 2 and 3, the position of the distal end 18 of the guide catheter 10 within the aortic arch 20 is illustrated. The tip 22 of the guide catheter 10 is disposed within the ostium 24 of the right coronar-y artery 26.
A balloon catheter 28 extends from the tip 22 of the guide catheter 10. A balloon 30 is disposed at the distal end of the balloon catheter 28. The balloon 30 is disposed within the right coronary artery 25 proximate a stenosis 36. The guide wire 32 extends through the lumen 38 o~ the stenosis 36. -Referring now to Fiyure ~, a prior art flexibleguiding catheter and balloon cath~ter system is illustrated. This prior art system comprises a flexible guide catheter 10 through which a guide wire 32 and/or balloon catheter 28 may be inserted to the site o~ stenosis 36. once positioned at the site of the stenosis 36 the distal end 34 of the guide wire 32 is inserted throu~h the lumen 38 of the stenosis 36 such that the balloon 30 may be urged over the, yuide wire 32 and through the lumen 38 of the stenosis 36 where it may be inflated to effect angioplasty.
.. . . . . . . . ..
" ' ~,' . ; , ~' ' ' ' . " ~ ' . ,' ' ' ' ! . ' , ~, ' ' ' ', " ` ' ,, ' ~'`'' ,: . ' ' ' , ' , , ,' . . " ', `'`'' ., ' ' " ' ,, , "" ': ' , ' .
2~9~79 ~15-Constant pressure ports 40 and 42. ~or th~ guide catheter 10 and the ball~on ca.theter 28, respectively, provide for the introduction of saline solution or the like to prevent the backflow of blood through the catheters 10 and 28, and to facilitate Elushi:ng of the catheters after the introduction of dye, vasodilators, or the liXe.
Syringes 44 and 46 permit the introduction through couplings 48 and 50, respectively, of dye, vasodilators, or the like into the guide catheter 10 and the balloon catheter 28. Trident housings 52 and 54 interconnect couplings 40 and 42 to the guide catheter 10 and the balloon catheter 28, respect.ively.
Referring now to Figures 5 and 6, occasionally difficulties are encountered when an attempt is made to inser~ the balloon 30 through the lumen 38 of a stenosis 36. If the lumen 38 of the stenosis 36 is so small that the balloon 30 must be forced therethrough, such forcing of the balloon cathater may cause the distal end 18 of the guide catheter 10 to be repelled or forced backwards away from the ostium 2~ of the right coronary artery 26. The distal tip of the balloon catheter 28 may thus become substantially unsupported intermediate the ~alloon 30 and the distal end 18 of the guide catheter 10. The balloon catheter 28 may consequently form a deformation or bend 56 2S due to the lack of support. This prevents the balloon ~0 from beiny forced further into the lumen 38 o~ the stenosis : 36 since further urging of the balloon catheter 28 toward the stenosis 36 merely increases ~he amount of deformation 2099~79 or bend 56 instead o~ moving the balloon 30 through the stenosis 36~
A common pxior art solution to this problem would have been to simply remove the original balloon catheter 28 and replace it with a second, more rigid, balloon catheker.
Such r~placement of the balloon catheter can be accomplished with minimal risk of disrupting positioning of the guide wire 32. Also, such replacement of balloon catheter wi.th a more rigid balloon catheter will ~requently 10 overcome the problem as the more rigid balloon catheter would be less likely to deform or wrinkle 56 in its distal region where it remains unsupported by the guide catheter lO. However, such removal and replacement of the original balloon catheter is highly undPsirable because balloon catheters are expensive disposable components which, once removed must be discarded and not reused. Furthermore, the substitution of a more rigid balloon catheter may not always achi~ve the desired result in view of the fact that the underlying problem of lack of support for the di~tal end of the balloon catheter remains unchecked.
Accordingly, the procedure of removing and replacing the balloon ~atheter results in substantial added expense and sometimes fails to remedy the underlyin~ problem.
In view of the expense and drawbacks associated with removal and replacement of the balloon catheter 28, it would be highly desirable i~ the operator could simply remove the oric~inally inserted guide catheter and replace it with a di~ferent guide c~theter having differing .
, , : :, . . , . ~, ., : .
flexibility characteristics and/or configuraticnal characteristics. Indeed, guide catheters are much cheaper than balloon catheters and, even if it were to be necessary to dispose of and not reuse the originally inserted guide catheter, such would still result in less expense than actual removal and replacement of the balloon catheter 28.
Therefore, a procedure for replacing the originally -:
inserted or first yuide catheter 10 with another guide catheter having different flexibility or configurational characteristics is desirable. However, any such procedure for replacing the originally inserted guide catheter 10 with another guide catheter must be carried out with continued control over the previously inserted guide wire 32 to ensure that the distal end of the guide wire 32 remains inserted through the stenosis 36. I~deed, if the guide wire 32 is inadvertently withdrawn from the stenosis, reinsertion of the guide wire may bP rendered difficult or impossible. There*ore, once the guide wire 32 has been successfully inserted through the stenotic lesion, it is extremely desirable to maintain such positioning of the guide wire 32 until the PTA procedure has been completed.
In fact, the patient's life may well depend upon khe ability to maintain the positioning of the guide wire within the lumen of the stenosis.
i. A~Preferred_Exchan~e~ Catheter Device The presently preferred apparatus of the present invention co~prises a pliahle sheath member, re~erred to herein as an "exchange catheter" 58 which may be passed ,: , . . . . . .
.: ' .'' ~ ; , . , : ~ : , over or threaded over the outer surfa~e o~ a flexible guide wire to shield and support the guide whils a surrounding guide catheter is extracted and replaced.
As shown in Figures 7 11, a presently preferred sheath or exchange catheter 58 of the present invention comprises an elongate tubular catheter body 60 having a lumen 62 extending longitudinally therethrough. The catheter body 60 has an outer diameter which i.s smaller ~han the inner diameter o~ ~he original guide catheter 10, or the replacement guide catheter to be inserted.- The distal end o~ the catheter body 60 is tapered and a flexible tubular tip member 70 is mounted on the distal end of the catheter body 60 forming an extension thereof such that the hollow lumen of the tubular tip member 70 is substantially .continuous with the hollow lumen of the catheter body 60~
A radiopaque band 72 i5 positioned between the distal end of the catheter body 60 and the flexible tip 70 so as to facilitate fluoroscopic visualization of the distal end of . the exchange catheter 5B.
. 20 A proximal guide wire exit aperture 74 is formed through the sidewall of the catheter body 68 near the approximate mid-point of the catheter body to permit a flexible guide wire 33 to pass ~rom the inner lumen of the exchange catheter 58, outwardly through such guide wire exit aperture 74.
A plug 80 may be positioned in the lumen 62 of the catheter body 60 at a position immediately proximal to the guide wire exit aperture 74 so a~ to block the lumen 62 of `
, ., . ,, ~..... . . .
20~7~
the guide catheter 58 at that poin~. A ramp or sloped sur~ace 82 may be formed on the distal aspect of the plug member 80 such that, as th~e exchange catheter 58 i5 advanced over the guide wire 32, the distal end of the guide wire 32 will register against ramp surface 82 and will be forced outwardly through guide wire exit aperture 74.
An optional guide wire re-entry aperture 76 may be formed proximal to the position of the guide wire exit aperture 74 to permit the proximal end of the guide wire 32 to be reinserted into ~he lumen 62 of the catheter body 60, thereby leaving a loop 33 of the guide.wire 32 outside of the catheter body 60~ Such loop 33 o~ the guide wire 32 may be directly grasped by the operator's hand, thereby ~allowing the operator to manipulate and hold the guide wire 32 in its desired position while the catheter exchange is taking place.
It will be appreciated that the second guide wire re-entry aperture. 76 is optional and that the exchange catheter 58 could function with only a single guide wire exit aperture 74 formed thexein. As shown in Figure 8, when the proximal portion of the guide wire 32 extends out of the guide wire exit aperture 74, it may be directly grasped by t~e operator and guided/manipulated in the desired manner without the need or re-entering the proximal end of the guide wire 32 back into the lumen 62 o~
the exchange catheter 58.
' - ' ' .,i .. ' ' ` ', :,. ' ' ' . ' :
203~579 An exchange catheter 58 of the present invention wherein the optional guide wire xe-entry aperture 76 is provided, the ability to reinsert the proximal end of the guide wire through the guide wire re-entry aperture 76 and into the lumen of the guide catheter will provide the additional advantage of allow.ing the proximal end o~ the guide wire 3~ to be housed within and shielded by the catheter body 60 while the initial guide catheter 10 is being withdrawn and while. the new guide catheter 10 is subsequently being advanced thereover. This is desirable because.the proximal ends of some guide wires may be sharp or may contain burrs which could cut or otherwise harm the inner lumen of the guide catheter lO as it is passed over the proximal end of the guide wire 32. Thus, so long as - 15 the ~roximal end of the,guide wire is posi~ioned within the lumen 62 of the exchange catheter 58, the body o~ the exchange catheter will serve t4 shield .and prevent the proximal end of the guide wire 32 from coming into contact :with the inner luminal sur~ace of either the original guide ,catheter 12 or the replacement guide catheter.
The length of the exchange catheter 58 and the locations of the exit aperture 74 and/or re entry aperture 76 on the catheter 58 may be specifically selected to ~acilitate the desired ~unction of the exchange catheter 58~ For example, i~ the preferred exchange catheter 58 is sized for use in adult coronary artery angioplasty procedures, the overall length of the exchange catheter 58 is ~referably approximately 290.~ centimeters, the catheter .
~99~79 body 60 being approximately 290 centimeters in length and the distal tip 70 being approximately 0.4 centimeters in length. In the preferred embodiment shown, the length A
from the proximal end 66 of the exchange catheter 58 to the optional guide wire re-entry aperture 76 is approximately 140 centimeters; the distance B between the re entry aperture 76 and the exit aperture 74 is approximately 20 centimeters. The distance C between the guide wire exit aperture 74 and the proximal end of the tapered section 6~
is approximately 129 centimeters; the length D o~ the tapered section 68 is approximately 1 centimeter and tha length E of the flexible tip 70 is approximately 0.4 centimsters.
The inner and outer diameter of the preferred embodiment of the exchange catheter 58 is determined by the relative diameters of the yuide wire 32 and the inner diameters o~ criginal and replacement guide cathe~ers being used. To wit: the outer diameter of the exchange catheter, at its largest point, is slightly smaller than the inner diameter(s) of the guide catheters 10, lOa so as to allow the exchange catheter to pass easily through the lumens of the guide catheters 10, lOa. Also, the inner diameter of the exchange catheter is larger than the outer diameter of the guide wire to allow the exchange cathete~
to pass easily over the guide wire.
~ enerally, cardiovascular guiding catheters 10, lOa used in the art have inner luminals o~ constant diameter of about 0.72 - 0~8 inches. Flexib~ guide wires used in the . ~. . . . , . . .: :
~:, . ~ : .
2Q99~7~
art typic~lly have constant outer diameters of about OolO -0.18 inches. The exchange catheter devi~e 58 of the present invention is preferably sized relativ~ to tha inner lumen size(s) of the guide catheters and the outer diameter of the guide wire being use~ in a particular procedure and, in view of the typical or stand~rd guide catheter and yuide wire sizes set forth above, may be speci~ically sized to be usable with such typical guide catheters and guide wire encountered in clinical or experimental practice.
10- In the presently preferred embodiment shown, the exchange catheter 58 of the present invention has an inner luminal diameter o~ approximately 0.20 - 0.23 inches and preferably about 0.21 inches (about 1.7 French) and an outer diameter of approximately 0.052 ~ 0.057 inches and preferably about 0.055 inches (about 4.3 Erench).
optional markings or other visible indicia may be formed at various points on the catheter body 60 to permit the operator to visually determine how much of the exchange catheter 58 has been inserted into the patient's body at any given point in time. Also, optional markings or visual indicia may be formed around or near the exit aperture 74 and/or re-entry aperture 76 to assist the operator in easily seeing and locating such apertures.
In the preferred embodiment shown, the elongate catheter body 60 is formed of flexible nylon material commercially available as PEBAX P6 (Ato Chin~ie, Courbevoire, Hauts-De-Seine, France). PEBAX P6 has a Shore D durometer hardness of 65 and a~flexural modulus tby the 2 09957~
~ 23-method o~ ASTMD-790) at 37~C o~ approximately 30,000 psi.
The soft distal tip 70 of the preferred embodiment shown is formed of PEBAX P3. PEBAX P3 has a Shore D durometer hardness of 35 and a *lexural modulus tby the method of A5TMD-790) at 37 C of approximately 5,000 psi.
Those skilled in the art will recognize that various -' other materials, other than the PEBAX materials disclosed above, may be utilized to form the catheter bod~ 60 and distal tip 70 and that materials of varied hardness and ~lexural properties of such materials may be selected and utili2ed depending on the desired spe~ific application of the,exchange catheter 58.
one alternative is that, rather than forming the catheter body of a plastic tube, the catheter body may comprise an elon~ate strand~ member or wire coiled about a generally hollow lumen to form a flexible, tube-like sheath ', or body having a hollow lumen extending therethrough.
ii. A Preferred Catheter_E~eh~nge Method As shown in Figure 13A, an original guide catheter lC
is initially inserted into an artery ,(e.g. the femoral or axillary artery) and advanced to a desired operative position. A guide wire 32 is then inserted khrough the lumen of the original guide catheter 10 and advanced to a position where the distal end 34 o~ the guide wire 32 has penetrated or passed through the stenotic lesion 36 to be treated. A balloon dilation catheter 2~ is then be advanced over the guide wire 3Z, through the lumen o~ the original guide catheter 10. An a~ttempt is made to advance .
2099~79 2~-the balloon catheter 28 fully to a point where the dilation balloon 30 lies directly adjacent the stenotic lesion 36 to be treated. If it is found that the guide catheter 10 is not properly configured for the particular application or -- 5 if it is found that the guide cathater 10 lacks sufficient rigidity to facilitate the desired placement of the balloon catheter 28, or if other problems with the guide catheter 10 are observed, a decision may be made to re~ove the . original guide catheter 10 and to replace it with a substitute guide catheter lOa having a different configuration, different flexural properties or other dif~erences relative to the original guide catheter lO.
A~ter the decision has been made to remove and replace the original guide catheter 10, an extension wire 84 may bs connected to the proximal end of the previously inserted guide wire 32 ~see Step A in Flow diagram of Figure 12~ to form a long guide wire assembly which.consists of both the original guide wire 32 and the extension wire 84. The extension guide wire 84 may be connected to the original guida wire 32 by way of a crimp connector 86 so as to form a substantially permanent connection therebetween.
Alternatively, various screw connectors or other detachable connectors may be used to attach the exten~sion guide wire 84 to the proximal end of the orig.inal guide wire 32.
Preferably, the length o~ the extension guide wire 84 lS approximately equal to that of the oriyinal guide wire 32 such that, when the extension guide wire 84 is connected to the proximal end of the ori~inal guide wire 32, the .~ .. . .
.. , ,~ , , .:, . .
: ~, .
;. ',. ~ ' , :
2~59 ~ ~ 7 9 guide wire assembly formed will be approximately twice the length of the original guide wire 32.
The length of the guide wire 32 or, alternatively, the combined length of the guide wire 32 and extension guide wire 84 (i.e. the length of the "guide wire assembly") is preferably such that, while the distal tip 34 of the guide wire remains in its desired operative pssition through the stenotic lesion 36, the portion of the guide wire assembly (the original guide wire 32 plus any guide wire extension 84) which extends outside of the human body is slightly longer than the overall length of either the original guide -~catheter 10 or the substitute guide catheter lOa.
Referring to Figure 13B, after the extension guide wire 84 has been attached to the proximal end o~ the original guide wire 32, the balloon catheter 28 is then extract~d in a proximal direction, over the g~ide wire assembly, and removed, thereby leaving just the original guide catheter 10 and the flexi~le guide wire 32 in place.
Therea~ter, as shown in Figure 13C, the proximal end 7~ of the guide wire assembly is inserted into the distal end of an exchange catheter 58 and the exchange catheter 58 is advanced thereover in a distal direction. When the proximal end 78 o~ the guide wirs assembly (e.g. the proximal end of the extension wire 84) reaches the guide wire exit aperture 74 of the exchange catheter 58, it is caused to pass outwardly through tha guide wire exit aperture 74, as shown. The exchange catheter 58 is ~hen further advanced over the guide ~ire 32 to a point where , .
2 ~9~79 the distal tip of the exchange catheter 58 .is positioned just proximal to the stenot:ic lesion 36. When so positioned, the exchange cat~eter 58 serves to sheath and surround the portion of the guide wire 32 that resides within the lumen of the original guide catheter 10.
After the exchange catheter 58 has been fully advanced to its dasired location such that the distal end of the .
exchange catheter is just proximal to the stenotic lesion . 36, tha proximal end 78 of the guide wire assembly may be inserted into the optional guide wire re-entry aperture 76 as shown. The proximal end 78 of the guide wire assembly is then advanced in a proximal direction through the lumen of the exchange catheter 58 to a point where the proximal end 78 remains with the lumen of the exchange catheter 58 and a loop 33 of guide wire 32 protrudes outwardly from the body of the exchange catheter 58~ between the guide wire exit aperture 74 and the guide wire re-entry aperture 7-~.
The loop 33 o~ guide wire extendin~ between exit aperture 74 and re-entry aperture 76 may subsequently be drawn down tiqht against the outer surface of the exchange catheter 58 (as indicated by the phantom lines on Figure 13D) by advancing the proximal end 7~ o~ the guide wire assembly in a further proximal direction. When ~uch maneuver is completed and the guide wire 32 i5 drawn down tight against the outer sur~ace of the exchange catheter 58, the proxi.mal end 78 of the guide wire assembly may extend out of and beyond the proximal end of ~he exchange catheter 58. Such extension of ~he proximal end 78 of th2 '' ~: ' ' 2~ 7 9 guide wire assembly is also shown in phantom line~ on Figure 13D.
With the loop 33 of guide wire 32 drawn down tightly against the region of the catheter body, the original guide catheter 10 is then withdrawn and pulled proximally over the body of the exchange cathete:r 58 and over the loop 33 of guide wire 32 which passes outside the exchange catheter 58, between apertures 74 and 76.
.The original guide catheter 10 is initially withdrawn to a point where the distal tip of the guide catheter 10 is proximal to the guide wire re~entry aperture 76. During such withdrawal of the guide catheter lO, the operator may maintain manual control of the guide wire assembly by grasping the proximal end of the guide wire assembly as it extends out of ~he proximal end of the exchange catheter.
With the o~iginal guide catheter 10 withdrawn to a point where its distal tip lies proximal to the re-entry aperture 76, the guide wire 32 is grasped by the operator and pulled in a manner which causes the proximal end 78 of the guide wir~ assembly to once again retract into the proximal end of the exchange catheter, thereby recreating the bulbous slackened loop 33 of guide wire 32 between the .. exit aperture 74 and re-entry aperture 76. Such ~aneuver also causes the distal tip 78 of the guide wire to become , ;~
fully housed with.in the lumen of the exchange catheter 58.
At that point, the original guidQ catheter 10 is further retracted in a proximal direction the rest of the way off of the surface of the exchange ~catheter 58 and without 20~9579 ~2~-direct contact with the proximal end 78 of the guide wire assembly as such proximal end 78 is housed within the lumen of the exchange catheter 58.
The open distal end of second guide catheter lOa is then advanced over the proxi.mal end of the exchange catheter 58 and the second guide catheter lOa is advanced to a point where the distal tip of the. second guide catheter lOa lies just proximal to the guide wire ra-entry aperture 76. At that point, the bulbous loop 33 of guide wire 32 between exit aperture 74 and re-entry aperture 76 is once again flattened or pressed do~m tight against the body of the catheter 58 in a manner which causes the proximal end 78 of the guide wire assembly to once again extend out of the proximal end of the exchange catheter 58~
15.~Thereafter, the replacement guid~ catheter lOa is further advanced in a distal direction over the sur~ace o~
the guide catheter 58 and over the flattened loop 33, to a point where the distal tip of the replacement gulde catheter lOa assumes a desired operative location (e.g.
inserted within the ostium of the coronary artery wherein the stenotic lesion 36 is located). During such advancement o~ the catheter, the operator may manually control the position of the guide wire 32 by grasping . and/or manipulating the proximal end 78 of the guide wire assembly as it extends out of and beyond the proximal end of the exchange catheter 58.
After the replacement guide catheter lOa has been fully advanced to its desired~operative position, the .. : - . . .... - . . . . .
~Q99~79 flattened loop 33 of guide wire 32 between the guide wire exit aperture 74 and guide wire re-entry aperture 76 is once again.be grasped and pulled outwardly ~rom the catheter in a manner which causes the pro~imal end 78 of the guide wire assembly to be once again drawn into the proximal portion of the exchange catheter 58 and whereby the loop 33 once again becomes bulbous or slackened such that the operator may manually grasp such loop 33 in order to maintain manual control of and to manipulate the guide 10. wire 32 as the exchange catheter is slowly withdrawn the rest of the way of~ of the guide wire assembly.
As shown in Figure 13F, after the exchange catheter 58 has been fully withdrawn o~ the guide wire assembly and with the second gulde catheter lOa situated in its desired operative position, the original guide wire 32 has at all times been maintained in its original op~rative position such that its distal end remains inserted thruugh the stenotic lesion 36 to be treated.
As shown in Figure 13H, after the guide catheter exchange procedure has been completed, the extension wire 84 may optionally be removed from the proximal end of the original guide wire 32, leaving only t.he original guide wire 32 in place for subse~uent operation.
Having thus completed the guide catheter exchange, the operator may once again advance the balloon catheter 28 over the guide wire 32 and through the newly inserted second guide catheter lOa to ef~ect the desired dilation o~
the stenotic lesion 36.
., : ... .. . . . . . .
2as3~79 The foregoing detailed description and the accompanying drawings are provided for the purpose o~
describing and illustraking prese.ntly preferred embodiments of the invention. It is to be understood that the invention is not limited to t:he preferred embodiments specifically described herein, but is capabl~ of numerous rearrangements, modifications and substitutions without departing ~rom the spirit of the invention. It is intended that all such rearrangements, modifications and substitutions be included within the scope of the following claims.
the guide catheter is positioned within a target blood vessel, near the obstructive lesion to be treated. A
flexible guide wire is then inserted through the lumen o~
the guide catheter such that the distal end of the guide wire emerges out of and extends beyond the distal tip of the guide catheter. The guide wire is then advanced under fluoroscopic guidance, to a point whereat the distal end o~
lo the wire has advanced ~ully through the stenotic lesion or obstruction to be treated. After the distal end o~ khe guide wire has been advanced through the stenotic lesion or obstruction, a small balloon catheter is then inserted and advanced over the guide wire, through the lumen of the guide ca~eter, to a point where the balloon of the balloon catheter lies adjacent the stenotic lesion or obstruction.
Therea~tar, the balloon is repeatedl~ infla~ed and deflated to bring about the desired dilatisn o~ the offending lesion andjor distention of the surrounding blood vessel wall.
After such dilatory treatment i5 completed, the balloon catheter, guide wire and guide catheter are withdrawn and removed from the patient's body.
Various types and ~izes of guide catheters are available. Care is generally taken, prior to the procedure, to pre-select a guide catheter o~ appropriate type and size for use in each particular patient. However, sometimes the pre-selected guide catheter proves to be inade~uate and it becomes ne~essary or desirable to '.:
: -: - , : :; - i. . .; , - 2~99~79 exchange one guide catheter ~or another during the course of the angioplasty procedureO If the de~ision to change a guide catheter is reached prior to insertion of the guide wire, the guide catheter may simply be extracted and replaced before the guide wire is inserted without any substantial risk o~ complication. However, if, as o~ten occurs, the decision to replace the guide catheter is not reached until after the guide wire has already b~en fully inserted through the gui~e catheter and advanced through the stenotic lesion, any attempt to replace the guide catheter at. that point .is complicated by the need to maintain the previously insert~.d guide wire in its operative position, without accidentally pulling the guide wire back through the stenotic lesion.
~In view o~ the foregoing problems in the prior art, there exists a need ~or a method and/or device to facilitate removal and replacement o~ a cardiovascular .-g~ide catheter ~hile a flexible guide wire, which has been previously inserted through the lumen of the original guide ~.
catheter,. remains in a substantially constant position without undue risk that the guide wixe will be inadvertently pulled in a distal direction or otherwise pulled, retracted or jerked from its previously attained operative position . The medical literature has previously reported two t2) techniques ~or removing an originally inserted guide catheter and replacing it with another guide catheter while maintaining the desired oper~tive . positioning of a .: , .
~ , . . . :
: .
2099~7~
previously inserted ~uide wire. One such technique is reported in: "Technique ~or Guiding Ca-theter Exchange During Coronary Angioplasty Wh.ile ~aintaining Guide Wire Access ~cross A Coronary Stenosis", by C. Mark Newton, M.D., Stephen Ao Lewis, M.D., and George W. Vetrovec, ~.D., Catheterizatlon_and Cardiovascular_ Dia~nosis, 15:173-175 (1988). The first technique of Newton et al. requires the insertion of a relatively thick exchange wire be inserted and advanced through the lumen of the guiding catheter, beside the originally placed angioplasty guide wire. In particular, Newton et al. discloses the use o~ 0.35 inch diameter exchange wire which, when inserted through the lumen of the .guiding catheter, lies adjacent to the . existing anyioplasty guide wire and provides ~ecessary support during extraction and exchange of the guiding catheter.. However, the passage o~ the exchange wire in immediate contact with the guide wire raises the possibility of inadvertent interference with and/or dislodgement of the guide wire. Moreover, the subsequent passage of the second guide catheter over the length af the existing guide wire ~ exchange wire may result in damage to or burring of the inner walls of the catheter.
The second techni~ue ~or exchan~ing a guide catheter is described in "Guiding Catheter Exchanged During Coronary Angioplasty", by Stephen G. Warren, M.D., and J. Craig Barnett, M.D., Catheterization _ and Cardiovascular Diaqnosls, 20:212-215 (1990). This second technique of Warren et al. is purely manipulative and relies solely upon , ;
- : . . . ... .
2~99~79 --5~
the skill of the practitioner. The technique o~ Warren et al. requires placement of an extension wire on the proximal end o~ the original guide wire and, thereafter, the guiding catheter is slowly and carefully withdrawn while simultaneously forming a slackened ar~a or "loop" in the guide wire within the ascending aorta. The slackened area or "loop" in the guide wire is formed to minimize khe likelihood of inadvertent withdrawal of the distal end of the guide wire from its trans-stenotic position. After the first yuide catheter has been withdrawn over the entire length of the extended guide wire, a second replacement guide catheter is then advanced over such extended guide wire and into a point where the distal end o~ the guide catheter is in the coronary ostium. Thereafter, the guide wire~ is gently retracted while the guide wire is simultaneously ~dvanced through the ostium. By this procedure, the "loop" in the guide wire is eliminated and the new guide catheter takes its desired position within the coronary artery.
This second guide catheter replacement kechni.que described by WARREN et al. is highly dependent upon the skill of the operator. ~oreover, the technique described by WARREN ~t al. fails to provide any sort of enhanced ~ support for the guide wire and, thus, allows the guide catheter to be moved over the thin guide wire w.ithout any protection or support ~or the guide wire.
one guida wire extension purported to facilitate exchange of a cardiovascular catheter with an existing 209~579 guide wire in place is described in U~ S. Patent No.
~,917,103 (Gambale et al.~..Anoth~r extendable guide wire for such procedures is described in U. S. Patent No. 4, 827,9al (Taylor et al.~.
Other U. S. patents which purport to describe devic~s usable in exchanging cardiovascular c~theters and/or guide wires are U. S. Patent No. 4,927,413 (Hess) and UO S.
Patent No. 4,932,413 (Shockey et: al.).
Because none of the prior art techniques or devices are truly optimal for effecting guide catheter exchange in all patientsj there remains a need in the art ~or improved methods and/or devices for facilitating such guide catheter exchange without dislodging or distur~ing the di~tal end positioning of a previously inserted guide wire.
~ Summary o~ the Invention The present invention overcomes some or all of the shortcomings of the prior art by providing a cardiovascul~r catheter exchange method and a .cardiovascular "exchange catheter" device which facilitates removal o~ a ~irst guide catheter and replacement thereof with a second guide catheter, without disturbing the operative placement of a guide wire which has previously been inserted through khe lumen of the first guide catheter.
In accordance with the invention, there is provided a method of supportiny and shielding a guide wire while removing and replacing a guide catheter through which said guide wire has been inserted, said method comprising the step of passing a tubular sheath m~ember over the guide wire , .
209~7~
to prokect and ~upport the guide wire while the guir7e catheter is removed and replaced.
In accordance with a more specific aspect of the method of the present invention, there is provided a method - 5 for removing a first guide catheter and replaclng said first guide catheter with a sacond guide catheter while maintaining the position of an elongate guide wire which has been previously been inserted through the first guide catheter, said method comprising the steps of:
lo (a) providing a flexible exchange catheter compri~ing a generally tubular body having an outer diameter which is smaller than the inner diameter of the first or second guide catheters, a proximal end, a distal end, at least one lumen extending longitudinally ther~through and a guide wire~exit aperture formed in the generally tubular body between the proximal and-distal ends thereof;
(b) p~sing the ~istal end o~ the exchange catheter onto the proximal end of the guide wire and advancing the exchange catheter over the guide wire in a distal direction to a point where the proximal end of the guide wire i~
adjacent the guide wir~ exit apertuxe of the exchange catheter;
(c~ causing the proximal end o~ the guide wire to emerge from the lumen of the exchanye catheter through the guide wire exit aperture;
~ d) further advancing the exchange catheter over the guide wire in a distal direction to a point where the 2099~79 ~ 8-distal end of the exchange catheter is proximate the distal end of the first gui~e cath~ter;
(e) extracting the first guide catheter in a proximal direction over the exchange catheter and over guide wire and thereby removing said first guide catheter from the patient;
(f) advancing a second guide catheter in a distal direction over the exchange ca~heter and over the guide wire to a point where the second guide catheter has reached its desired operative position within the patient; and (g) proximally withdrawing and removing the exchange catheter, leaving the second guide cathetex in its operati~e position with the guide wire extending therethrough.
15~Further in accordance with the method of the present invention, said method may further comprise the step of manual grasping, holding and manipulation o* the portion of the guide wire which is emergent from the guide wire exit - aperture, during at least portions of the time during which the original guide catheter, replacement guide catheter and/or exchange catheter device are being inserted and/or retractedO Such manual grasping, holdin~ and/or manipulation o~ the guide wire enables the operator to maintain the desired operative placement of the distal end 2$ o~ the guide wire and serves to prevent the guide wire from becoming substantially displaced or distally retracted during the catheter exchange procedure. Additionally, the proximal end of the guide wire m~y be shielded within the 20~ ~379 _9_ body of the exchange catheter device when the first and second guide catheters are passed thereover so as to prevent damage to the lumens of the first or second guide catheters by the cut proximal end of the guide wlre.
Further in accordance with the invention, there is provided an "exchange catheter" device comprising a flexible, generally tubular body having a proximal end, a distal end and at least one lumen extending longitudinally therethrough and at least o~e guide wire exit aperture formed therein between the proximal and distal ends thereof. An optional guide wire re-entry aperture may also be formed in the tubular body proximal to the guide wire exit aperture. A ramp mèmber may be formed within the lumen of the tubular body to urge the leading tip of the guide wire out of the guide wire exit aperture as the exchange catheter is advanced over the guide wire.
The b~dy o~ the exchange catheter device may be formed of any suitable material. Specifically, such exchange catheter device may be formed of tubular plastis, or, such exchange catheter device may be formed of an elongate coiled member such as a fine wire coiled about a hollow lumen to form a generally tubular sheath-like structure which may be passed ovex the outer surface o~ a guide wixe.
Still further in accordance with the inven~ion, there is provided a system for removing a first guide catheter and replacing it with a second guide catheter while a guide wire, previously inserted through the ~ixst guide~_atheter, remains in place. Such system c~mprises ta) a first guide ':
,'.''''.,"'''','''~, .''"';",''','':,,'.' '',,''',';''' "'',;" ~' ~, , ; , "
2~99~79 catheter, (b) a second guide catheter, (c) an elongate guide wire and (d) a generally tubular exchanye catheter.
Additionally, the system of the present inv~ntion may further include (e) an extensi.on wire attachable to the proximal end of the elonyate guide wixe to form a "guide wire assembly" which is suffic:iently long such that th~
portion o~ the guide wire assembly which extends outside o~
the patient's body will be at least as long as the longest of said first and second guide catheters.
~0These, as well as other elements, objects and advantages of the present invention will be more apparent from the following description and drawings. It is understood that changes in the specific structure shown and de~cribed may be made within the scope o~ the claims , 5 without departing ~rom the spirit of the invention.
8rie~ Descripition of the Drawings Figure 1 is an illustration of a prior art guide catheter inserted through the femoral artery of a human being in positioned for percutaneous transluminal angioplasty of the right coronary artery;
Figure 2 is an enlarged cross~sectional view of the ~distal end of the prior art guide catheter of Figure 1 disposed within the aortic arch;
Figure 3 is an enlarged view of the tip o~ the prior art guide catheter of Figure 2 showing the balloon catheter and guide wire extending there~rom with the guide wire extending through the lumen of the stenosis;
' .
209957~
~11--Figure 4 is an illustration of the prior art percutaneous transluminal angioplasty s~stem showing the guide catheter, balloon cathete!r, and guide wire;
Figure 5 is an illustration of the prior art guide catheter, balloon catheter, and guide wire as an attempt is made to extend the balloon into the lumen of th~ stenosis, resulting in displacement of the tip of the guide catheter and deformation or bending of the balloon catheter;
. Figure 6 is an enlarged view of the tip of the prior art guide catheter, balloon catheter, and guide wire of Figure 5;
Figure 7 is a top plan view of the exchange catheter .of the present învention;
.. ~:. .
Figure 8 is an illustration of the exchange catheter o~ Figure 7 after it has been i~s~rted into the femoral artery of a human being and al50 showing the guide wire extending therefrom;
Figure 9~is a sectional view of the exchange catheter of Figure 7 showing the guide wire extending therefrom and re-inserted therein;
- Figure 10 is an enla.rged cross-sectional view of the proximal end o~ the exchange catheter of Figure 7 showing the position of the proximal end of the guide wira extension disposed therein such that a new guide catheter 25 may be inse:rted over the exchange catheter without .
contactiny the proximal end of the guide wire extension; :.
Figure ~1 is a cross-sectional side view of the first aperture of the exchange cathete~ of Figures 7 and 9;
:.
2099~79 Figur~ 12 is a flow chart illustrating a preferred guide catheter exchange method of the present invention;
~ igures 13A-13H illustrate the steps of Figure 12 with corresponding letters indicat:ing the illustration o~
corresponding steps.
Detailed escription o~ the Preferred Embodiment The detailed description set forth below in conn~ction with the appended drawings is intended to describe and illustrate a presently preferred embodiment of the invention, and is not intended to represent the only form in which the present invention may be constructed or utilized. The description provided herein sets forth the functions and sequen~e of steps for constructing and operating the invention in connection with the illustrated embodiment. It is to be understood, howeYer, that the same or equivalent functions and sequences may be accomplished by different embodiments and it is intended that all such different embodiments be encompassed within the spirit and scope of the invention.
Broadly stated, the present invention comprises a flexible sheath-like member ox "exchange catheter" which may be passed over the outer surface of a pre-positioned guide wire to support and shield the guide wire while a surrounding guiding cathëter is extracted and replaced.
The preferred apparatus of the present invention incorporates specific elements and design attributes which enable the operator to carefully control and maintain the placement of the distal tip of~the guide wire across a . . , ;. , l ~ , ., ,., .. . . . . . ,, - . .: . :.
.: ~: . . . : . . . :: : : - . : . . : .
2099~79 ~13-~esired stenotic lesion, while the guide catheter is 'being exchanged, without undue risk of inadvertent disruption or movement of the guide wirP tip back through the stenotic lesion. Also, the present invention includes a method for exchanging a coronary guide catheter wherein a protective sheath or "exchange catheter" o* the above-described kype is utilized.
The preferred apparatus and methodology described in the presently preferred embodiment is notably applicab'le to coronary angioplasty procedures and is speci~ically described in such context. It is to be understood, -however, that the apparatus and methodology of the present-invention need not be limited to coronary artery procedure but, rather, may be utilized in a wide range of medical procedures wherein it is desirable to exch~nge one catheter for another while maintaining the operative location of a guide wire which has previously been inserted throu~h a lumen of the original catheter.
Figures 1-6 set forth schematic diagrams of typical 20 transluminal angioplasty procedures of the prior art and ' '' illustrations of problems which commonly occur during such procedures. The method and device of the present invention are illustrated in Figures 7-13H.
Re~erring now to Figure 1, the path followed by a ' flexible gu.ide cathe.ter, balloon catheter, and guide wire during percutaneous transluminal coronary angioplasty i5 illustrated. The guide catheter 10 enters the human being 14 through an opening 12 to the fe~oral artery at the thigh " ~
' :
. ~ ~
~099~7~
and travels upward and into the heart. The proximal end 16 of the guide catheter 10 remains outside of the body and may be manipulated to effect motion of the dist~l ~nd 18 within the heart. The guide wire and balloon catheter are insexted through the guide catheter 10 and thus follow the same path from the femoral artery to the heart.
Referring now to Figures 2 and 3, the position of the distal end 18 of the guide catheter 10 within the aortic arch 20 is illustrated. The tip 22 of the guide catheter 10 is disposed within the ostium 24 of the right coronar-y artery 26.
A balloon catheter 28 extends from the tip 22 of the guide catheter 10. A balloon 30 is disposed at the distal end of the balloon catheter 28. The balloon 30 is disposed within the right coronary artery 25 proximate a stenosis 36. The guide wire 32 extends through the lumen 38 o~ the stenosis 36. -Referring now to Fiyure ~, a prior art flexibleguiding catheter and balloon cath~ter system is illustrated. This prior art system comprises a flexible guide catheter 10 through which a guide wire 32 and/or balloon catheter 28 may be inserted to the site o~ stenosis 36. once positioned at the site of the stenosis 36 the distal end 34 of the guide wire 32 is inserted throu~h the lumen 38 of the stenosis 36 such that the balloon 30 may be urged over the, yuide wire 32 and through the lumen 38 of the stenosis 36 where it may be inflated to effect angioplasty.
.. . . . . . . . ..
" ' ~,' . ; , ~' ' ' ' . " ~ ' . ,' ' ' ' ! . ' , ~, ' ' ' ', " ` ' ,, ' ~'`'' ,: . ' ' ' , ' , , ,' . . " ', `'`'' ., ' ' " ' ,, , "" ': ' , ' .
2~9~79 ~15-Constant pressure ports 40 and 42. ~or th~ guide catheter 10 and the ball~on ca.theter 28, respectively, provide for the introduction of saline solution or the like to prevent the backflow of blood through the catheters 10 and 28, and to facilitate Elushi:ng of the catheters after the introduction of dye, vasodilators, or the liXe.
Syringes 44 and 46 permit the introduction through couplings 48 and 50, respectively, of dye, vasodilators, or the like into the guide catheter 10 and the balloon catheter 28. Trident housings 52 and 54 interconnect couplings 40 and 42 to the guide catheter 10 and the balloon catheter 28, respect.ively.
Referring now to Figures 5 and 6, occasionally difficulties are encountered when an attempt is made to inser~ the balloon 30 through the lumen 38 of a stenosis 36. If the lumen 38 of the stenosis 36 is so small that the balloon 30 must be forced therethrough, such forcing of the balloon cathater may cause the distal end 18 of the guide catheter 10 to be repelled or forced backwards away from the ostium 2~ of the right coronary artery 26. The distal tip of the balloon catheter 28 may thus become substantially unsupported intermediate the ~alloon 30 and the distal end 18 of the guide catheter 10. The balloon catheter 28 may consequently form a deformation or bend 56 2S due to the lack of support. This prevents the balloon ~0 from beiny forced further into the lumen 38 o~ the stenosis : 36 since further urging of the balloon catheter 28 toward the stenosis 36 merely increases ~he amount of deformation 2099~79 or bend 56 instead o~ moving the balloon 30 through the stenosis 36~
A common pxior art solution to this problem would have been to simply remove the original balloon catheter 28 and replace it with a second, more rigid, balloon catheker.
Such r~placement of the balloon catheter can be accomplished with minimal risk of disrupting positioning of the guide wire 32. Also, such replacement of balloon catheter wi.th a more rigid balloon catheter will ~requently 10 overcome the problem as the more rigid balloon catheter would be less likely to deform or wrinkle 56 in its distal region where it remains unsupported by the guide catheter lO. However, such removal and replacement of the original balloon catheter is highly undPsirable because balloon catheters are expensive disposable components which, once removed must be discarded and not reused. Furthermore, the substitution of a more rigid balloon catheter may not always achi~ve the desired result in view of the fact that the underlying problem of lack of support for the di~tal end of the balloon catheter remains unchecked.
Accordingly, the procedure of removing and replacing the balloon ~atheter results in substantial added expense and sometimes fails to remedy the underlyin~ problem.
In view of the expense and drawbacks associated with removal and replacement of the balloon catheter 28, it would be highly desirable i~ the operator could simply remove the oric~inally inserted guide catheter and replace it with a di~ferent guide c~theter having differing .
, , : :, . . , . ~, ., : .
flexibility characteristics and/or configuraticnal characteristics. Indeed, guide catheters are much cheaper than balloon catheters and, even if it were to be necessary to dispose of and not reuse the originally inserted guide catheter, such would still result in less expense than actual removal and replacement of the balloon catheter 28.
Therefore, a procedure for replacing the originally -:
inserted or first yuide catheter 10 with another guide catheter having different flexibility or configurational characteristics is desirable. However, any such procedure for replacing the originally inserted guide catheter 10 with another guide catheter must be carried out with continued control over the previously inserted guide wire 32 to ensure that the distal end of the guide wire 32 remains inserted through the stenosis 36. I~deed, if the guide wire 32 is inadvertently withdrawn from the stenosis, reinsertion of the guide wire may bP rendered difficult or impossible. There*ore, once the guide wire 32 has been successfully inserted through the stenotic lesion, it is extremely desirable to maintain such positioning of the guide wire 32 until the PTA procedure has been completed.
In fact, the patient's life may well depend upon khe ability to maintain the positioning of the guide wire within the lumen of the stenosis.
i. A~Preferred_Exchan~e~ Catheter Device The presently preferred apparatus of the present invention co~prises a pliahle sheath member, re~erred to herein as an "exchange catheter" 58 which may be passed ,: , . . . . . .
.: ' .'' ~ ; , . , : ~ : , over or threaded over the outer surfa~e o~ a flexible guide wire to shield and support the guide whils a surrounding guide catheter is extracted and replaced.
As shown in Figures 7 11, a presently preferred sheath or exchange catheter 58 of the present invention comprises an elongate tubular catheter body 60 having a lumen 62 extending longitudinally therethrough. The catheter body 60 has an outer diameter which i.s smaller ~han the inner diameter o~ ~he original guide catheter 10, or the replacement guide catheter to be inserted.- The distal end o~ the catheter body 60 is tapered and a flexible tubular tip member 70 is mounted on the distal end of the catheter body 60 forming an extension thereof such that the hollow lumen of the tubular tip member 70 is substantially .continuous with the hollow lumen of the catheter body 60~
A radiopaque band 72 i5 positioned between the distal end of the catheter body 60 and the flexible tip 70 so as to facilitate fluoroscopic visualization of the distal end of . the exchange catheter 5B.
. 20 A proximal guide wire exit aperture 74 is formed through the sidewall of the catheter body 68 near the approximate mid-point of the catheter body to permit a flexible guide wire 33 to pass ~rom the inner lumen of the exchange catheter 58, outwardly through such guide wire exit aperture 74.
A plug 80 may be positioned in the lumen 62 of the catheter body 60 at a position immediately proximal to the guide wire exit aperture 74 so a~ to block the lumen 62 of `
, ., . ,, ~..... . . .
20~7~
the guide catheter 58 at that poin~. A ramp or sloped sur~ace 82 may be formed on the distal aspect of the plug member 80 such that, as th~e exchange catheter 58 i5 advanced over the guide wire 32, the distal end of the guide wire 32 will register against ramp surface 82 and will be forced outwardly through guide wire exit aperture 74.
An optional guide wire re-entry aperture 76 may be formed proximal to the position of the guide wire exit aperture 74 to permit the proximal end of the guide wire 32 to be reinserted into ~he lumen 62 of the catheter body 60, thereby leaving a loop 33 of the guide.wire 32 outside of the catheter body 60~ Such loop 33 o~ the guide wire 32 may be directly grasped by the operator's hand, thereby ~allowing the operator to manipulate and hold the guide wire 32 in its desired position while the catheter exchange is taking place.
It will be appreciated that the second guide wire re-entry aperture. 76 is optional and that the exchange catheter 58 could function with only a single guide wire exit aperture 74 formed thexein. As shown in Figure 8, when the proximal portion of the guide wire 32 extends out of the guide wire exit aperture 74, it may be directly grasped by t~e operator and guided/manipulated in the desired manner without the need or re-entering the proximal end of the guide wire 32 back into the lumen 62 o~
the exchange catheter 58.
' - ' ' .,i .. ' ' ` ', :,. ' ' ' . ' :
203~579 An exchange catheter 58 of the present invention wherein the optional guide wire xe-entry aperture 76 is provided, the ability to reinsert the proximal end of the guide wire through the guide wire re-entry aperture 76 and into the lumen of the guide catheter will provide the additional advantage of allow.ing the proximal end o~ the guide wire 3~ to be housed within and shielded by the catheter body 60 while the initial guide catheter 10 is being withdrawn and while. the new guide catheter 10 is subsequently being advanced thereover. This is desirable because.the proximal ends of some guide wires may be sharp or may contain burrs which could cut or otherwise harm the inner lumen of the guide catheter lO as it is passed over the proximal end of the guide wire 32. Thus, so long as - 15 the ~roximal end of the,guide wire is posi~ioned within the lumen 62 of the exchange catheter 58, the body o~ the exchange catheter will serve t4 shield .and prevent the proximal end of the guide wire 32 from coming into contact :with the inner luminal sur~ace of either the original guide ,catheter 12 or the replacement guide catheter.
The length of the exchange catheter 58 and the locations of the exit aperture 74 and/or re entry aperture 76 on the catheter 58 may be specifically selected to ~acilitate the desired ~unction of the exchange catheter 58~ For example, i~ the preferred exchange catheter 58 is sized for use in adult coronary artery angioplasty procedures, the overall length of the exchange catheter 58 is ~referably approximately 290.~ centimeters, the catheter .
~99~79 body 60 being approximately 290 centimeters in length and the distal tip 70 being approximately 0.4 centimeters in length. In the preferred embodiment shown, the length A
from the proximal end 66 of the exchange catheter 58 to the optional guide wire re-entry aperture 76 is approximately 140 centimeters; the distance B between the re entry aperture 76 and the exit aperture 74 is approximately 20 centimeters. The distance C between the guide wire exit aperture 74 and the proximal end of the tapered section 6~
is approximately 129 centimeters; the length D o~ the tapered section 68 is approximately 1 centimeter and tha length E of the flexible tip 70 is approximately 0.4 centimsters.
The inner and outer diameter of the preferred embodiment of the exchange catheter 58 is determined by the relative diameters of the yuide wire 32 and the inner diameters o~ criginal and replacement guide cathe~ers being used. To wit: the outer diameter of the exchange catheter, at its largest point, is slightly smaller than the inner diameter(s) of the guide catheters 10, lOa so as to allow the exchange catheter to pass easily through the lumens of the guide catheters 10, lOa. Also, the inner diameter of the exchange catheter is larger than the outer diameter of the guide wire to allow the exchange cathete~
to pass easily over the guide wire.
~ enerally, cardiovascular guiding catheters 10, lOa used in the art have inner luminals o~ constant diameter of about 0.72 - 0~8 inches. Flexib~ guide wires used in the . ~. . . . , . . .: :
~:, . ~ : .
2Q99~7~
art typic~lly have constant outer diameters of about OolO -0.18 inches. The exchange catheter devi~e 58 of the present invention is preferably sized relativ~ to tha inner lumen size(s) of the guide catheters and the outer diameter of the guide wire being use~ in a particular procedure and, in view of the typical or stand~rd guide catheter and yuide wire sizes set forth above, may be speci~ically sized to be usable with such typical guide catheters and guide wire encountered in clinical or experimental practice.
10- In the presently preferred embodiment shown, the exchange catheter 58 of the present invention has an inner luminal diameter o~ approximately 0.20 - 0.23 inches and preferably about 0.21 inches (about 1.7 French) and an outer diameter of approximately 0.052 ~ 0.057 inches and preferably about 0.055 inches (about 4.3 Erench).
optional markings or other visible indicia may be formed at various points on the catheter body 60 to permit the operator to visually determine how much of the exchange catheter 58 has been inserted into the patient's body at any given point in time. Also, optional markings or visual indicia may be formed around or near the exit aperture 74 and/or re-entry aperture 76 to assist the operator in easily seeing and locating such apertures.
In the preferred embodiment shown, the elongate catheter body 60 is formed of flexible nylon material commercially available as PEBAX P6 (Ato Chin~ie, Courbevoire, Hauts-De-Seine, France). PEBAX P6 has a Shore D durometer hardness of 65 and a~flexural modulus tby the 2 09957~
~ 23-method o~ ASTMD-790) at 37~C o~ approximately 30,000 psi.
The soft distal tip 70 of the preferred embodiment shown is formed of PEBAX P3. PEBAX P3 has a Shore D durometer hardness of 35 and a *lexural modulus tby the method of A5TMD-790) at 37 C of approximately 5,000 psi.
Those skilled in the art will recognize that various -' other materials, other than the PEBAX materials disclosed above, may be utilized to form the catheter bod~ 60 and distal tip 70 and that materials of varied hardness and ~lexural properties of such materials may be selected and utili2ed depending on the desired spe~ific application of the,exchange catheter 58.
one alternative is that, rather than forming the catheter body of a plastic tube, the catheter body may comprise an elon~ate strand~ member or wire coiled about a generally hollow lumen to form a flexible, tube-like sheath ', or body having a hollow lumen extending therethrough.
ii. A Preferred Catheter_E~eh~nge Method As shown in Figure 13A, an original guide catheter lC
is initially inserted into an artery ,(e.g. the femoral or axillary artery) and advanced to a desired operative position. A guide wire 32 is then inserted khrough the lumen of the original guide catheter 10 and advanced to a position where the distal end 34 o~ the guide wire 32 has penetrated or passed through the stenotic lesion 36 to be treated. A balloon dilation catheter 2~ is then be advanced over the guide wire 3Z, through the lumen o~ the original guide catheter 10. An a~ttempt is made to advance .
2099~79 2~-the balloon catheter 28 fully to a point where the dilation balloon 30 lies directly adjacent the stenotic lesion 36 to be treated. If it is found that the guide catheter 10 is not properly configured for the particular application or -- 5 if it is found that the guide cathater 10 lacks sufficient rigidity to facilitate the desired placement of the balloon catheter 28, or if other problems with the guide catheter 10 are observed, a decision may be made to re~ove the . original guide catheter 10 and to replace it with a substitute guide catheter lOa having a different configuration, different flexural properties or other dif~erences relative to the original guide catheter lO.
A~ter the decision has been made to remove and replace the original guide catheter 10, an extension wire 84 may bs connected to the proximal end of the previously inserted guide wire 32 ~see Step A in Flow diagram of Figure 12~ to form a long guide wire assembly which.consists of both the original guide wire 32 and the extension wire 84. The extension guide wire 84 may be connected to the original guida wire 32 by way of a crimp connector 86 so as to form a substantially permanent connection therebetween.
Alternatively, various screw connectors or other detachable connectors may be used to attach the exten~sion guide wire 84 to the proximal end of the orig.inal guide wire 32.
Preferably, the length o~ the extension guide wire 84 lS approximately equal to that of the oriyinal guide wire 32 such that, when the extension guide wire 84 is connected to the proximal end of the ori~inal guide wire 32, the .~ .. . .
.. , ,~ , , .:, . .
: ~, .
;. ',. ~ ' , :
2~59 ~ ~ 7 9 guide wire assembly formed will be approximately twice the length of the original guide wire 32.
The length of the guide wire 32 or, alternatively, the combined length of the guide wire 32 and extension guide wire 84 (i.e. the length of the "guide wire assembly") is preferably such that, while the distal tip 34 of the guide wire remains in its desired operative pssition through the stenotic lesion 36, the portion of the guide wire assembly (the original guide wire 32 plus any guide wire extension 84) which extends outside of the human body is slightly longer than the overall length of either the original guide -~catheter 10 or the substitute guide catheter lOa.
Referring to Figure 13B, after the extension guide wire 84 has been attached to the proximal end o~ the original guide wire 32, the balloon catheter 28 is then extract~d in a proximal direction, over the g~ide wire assembly, and removed, thereby leaving just the original guide catheter 10 and the flexi~le guide wire 32 in place.
Therea~ter, as shown in Figure 13C, the proximal end 7~ of the guide wire assembly is inserted into the distal end of an exchange catheter 58 and the exchange catheter 58 is advanced thereover in a distal direction. When the proximal end 78 o~ the guide wirs assembly (e.g. the proximal end of the extension wire 84) reaches the guide wire exit aperture 74 of the exchange catheter 58, it is caused to pass outwardly through tha guide wire exit aperture 74, as shown. The exchange catheter 58 is ~hen further advanced over the guide ~ire 32 to a point where , .
2 ~9~79 the distal tip of the exchange catheter 58 .is positioned just proximal to the stenot:ic lesion 36. When so positioned, the exchange cat~eter 58 serves to sheath and surround the portion of the guide wire 32 that resides within the lumen of the original guide catheter 10.
After the exchange catheter 58 has been fully advanced to its dasired location such that the distal end of the .
exchange catheter is just proximal to the stenotic lesion . 36, tha proximal end 78 of the guide wire assembly may be inserted into the optional guide wire re-entry aperture 76 as shown. The proximal end 78 of the guide wire assembly is then advanced in a proximal direction through the lumen of the exchange catheter 58 to a point where the proximal end 78 remains with the lumen of the exchange catheter 58 and a loop 33 of guide wire 32 protrudes outwardly from the body of the exchange catheter 58~ between the guide wire exit aperture 74 and the guide wire re-entry aperture 7-~.
The loop 33 o~ guide wire extendin~ between exit aperture 74 and re-entry aperture 76 may subsequently be drawn down tiqht against the outer surface of the exchange catheter 58 (as indicated by the phantom lines on Figure 13D) by advancing the proximal end 7~ o~ the guide wire assembly in a further proximal direction. When ~uch maneuver is completed and the guide wire 32 i5 drawn down tight against the outer sur~ace of the exchange catheter 58, the proxi.mal end 78 of the guide wire assembly may extend out of and beyond the proximal end of ~he exchange catheter 58. Such extension of ~he proximal end 78 of th2 '' ~: ' ' 2~ 7 9 guide wire assembly is also shown in phantom line~ on Figure 13D.
With the loop 33 of guide wire 32 drawn down tightly against the region of the catheter body, the original guide catheter 10 is then withdrawn and pulled proximally over the body of the exchange cathete:r 58 and over the loop 33 of guide wire 32 which passes outside the exchange catheter 58, between apertures 74 and 76.
.The original guide catheter 10 is initially withdrawn to a point where the distal tip of the guide catheter 10 is proximal to the guide wire re~entry aperture 76. During such withdrawal of the guide catheter lO, the operator may maintain manual control of the guide wire assembly by grasping the proximal end of the guide wire assembly as it extends out of ~he proximal end of the exchange catheter.
With the o~iginal guide catheter 10 withdrawn to a point where its distal tip lies proximal to the re-entry aperture 76, the guide wire 32 is grasped by the operator and pulled in a manner which causes the proximal end 78 of the guide wir~ assembly to once again retract into the proximal end of the exchange catheter, thereby recreating the bulbous slackened loop 33 of guide wire 32 between the .. exit aperture 74 and re-entry aperture 76. Such ~aneuver also causes the distal tip 78 of the guide wire to become , ;~
fully housed with.in the lumen of the exchange catheter 58.
At that point, the original guidQ catheter 10 is further retracted in a proximal direction the rest of the way off of the surface of the exchange ~catheter 58 and without 20~9579 ~2~-direct contact with the proximal end 78 of the guide wire assembly as such proximal end 78 is housed within the lumen of the exchange catheter 58.
The open distal end of second guide catheter lOa is then advanced over the proxi.mal end of the exchange catheter 58 and the second guide catheter lOa is advanced to a point where the distal tip of the. second guide catheter lOa lies just proximal to the guide wire ra-entry aperture 76. At that point, the bulbous loop 33 of guide wire 32 between exit aperture 74 and re-entry aperture 76 is once again flattened or pressed do~m tight against the body of the catheter 58 in a manner which causes the proximal end 78 of the guide wire assembly to once again extend out of the proximal end of the exchange catheter 58~
15.~Thereafter, the replacement guid~ catheter lOa is further advanced in a distal direction over the sur~ace o~
the guide catheter 58 and over the flattened loop 33, to a point where the distal tip of the replacement gulde catheter lOa assumes a desired operative location (e.g.
inserted within the ostium of the coronary artery wherein the stenotic lesion 36 is located). During such advancement o~ the catheter, the operator may manually control the position of the guide wire 32 by grasping . and/or manipulating the proximal end 78 of the guide wire assembly as it extends out of and beyond the proximal end of the exchange catheter 58.
After the replacement guide catheter lOa has been fully advanced to its desired~operative position, the .. : - . . .... - . . . . .
~Q99~79 flattened loop 33 of guide wire 32 between the guide wire exit aperture 74 and guide wire re-entry aperture 76 is once again.be grasped and pulled outwardly ~rom the catheter in a manner which causes the pro~imal end 78 of the guide wire assembly to be once again drawn into the proximal portion of the exchange catheter 58 and whereby the loop 33 once again becomes bulbous or slackened such that the operator may manually grasp such loop 33 in order to maintain manual control of and to manipulate the guide 10. wire 32 as the exchange catheter is slowly withdrawn the rest of the way of~ of the guide wire assembly.
As shown in Figure 13F, after the exchange catheter 58 has been fully withdrawn o~ the guide wire assembly and with the second gulde catheter lOa situated in its desired operative position, the original guide wire 32 has at all times been maintained in its original op~rative position such that its distal end remains inserted thruugh the stenotic lesion 36 to be treated.
As shown in Figure 13H, after the guide catheter exchange procedure has been completed, the extension wire 84 may optionally be removed from the proximal end of the original guide wire 32, leaving only t.he original guide wire 32 in place for subse~uent operation.
Having thus completed the guide catheter exchange, the operator may once again advance the balloon catheter 28 over the guide wire 32 and through the newly inserted second guide catheter lOa to ef~ect the desired dilation o~
the stenotic lesion 36.
., : ... .. . . . . . .
2as3~79 The foregoing detailed description and the accompanying drawings are provided for the purpose o~
describing and illustraking prese.ntly preferred embodiments of the invention. It is to be understood that the invention is not limited to t:he preferred embodiments specifically described herein, but is capabl~ of numerous rearrangements, modifications and substitutions without departing ~rom the spirit of the invention. It is intended that all such rearrangements, modifications and substitutions be included within the scope of the following claims.
Claims (35)
1. A method for removing a first guide catheter and replacing said first guide catheter with a second guide catheter while maintaining the position of an elongate guide wire which has previously been inserted through the first guide catheter, said method comprising the steps of:
(a) providing a flexible exchange catheter comprising a generally tubular body having an outer diameter which is smaller than the inner diameter of the first or second guide catheters, a proximal end, a distal end, at least one lumen extending longitudinally therethrough and a guide wire exit aperture formed in the generally tubular body between the proximal and distal ends thereof;
(b) passing the distal end of the exchange catheter onto the proximal end of the guide wire and advancing the exchange catheter over the guide wire in a distal direction to a point where the proximal end of the guide wire is adjacent the guide wire exit aperture of the exchange catheter;
(c) causing the proximal end of the guide wire to emerge from the lumen of the exchange catheter through the guide wire exit aperture;
(d) further advancing the exchange catheter over the guide wire in a distal direction to a point where the distal end of the exchange catheter is proximate the distal end of the first guide catheter;
(e) extracting the first guide catheter in a proximal direction over the exchange catheter and over guide wire and thereby removing said first guide catheter from the patient;
(f) advancing a second guide catheter in a distal direction over the exchange catheter and over the guide wire to a point where the second guide catheter has reached its desired operative position within the patient;
(g) proximally withdrawing and removing the exchange catheter, leaving the second guide catheter in its operative position with the guide wire extending therethrough.
(a) providing a flexible exchange catheter comprising a generally tubular body having an outer diameter which is smaller than the inner diameter of the first or second guide catheters, a proximal end, a distal end, at least one lumen extending longitudinally therethrough and a guide wire exit aperture formed in the generally tubular body between the proximal and distal ends thereof;
(b) passing the distal end of the exchange catheter onto the proximal end of the guide wire and advancing the exchange catheter over the guide wire in a distal direction to a point where the proximal end of the guide wire is adjacent the guide wire exit aperture of the exchange catheter;
(c) causing the proximal end of the guide wire to emerge from the lumen of the exchange catheter through the guide wire exit aperture;
(d) further advancing the exchange catheter over the guide wire in a distal direction to a point where the distal end of the exchange catheter is proximate the distal end of the first guide catheter;
(e) extracting the first guide catheter in a proximal direction over the exchange catheter and over guide wire and thereby removing said first guide catheter from the patient;
(f) advancing a second guide catheter in a distal direction over the exchange catheter and over the guide wire to a point where the second guide catheter has reached its desired operative position within the patient;
(g) proximally withdrawing and removing the exchange catheter, leaving the second guide catheter in its operative position with the guide wire extending therethrough.
2. The method of Claim 1 further comprising the step of:
grasping and holding the portion of the guide wire which is emergent from the guide wire exit aperture and exerting force upon said guide wire to prevent said guide wire from becoming substantially displaced during further advancement of the exchange catheter over the guide wire.
grasping and holding the portion of the guide wire which is emergent from the guide wire exit aperture and exerting force upon said guide wire to prevent said guide wire from becoming substantially displaced during further advancement of the exchange catheter over the guide wire.
3. The method of Claim 1 further comprising the step of:
grasping and holding the portion of the guide wire which is emergent from the guide wire exit aperture and exerting force upon said guide wire to prevent said guide wire from becoming substantially displaced during extraction of the first guide catheter in a proximal direction.
grasping and holding the portion of the guide wire which is emergent from the guide wire exit aperture and exerting force upon said guide wire to prevent said guide wire from becoming substantially displaced during extraction of the first guide catheter in a proximal direction.
4. The method of Claim 1 further comprising the step of:
grasping and holding the portion of the guide wire which is emergent from the guide wire exit aperture and exerting force upon said guide wire to prevent said guide wire from becoming substantially displaced during placement of the second guide catheter in a distal direction.
grasping and holding the portion of the guide wire which is emergent from the guide wire exit aperture and exerting force upon said guide wire to prevent said guide wire from becoming substantially displaced during placement of the second guide catheter in a distal direction.
5. The method of Claim 1 further comprising the step of:
grasping and holding the portion of the guide wire which is emergent from the guide wire exit aperture and exerting force upon said guide wire to prevent said guide wire from becoming substantially displaced during withdrawal and removal of the exchange catheter.
grasping and holding the portion of the guide wire which is emergent from the guide wire exit aperture and exerting force upon said guide wire to prevent said guide wire from becoming substantially displaced during withdrawal and removal of the exchange catheter.
6. The method of Claim 1 wherein step (a) further comprises:
providing a flexible exchange catheter comprising a generally tubular body having an outer diameter which is smaller than the inner diameter of the first or second guide catheters, a proximal end, a distal end, at least one lumen extending longitudinally therethrough, a guide wire exit aperture formed in the generally tubular body between the proximal and distal ends thereof and a guide wire re-entry aperture formed proximal to said guide wire exit aperture;
and wherein, between steps (c) and (d), the method further comprises the additional step of:
inserting the proximal end of the guide wire into the guide wire re-entry aperture and further advancing the proximal end of the guide wire in a proximal direction through the lumen of the exchange catheter such that a loop of guide wire remains outside of the exchange catheter between said guide wire exit aperture and said guide wire re-entry aperture.
providing a flexible exchange catheter comprising a generally tubular body having an outer diameter which is smaller than the inner diameter of the first or second guide catheters, a proximal end, a distal end, at least one lumen extending longitudinally therethrough, a guide wire exit aperture formed in the generally tubular body between the proximal and distal ends thereof and a guide wire re-entry aperture formed proximal to said guide wire exit aperture;
and wherein, between steps (c) and (d), the method further comprises the additional step of:
inserting the proximal end of the guide wire into the guide wire re-entry aperture and further advancing the proximal end of the guide wire in a proximal direction through the lumen of the exchange catheter such that a loop of guide wire remains outside of the exchange catheter between said guide wire exit aperture and said guide wire re-entry aperture.
7. A method of supporting and shielding a guide wire while removing and replacing a guide catheter through which said guide wire has been inserted, said method comprising the step of:
passing a tubular sheath member over the guide wire to protect and support the guide wire while the guide catheter is removed and replaced.
passing a tubular sheath member over the guide wire to protect and support the guide wire while the guide catheter is removed and replaced.
8. The method of Claim 7 wherein the step of "passing a tubular sheath member over the guide wire to protect and support the guide wire while the guide catheter is removed and replaced" further comprises the steps of providing a tubular sheath member having a proximal end, a distal end and a guide wire exit aperture formed therein between the proximal and distal ends thereof;
passing the distal end of the tubular sheath over the guide wire and advancing the tubular sheath in a distal direction to a point where the leading tip of the guide wire is adjacent the guide wire exit aperture;
causing the leading tip of the guide wire to emerge out of the guide wire exit aperture;
further advancing the tubular sheath member to a point where the tubular sheath member extends fully through the lumen of the guide catheter;
withdrawing and removing the original guide catheter;
passing a replacement guide catheter over the guide wire and tubular sheath member and advancing said replacement guide catheter in a distal direction to a fully inserted operative position; and withdrawing the tubular sheath member in a distal direction and removing the tubular sheath member to leave the replacement guide catheter in place with the guide wire inserted therethrough.
passing the distal end of the tubular sheath over the guide wire and advancing the tubular sheath in a distal direction to a point where the leading tip of the guide wire is adjacent the guide wire exit aperture;
causing the leading tip of the guide wire to emerge out of the guide wire exit aperture;
further advancing the tubular sheath member to a point where the tubular sheath member extends fully through the lumen of the guide catheter;
withdrawing and removing the original guide catheter;
passing a replacement guide catheter over the guide wire and tubular sheath member and advancing said replacement guide catheter in a distal direction to a fully inserted operative position; and withdrawing the tubular sheath member in a distal direction and removing the tubular sheath member to leave the replacement guide catheter in place with the guide wire inserted therethrough.
9. The method of Claim 8 further comprising the step of:
grasping and exerting force on the portion of the guide wire which is emergent from the guide wire exit aperture to maintain the position of the guide wire while the tubular sheath, original guide catheter and replacement guide catheter are individually advanced and withdrawn.
grasping and exerting force on the portion of the guide wire which is emergent from the guide wire exit aperture to maintain the position of the guide wire while the tubular sheath, original guide catheter and replacement guide catheter are individually advanced and withdrawn.
10. The method of Claim 7 further comprising the step of:
attaching an extension wire to the guide wire to form a guide wire assembly having an extracorporeal portion which is at least as long as the longest guide catheter to be removed or inserted.
attaching an extension wire to the guide wire to form a guide wire assembly having an extracorporeal portion which is at least as long as the longest guide catheter to be removed or inserted.
11. An exchange catheter comprising:
a flexible generally tubular body having a proximal end, a distal end and at least one lumen extending longitudinally therethrough; and at least one guide wire exit aperture formed in the tubular body between the proximal and distal ends thereof.
a flexible generally tubular body having a proximal end, a distal end and at least one lumen extending longitudinally therethrough; and at least one guide wire exit aperture formed in the tubular body between the proximal and distal ends thereof.
12. The device of Claim 1 further comprising:
a guide wire re-entry aperture formed in the generally tubular body proximal to said guide wire exit aperture.
a guide wire re-entry aperture formed in the generally tubular body proximal to said guide wire exit aperture.
13. The device of Claim 12 further comprising:
a ramp member formed within the lumen of the tubular body adjacent the guide wire exit aperture to engage the leading tip of a guide wire being advanced in a proximal direction through the lumen and to cause the leading tip of the guide wire to pass out of said guide wire exit aperture.
a ramp member formed within the lumen of the tubular body adjacent the guide wire exit aperture to engage the leading tip of a guide wire being advanced in a proximal direction through the lumen and to cause the leading tip of the guide wire to pass out of said guide wire exit aperture.
14. The device of Claim 11 further comprising:
a tapered portion formed at the distal end of said tubular body.
a tapered portion formed at the distal end of said tubular body.
15. The exchange catheter of Claim 11 further comprising a flexible tip formed on the distal end of the generally tubular body, said flexible tip being more flexible than said tubular body.
16. The exchange catheter of Claim 14 further comprising:
a flexible tip formed on and extending distally from said tapered portion, said flexible tip being comprised of softer material than said tubular body.
a flexible tip formed on and extending distally from said tapered portion, said flexible tip being comprised of softer material than said tubular body.
17. The exchange catheter of Claim 1 further comprising:
a radiopaque marking member disposed on the tubular body to facilitate radiographic visualization of the exchange catheter.
a radiopaque marking member disposed on the tubular body to facilitate radiographic visualization of the exchange catheter.
18. The exchange catheter of Claim 1 wherein said generally tubular body comprises a flexible plastic tube.
19. The exchange catheter of Claim 17 wherein said exchange catheter further comprises a flexible plastic tube formed of PEBAX P6 material.
20. The exchange catheter of Claim 15 wherein said exchange catheter body comprises a flexible plastic tube formed of PEBAX P6 material and said flexible tip member comprises a tubular tip formed of PEBAX P3 material.
21. The exchange catheter of Claim 16 wherein said exchange catheter body comprises a flexible plastic tube formed of PEBAX P6 material and said flexible tip member comprises a tubular tip formed of PEBAX P3 material.
22. The exchange catheter of Claim 11 wherein said exchange catheter body comprises an elongate member coiled about a hollow inner lumen to form said generally tubular body.
23. The exchange catheter of Claim 20 wherein said elongate member comprises metal wire coiled about a hollow inner lumen.
24. The exchange catheter of Claim 11 further comprises a braided reinforcement member disposed in at least a portion of said tubular body.
25. The exchange catheter of Claim 11 wherein said exchange catheter is approximately 290 centimeters in length.
26. The exchange catheter of Claim 15 wherein said tubular body is approximately 29.0 centimeters in length and said flexible distal tip is approximately 0.4 centimeters in length.
27. The exchange catheter of Claim 11 wherein the distance from the proximal end of the exchange catheter to the guide wire exit aperture is approximately 160 centimeters and the distance from the guide wire exit aperture to the distal tip of the exchange catheter is approximately 130.4 centimeters.
28. The exchange catheter of Claim 12 wherein the distance from the proximal end of the exchange catheter to the guide wire re-entry aperture is approximately 140 centimeters, the distance from the guide wire re-entry aperture to the guide wire exit aperture is approximately 20 centimeters and the distance from the guide wire exit aperture to the distal tip of the exchange catheter is approximately 130.4 centimeters.
29. The exchange catheter of Claim 11 wherein the lumen of the exchange catheter has a diameter of approximately 0.20 - 0.23 inches and wherein the outer diameter of the exchange catheter is approximately 0.052 -0.057 inches.
30. The exchange catheter of Claim 11 wherein the inner diameter of the exchange catheter lumen is about 0.21 inches and the outer diameter of the exchange catheter is about 0.055 inches.
31. A system for removing a first guide catheter and replacing said first guide catheter with a second guide catheter while a guide wire, previously inserted through the first guide catheter, remains in place, said system comprising:
a first guide catheter having a proximal end, a distal end, an outer surface and a lumen extending longitudinally therethrough, said outer surface being of a first outer diameter at its largest point and said lumen being of a first inner diameter at its narrowest point;
a second guide catheter having a proximal end, a distal end, an outer surface and a lumen extending longitudinally therethrough, said outer surface being of a second outer diameter at its largest point and said lumen being of a second inner diameter at its narrowest point;
an elongate guide wire having a proximal end and a distal end, said guide wire having, at its largest point, an outer diameter which is smaller than either the first inner diameter of the first guide catheter or the second inner diameter of the second guide catheter so that the guide wire may pass through and reside within the lumens of the first and second guide catheters; and a generally tubular exchange catheter having a proximal end, a distal end, an outer surface, a lumen extending longitudinally therethrough and guide wire exit aperture formed therein between the proximal and distal ends thereof, said exchange catheter having:
(a) an outer diameter which is smaller than the first and second inner diameters of the first and second guide catheters and (b) an inner diameter which is larger than the outer diameter of the elongate guide wire.
a first guide catheter having a proximal end, a distal end, an outer surface and a lumen extending longitudinally therethrough, said outer surface being of a first outer diameter at its largest point and said lumen being of a first inner diameter at its narrowest point;
a second guide catheter having a proximal end, a distal end, an outer surface and a lumen extending longitudinally therethrough, said outer surface being of a second outer diameter at its largest point and said lumen being of a second inner diameter at its narrowest point;
an elongate guide wire having a proximal end and a distal end, said guide wire having, at its largest point, an outer diameter which is smaller than either the first inner diameter of the first guide catheter or the second inner diameter of the second guide catheter so that the guide wire may pass through and reside within the lumens of the first and second guide catheters; and a generally tubular exchange catheter having a proximal end, a distal end, an outer surface, a lumen extending longitudinally therethrough and guide wire exit aperture formed therein between the proximal and distal ends thereof, said exchange catheter having:
(a) an outer diameter which is smaller than the first and second inner diameters of the first and second guide catheters and (b) an inner diameter which is larger than the outer diameter of the elongate guide wire.
32. The system of Claim 31 further comprising:
an extension wire attachable to the proximal end of the elongate guide wire to form a guide wire assembly which, when fully inserted through the guide catheter, will have an exteriorized portion of a length at least equal to the longest of said first and second guide catheters.
an extension wire attachable to the proximal end of the elongate guide wire to form a guide wire assembly which, when fully inserted through the guide catheter, will have an exteriorized portion of a length at least equal to the longest of said first and second guide catheters.
33. The system of Claim 31 wherein said "generally tubular exchange catheter" further comprises:
a generally tubular exchange catheter having a proximal end, a distal end, an outer surface, a lumen extending longitudinally therethrough, a guide wire exit aperture formed therein between the proximal and distal ends thereof and guide wire re-entry aperture formed proximal to said guide wire exit aperture, said exchange catheter having:
(a) an outer diameter which is smaller than the first and second inner diameter which is smaller than the first and second inner diameters of the first and second guide catheters and (b) an inner diameter which is larger than the outer diameter of the elongate guide wire.
a generally tubular exchange catheter having a proximal end, a distal end, an outer surface, a lumen extending longitudinally therethrough, a guide wire exit aperture formed therein between the proximal and distal ends thereof and guide wire re-entry aperture formed proximal to said guide wire exit aperture, said exchange catheter having:
(a) an outer diameter which is smaller than the first and second inner diameter which is smaller than the first and second inner diameters of the first and second guide catheters and (b) an inner diameter which is larger than the outer diameter of the elongate guide wire.
34. The system of Claim 31 wherein the inner diameters of the first and second guide catheters are equal.
35. The system of Claim 31 wherein the inner diameters of the first and second guide catheters are different and the outer diameter of the exchange catheter is smaller than the smallest of the inner diameters of said first and second guide catheters.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US665,513 | 1991-03-06 | ||
| US07/665,513 US5234407A (en) | 1991-03-06 | 1991-03-06 | Method and device for exchanging cardiovascular guide catheter while a previously inserted angioplasty guide wire remains in place |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2099579A1 true CA2099579A1 (en) | 1992-09-07 |
Family
ID=24670410
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002099579A Abandoned CA2099579A1 (en) | 1991-03-06 | 1992-02-27 | Method and device for exchanging cardiovascular guide catheter while a previously inserted angioplasty guide wire remains in place |
Country Status (6)
| Country | Link |
|---|---|
| US (1) | US5234407A (en) |
| EP (1) | EP0574542B1 (en) |
| JP (1) | JPH06507327A (en) |
| CA (1) | CA2099579A1 (en) |
| DE (1) | DE69219883T2 (en) |
| WO (1) | WO1992015357A1 (en) |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| NL6708421A (en) * | 1966-09-14 | 1968-03-15 | ||
| US4661094A (en) * | 1985-05-03 | 1987-04-28 | Advanced Cardiovascular Systems | Perfusion catheter and method |
| US4917103A (en) * | 1985-09-18 | 1990-04-17 | C. R. Bard, Inc. | Guide wire extension |
| AU594684B2 (en) * | 1985-09-18 | 1990-03-15 | C.R. Bard Inc. | Guide wire extension |
| JPH084630B2 (en) * | 1986-02-04 | 1996-01-24 | 日本シヤ−ウツド株式会社 | Catheter introducer |
| US5040548A (en) * | 1989-06-01 | 1991-08-20 | Yock Paul G | Angioplasty mehtod |
| US4748982A (en) * | 1987-01-06 | 1988-06-07 | Advanced Cardiovascular Systems, Inc. | Reinforced balloon dilatation catheter with slitted exchange sleeve and method |
| US4988356A (en) * | 1987-02-27 | 1991-01-29 | C. R. Bard, Inc. | Catheter and guidewire exchange system |
| US4927413A (en) * | 1987-08-24 | 1990-05-22 | Progressive Angioplasty Systems, Inc. | Catheter for balloon angioplasty |
| US4827941A (en) * | 1987-12-23 | 1989-05-09 | Advanced Cardiovascular Systems, Inc. | Extendable guidewire for cardiovascular procedures |
| US4932413A (en) * | 1989-03-13 | 1990-06-12 | Schneider (Usa), Inc. | Guidewire exchange catheter |
| CA2035851A1 (en) * | 1990-02-07 | 1991-08-08 | Peter R. Mcinnes | Readily exchangeable perfusion catheter |
-
1991
- 1991-03-06 US US07/665,513 patent/US5234407A/en not_active Expired - Lifetime
-
1992
- 1992-02-27 EP EP92908797A patent/EP0574542B1/en not_active Expired - Lifetime
- 1992-02-27 JP JP4508197A patent/JPH06507327A/en active Pending
- 1992-02-27 CA CA002099579A patent/CA2099579A1/en not_active Abandoned
- 1992-02-27 DE DE69219883T patent/DE69219883T2/en not_active Expired - Fee Related
- 1992-02-27 WO PCT/US1992/001477 patent/WO1992015357A1/en active IP Right Grant
Also Published As
| Publication number | Publication date |
|---|---|
| DE69219883D1 (en) | 1997-06-26 |
| US5234407A (en) | 1993-08-10 |
| JPH06507327A (en) | 1994-08-25 |
| EP0574542A1 (en) | 1993-12-22 |
| DE69219883T2 (en) | 1998-01-22 |
| EP0574542B1 (en) | 1997-05-21 |
| WO1992015357A1 (en) | 1992-09-17 |
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| FZDE | Discontinued |