U.S. patent application number 09/384846 was filed with the patent office on 2002-10-24 for catheter system having imaging, balloon angioplasty, and stent deployment capabilities, and method of use guided stent deployment.
Invention is credited to GARCIA, RIZZA A., JANG, YUE-TEH, SALMON, STEPHEN M., WHITE, DAVID A..
Application Number | 20020156515 09/384846 |
Document ID | / |
Family ID | 24222294 |
Filed Date | 2002-10-24 |
United States Patent
Application |
20020156515 |
Kind Code |
A1 |
JANG, YUE-TEH ; et
al. |
October 24, 2002 |
CATHETER SYSTEM HAVING IMAGING, BALLOON ANGIOPLASTY, AND STENT
DEPLOYMENT CAPABILITIES, AND METHOD OF USE GUIDED STENT
DEPLOYMENT
Abstract
A catheter system has a balloon angioplasty device disposed
about a common lumen near its distal end. The balloon catheter is
pre-fitted with a stent which is deployed when the balloon is
inflated. The common lumen is in communication with multiple lumens
within a proximal region of the catheter body to allow for
positioning of the catheter over a movable guide wire and
convenient delivery of imaging or interventional devices to a
desired region of a body passageway being Treated. The procedure
for stent deployment optionally includes steps of imaging a lumen
by ultrasound before and after stent deployment to identify the
site at which a stent is needed, to confirm that the stent is being
and has been deployed at a longitudinal position which does not
overlap a branched segment of the body passageway, and to ensure
that the stent has been radially opened to an optimum diameter.
Inventors: |
JANG, YUE-TEH; (FREMONT,
CA) ; SALMON, STEPHEN M.; (SUNNYVALE, CA) ;
WHITE, DAVID A.; (SAN JOSE, CA) ; GARCIA, RIZZA
A.; (SAN JOSE, CA) |
Correspondence
Address: |
ATTN JOHN C KAPPOS
LYON & LYON LLP
633 WEST FIFTH STREET 47TH FLOOR
LOS ANGELES
CA
90071
|
Family ID: |
24222294 |
Appl. No.: |
09/384846 |
Filed: |
August 27, 1999 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
09384846 |
Aug 27, 1999 |
|
|
|
08880947 |
Jun 23, 1997 |
|
|
|
6074362 |
|
|
|
|
08880947 |
Jun 23, 1997 |
|
|
|
08556660 |
Nov 13, 1995 |
|
|
|
5749848 |
|
|
|
|
Current U.S.
Class: |
623/1.11 ;
600/437 |
Current CPC
Class: |
A61F 2/958 20130101;
Y10S 623/902 20130101 |
Class at
Publication: |
623/1.11 ;
600/437 |
International
Class: |
A61F 002/06 |
Claims
What is claimed is:
1. A vascular catheter system for guided placement and implanting
of a prosthesis within a body passageway, said system comprising: a
catheter body having proximal and distal ends, and a proximal and a
distal region, the proximal region having at least two lumens and
the distal region having a common lumen connected to and in
communication with both lumens of the proximal region; a balloon
disposed about the common lumen; and an expandable prosthesis
associated with the balloon, said prosthesis having a first
diameter which permits intraluminal delivery of the prosthesis into
a body passageway and which places the prosthesis in close
proximity to the balloon, and a second expanded diameter upon the
application of radial, outwardly extending force from the interior
of the prosthesis.
2. The vascular catheter system of claim 1, further comprising a
guidewire having a distal end, wherein the guidewire is
positionable within the common lumen of the distal region so that
the distal end of the guidewire can extend past the distal end of
the catheter body.
3. The vascular catheter system of claim 1, further comprising a
removable imaging core having an elongate drive shaft adapted for
positioning in the guidewire lumen of said catheter system, a
transducer portion connected to a distal portion of the elongate
drive shaft, and a proximal section connected to the proximal end
of the elongate shaft for transmission of electrical signals from a
proximal control apparatus to the transducer via the elongate drive
shaft.
4. A vascular catheter system for guided placement and implanting
of a prosthesis within a body passageway, said system comprising: a
catheter body having proxiral and distal ends, and a proximal and a
distal region, the proximal region having at least two lumens and
the distal region having a common lumen connected to and in
communication with both lumens of the proximal region; means for
retaining the prosthesis in close proximity to the distal region of
said catheter body; and an expandable prosthesis associated with
said retaining means, said prosthesis having a first diameter which
permits intraluminal delivery of the prosthesis into a body
passageway and which places the prosthesis in close radial
proximity to said catheter body, and a second expanded diameter
upon removal of said retaining means.
5. The vascular catheter system of claim 4, wherein said retaining
means comprises a sheath disposed about the distal region of said
catheter body.
6. The vascular catheter system of claim 5, wherein the prosthesis
is disposed between the catheter body and the sheath.
7. The vascular catheter system of claim 4, further comprising a
guidewire having a distal end, wherein the guidewire is
positionable within the common lumen of the distal region so that
the distal end of the guidewire can extend past the distal end of
the catheter body.
8. The vascular catheter system of claim 4, further comprising a
removable imaging core having an elongate drive shaft adapted for
positioning in the guidewire lumen of said catheter system, a
transducer portion connected to a distal portion of the elongate
drive shaft, and a proximal section connected to the proximal end
of the elongate shaft for transmission of electrical signals from a
proximal control apparatus to the transducer via the elongate drive
shaft.
9. A method for guided placement and implanting of a prosthesis
within a body passageway using a catheter having proximal and
distal regions, wherein the prosthesis is associated with the
distal region of the catheter, said prosthesis having proximal and
distal ends, said method comprising the steps of: advancing the
catheter into the body passageway until the prosthesis lies within
a region of interest; imaging by ultrasound from within the body
passageway at least one of the proximal and distal ends of the
prosthesis to ensure that the prosthesis is positioned at a desired
location; and expanding the prosthesis at the region of
interest.
10. The method of claim 9, wherein the catheter includes an
angioplasty balloon disposed about the distal region and associated
with the prosthesis.
11. The method of claim 10, wherein the step of expanding the
prosthesis includes inflating the balloon to controllably expand
the prosthesis at the region of interest.
12. The method of claim 9, wherein the catheter includes a sheath
disposed about the distal region of the catheter body.
13. The method of claim 12, wherein the step of expanding the
prosthesis includes removing the sheath.
14. The method of claim 9, wherein the body passageway is a blood
vessel.
15. The method of claim 9, wherein the prosthesis is a stent.
16. The method of claim 9, wherein imaging is performed to ensure
that the prosthesis is not positioned at a branching segment of the
body passageway.
17. The method of claim 15, wherein the stent comprises a wire mesh
tube having a first collapsed diameter which permits the stent to
be disposed upon the catheter, and inserted into the body
passageway, wherein the wire mesh tube can be expanded to a second
diameter.
18. The method of claim 11, further comprising the steps of:
imaging the prothesis while disposed about the inflated balloon to
determine a first diameter of the expanded prosthesis; and imaging
the prosthesis after deflating the balloon to determine a second
diameter to ensure that the expanded prosthesis has a desired
diameter.
19. The method of claim 13, further comprising the step of imaging
the prosthesis after removing the sheath to determine an expanded
diameter and to ensure that the expanded prosthesis has a desired
diameter.
20. The method of claim 19, further comprising the step of
expanding a second prosthesis within the prosthesis to enlarge the
diameter.
21. The method of claim 9, further comprising the step of advancing
an imaging core through a lumen of the catheter and into the region
of interest.
22. The method of claim 16, further comprising the step of
repositioning the prosthesis prior to expanding the prosthesis to
avoid the branching segment of the body passageway.
23. A method for implanting a prosthesis within a body passageway
using a catheter having proximal and distal regions, and an
angioplasty balloon disposed about the distal region, wherein the
prosthesis is associated with said balloon, said method comprising
the steps of: positioning the catheter within the body passageway
so that the angioplasty balloon lies within a region of interest;
inflating the balloon to controllably expand the prosthesis at the
region of interest; imaging the prosthesis while disposed about the
inflated balloon to determine a first diameter of the expanded
prosthesis; deflating the balloon, whereby the prosthesis is
allowed to recoil; and imaging the prosthesis to determine a second
diameter to ensure that the recoiled prosthesis has a diameter
sufficiently large.
24. The method of claim 23, wherein the body passageway is a blood
vessel.
25. The method of claim 23, wherein the prosthesis is a stent.
26. The method of claim 25, wherein the stent comprises a wire mesh
tube having a predetermined collapsed diameter which permits the
stent to be disposed upon the catheter, and inserted into the body
passageway, wherein the wire mesh tube can be expanded to the first
diameter.
27. The method of claim 23, wherein said prosthesis has proximal
and distal ends, and wherein said method further comprises the step
of imaging at least one of the proximal and distal ends of the
prosthesis prior to expanding the prosthesis to ensure that the
prosthesis is positioned at the desired location and not at a
branching segment of the body passageway.
28. The method of claim 27, further comprising the step of
repositioning the prosthesis prior to expanding the prosthesis to
avoid the branching segment of the body passageway.
29. The method of claim 23, further comprising the steps of:
inflating the balloon to controllably expand the prosthesis at the
region of interest; imaging the prosthesis while disposed about the
inflated balloon to determine a third diameter of the expanded
prosthesis, said third diameter being greater than either of said
first or said second diameters; deflating the balloon, whereby the
prosthesis is allowed to recoil; and imaging the prosthesis to
determine a fourth diameter which is larger than said second
diameter.
30. A method for implanting a prosthesis within a body passageway
using a catheter having proximal and distal regions, wherein a
first prosthesis is associated with the distal region, said method
comprising the steps of: positioning the catheter within the body
passageway so that the first prosthesis lies within a region of
interest; expanding the first prosthesis at the region of interest;
and imaging the expanded prosthesis to determine a first diameter
of the expanded prosthesis.
31. The method of claim 30, further comprising the step of
expanding a second prosthesis within the first prosthesis to
enlarge the diameter of said first prosthesis.
Description
FIELD OF THE INVENTION
[0001] The present invention relates generally to guided stent
deployment using a catheter system for imaging and treatment of
stenoses within a body passageway, including a patient's vascular
system, and more particularly to a catheter system in which an
angioplasty balloon can be used to deploy a stent device, said
catheter system further including an imaging element for use within
a region of a blood vessel so that placement and expansion of the
stent can be observed.
DESCRIPTION OF THE BACKGROUND ART
[0002] Arteriosclerosis, also known as atherosclerosis, is a common
human ailment arising from the deposition of fat-like substances,
referred to as atheroma or plaque, on the walls of blood vessels.
Such deposits occur both in peripheral blood vessels that feed
limbs of the body and coronary blood vessels that feed the heart.
Localized accumulation of deposits within regions of the blood
vessels may result in stenosis, or narrowing of the vascular
channel. When this occurs, blood flow is restricted and the
person's health is at serious risk.
[0003] Numerous approaches for treating such vascular deposits have
been proposed, including balloon angioplasty, in which a
balloon-tipped catheter is used to dilate a stenosed region within
the blood vessel; athertomy, in which a blade or other cutting
element is used to sever and remove the stenotic material; laser
angioplasty, in which laser energy is used to ablate at least a
portion of the stenotic material; and the like.
[0004] Where removal of vascular deposits is not desired,
endovascular grafts have been developed to enlarge an occluded
vessel lumen, and to hold tissue in place or to provide a support
for a graft while healing is taking place. Intraluminal
endovascular grafting has been shown to provide an alternative to
conventional vascular surgery. Endovascular grafting involves
percutaneous insertion of a prosthetic graft into a blood vessel,
and such devices are generally delivered via a catheter to a region
of interest within the vascular system. These techniques have the
clear advantage over conventional surgery of eliminating a need for
surgically exposing, replacing, incising, removing, or bypassing a
defective blood vessel. Several structures have been shown to have
use as intraluminal prosthetic grafts. These structures include
coiled stainless steel springs, helically wound coil springs, and
expanding stainless steel stents.
[0005] In order to apply certain intervention techniques more
effectively, a variety of vascular imaging devices and methods may
be employed. Of particular interest to the present invention,
imaging catheters having ultrasonic transducers at their distal
ends have been employed to produce images of the stenotic region
from within the blood vessel.
[0006] A number of specific designs for ultrasonic imaging
catheters have been described. An early design is illustrated in
U.S. Pat. No. 4,794,931, where the mechanical components of the
imaging system are located within a housing at the distal end of
the catheter. The housing includes a fixed guidewire at its distal
tip, which is used to position the catheter within the vascular
system. While the use of such fixed-guidewire designs can provide
excellent image quality, under some circumstances it is desirable
to use an "over-the-wire" design where the catheter may be
introduced over a separate (movable) guidewire. The use of a
movable guidewire offers certain advantages, including improved
steering capability through narrow regions and easier catheter
exchange, e.g., substitution of an interventional catheter for the
imaging catheter.
[0007] Various designs for removable and non-removable imaging
cores have also been described. Specific examples are set forth in
Sieben et al., U.S. Pat. No. 5,243,988, and in Sieben et al., U.S.
Pat. No. 5,353,798, both of which are incorporated herein by
reference. These devices generally include an imaging core designed
to operate within a guidewire lumen of therapeutic catheters which
accept a guidewire of 0.018 inch or smaller. In one embodiment, the
device consists of a fixed, non-removable proximal hub apparatus,
which is not disconnectable from the imaging core. The main body of
the device consists of the drive shaft, and this shaft provides for
ease of loading the imaging core into the therapeutic catheter, and
steady rotational movement in order to obtain an image without
distortion.
[0008] Exchanging the imaging catheter for an interventional or
other catheter within a patient's vascular system is time consuming
and may be injurious to the patient. It is desirable therefore to
combine imaging and interventional capabilities in a single
catheter system. A design for an ultrasonic imaging catheter having
a balloon angioplasty device is described in U.S. Pat. No.
5,117,831. One depicted embodiment uses a fixed guidewire and is
thus subject to the disadvantages noted above. Another embodiment
has a guidewire movable through the ultrasonic imaging transducer
and is associated drive shaft. This requires that the transducer
and is associated drive shaft and not movable along the length of
the catheter.
[0009] To be able to cross very narrow lesions, the diameter of the
catheter should be as small as possible at its distal end.
Furthermore, the need to move the catheter body within the patient
should be minimized. The blood vessel interior is delicate, may be
weakened by disease, and is therefore susceptible to injury from
movement of the catheter body within it.
[0010] Despite the availability of devices for imaging a body
passageway as described above, there is a dearth of techniques for
guided placement of prosthetic devices, including stents, within a
body passageway, including the vascular system. The vasculature of
the human body is highly curved and includes many branches in
vessels. It is moreover undesirable to place a prosthetic device in
a branched segment of a blood vessel for at least two reasons.
First, a prosthetic device such as a stent will, in time,
accumulate endothelial cell growth which will clog the wire mesh of
the stent. If the stent is located at a vessel branch point, then
the stent, once clogged, will act as an impermeable barrier to
blood flow into the vessel which branches away from the main
vessel. Second, if a later episode of vascular disease occurs in
the vessel which branches away from the main vessel, then the stent
which is located at the vessel branch point will block access to
the branched vessel, and will thereby preclude the later use of a
vascular catheter as an interventional therapy for this branched
blood vessel.
[0011] The present techniques for guided placement of a prosthetic
device within a vessel rely on X-ray imaging or fluoroscopy to
visualize the location of the stent, and angiography using a
radiopaque substance to visualize the branch points of blood
vessels. This technique suffers from the serious disadvantage that
the prosthetic device or stent is detectable by fluoroscopy only
when the device is constructed from metal which is sufficiently
thick. However, the thickness of metal needed for fluoroscopic
detection causes the prosthetic device to be too stiff to safely
navigate the tortuous passageways of blood vessels. For this
reason, the presently available techniques for guided placement of
stents cannot be utilized with the most widely used and most
preferred stents; flexible stents adapted for entry into narrow and
highly curved blood vessels, such as the Palmaz-Schatz stent
available from Johnson & Johnson. For these reasons,
approximately 95% of the stents which are in wide use today are not
radiopaque.
[0012] For the reasons stated above, it would be advantageous to
provide a catheter system having a balloon angioplasty system with
a prosthetic device such as a vascular graft or stent associated
therewith, in combination with visualization capabilities for
guided placement of the prosthetic device within a region of
interest within the vascular system. Such delivery should be
accomplished with a minimum repositioning of the catheter body
within the blood vessel. Additionally, the catheter should be as
narrow as possible at its distal end to allow for entry into and
through narrow and tortuous regions of the patient's vascular
system.
SUMMARY OF THE INVENTION
[0013] The present invention provides a catheter system having the
ability to deliver both an angioplasty balloon and another work
element for imaging or treating a region within a patient's
vascular system, said catheter system further having the ability to
implant a stent in the vascular system and to perform a guided
stent placement procedure. The catheter system comprises a catheter
body having a proximal and a distal region. The proximal region has
at least two lumens, one for carrying a movable guidewire and
another for carrying a work element. The work element will
typically be an ultrasonic imaging transducer but may be another
imaging device or even an interventional device for treating the
blood vessel in combination with the angioplasty balloon. The
distal region of the catheter body has a common lumen connected to
and in communication with the two lumens of the proximal region.
The angioplasty balloon is disposed about the common lumen of the
distal region, and the catheter system further includes a
prosthetic device, such as a vascular graft or a stent, associated
with said balloon, and an associated means for inflating the
balloon, typically an inflation lumen extending from the proximal
end of the catheter body to the balloon. The prosthesis will
generally be flexible, and have a tubular shape with proximal and
distal ends, and may include a metallic wire mesh. The prosthesis
will typically be crimped onto the balloon so that it is disposed
closely about the balloon, and is capable of controlled radial
expansion in a region of interest upon the application of a radial,
outwardly extending force from the interior of the prosthesis.
[0014] In an alternative embodiment, the catheter has one or more
lumens in the proximal region, and the movable guidewire is secured
to the distal region of the catheter with a monorail type catheter
design as disclosed by Yock, U.S. Pat. No. 5,350,395, incorporated
herein by reference. In this design, the movable guidewire is not
carried by any of the one or more lumens in the proximal
region.
[0015] Another alternative catheter has one or more lumens in the
proximal region, and two or more lumens in the distal region of the
catheter, wherein at least one of the proximal lumens is in
communication with at least one of the distal lumens. In this
embodiment, the guidewire occupies one lumen in the distal region
and can remain in place during imaging. This design offers the
convenience of imaging using a movable imaging core in the second
distal lumen while the guidewire remains in place in the first
distal lumen. Operations using this design save time associated
with withdrawing and advancing of instruments through the various
lumens, but suffer the small drawback of displaying an image having
artifacts associated with the presence of the guidewire positioned
at one location in the ultrasound scan.
[0016] The catheter of the present invention will allow for
performance of rapid and convenient balloon angioplasty and imaging
for guided placement of a prosthetic device or stent within a
diseased vessel, while minimizing the need to reposition the
catheter body between procedures. Additionally, the distal end of
the catheter will be relatively narrow to allow for movement of the
catheter into restricted spaces of the patient's vascular system
and particularly into narrow regions and stenoses within the
coronary arteries. Further, the catheter of the invention enables
stent deployment in combination with balloon angioplasty and
imaging, and will allow for a guided stent placement procedure.
[0017] An alternative catheter is equipped with a self-expanding
prosthetic device, such as a stent, which is composed of a shape
retaining metal, such as nitinol. This catheter may generally
include a means for retaining the self-expanding prosthesis so that
it is disposed radially closely about the balloon. Retaining means
may be provided in the form of a sheath disposed about the distal
region of the catheter body so that the prosthesis is operatively
associated with the sheath. In one embodiment, the prosthesis may
be disposed between the catheter body and the sheath so that when
the sheath is removed, the prosthesis is released and automatically
enlarges to an expanded diameter. When a self-expanding prosthesis
is employed, an angioplasly balloon is not required on the catheter
for enlarging the prosthesis, but may be included where balloon
angioplasty is desired in combination with stent deployment. The
self-expanding prosthesis is installed on the catheter at a first
diameter which permits intraluminal delivery of the prosthesis into
a body passageway and which places the prosthesis in close
proximity to the catheter body. The prosthesis has a shape memory
which allows it to expand to a larger diameter when the means for
retaining the prosthesis are removed.
[0018] The present invention also provides methods for guided
positioning and deployment of prosthetic devices, including
intraluminal grafts and stents, to a region of interest within a
body passageway without use of fluoroscopy or angiography. The
methods employ a catheter having proximal and distal ends with an
angioplasty balloon or a sheath disposed about the distal region.
The catheter further includes a prosthesis such as an intravascular
graft or a stent associate with the balloon or the sheath. The
stent may be constructed from metal, and may be crimped onto the
balloon or disposed between the sheath and the catheter body so
that it is disposed closely about the distal region of the catheter
body. According to one method, the catheter may be advanced into a
body passageway until the prosthesis lies within a region of
interest. An ultrasound transducer is then used to image the
proximal edge of the prosthesis, the distal edge of the prosthesis,
or both edges of the prosthesis to ensure that the prosthesis is
positioned at a desired location, and particularly to verify that
the prosthesis does not overlap with a branching segment of the
body passageway. If the observed position of the prosthesis is
suboptimal, the longitudinal position of the catheter may be
adjusted to relocate the balloon and the associated prosthesis so
it is clear of the branching segment of the body passageway.
Repositioning of the prosthesis may also be desirable to achieve
proper overlap of the prosthesis on each side with healthy segments
of a blood vessel. The prosthesis is then deployed, either by
inflating the balloon to controllably expand the prosthesis at the
region of interest, or by removing the sheath, whereby the
self-expanding prosthesis enlarges. The catheter is then removed
from the body passageway, thereby leaving the implanted prosthesis
or stent in place. Where an angioplasty balloon is used, the
balloon must be deflated before removing the catheter from the
region of interest.
[0019] An alternative method for guided deployment of a prosthetic
device in a body passageway using the catheters of the invention
may include the step of advancing a guidewire into the blood vessel
until a distal end of the guidewire lies within a stenosed region
or a region having a lesion, and a proximal end of the guidewire
extends from the patient. The proximal end of the guidewire may
then be loaded into the common lumen of the distal region of the
catheter body, into a guidewire lumen, or into the monorail lumen,
and then the catheter is advanced over the guidewire into the blood
vessel until the prosthesis associated with the distal region of
the catheter lies within the region of interest. Where a common
lumen catheter is employed, the guidewire may be retracted out of
the common lumen and into the proximal region of the catheter body.
An ultrasonic imaging transducer and associated drive shaft may
then be advanced through a lumen of the proximal region of the
catheter body and into the common lumen. Where a monorail catheter
or a catheter having at least two lumens at the distal region is
employed, then the guidewire need not be withdrawn to allow access
by the ultrasonic imaging transducer, but the guidewire may be
withdrawn to improve image quality. The ultrasonic imaging
transducer may be provided in the form of a removable imaging core
or a non-removable imaging core. The transducer is then activated
to provide images of at least one of the proximal and distal ends
of the prosthetic device to ensure that the prosthesis is
positioned at a desired location, away from a branching segment of
the blood vessel, and overlapping with healthy segments of the
vessel on both sides of the prosthesis. The catheter is then
removed from the body passageway, thereby leaving the implanted
prosthesis or stent in place. Where an angioplasty balloon is used,
the balloon must be deflated before removing the catheter from the
region of interest.
[0020] The invention also provides methods for implanting a
prosthesis within a body passageway using the catheters of the
invention so that optimal radial expansion of the prosthesis may be
achieved. The catheter is positioned within a body passageway so
that the prosthesis associated with the distal region of the
catheter lies within a region of interest. The balloon is inflated
to controllably expand the prosthesis at the region of interest. An
ultrasound transducer is provided in the region of the angioplasty
balloon, and said transducer is activated to obtain images of the
prosthesis while disposed about the inflated balloon, and thereby
provide a first diameter of the expanded prosthesis. The balloon
may then be deflated, whereby the prosthesis is permitted to
recoil. The internal region of the prosthesis is then imaged again
to determine a second diameter to ensure the expanded prothesis has
maintained a sufficiently large opening after recoil. In this
manner, if the recoil diameter is smaller than the desired
diameter, the balloon can be reinflated to a second diameter larger
than the first diameter, such that after recoil, the desired
diameter is achieved. For example, if a 10% recoil in diameter
occurs, the balloon can be reinflated to a diameter which is
greater than the desired diameter by an amount so that, after a 10%
recoil occurs, a final diameter of precisely that desired is
achieved.
[0021] In an alternative embodiment where a self-expanding
prosthesis is employed, the catheter is positioned within a body
passageway so that the prosthesis which is associated with the
distal region of the catheter lies within the region of interest.
The prosthesis is released at the region of interest by withdrawing
the sheath, or by any other known means to release a self-expanding
prosthesis, whereby the prosthesis expands. The expanded prosthesis
is then imaged to determine a first diameter of the expanded
prosthesis. If this diameter is not sufficiently large, then a
second prosthesis can be inserted within the first prosthesis to
further enlarge the diameter of the first prosthesis.
BRIEF DESCRIPTION OF THE DRAWINGS
[0022] FIG. 1 depicts a preferred embodiment of a catheter
according to the present invention.
[0023] FIG. 2A is a cross-sectional view through section line A-A
of the catheter depicted in FIG. 1.
[0024] FIG. 2B is a cross-sectional view through section line B-B
of the catheter depicted in FIG. 1.
[0025] FIG. 3 depicts a transition region between proximal and
distal regions of the body of the catheter depicted in FIG. 1.
[0026] FIG. 4 depicts the transition region and distal region of an
alternative preferred embodiment of a catheter according to the
present invention.
[0027] FIG. 5 depicts an alternative preferred embodiment of a
catheter according to the present invention.
[0028] FIG. 6 depicts the transition region and distal region of a
single lumen catheter according to the present invention.
[0029] FIG. 6A depicts a cross-sectional view through section line
A-A of the catheter depicted in FIG. 6.
[0030] FIG. 7 depicts the transition region and distal region of an
alternative common lumen catheter according to the present
invention.
[0031] FIG. 7A depicts a cross-sectional view through section line
A-A of the catheter depicted in FIG. 7.
[0032] FIG. 8 depicts the transition region and distal region of an
alternative common lumen catheter according to the present
invention.
[0033] FIG. 8A depicts a cross-sectional view through section line
A-A of the catheter depicted in FIG. 8.
[0034] FIG. 9 depicts the distal region of a dual lumen catheter
which does not have a common lumen according to the present
invention.
[0035] FIG. 9A depicts a cross--sectional view through section line
A-A of the catheter depicted in FIG. 9.
[0036] FIG. 9B depicts a cross-sectional view through section line
B-B of the catheter depicted in FIG. 9.
[0037] FIG. 10 depicts a removable imaging core according to the
present invention.
[0038] FIG. 11 depicts a vessel having blockage near a branching
segment.
[0039] FIGS. 12, 13, and 14 depict a method of treating a diseased
region of a vessel in accordance with methods and structures
disclosed herein.
DETAILED DESCRIPTION
[0040] The prosthetic devices which are preferred for use with the
catheters and methods described herein include stents, and
particularly the Palmaz-Schatz stent which is available from
Johnson & Johnson. Stents for use herein are disclosed in
Palmaz, U.S. Pat. No. 4,733,665, and Cragg, U.S. Pat. No.
5,405,377, both of which are expressly incorporated herein by
reference. Briefly, these stents include a tubular-shaped member
having first and second ends and a wall surface disposed between
the first and second ends, the wall surface being formed by a
plurality of intersecting elongate members, at least some of the
elongate members intersecting with one another intermediate the
first and second ends of the tubular-shaped member; the
tubular-shaped member having a first diameter which permits
intraluminal delivery of the tubular-shaped member into a body
passageway having a lumen; and the tubular-shaped member having a
second, expanded diameter, upon the application from the interior
of the tubular-shaped member of a radially, outwardly extending
force, which second diameter is variable and dependent upon the
amount of force applied to the tubular-shaped member, whereby the
tubular-shaped member may be expanded to expand the lumen of the
body passageway. Methods for deploying prosthetic devices,
including stents, are disclosed in Lau et al., U.S. Pat. No.
5,158,548, and in Cox, U.S. Pat. No. 5,257,974, both of which are
expressly incorporated herein by reference.
[0041] The prosthetic devices may be composed of a shape retaining
or shape memory material such as nitinol so that the devices are
self-expanding and thermally activatable within a vessel upon
release from a retaining means which holds the prosthetic device in
a compressed state at the first diameter. These devices will
automatically expand to a second, expanded diameter upon being
released. The construction and deployment of a self-expanding stent
is disclosed in Morgentaler, U.S. Pat. No. 5,224,953, which is
expressly incorporated herein by reference.
[0042] The plurality of elongate members may be a plurality of
wires, and the wires may be fixedly secured to one another where
the wires intersect with one another. The plurality of elongate
members may be a plurality of thin bars which are fixedly secured
to one another where the bars intersect with one another. The
tubular-shaped member may have a biologically inert coating on its
wall surface, and the coating may include a means for anchoring the
tubular-shaped member to the body passageway.
[0043] The catheters for use herein include those described in
Jang, U.S. Pat. No. 5,364,347, and Willard et al., U.S. Pat. No.
5,219,335, both of which are expressly incorporated herein by
reference. The catheters may comprise an elongate catheter body
having proximal and distal ends and at least two regions, a
proximal region and a distal region. The proximal region of the
catheter body may have at least two lumens extending at least
partly therethrough. The distal region of the catheter body will
have a single common lumen in communication with both of the lumens
of the proximal region. Additionally, an inflatable angioplasty
balloon will be disposed about the common lumen of the distal
region of the catheter, and a prosthetic device, vascular graft, or
stent will be releasably disposed about the angioplasty balloon, or
associated therewith.
[0044] In use, a catheter will be advanced over a guidewire into a
patient's vascular system. First the guidewire will be advanced
alone into the patient until the guidewire lies within a particular
region of interest. This will typically be a region in which a
blood vessel has been narrowed by a stenotic lesion. The distal end
of the guidewire will be advanced into the region of stenosis with
the proximal end of the guidewire remaining outside of the
patient's body. The proximal end of the guidewire may then be
inserted into the distal end of the catheter body and fed through
the common lumen of the distal region. When the proximal end of the
guidewire reaches a transition region between the distal and
proximal region of the catheter body, the guidewire will be
directed into a particular guidewire lumen of the proximal
region.
[0045] Once the guidewire has been directed into the guidewire
lumen, the catheter will be advanced into the patient's vascular
system until the prosthetic device associated with the distal
region lies within the region of interest. During advancement of
the catheter into the blood vessel, the proximal end of the
guidewire will exit the catheter body through a guidewire port
located some distance proximal of the distal region (in either an
"over-the-wire" configuration, or a "monorail" configuration). The
proximal end of the guidwire may then be grasped and pulled back
sufficiently to withdraw the distal end of the guidewire into the
guidewire lumen and clear of the common lumen of the distal region.
An ultrasonic imaging transducer or other work element may then be
advanced through another lumen of the proximal region and into the
common lumen for imaging the region of interest.
[0046] Prior to inflation of the balloon, the imaging transducer is
activated to determine the position of the proximal edge of the
prosthesis, the distal edge of the prosthesis, or both edges of the
prosthesis. This step is performed for the purpose of determining
whether the prosthetic device overlaps with a branching segment of
the blood vessel so that the balloon and its associated prosthetic
device can be repositioned away from the branching segment before
inflation of the balloon and deployment of the prosthetic device.
The exact positioning of the prosthetic device is also important
because it is desirable to have the prosthetic device extend
longitudinally at both its proximal and distal ends to healthy
segments of the blood vessel. It is difficult to determine exactly
where the diseased segment of the blood vessel begins and ends
without ultrasound imaging from within the body passageway.
[0047] Thus, a catheter according to the present invention will
allow for the convenient delivery of a balloon angioplasty device
and an associated prosthetic device in combination with another
interventional or imaging device to a region of interest within the
patient. Because the catheter uses a single common distal lumen, it
may be made with a reduced profile at its distal end. This will
allow delivery of the balloon angioplasty, associated stent,
imaging, or other interventionl devices even within narrow,
tortuous regions of the patient's vascular system. Furthermore, the
various work elements are delivered through a common lumen lying
within the balloon, thus minimizing the need to reposition the
catheter body between treatment steps.
[0048] FIG. 1 depicts a preferred embodiment of a catheter
according to the present invention. The catheter has a catheter
body 12, which comprises proximal region 15, distal region 18, and
transition region 20. FIG. 2A is a cross-sectional view of the
proximal region of catheter body 12 through section line A-A. In
this embodiment, proximal region 15 has three lumens, work element
lumen 23, guidewire lumen 25, and proximal balloon inflation lumen
27. Other embodiments could have still more lumens to accommodate
additional imaging or interventional devices, as described
generally in co-pending U.S. application Ser. No. 07/975,769, filed
Nov. 13, 1992, the full disclosure of which is incorporated herein
by reference. Guidewire port 30 and balloon inflation port 32 (FIG.
1) place guidewire lumen 25 and proximal balloon inflation lumen 27
in communication with the exterior of the catheter near its
proximal end.
[0049] In the embodiment depicted in FIG. 1, drive shaft 45 is
reciprocatably disposed within work element lumen 23. (For clarity,
only a distal portion of drive shaft 45 is illustrated.) At its
proximal end, work element lumen 23 is in communication with
expandable member 39, which is connected in turn to proximal
housing 35. The proximal housing is adapted to connect a proximal
end of drive shaft 45 to a drive motor (not shown) for rotating the
drive shaft.
[0050] Expandable member 39 allows the drive shaft to be
conveniently advanced and retracted within work element lumen 23 by
moving proximal housing 35 with respect to the catheter body to
lengthen or shorten expandable member 39 as desired. Proximal
housing 35 is provided further with flush port 50, to allow for the
flushing of trapped air bubbles from within work element lumen 23.
The construction and use of proximal housing 35 in conjunction with
a multi-lumen catheter is more fully described in co-pending U.S.
application Ser. No. 07/976,228, filed Nov. 13, 1992, the full
disclosure of which is incorporated herein by reference.
[0051] A cross-section through distal region 18 of catheter body 12
through section line B-B is depicted in FIG. 2B. As can be seen
therein, distal region 18 has two concentric lumens. In the distal
region, common lumen 60 is disposed within distal balloon inflation
lumen 62.
[0052] Referring again to FIG. 1, balloon 65 is disposed about
common lumen 60. The balloon is in communication with distal
balloon inflation lumen 62 to provide for inflation of the balloon.
Radiopaque band 68 is wrapped around the common lumen at a position
within the balloon to allow for fluoroscopic imaging to assist in
placing the balloon within the desired region of the blood vessel.
A prosthetic device 90, such as a stent, is disposed about the
balloon 65, and is in close radial proximity thereto. Where the
prosthetic device is a wire mesh stent composed of metallic
material, the distal region of the catheter may be equipped with
the stent by crimping the stent onto the distal region of the
catheter body, such as over the balloon.
[0053] The length of common lumen 60 will generally be between 5
and 30 centimeters, with balloon 65 typically having a length in
the range of 1.5-4.5 centimeters. The balloon crossing profile, the
minimum width crossable by the balloon when deflated, will
typically be in the range of 0.020-0.045 inches. The outside
diameter of the balloon when inflated within a blood vessel will
commonly be between 1.5 and 4.5 millimeters. The foregoing ranges
are set forth solely for the purpose of illustrating typical device
dimensions. The actual dimensions of a device constructed according
to the principles of the present invention may obviously vary
outside of the listed ranges without departing from those basic
principles.
[0054] FIG. 3 depicts transition region 20 between the three
parallel lumens of proximal region 15 and the two concentric lumens
of distal region 18. Transition region 20 provides for
communication between common lumen 60 of the distal region and both
guidewire lumen 25 and work element lumen 23 of the proximal
region. Also, distal balloon inflation lumen 62 is placed in
communication with proximal balloon inflation lumen 27 through
balloon inflation lumen connection 70, which is formed by cutting
through the exterior of proximal region 15 to expose a portion of
the proximal balloon inflation lumen to close it off from common
lumen 60. Thus, a continuous inflation path exists from balloon
inflation port 32, through proximal and distal balloon inflation
lumens 27 and 62, and into balloon 65. Injection of fluid into
balloon inflation port 32 will thereby result in inflation of
balloon 65.
[0055] It is contemplated that the catheter depicted in FIG. 1 will
be used as follows. First, a conventional guidewire will be
advanced into the patient's vascular system until it lies within
the region of stenosis. Next, the guidewire will be inserted into
distal tip 77 (FIG. 1) of the catheter and through common lumen 60
of distal region 18. The catheter will then be advanced into the
patient's body over the guidewire until the guidewire reaches
transition region 20. At this point, the guidewire will be directed
into guidewire lumen 25 and through the proximal region until it
exists the catheter through guidewire port 30 as the catheter is
advanced further into the patient's body. Eventually, the catheter
will be advanced to a point where common lumen 60, balloon 65, and
prosthetic device 90 lie within the region of interest.
[0056] The operator of the system can then grasp the guidewire at
the end protruding from the guidewire port. The operator will pull
the guidewire back a short distance into guidewire lumen 25 of
proximal region 15 in order to clear common lumen 60 of distal
region 18. A work element 75, which will typically be an ultrasonic
imaging transducer, fixed to the distal end of drive shaft 45, may
then be advanced through work element lumen 23 of the proximal
region and into the common lumen of the distal region. Imaging of
the region of interest may then take place to ensure that the
prosthesis is positioned away from any branching segments of the
blood vessel and is anchored on both sides in contact with healthy
tissue.
[0057] Following imaging, the prosthesis is expanded in the region
of interest by inflating the balloon to a desired diameter.
Alternatively, where a self-expanding prosthesis is employed, no
balloon inflation is needed to expand the prosthesis. After the
prosthesis has been expanded, the region of interest may be imaged
again to verify that optimal positioning of the prosthesis has
occurred and to determine the diameter of expansion achieved by the
prosthesis. The prosthesis may then be further expanded if desired,
or a second prosthesis having a larger expanded diameter may be
installed within the first prosthesis. When proper diameter and
positioning of the prosthesis has been achieved, the balloon, if
used, is deflated, and the catheter is removed from the region of
interest.
[0058] FIG. 1 depicts a catheter in which the common lumen is
narrowed at a restriction 80 just proximal to the balloon. Distal
of the restriction, the common lumen will be just large enough to
allow passage of the guidewire. This allows the balloon crossing
profile, the width of the catheter in the region of the balloon
when not inflated, to be as small as possible. This is advantageous
in that it allows the balloon to be advanced into narrow and
tortuous regions of the blood vessel. Placing the restriction
proximal to the balloon is disadvantageous, however, in that it may
prevent entry of the work element into the common lumen within the
balloon. Thus, some repositioning of the catheter body within the
blood vessel, i.e., advancement of the catheter body further into
the blood vessel, may be necessary to allow for imaging of the
treated region.
[0059] FIG. 4 depicts the distal region of an alternative preferred
embodiment in which the common lumen is not restricted in the
region proximal to the balloon and the prosthesis. In this
embodiment, the work element may travel through the common lumen
into, through, and beyond the balloon. This is advantageous in that
it allows for imaging of the blood vessel throughout the region of
the prosthesis without repositioning the catheter body.
[0060] As discussed above, it is desirable at present to have the
guidewire in place within the common lumen during balloon inflation
in case rapid withdrawal of the catheter over the guidewire becomes
necessary. However, future developments in interventional devices
and techniques may make this unnecessary. If this becomes the case,
imaging will be possible from within the balloon even while the
balloon is being inflated. Of course, an increased diameter common
lumen within the balloon requires a slightly larger balloon
crossing profile. Some ability to enter narrow regions must thereby
be sacrificed in order to achieve a more flexible imaging
capability.
[0061] The embodiment of FIG. 4 depicts the common lumen having
restriction 80 at some distance distal to balloon 65. This
restriction will prevent the accidental exit of the work element
from the distal tip 77 of the catheter body while still allowing
passage of the guidewire. This prevents injury to the blood vessel
wall, which might result from accidental contact by the rotating
work element. In order to further safeguard against trauma to the
blood vessel, distal region 60 and distal tip 77 are preferably
constructed of a material which is highly atraumatic; a material
which is extremely soft and flexible so that the catheter can be
repositioned in the vessel without using a guidewire and without
harm to the vessel.
[0062] A catheter according to the present invention could also be
made to carry an interventional work element such as a rotating
cutter or a laser ablation device. In such a case, it would be
necessary for the work element to advance beyond the distal tip 77
of the catheter body. In such a catheter system, restriction 80
would be omitted altogether to allow for unhindered passage of the
work element.
[0063] FIG. 5 depicts the proximal and distal regions of an
alternative preferred embodiment which does not require an
angioplasty balloon for expansion of the prosthetic device. This
embodiment shares certain components with the catheter depicted in
FIG. 1, and those common aspects share the same numerals with this
earlier-described catheter. The prosthetic device 90 is a
self-expanding stent which is disposed on the distal region of the
catheter body 12. The stent is held in close radial proximity to
the catheter body by a sheath 91 which covers the stent at the
distal region of the catheter. In this embodiment, the stent 90 is
disposed between the catheter body 12 and the sheath 91. The sheath
91 extends to the proximal region of the catheter body to provide a
proximal region 92 of the sheath which allows the sheath to be
withdrawn proximally to release the prosthetic device at the region
of interest.
[0064] FIG. 6 depicts the distal region of another alternative
embodiment which does include an angioplasty balloon. This
embodiment shares certain components with the catheter depicted in
FIG. 4, and those common aspects share the same numerals with this
earlier-described catheter. This catheter includes inflation port
101, guidewire lumen wall 102, and guidewire/ultrasound lumen 103
within catheter body 100. The catheter is provided with a short
atraumatic region 104 extending beyond the angioplasty balloon 65.
FIG. 6A is a cross-sectional view of the proximal region of
catheter body 100 through section line A-A. The proximal region has
two lumens: one for inflation and one for a guidewire or ultrasound
imaging device. A prosthetic device (not shown) is disposed about
the angioplasty balloon 65 as shown in FIGS. 1 and 4,. In use, the
catheter requires that the positioning guidewire be completely
withdrawn from the lumen before an imaging device can be inserted
therein for the purpose of imaging the prosthesis within a body
passageway to determine whether it is positioned longitudinally
within an optimal region.
[0065] FIG. 7 depicts the distal region of another alternative
embodiment which also includes an angioplasty balloon. FIG. 7A is a
cross-sectional view of the proximal region of the catheter body
100 through section line A-A. The proximal region includes separate
lumens 105 and 106 for receiving a guidewire and an ultrasound
imaging core. The distal region includes a common lumen 107, the
proximal end of which includes a transition region which is in
communication with both lumens 105 and 106. The common lumen 107
can alternately receive a guidewire or an imaging core. A
prosthetic device (not shown) is disposed about the angioplasty
balloon as shown in FIGS. 1 and 4. In use, the catheter is
positioned over a guidewire extending through the guidewire lumen
and the common lumen. The guidewire is then withdrawn proximal
beyond the transition region, and is housed in the guidewire lumen,
leaving the common lumen open to receive an imaging core. The
imaging core is then advanced into the common lumen and used to
position the prosthesis within the body passageway.
[0066] FIG. 8 depicts the distal region of another alternative
embodiment which shares many components with FIG. 7, and these
common aspects share the same numerals. FIG. 8A is a
cross-sectional view of the proximal region of the catheter body
100 through section line A-A. Inflation lumen 101 is in
communication with balloon 65 through pore 110. Wire lumen 105 and
ultrasound lumen 106 merge into common lumen 107 at the distal
region of the catheter. The catheter of FIG. 8 has a short common
lumen 107. This catheter allows for exchange of the imaging core
for the guidewire with only minimal withdrawal of the guidewire. A
prosthetic device (not shown) is disposed about the angioplasty
balloon as shown in FIGS. 1 and 4.
[0067] FIG. 9 depicts the distal region of another alternative
embodiment which shares many components with FIG. 8, and these
common aspects share the same numerals. FIG. 9A is a
cross-sectional view of the proximal region of the catheter body
100 through section line A-A, while FIG. 9B is a cross-sectional
view of the distal region of the catheter beyond the balloon 65
through section line B-B. In this embodiment, the guidewire lumen
105 and the ultrasound lumen 106 extend as separate lumens through
the entire distal end of the catheter. There is no transition
region and no common lumen. The guidewire lumen may extend
proximally to the proximal end of the catheter. Alternatively, the
guidewire lumen may terminate in the distal region of the catheter
or just proximal thereto so as to include a monorail design as
disclosed by Yock, U.S. Pat. No. 5,350,395, which is expressly
incorporated herein by reference. In use, this catheter allows
positioning over a guidewire, followed by imaging of a prosthesis
(not shown) without repositioning or withdrawing the guidewire.
Accordingly, the guidewire can be left in place in the guidewire
lumen while imaging takes place in the ultrasound lumen. Image
artifacts may be observed when such use is undertaken, but can be
eliminated by withdrawing the guidewire a small distance during
imaging.
[0068] The ultrasonic transducer device for use with catheters
herein include removable imaging cores as disclosed in Crowley et
al., U.S. Pat. No. 4,951,677, Griffith et al., U.S. Pat. No.
5,115,814, and Sieben, U.S. Pat. No. 5,353,798, all of which are
expressly incorporated herein by reference. The imaging devices
also may include non-removable imaging cores as disclosed by Sieben
et al., U.S. Pat. No. 5,243,988, incorporated herein by reference,
which include an intravascular imaging device having an ultrasonic
sensor located at a distal end of an intravascular wire sized and
adapted to be located within the guidewire lumen of conventional
catheters used for intravascular procedures. As such, the imaging
cores have several significant advantages. For example, the imaging
core can utilize the path provided by the guidewire lumen of a
conventional catheter to image at the arterial location to which
the catheter is advanced. Moreover, in several embodiments, the
imaging core may be provided with conventional guidewire features,
e.g., a floppy spring tip, to enable the imaging guidewire to be
used as both a conventional guidewire for positioning an
intravascular catheter as well as imaging features, e.g., a sensor,
to enable imaging the intravascular regions accessible thereby.
[0069] In order to be utilized in the above-described manner, an
embodiment of the imaging core 120 is provided, as shown in FIG.
10. The imaging core 120 includes a tip section 122, a sensor
section 124, a drive cable section 126, and a proximal connector
section 128. As mentioned above, an essential requirement for the
imaging core is that it possess an outer profile of a size that
allows it to fit through a guidewire lumen in conventional
interventional catheters. In catheters that use 0.018 inch
guidewires, the guidewire lumen has a diameter typically in a range
between 0.020 and 0.022 inches. The diameter of the proximal
section 128 of the imaging core 120 may be as large as 0.020
inches, but the rest of the imaging core should be not more than
approximately 0.018 inches. For use with catheters designed with
guidewire lumens of other sizes, relative adjustments in dimension
apply.
[0070] The catheters and methods disclosed herein are particularly
well adapted for treatment of vascular stenosis positioned in close
proximity to a branching segment of a blood vessel as depicted in
FIG. 11. In use, the catheter is positioned over a guidewire as
shown in FIG. 12 in the region of a body passageway having a
stenosis. With the aid of ultrasound imaging through lumen 60 which
extends through the prosthetic device, the prosthesis is positioned
to cover the stenosis but to avoid the branching segment of the
vessel. The prosthetic device is then expanded in the region of
interest as shown in FIG. 13. The stent is left in place while the
catheter is removed from the region of interest. The stent holds
the lumen at an expanded diameter.
[0071] Although the foregoing invention has, for purposes of
clarity of understanding, been described in some detail by way of
illustration and example, it will be obvious that certain changes
and modifications may be practiced which will still fall within the
scope of the appended claims.
* * * * *