WO1993007925A1

WO1993007925A1 - Innerless dilatation catheter with balloon stretch valve

Info

Publication number: WO1993007925A1
Application number: PCT/US1992/008752
Authority: WO
Inventors: Michelle Arney
Original assignee: Scimed Life Systems, Inc.
Priority date: 1991-10-15
Filing date: 1992-10-05
Publication date: 1993-04-29
Also published as: EP0562099A1; CA2098383A1; US5217434A; JPH06503503A; EP0562099A4

Abstract

An innerless dilatation balloon catheter (10) uses a balloon (22) which is longitudinally compliant so that it elongates as it is inflated. The catheter (10) includes a valve (30) which is responsive to elongation of the balloon (22) for effectively blocking fluid flow through a lumen extension (24, 26) through which the guide wire (12) passes. The valve (30) allows the guide wire (12) to move freely when the balloon (22) is deflated.

Description

INNERLESS DILATATIONCATHETER

WITH BALLOONSTRETCHVALVE

BACKGROUND OF THE INVENTION The present invention relates to angioplasty. In particular, the present invention relates to an innerless dilatation balloon catheter.

Angioplasty has gained wide acceptance in recent years as an efficient and effective method for treating vascular diseases. In particular, angioplasty is widely used for opening stenoses in coronary arteries. It is also used for treatment of stenoses in other parts of the vascular system.

A common form of angioplasty makes use of a dilatation catheter which has an inflatable balloon at its distal end. With the aid of fluoroscopy, a physician guides the catheter through the vascular system until the balloon is positioned across the stenosis. The balloon is then inflated by applying fluid pressure through an inflation lumen to the balloon. Inflation of the balloon causes stretching of the artery and pressing of the stenosis-causing lesion into the artery wall to reestablish acceptable blood flow through the artery.

Dilatation catheters can generally be divided into those which are fed over a guide wire (i.e., "over- the-wire" catheters) and those catheters which serve as their own guide wire (i.e., "fixed-wire" catheters) . Both types of catheters have advantages and disadvantages. Innerless dilatation balloon catheters have been developed in an attempt to obtain some of the advantages of a fixed-wire catheter while still retaining the advantages of an over-the-wire catheter. These innerless catheters feature a shaft having a single lumen which acts as both an inflation lumen and a guide wire lumen. A lumen extension extends through the balloon, which is mounted on the distal end of the shaft. The shaft lumen is in fluid communication with the interior of the balloon. The guide wire extends through the shaft lumen, the lumen extension and out the distal end of the balloon.

Examples of innerless dilatation balloon catheters are shown in U.S. Patents 5,032,113 and 5,035,705 by Matthew M. Burns.

One consideration in the successful design of any innerless dilatation catheter is that during balloon inflation the inflation fluid must be permitted to flow from the shaft lumen to the interior of the balloon, without substantial leakage of inflation fluid through the lumen extension and out the distal end of the catheter. Similarly, during balloon deflation, blood must not be drawn into the catheter through the lumen extension to such an extent that the balloon will not deflate.

SUMMARY OF THE INVENTION

The present invention is an innerless balloon catheter which includes a shaft with a lumen, a balloon carried at the distal end of the shaft, and a lumen extension which extends through the interior of the balloon and which is an extension of the lumen of the shaft to provide a passage for a guide wire. The innerless catheter of the present invention uses a balloon which is longitudinally compliant so that it increases in length as it is inflated. The catheter also includes a valve which is responsive to the length of the balloon. The valve permits free traversal movement of the guide wire from the shaft lumen through the lumen extension when the balloon is deflated. As the balloon is inflated, it stretches axially and increases in length. The valve correspondingly constricts as it stretches to provide a fluid restriction around the guide wire to block fluid flow through the lumen extension.

In a preferred embodiment, the innerless catheter of the present invention includes a two-part lumen extension. The proximal part of the lumen extension is connected to the shaft and provides a flow passage between the shaft lumen and the interior of the balloon. The proximal part of the lumen extension is bonded to a proximal end of the balloon. The distal part of the lumen extension, which extends through a portion of the interior of the balloon, is an inner tube, generally rigid along its axis, having a distal end connected to a distal end of the balloon. In this embodiment, the valve is a stretchable and elastic tube which is connected between the proximal and distal parts of the lumen extension. As the balloon is inflated and stretches axially, the proximal and distal parts of the lumen extension move apart, which coincidentally causes the stretchable tube to stretch axially. The stretchable tube returns to its unstretched state when the balloon is deflated thereby allowing free movement of the guide wire. The stretchable tube has a first inner and outer diameter when the balloon is deflated and has a second, smaller inner and outer diameter when the balloon is inflated and the stretchable tube is stretched. The inner diameter of the stretchable tube valve in its stretched state approximates an outer diameter of the guide wire which extends through the shaft lumen and lumen extension. This results in an effective seal between the shaft lumen and guide wire which prevents leakage of inflation fluid out of the distal end of the catheter.

BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 is a partial sectional view of a preferred embodiment of the innerless dilatation catheter of the present invention.

Figure 2 is a partial sectional view showing in further detail the distal portion of the innerless dilatation catheter of Figure 1. Figure 3 is a sectional view of the innerless dilatation catheter taken on line 3-3 of Figure 2 with an open valve.

Figure 3B is a sectional view of the innerless dilatation catheter taken on line 3-3 of Figure 2 with a closed valve.

Figure 4 is a partial sectional view showing another embodiment of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Figure 1 shows dilatation catheter 10 and guide wire 12, which are used to perform angioplasty procedures. Dilatation catheter 10 includes manifold 14, proximal shaft 16, distal shaft 18, strain relief 20, balloon 22, proximal lumen extension 24, distal lumen extension 26, marker band 28, and stretch responsive valve 30.

Manifold 14 is located at the proximal end of the dilatation catheter 10. Manifold 14 includes thru port 32 ("through which guide wire 12 passes) , balloon port 34 (through which inflation fluid is provided to and withdrawn from balloon 22) and manifold valve 35. Proximal shaft 16 is a single lumen tube having its proximal end 36 connected to manifold 14, and its distal end 38 connected to distal shaft 18. Shaft lumen 40 extends from proximal end 36 to distal end 38 of shaft 16. Lumen 40 is in fluid communication with balloon port 34 and thru port 32 of manifold 14, and also provides a passage for guide wire 12.

Distal shaft 18 includes proximal neck section 42, shaft sections 44 and 46, bond neck section 48, and valve neck section 50. Proximal neck section 42 is bonded to distal end 38 of proximal shaft 16.

Strain relief 20, which is preferably a wrapped stainless steel ribbon covered by a thin heat- shrunk polymer sleeve, fits over the bond between distal portion of shaft 16 and the proximal portion of shaft 18. Strain relief 20 provides additional strength at the bond between shafts 16 and 18, particularly when tension is applied to the bond. Shaft section 44 of distal shaft 18 has an outer diameter which is equal to or slightly less than the outer diameter of proximal shaft 16. In the embodiment shown in Figure 1, shaft section 46 is positioned intermediate to shaft section 44 and bond neck section 48. Shaft section 46 has a reduced outer and inner diameter with respect to section 44 and, in the preferred embodiment, has a greater flexibility than proximal shaft 16 and shaft section 44 of distal shaft 18. Bond neck section 48 has a reduced outer and inner diameter with respect to shaft section 46. Valve neck section 50 has a reduced outer and inner diameter with respect to bond neck section 48. Bond neck section 48 and valve neck section 50 together form proximal lumen extension 24. Distal shaft 18 has a lumen 52 which is aligned with lumen 40 of proximal shaft 16.

Balloon 22 includes proximal balloon waist 54, main balloon body 56, and distal end section 58. Proximal balloon waist 54 is bonded to bond neck section 48 by adhesive 60. Similarly, distal end section 58 of balloon 22 is bonded by adhesive 62 to the distal end of distal lumen extension 26.

As shown in Figure 1, guide wire 12 extends from thru port 32 of manifold 14, through shaft lumens 40 and 52, through proximal lumen extension 24 (formed by bond neck section 48 and valve neck section 50) , through stretch responsive valve 30, through distal lumen extension 26 and out the distal end 58 of balloon 22 of catheter 10.

Inflation of balloon 22 is effected by passing fluid (not shown) through lumens 40 and 52 and vent holes 64 and 65 in proximal lumen extension 24. The fluid flow resistance through vent holes 64 and 65 is preferably less than the fluid resistance between guide wire 12 and the remainder of the lumen extension distal to vent holes 64 and 65. In this way, it is possible to supply inflation fluid under pressure to the interior of balloon 22 through the same lumen 40, 52 used by guide wire 12.

Referring to Figures 1 and 2, the present invention further limits the flow of fluid in either direction between lumen 52 and the distal end of catheter 10 by the action of stretch responsive valve 30 during balloon inflation. The present invention takes advantage of a characteristic of certain balloon material: a longitudinal compliance of balloon 22. In other words, as balloon 22 is inflated, it tends to elongate. This causes the distance between proximal balloon waist 54 and distal end section 58 to increase as balloon 22 is inflated. Because proximal balloon waist 54 is secured by adhesive 60 to bond neck section 48, and distal end section 58 is attached by adhesive 62 to a distal end 26A of distal lumen extension 26, a proximal end 26B of distal lumen extension 26 tends to move away from valve neck section 50 as the balloon 22 is inflated.

As best shown in Figure 2, stretch responsive valve 30 is preferably a stretchable tube having a proximal section 66 attached to valve neck section 50, and a distal section 68 attached to proximal end 26b of distal lumen extension 26. Intermediate section 70 of valve 30 is located in the gap between valve neck 50 and distal lumen extension 26.

Elongation of balloon 22 due to its inflation causes valve 30 to stretch. As valve 30 is stretched, the length of intermediate section 70 increases and the inner diameter of intermediate section 70 correspondingly decreases. Consequently, stretching valve 30 effectively decreases the inner diameter of a portion of the lumen extension. Preferably the amount of stretching of balloon 22, and the dimensions of valve 30 and guide wire 12 are determined while balloon 22 is inflated to pressures in its working range (approximately 0 to 18 atmospheres) ; the inner wall of valve 30 should approximate the outer surface of guide wire 12 and substantially block fluid flow in either direction through valve 30. At low inflation pressures of balloon 22, valve 30 stretches sufficiently to effect the constricting action of valve 30 and restrict fluid flow between lumen 52 and distal end 26a of distal lumen extension 26. To achieve this valve action, proximal lumen extension 24 (formed by bond neck section 48 and valve neck section 50) and distal lumen extension 26 must be sufficiently rigid to transmit force to valve 30. In a preferred embodiment of the present invention, the amount of elongation of balloon 22 in its working range is approximately 0 to 10 millimeters.

In a preferred embodiment of the present invention, balloon 22 is a polyolefin balloon material, such as Surlyn 8527 from Dupont, which exhibits longitudinal compliance (stretching) during inflation.

Proximal balloon waist 54 has an inner diameter of about

0.0262 to 0.0280 inches and an outer diameter of about

0.033 to 0.042 inches maximum depending on the inflated outer diameter of balloon 22. Distal end section 58 of balloon 22 has an inner diameter of about 0.0205 to

0.023 inches. The overall length of balloon 22 is typically between 1 to 4 centimeters. Proximal balloon waist 54 has a length of about 8 millimeters, and distal end section 58 has a length of about 3 millimeters.

Proximal shaft 16 is preferably a polyimide/stainless steel braid composite tube from HV Technologies of Trenton, Georgia with an inner diameter of about 0.0265 inches and an outer diameter of about 0.033 inches. The length of proximal shaft 16 is about 103 centimeters. Alternatively, proximal shaft 16 is made of any other material which provides enough rigidity for good pushability and relatively thin walls. Strain relief 20 is a 0.001 inch by 0.004 inch stainless steel ribbon which is wrapped around proximal shaft 16 and distal shaft 18 and covered by a heat- shrunk polymer sheath. Strain relief 20 has an outer diameter of about 0.038 inches and a length of about 2.5 centimeters. In a preferred embodiment of the present invention, distal shaft 18 and distal lumen extension 26 are formed of high density polyethylene tubing and are formed as one piece by a series of necking operations. Distal lumen extension 26 is subsequently severed from valve neck section 50 to create the gap for valve 30.

In this embodiment, proximal neck section 42 has a length of about 4 millimeters, an inside diameter of about 0.021 inches, and an outer diameter of about 0.025 inches. Shaft section 44 has a length of about 9 centimeters, and an inner diameter of about 0.0245 to 0.0270 inches, and an outer diameter of about 0.032 inches. Shaft section 46 has a length of about 23 centimeters, an inner diameter of about 0.020 to 0.027 inches and an outer diameter of about 0.025 to 0.033 inches. Bond neck section 48 has a length of about 10 millimeters, an outer diameter of about 0.0252 to 0.0257 inches and an inner diameter of about 0.020 to 0.021 inches. Vent holes 64 and 65 are round holes about 0.007 to 0.010 inches in diameter. Vent hole 64 is located about 9.5 millimeters distal to shaft section 46. Vent hole 65 is located about 8.5 millimeters distal to shaft section 46. Vent hole 64 is positioned 180 degrees from vent hole 65 around the circumference of bond neck section 48, as illustrated in Figures 1 and 2.

Valve neck section 50 and distal lumen extension 26 have inner diameters of about 0.0155 to 0.016 inches and outer diameters of about 0.019 to 0.020 inches. Valve neck section 50 has a length of about 2.5 millimeters, while distal lumen extension 26 has a length which depends on the size and length of balloon 22.

The reduced diameter sections of dilatation catheter 10, such as valve neck section 50 and distal lumen extension 26, have become oriented molecularly as a result of the necking down of the high density polyethylene tubing. This provides the additional rigidity in the axial direction necessary to transmit force from proximal balloon waist 54 and distal end section 58 of balloon 22 to valve 30. In this preferred embodiment, valve 30 is a tube made of a polyurethane, such as Pellethane 2352- 70A from Dow Chemical, with an inner diameter of about 0.0145 to 0.0150 inches and a maximum outer diameter of about 0.020 inches. Valve 30 is soaked in alcohol and then stretched over valve neck section 50 and proximal end 26b of distal lumen extension 26. Proximal section 66 and distal section 68 of valve 30 are about 1.5 to 2.0 millimeters in length, while intermediate section 70 is about 1 to 5 millimeters in length in its unstretched state. The total elongation of balloon 22 is about 0 to 10 millimeters.

Marker band 28 is a band of radiopaque metal located on distal lumen extension 26 near proximal end 26b such that marker band 28 is positioned approximately in the center of balloon 22. Marker band 28 has an inner diameter of about 0.0205 to 0.0210 inches and a wall thickness of about 0.0019 to 0.0020 inches.

Guide wire 12, used in conjunction with catheter 10, has an overall length of about 175 centimeters. The outer diameter of guide wire 12 is about 0.014 inches over the length of the body. The inner surfaces of proximal lumen extension 24, distal lumen extension 26 and valve 30 must be large enough to permit free passage of guide wire 12 when balloon 22 is not inflated, yet be in close enough proximity to guide wire 12 to allow valve 30 to create the desired seal around wire 12 while balloon 22 is in a inflated state.

As shown in Figure 3A, in an unstretched state, the inner surface 72 of valve 30 is not in contiguous contact with guide wire 12, thereby permitting free passage of guide wire 12 through valve 30. The close proximity of guide wire 12 with inner surface 72 of valve 30 and the inner surfaces of valve neck section 50 and distal lumen extension 26 (not shown) are such that the inflation fluid distal to vent holes 64 and 65 experiences greater flow resistance with respect to the fluid flow resistance through vent holes 64 and 65 shown in Figure 2. This yields minimal fluid leakage out the distal end of innerless dilatation catheter 10 while balloon 22 is inflating and valve 30 is constricting around guide wire 12 to block fluid flow.

Figure 3B demonstrates valve 30 in a stretched state where the stretching decreases the inner and outer diameter of valve 30 thereby bringing inner surface 72 of valve 30 in contiguous contact with guide wire 12 and blocking fluid flow through distal lumen extension 26 (not shown) . Other constructions of valve 30 are also possible within the scope of the present invention. For example, the location of valve 30 within balloon 22 may be varied, and the dimensions of valve 30 can be changed. Also, valve 30 could be positioned within the distal portion of shaft 18.

A sectional view of another embodiment of the present invention is shown in Figure 4. Distal end of catheter 100 with balloon 102 is shown with proximal lumen extension 104 connected to and extending from the distal end of shaft 106. Vent holes 108 and 110 are positioned on proximal lumen extension 104 to permit fluid communication between lumen 112 of shaft 106 and balloon 102. Unlike the embodiment shown in Figure 3, however, the proximal lumen extension 104 extends to approximately an intermediate location within balloon 102. Marker band 114 is affixed near the distal end of proximal lumen extension 104.

The proximal end of valve 116 is connected to the distal end of proximal lumen extension 104, and the distal end of valve 116 is bonded to distal balloon waist 118. Valve 116 therefore de ines the distal lumen extension 26 of Figure 3. Like valve 30 of Figure 3, valve 116 is axially compliant when tension is applied during balloon inflation. Other constructions of valve

116 are also possible. For example, valve 116 and distal lumen extension 104 can be incorporated into a single elastic tubular member which has compression strength in the axial direction and flexibility in tension while retaining sufficient elasticity to allow the tubular member to stretch and create a seal around guide wire 120 as balloon 102 inflates and elongates.

Guide wire 120 extends from lumen 112 of shaft

106 through proximal lumen extension 104 and valve 116 (shown in its unstretched state) and out the distal end of catheter 100. As balloon 102 is inflated and elongated, tension is applied to valve 116 thereby causing valve 116 to stretch and reduce its inner and outer diameter along essentially the entire length of valve 116. The inner diameter of a substantial length of valve 116 in a stretched state approximates the outer diameter of guide wire 120 while balloon 102 is inflated. This causes an effective obstruction of lumen

112 which essentially suppresses the flow of inflation fluid out the distal end of catheter 100 while balloon

102 is inflated.

Other constructions of innerless catheter 10 are also possible within the scope of the present invention. For example, catheter 10 can also accompany guide wires of different outer diameters (e.g., 0.010, 0.018, and 0.035 inches) and balloons of different inflated diameters. The components of catheter 10 are dimensionally scaled accordingly.

Although the present invention has been described with reference to preferred embodiments, workers skilled in the art will recognize that changes may be made in form and detail without departing from the spirit and scope of the invention.

Claims

WHAT IS CLAIMED IS: l. A balloon catheter assembly comprising: a guide wire; a shaft having a proximal end, a distal end, and a lumen which extends between the proximal end and the distal end, the guide wire extending through the lumen; a balloon carried at the distal end of the shaft, the balloon having an interior which is in fluid communication with the lumen to permit inflation and deflation of the balloon, wherein the balloon increases in length as it is inflated; a lumen extension through the interior of the balloo to provide a passage for the guide wire to extend through the balloon, the lumen extension having an inner diameter which permits relative movement of the guide wire and the balloon catheter and which provides a resistance to fluid flow past the guide wire in the lumen extension which is greater than resistance to fluid flow between the lumen and the interior of the balloon at least at initiation of balloon inflation; and valve means responsive to elongation of the balloon for blocking fluid flow through the lumen extension during at least a part of the inflation and deflation of the balloon when the length of the balloon is greater than a threshold value. '

SUBSTITUTESHEET 2. The balloon catheter assembly of claim 1 wherein the valve means comprises a flexible tube positioned within the interior of the balloon which stretches as the balloon elongates, the flexible tube having an inner surface which defines a portion of the lumen extension and which engages the guide wire to block fluid flow through the lumen extension when the flexible tube is stretched.

3. The balloon catheter assembly of claim 2 wherein the lumen extension includes a proximal portion connected to the shaft and a distal portion connected to a distal end of the balloon. . The balloon catheter assembly of claim 3 wherein the flexible tube extends between the proximal portion and the distal portion of the lumen extension.

5. The balloon catheter assembly of claim 4 wherein the flexible tube defines the distal portion of the lumen extension and is connected to the proximal portion of the lumen extension and the distal end of the balloon.

6. A balloon catheter assembly comprising: an inflatable balloon which elongates as it is inflated; a shaft which carries the inflatable balloon at a distal end of the shaft, the shaft having a lumen therethrough with the lumen being in fluid communication with an interior of the balloon for inflation and deflation of the balloon via the lumen; a lumen extension through the balloon, the lumen extension being in fluid communication with the lumen;

SUBSTITUTESHEET a guide wire movably extending through the lumen and the lumen extension, wherein resistance to fluid flow past the guide wire in the lumen extension is greater than resistance to fluid flow between the lumen and the interior of the balloon at least at initiation of balloon inflation; and valve means responsive to the elongation of the balloon for limiting fluid flow through the lumen extension during at least a part of the inflation and deflation of the balloon.

7. The balloon catheter assembly of claim 6 wherein the valve means comprises resilient means within the lumen extension which surrounds the guide wire within the lumen extension.

8. The balloon catheter assembly of claim 7 wherein the lumen extension includes a tubular portion having an annular break, the resilient means comprising a flexible ring generally coaxial with the lumen extension and spanning the annular break.

9. The balloon catheter assembly of claim 6 wherein the lumen extension includes a tubular portion having an annular break; and the valve means is located at the break.

10. An angioplasty balloon catheter assembly comprising: a shaft having a proximal end and a distal end, and having a lumen extending therethrough from the proximal end to the distal end; an inflatable balloon at the distal end of the shaft with its interior in fluid

SUBSTITUTESHEET communication with the lumen, and with the balloon having a proximal segment, an intermediate expandable segment and a distal segment, wherein the balloon

5 increases in length as it is inflated; a guide wire movably extending through the lumen of the shaft and the balloon interior; a lumen extension connected to the shaft and

10 the distal segment of the balloon for defining a path for the guide wire through the balloon and out of the balloon through the distal segment thereof, wherein the lumen extension has

15 an inner diameter which is greater than an outer diameter of the guide wire to permit relative axial movement of the guide wire and the lumen extension while defining a passage around the guide wire

20 in the lumen extension which has a resistance to fluid flow which is substantially greater than resistance to fluid flow between the lumen and the interior of the balloon at least at

25 initiation of balloon inflation; and valve means, responsive to elongation of the balloon and positioned across the path which permits longitudinal movement of the guide wire freely therethrough, for

30 providing a fluid restriction around the guide wire and across the path during at least a part of inflation and deflation of the balloon.

SUBSTITUTESHEET 11. A balloon catheter assembly comprising: a guide wire; a shaft having a proximal end and a distal end, and having a lumen extending therethrough from the proximal end to the distal end; a lumen extension connected to and extending distally from the shaft; an inflatable balloon at the distal end of the shaft with an interior in communication with the lumen, the balloon surrounding the lumen extension and being connected at a distal end to the lumen extension, wherein the balloon elongates as it is inflated; valve means responsive to elongation of the balloon for providing an essentially fluid-tight seal around the guide wire during at least a part of inflation and deflation of the balloon; and wherein the lumen extension has an inner diameter which permits relative movement of the guide wire and the balloon catheter and which provides a resistance to fluid flow past the guide wire in the lumen extension which is greater than resistance to fluid flow between the lumen and the interior of the balloon at least at initiation of balloon inflation.

12. The catheter assembly of claim 11 wherein the lumen extension has a port communicating between the lumen and the interior of the balloon.

SUBSTITUTESHEET 13. The catheter assembly of claim 11 wherein the balloon member has a proximal segment, and intermediate balloon segment, and a distal segment.

14. The catheter assembly of claim 13 wherein the valve means is located within the intermediate balloon segment.

15. The catheter assembly of claim 11 wherein the valve means comprises a flexible tube which surrounds the guide wire and which deforms radially inwardly in response to elongation of the balloon.

16. A balloon catheter assembly comprising: a guide wire; a shaft having a proximal end and a distal end and having a shaft lumen which extends from the proximal end to the distal end; a balloon having a proximal end and a distal end, wherein the balloon increases in length as it is inflated, the proximal end being connected to the distal end of the shaft; means for providing a flow passage between the shaft lumen and an interior of the balloon to permit inflation and deflation of the balloon via the shaft lumen; a rigid inner tube which is generally rigid in an axial direction extending through a portion of the interior of the balloon, the rigid inner tube having a distal end connected to the distal end of the balloon, the rigid inner tube providing a guide wire lumen through which the guide wire extends out the

SUBSTITUTE SHEET distal end of the balloon, the inner tube and the guide wire having respective inner and outer diameters such that fluid resistance between the 5 inner tube and the guide wire is greater at least at initiation of balloon inflation than fluid resistance of the flow passage between the shaft lumen and the interior of the balloon; and 10 a stretchable tube connected between the means for providing a flow passage and the rigid inner tube, the stretchable tube having a lumen through which the guide wire passes, the stretchable tube 15 having a first inner diameter when the balloon is deflated which permits movement of the guide wire through the lumen and having a second, smaller, inner diameter when the balloon is 20 inflated and the tube is stretched as a result of elongation of the balloon, so that when the tube is stretched, it provides an effective fluid seal around the guide wire during at least part of 25 inflation and deflation of the balloon.

SUBSTITUTESHEET