WO2000009195A1 - Percutaneous in-situ coronary bypass method and apparatus - Google Patents
Percutaneous in-situ coronary bypass method and apparatus Download PDFInfo
- Publication number
- WO2000009195A1 WO2000009195A1 PCT/US1999/017785 US9917785W WO0009195A1 WO 2000009195 A1 WO2000009195 A1 WO 2000009195A1 US 9917785 W US9917785 W US 9917785W WO 0009195 A1 WO0009195 A1 WO 0009195A1
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- Prior art keywords
- vein
- stent
- artery
- coronary
- catheter
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- A61B90/40—Apparatus fixed or close to patients specially adapted for providing an aseptic surgical environment
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- A—HUMAN NECESSITIES
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2/06—Blood vessels
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- A—HUMAN NECESSITIES
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
- A61F2/90—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
- A61F2002/3006—Properties of materials and coating materials
- A61F2002/30079—Properties of materials and coating materials magnetic
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/848—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents having means for fixation to the vessel wall, e.g. barbs
- A61F2002/8486—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents having means for fixation to the vessel wall, e.g. barbs provided on at least one of the ends
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- A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2210/009—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof magnetic
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- A—HUMAN NECESSITIES
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- 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
- A61M2025/0004—Catheters; Hollow probes having two or more concentrically arranged tubes for forming a concentric catheter system
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- 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
- A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
- A61M25/0074—Dynamic characteristics of the catheter tip, e.g. openable, closable, expandable or deformable
- A61M25/0075—Valve means
- A61M2025/0076—Unidirectional valves
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- A—HUMAN NECESSITIES
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- A61M25/00—Catheters; Hollow probes
- A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
- A61M25/0082—Catheter tip comprising a tool
- A61M25/0084—Catheter tip comprising a tool being one or more injection needles
- A61M2025/0089—Single injection needle protruding axially, i.e. along the longitudinal axis of the catheter, from the distal tip
- A61M2025/009—Single injection needle protruding axially, i.e. along the longitudinal axis of the catheter, from the distal tip the needle having a bent tip, i.e. the needle distal tip is angled in relation to the longitudinal axis of the catheter
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- A61M25/00—Catheters; Hollow probes
- A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
- A61M25/0082—Catheter tip comprising a tool
- A61M2025/0096—Catheter tip comprising a tool being laterally outward extensions or tools, e.g. hooks or fibres
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- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M2025/018—Catheters having a lateral opening for guiding elongated means lateral to the catheter
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- A—HUMAN NECESSITIES
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- 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
- A61M2025/1043—Balloon catheters with special features or adapted for special applications
- A61M2025/1052—Balloon catheters with special features or adapted for special applications for temporarily occluding a vessel for isolating a sector
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- A—HUMAN NECESSITIES
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- 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
- A61M2210/00—Anatomical parts of the body
- A61M2210/12—Blood circulatory system
- A61M2210/125—Heart
Definitions
- Figure 8 is a side view of the stent of Figure 7;
- Figure 9 is a partial cross-sectional view of an alternative stent device ,-
- FIG 13 is an enlarged view of the myocardium showing an alternative variation of the PIBS procedure.
- DESCRIPTION OF THE PREFERRED EMBODIMENT Referring first to Figure 3, an explanation will be given of the PIBS procedure of the present invention in accordance with a first procedure.
- a coronary artery 10 that is substantially blocked by a stenotic lesion 12.
- a venous segment 14 Located closely adjacent the arterial segment 10 is a venous segment 14.
- a catheter-like instrument such as is shown in Figures 5 and 6, is used. It is designed to be introduced into the vascular system using the Seldinger technique.
- a radiopaque guide wire 16 is fed through an introducer and advanced through the vascular system and through the coronary ostium until the distal end of the guide wire 16 approaches the stenotic lesion 12 proximally thereof.
- the guide wire being radiopaque can readily be viewed on a fluoroscope.
- a guide catheter 10 may be fed over the proximal end of the guide wire and advanced there along.
- the guide catheter 18 has a side exit port 22 located a predetermined distance proximal of the distal end thereof connected to an internal lumen 24 ( Figure 11) .
- a working catheter 26 which may comprise an electrosurgical device having either monopolar or bipolar electrode (s) as at 28 and 30 at its distal end, is retracted so that the distal end portion thereof is fully contained within the lumen 24 as the guiding catheter 18 is being advanced over the guide wire 16.
- the working catheter 26 has a plug 32 at its proximal end which is adapted to be connected to terminals of an electrosurgical generator (not shown) .
- An optical fiber driven by an external laser may also be used.
- the electrosurgical catheter 26 (or laser fiber as the case may be) may be stripped out from the lumen 24 and replaced with a conventional stent delivery catheter carrying a pair of self-expanding "cufflink" stents, such as depicted in Figures 7 and 8 of the drawings.
- the tubular stent 39 is preferably a self- expandable, double disk device made from braided stainless steel or Nitinol wire, the two disks 40 and 42 being linked together by a short tubular connecting waist 43 corresponding to the size of the surgically created openings in the wall of the artery 10 and the vein 14.
- the diameter of the disks 40 and 42 may be about 3-5 mm and the lumen 37 thereof may have a diameter of about 2-4 mm.
- the lap or flange on the proximal and distal ends of the stent prevent it from migrating with blood flow into the vein.
- the stent material preferably has a three-dimensional nature, permitting marked tissue ingrowth so that the neointima can support the connection without developing stenosis.
- the stent material also has non-porous, impermeable sides to prevent stenotic AV connections. The porosity of the covered stent material is important to permit tissue ingrowth for anchoring within a relatively short time period.
- the stent of Figure 7 will be stretched .longitudinally sufficiently so that the disk-like end portions 40 and 42 will be of a sufficiently reduced diameter so as to fit within the lumen of a 6-8 Fr. delivery catheter.
- the stent out from the distal end of the delivery catheter it will assume a shape like that of Figure 7 due to the memory property of the Nitinol wire from which the stent is initially braided.
- the stent delivery catheter (not shown) has been advanced through the lumen 24 of the guide catheter 18 sufficiently far to engage the diverter plug 36, its distal end will be directed normal to the longitudinal axis of the guide catheter 18.
- the stent device of Figures 7 and 8 has been inserted through the openings formed through the venous and arterial walls, the stent will be deployed, such that the flared end portions 40 and 42, respectively, reside in the lumen of the vein 14 and the lumen of the artery 10 as shown in Figure 3.
- the stent delivery catheter can be retracted back through the exit opening 22 until fully contained within the lumen 24.
- Figure 10 illustrates a cutting catheter 26' that uses straight mechanical cutting rather than an electrosurgical approach. It comprises an outer tubular sheath 58 coaxially surrounding an elongated, pushable, torqueable tubular member 60 having a cutting blade 62 affixed to the distal end thereof, the cutting blade also being tubular, but with a tapered leading edge 64 and a pointed tip 66. The tapered edge 64 is beveled to be razor-sharp. Because both the elongated member 60 and the cutting blade 62 are tubular, a guide wire 16 may be used for facilitating the routing of the instrument 26' through the vascular system. During the advancement of the instrument through the vascular system, the blade portion 64 will be fully retracted within the sheath 26' and will only be deployed when properly positioned for cutting through the arterial and venous walls.
Abstract
Description
Claims
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU54672/99A AU5467299A (en) | 1998-08-10 | 1999-08-04 | Percutaneous in-situ coronary bypass method and apparatus |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/192,554 | 1998-08-10 | ||
US09/192,554 US6283983B1 (en) | 1995-10-13 | 1998-08-10 | Percutaneous in-situ coronary bypass method and apparatus |
Publications (1)
Publication Number | Publication Date |
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WO2000009195A1 true WO2000009195A1 (en) | 2000-02-24 |
Family
ID=22710157
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US1999/017785 WO2000009195A1 (en) | 1998-08-10 | 1999-08-04 | Percutaneous in-situ coronary bypass method and apparatus |
Country Status (3)
Country | Link |
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US (1) | US6283983B1 (en) |
AU (1) | AU5467299A (en) |
WO (1) | WO2000009195A1 (en) |
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US6253768B1 (en) | 1999-08-04 | 2001-07-03 | Percardia, Inc. | Vascular graft bypass |
US6254564B1 (en) | 1998-09-10 | 2001-07-03 | Percardia, Inc. | Left ventricular conduit with blood vessel graft |
US6261304B1 (en) | 1998-09-10 | 2001-07-17 | Percardia, Inc. | Delivery methods for left ventricular conduit |
US6302892B1 (en) | 1999-08-04 | 2001-10-16 | Percardia, Inc. | Blood flow conduit delivery system and method of use |
WO2002100280A1 (en) * | 2001-06-12 | 2002-12-19 | Russell John Price | Treatment of alopecia |
US6511458B2 (en) | 1998-01-13 | 2003-01-28 | Lumend, Inc. | Vascular re-entry catheter |
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US7704275B2 (en) | 2007-01-26 | 2010-04-27 | Reva Medical, Inc. | Circumferentially nested expandable device |
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