Helically advancing constriction crossing mechanism and wire guide positioning method for performing percutaneous vascular procedures

Patent metadata

Field	Value
Publication number	US-9375233-B2
Application number	US-201314055215-A
Country	US
Kind code	B2
Filing date	Oct 16, 2013
Priority date	Dec 29, 2009
Publication date	Jun 28, 2016
Grant date	Jun 28, 2016

Abstract

A vascular procedure includes sliding a constriction crossing mechanism over a wire guide having a tip positioned at a proximal side of a constriction, and rotating a sheath of the mechanism about an axis relative another sheath of the mechanism. The method further includes helically engaging the sheaths, and guiding an intraluminal treatment device into or past the vascular constriction. The mechanism includes a first sheath and a second sheath, and a tip coupled with the first sheath. The mechanism further includes a helical coupling between the first and second sheaths, which is configured to convert a torque on one of the sheaths to an axial force on the other of the sheaths for crossing a vascular constriction with the tip. An anchoring mechanism coupled with one of the sheaths includes a deployed state resisting displacement of the second sheath within a vascular structure of a patient.

First claim

What is claimed is:

1. A vascular constriction crossing mechanism comprising:
an inner sheath defining a longitudinal axis and an axially extending wire guide lumen;
a first outer sheath positioned about the inner sheath and having an attached constriction crossing tip defining an opening to the wire guide lumen;
a helical coupling between the inner sheath and the first outer sheath;
a second outer sheath positioned about the inner sheath and the first outer sheath;
a direct contact interaction of the first outer sheath with the second outer sheath slidably journaling the first outer sheath so as to restrict its rotation, such that the helical coupling causes rotation of the inner sheath to induce axial displacement of the first outer sheath relative to the second outer sheath and the inner sheath for driving through a vascular constriction in a patient; and
an anchoring mechanism attached to the second outer sheath and including a undeployed state, and a vascular-wall-contacting deployed state for resisting displacement of the second outer sheath during the driving.

2. The mechanism of claim 1 wherein the second outer sheath includes a proximal end and a distal end, and an anchoring control lumen extends between the proximal end and the distal end of the second outer sheath.

3. The mechanism of claim 2 wherein the anchoring mechanism includes a flexible wall attached to the second outer sheath, and wherein a cavity is defined in part by the flexible wall and in part by the second outer sheath and is in fluid communication with the anchoring control lumen.

4. The mechanism of claim 3 wherein the second outer sheath has a length extending from the proximal end to the distal end, and wherein the flexible wall extends circumferentially around the second outer sheath and the attachment of the flexible wall is distal to a midpoint of the length.

5. The mechanism of claim 1 wherein the helical coupling includes a screw element located on one of the inner sheath and the first outer sheath.

6. The mechanism of claim 5 wherein the screw element includes an external thread located on the inner sheath, and the helical coupling further includes an internal thread located on the first outer sheath.

7. The mechanism of claim 1 wherein the direct contact interaction includes the first outer sheath including a projecting tab, and the second outer sheath defines a longitudinal channel receiving the tab.

8. The mechanism of claim 7 wherein the direct contact interaction further includes the first outer sheath including a second projecting tab, and the second outer sheath defines a second longitudinal channel receiving the second projecting tab.

9. The mechanism of claim 1 including a wire guide positioned in the wire guide lumen and slidably extending distally beyond a distal end of the inner sheath.

10. A method of positioning a wire guide with a vascular constriction crossing mechanism that includes an inner sheath defining a longitudinal axis and an axially extending wire guide lumen; a first outer sheath positioned about the inner sheath and having an attached constriction crossing tip defining an opening to the wire guide lumen; a helical coupling between the inner sheath and the first outer sheath; a second outer sheath positioned about the inner sheath and the first outer sheath, and a direct contact interaction of the first outer sheath with the second outer sheath slidably journaling the first outer sheath so as to restrict its rotation, such that the helical coupling causes rotation of the inner sheath to induce axial displacement of the first outer sheath relative to the second outer sheath and the inner sheath for driving through a vascular constriction in a patient; and an anchoring mechanism attached to the second outer sheath and including a undeployed state, and a vascular-wall-contacting deployed state for resisting displacement of the second outer sheath during the driving, and the method comprising the steps of:
sliding the vascular constriction crossing mechanism in a proximal to distal direction over the wire guide;
rotating the inner sheath defining the longitudinal axis and the wire guide lumen extending axially through the inner sheath, in the vascular constriction crossing mechanism;
slidably journaling the first outer sheath in the vascular constriction crossing mechanism during the rotation, such that the helical coupling between the first outer and inner sheaths applies an axial displacement force to the first outer sheath in response to the rotation;
anchoring the vascular constriction crossing mechanism during the rotation, such that the first outer sheath is driven via the axial displacement force in the proximal to distal direction relative to the inner sheath and the second outer sheath; and
advancing the wire guide through the wire guide lumen and out of an opening to the wire guide lumen formed in a constriction crossing tip attached to the outer sheath.

11. The method of claim 10 further comprising a step of applying the axial displacement force via a screw element of the helical coupling.

12. The method of claim 11 wherein the step of applying further includes applying the axial displacement force via engaged inner and outer threads of the helical coupling.

13. The method of claim 10 wherein the step of anchoring further includes supplying fluid through an anchoring control lumen to a cavity in an expandable anchor of the vascular constriction crossing mechanism so as to deploy the expandable anchor.

14. The method of claim 13 wherein the step of anchoring further includes contacting the expandable anchor with a vascular wall in a patient such that the anchoring occurs without plastically deforming the vascular wall.

15. The method of claim 13 wherein the step of slidably journaling further includes receiving a projecting tab on the first outer sheath within a longitudinal channel formed in a second outer sheath.

16. The method of claim 14 wherein the step of rotating further includes rotating the inner sheath simultaneously about a plurality of different axes of rotation in a first direction of rotation, and further comprising a step of retracting the first outer sheath at least in part by rotating the inner sheath simultaneously about the plurality of different axes of rotation in a reverse direction of rotation.

Assignees

• Cook Medical Technologies Llc

Inventors

• Mcghie Thomas

Classifications

• A61B17/320725 Primary

  with radially expandable cutting or abrading elements (A61B17/32075 takes precedence) · CPC title

• A61B2017/22069

  Immobilising; Stabilising · CPC title

• A61B2017/22048

  Balloons · CPC title

• A61B2017/22094

  for crossing total occlusions, i.e. piercing · CPC title

• A61B2017/22044

  with a pointed tip · CPC title