Angioplasty catheter with guidewire

Surgery – Instruments – Blood vessel – duct or teat cutter – scrapper or abrader

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Details

A61B 1722

Patent

active

057761531

DESCRIPTION:

BRIEF SUMMARY
This invention relates to a novel apparatus for use in angioplasty, and to a method of carrying out angioplasty.
Angioplasty is a technique for treating constriction of a blood vessel or heart valve by introducing a balloon into the constriction to widen it. A blood vessel may be a coronary vessel or a peripheral vessel. A hollow needle is generally inserted into the femoral artery. A guide wire is pushed through the needle into the artery, then along it, with the aid of imaging equipment, towards the blood vessel or heart valve to be treated. If there is a stenosis (narrowing) through which the guide wire can pass, it is advanced through it. A catheter is then threaded over the guide wire and pushed along it until it reaches the constriction. The catheter has an end region which can be inflated to form a balloon. The balloon is inflated and deflated, generally a few times, to widen the constriction, and then withdrawn. Sometimes the catheter is already engaged on the wire as the wire is advanced, the distal end of the wire extending beyond the distal end of the catheter.
There is a wide variety of balloon technology available. Balloons of various sizes from 1.5 mm to 30 mm in diameter may be obtained.
A problem arises when a blood vessel or heart valve is so occluded that the guide wire cannot simply be passed through the occlusion. A plethora of techniques has been proposed to overcome this problem. Work has been done on laser systems, but it has proved difficult to find a system which will ablate an occlusion without causing damage to the surrounding tissue. Thermal damage from continuous wave lasers can be very extensive whilst pulse lasers may have a smaller effect on surrounding tissues, but often fail to deliver sufficient energy over a large enough region to effect ablation. Mechanical devices have also been proposed. For example, the Kensey catheter employs a blunt rapidly rotating cam together with a fluid jet which creates a vortex at the tip of the catheter. The occlusion is pulverised by a combination of mechanical energy and the action of the fluid jet forming small particles which are dissipated into the blood stream. However, a high number of perforations and dissections in severely diseased vessels, where the arterial wall is calcified and therefore less compliant, have been observed. A lower speed rotational device known as the Rotacs system has also been used. Such a device is not designed to ablate an occlusion, but to provide some mechanical energy to the wire, to enable it to find the path of least resistance through an occluded vessel. However, the success rate with such a device is not very high.
A further idea has been to use hydrophilic guide wires, introduced by standard manual procedures. These are proprietary wires, thought to be of tantalum or stainless steel, coated with a proprietary material to make them slippery. This is thought to help them to take the path of least resistance through an occlusion. These wires are simple to use but a significant disadvantage is that there is a tendency to effect a sub-intimal passage of the wire past the occlusion. That is to say, the wire , tends to find a route through the wall of a vessel, rather than through the central region of an occlusion.
Despite the substantial earlier body of work aiming to devise a system to improve angioplasty as applied to occluded vessels and valves, no prior system has been wholly satisfactory.
In accordance with the present invention there is provided apparatus for use in angioplasty, comprising a catheter, a wire which serves as a guide for the catheter and whose distal end extends, in use, beyond the distal end of the catheter, and a drive unit which is coupled to the proximal end of the wire so as to vibrate the proximal end.
Preferably the catheter comprises means to act upon a blood vessel to improve or restore its function. Thus, it may comprise an expandable balloon at its distal end, although other forms of catheter may be used.
In use, the wire is fed through blood vessels to an occlusion. The ca

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patent: 4936845 (1990-06-01), Stevens
patent: 5116350 (1992-05-01), Stevens
patent: 5127917 (1992-07-01), Niederhauser et al.
patent: 5243997 (1993-09-01), Uflacker et al.
patent: 5443078 (1995-08-01), Uflacker

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