Surgery – Truss – Pad
Patent
1991-05-03
1995-06-13
Hindenburg, Max
Surgery
Truss
Pad
A61B 500
Patent
active
054233313
DESCRIPTION:
BRIEF SUMMARY
FIELD OF THE INVENTION
The present invention relates to steering or torquing devices for manipulating or guiding a guidewire, catheter, fiber optic bundle or the like in percutaneous or intraoperative medical procedures such as percutaneous transluminal angioplasty.
BACKGROUND OF THE INVENTION
Percutaneous transluminal angioplasty has recently become well known in the art as a delicate and artful procedure which has revolutionized medical treatment of atherosclerotic stenosis in arteries. The use of a catheter to dilate an atherosclerotic stenosis in blood vessels was first disclosed in 1964 by Dotter and Judkins. These investigators reported the development of a series of coaxial tapered dilating catheters that could be placed percutaneously through femoral artery atherosclerotic obstructions. The technique was subsequently modified by Gruntzig, who developed the balloon catheter concept. Today, balloon angioplasty is widely used to treat arterial stenosis or arterial blockages in lieu of more invasive procedures such as coronary artery bypass grafting, vascular surgery and the like.
Coronary angioplasty is now a very well known procedure. The utility of the present invention will be described in relation to coronary angioplasty although it has applications as a steering device for angioplasty of any vessel, as well as for other medical procedures involving steering a distal end of an elongated wire or strand by manipulating a proximal portion of the strand.
In the initial stages of a coronary angioplasty, a guiding catheter is inserted into the femoral artery in the groin. The guiding catheter is subsequently passed through the femoral artery into the aorta and over the aortic arch, and then maneuvered into the ostium of the coronary artery under fluoroscopic guidance. In order to dilate a coronary artery stenosis, a balloon catheter is directed through the guiding catheter and into the coronary artery until the deflated balloon is positioned across the stenosis. The balloon is then briefly inflated, thereby expanding the stenosis and relieving the blood vessel of the obstruction.
In order to guide the balloon catheter to the location of the stenosis, the balloon catheter is equipped with a guidewire which extends well beyond the distal end of the balloon catheter. The initial step in inserting the balloon catheter into the coronary artery involves advancing the guidewire beyond the guiding catheter and into the coronary artery under fluoroscopic guidance. After the guidewire is in place in the coronary artery, it is used to guide the balloon catheter into position by sliding the balloon catheter along the guidewire. In order to direct the guidewire successfully into position within the coronary artery without causing injury to the lining thereof, precise control of the guidewire is required. To provide such precise control, steering devices have been developed which allow precise rotational control of a J-tip which is generally provided at the distal end of the guidewire. Because the guidewire has extremely limited rotational flexibility, rotation of the steering device will generally result in a corresponding rotation of the J-tip. Because the guidewire must have considerable linear flexibility in spite of the need for limited rotational flexibility, workers in the field note that one may retain good control of the forward movement of the guidewire during insertion into the coronary artery by limiting the distance between the location of the steering device on the guidewire and the hub at the proximal end of the balloon catheter. If the distance between the steering device and the hub of the balloon catheter is relatively large, the control afforded the operator will be diminished because of the increased tendency for the guidewire to bend in a position between the steering device and the hub of the balloon catheter. Therefore, it is important that the distance between the steering device and the hub of the balloon catheter always be minimized. Preferably, this distance will be limited to 2-3 centi
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Hindenburg Max
Ramsey Foundation
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