CA2399867C - Single operator stenting system - Google Patents

Single operator stenting system Download PDF

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Publication number
CA2399867C
CA2399867C CA002399867A CA2399867A CA2399867C CA 2399867 C CA2399867 C CA 2399867C CA 002399867 A CA002399867 A CA 002399867A CA 2399867 A CA2399867 A CA 2399867A CA 2399867 C CA2399867 C CA 2399867C
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Prior art keywords
balloon
wire
stent system
wires
stent
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Expired - Fee Related
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CA002399867A
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French (fr)
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CA2399867A1 (en
Inventor
Jacob Richter
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Medinol Ltd
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Medinol Ltd
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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M25/00Catheters; Hollow probes
    • A61M25/01Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02Holding devices, e.g. on the body
    • A61M25/04Holding devices, e.g. on the body in the body, e.g. expansible
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/958Inflatable balloons for placing stents or stent-grafts

Abstract

Embodiments of a stent system include a catheter is made with only one lumen leading to a balloon. An arrangement is provided to easily lock a short wire in place at the distal end of the balloon. Multiple wires of different properties can be included in a package containing the stent and the delivery catheter, such that the physician will be able to choose the right wire tip according to the lesion and vessel treated and attach it at the distal tip of the balloon before beginning the stenting procedure.

Description

SINGLE OPERATOR STENTING SYSTEM
FIELD OF THE INVENTION
The present invention relates generally to iiitravascular stents for implanting into a living body. In particular, the present invention relates to an iniproved balloon catheter for inserting intravascular stents into a vessel in the body.

BACKGROUND OF THE INVENTION
Intravascular stents having a constricted diameter for delivery through a blood vessel and an expanded diameter for applying a radially outwardly extending force for supporting the blood vessel are known in the art. Both self-expandable stents and balloon expandable stents are well known.

In conventional stent mounting and securing procedures, the stent is usually first slid over the distal end of a balloon catheter so that the expandable balloon is disposed within the longitudinal bore of the stent. The sterit is then crimped to mount or secure the stent and maintain its position with respect to the expandable balloon as the balloon catheter is advanced to the target area.

Typical catheters for interventional angioplasty are based on a catheter that rides on a guide wire. The guide wire has some characteristics of flexibility and pushibility that may vary along its length. The catheter (balloon catheter) also has some characteristics of flexibility and stiffness that may vary along its length. The variations of flexibility and pushibility do not match each other as the catheter tracks aiong different sections of the wire. Also, the profile of the catheter has to permit the free ride of an internal lunien in the catheter over the wire, resulting in zi bigger profile and less flexible catheter shaft. The tip of the balloon catheter may latch on plaque when pushed to the vessel wall by the guide wire ancl thus prevent insertion through constricted areas and through another stent.

An zu-rangement which does not use a guide wire is disclosed in European Patent Application EP 1 101445. In that arrangement, a stent delivery system is provided for percutaneous insertion into a vessel of the hurnan body in order to place a balloon expandable stent at the site of an obstruction in the vessel. 'The stent delivery system includes a balloon angioplasty catheter having a distal section with an inflatable balloon located at the distal section of the balloon angioplasty catheter. A balloon expandable stent is co-axially mounted on the
2 inflatable balloon. A flexible guide wire is fixedly attached to and extends distally from the distal section of the balloon angioplasty catheter.

In today's arena where direct stenting has become very popular and no other catheter is threaded on the guide wire before, or after the stent delivery system, such a stent delivery system that is combined with a wire tip at its forward end becomes yuite reasonable.
It can solve the problems of optimal flexibility transition, optimal profile and elimination of "steps" between the catheter tip and the wire. Furthermore, it can make for a faster and less traumatic procedure with one insertion instead of two (wire and then catheter). Thus, a catheter with a wire tip at the length of a single operator catheter does not require a second hand for holding the wire during the insertion of the catheter, and thus forms a single operator stent system.

However, one of the disadvantages of an arrangement such as that shown in EP 1 is that today there are at least three different classes of guide wires used.
These differ in their overall flexibility and the arrangement of different sections with different flexibility (e.g. floppy wire, soft wire, hard wire, super-harcl wire etc.). The selection of wire is often dictated by the conditions on the way to a lesion to be treated and not by the lesion itself.

Once the leading wire is combined with the balloon, the freedoni to select different types of wire is lost. One solution would be to multiply the line of crimped stent systems to have parallel systems with different wire tips. "I'his is obviously a complex and costly solution. Thus, there is a need for a single operator stent system, whicli avoids this loss of freedom in an effective and cost efficient manner.

SUMMARY OF THE INVENTION
Embodiments of the stent system of the present invention preserve the choice of different vvire flexibility in an economical fashion. In such ertibodiments a catheter may be made with only one lurnen leading to the balloon. An arrangement is provided to easily lock a short wire in place at the distal end of the balloon. Multiple wires of different properties can be included in a package containing the stent and the delivery catheter, such that the physician will be able to choose the right wire tip according to the lesion and vessel treated and attacli it at the distal tip of the balloon.

L'IRIEF DESCRIPTION OF THE DRAWINGS

Fig. 1 is a schematic drawing of'the prior art arrangement using a guide wire.

Fig. 2 is a schematic drawing of the single operator stent system of the present invention with interchangeable wire tips.

DETAILED DESCRIPTION
In today's catheterization lab, the interventional cardiologist has several choices to make in order best to optimize the equipment he is using to the conditions of the vessels he needs to treat. The relevant conditions that would detemiine the equipment used are the basic anatomy of the vessel both in the treated section and all the wav from the entry point to the treated segment.
Once a guiding catheter has been selected and inserted so that it engages the ostium of the treated coronary artery, the next choice is the guide wire to be used and then the balloon catheter and/or a pre-mounted stent system.

The choice of wire is critical for the probability of safely and optimally traversing the treated lesion with the wire and for lending the right support for the balloon catheter that needs to be threaded. on the guide wire on its way to the lesion. Wires available for selection come in a variety of configurations and even any given single supplier of guide wires has three or more configurations that differ significantly in their properties. The properties of the different wires are selected by the cardiologist based on the tortuosity of the vessel, the length and tortuosity of the lesion and the rate of occlusion and nature (hardness) of the occlusive rriass.

Thus, wires differ in their stiffness, in the length and combination of different sections of the wire and in the properties of the tip of the wire that is used to guide the wire into preferred branches in bifurcating vessels, but also to push against and penetrate total occlusions. 'The choice of wire is independent of the stent used and the lreedom of separatel,y optimizing the wire and the catheter or stent is important to cardiologists. It is, thus, disadvantageous to make a clelivery catheter integrated with a wirc as in EP 1 10 1 445, since it will deprive the physician of t:hat freedoni of choice.

Fig. I illustrates, in schematic form, the typical present-day arrangement. A
guide wire 11 is provided, which has been first inserted into the vessel to a position beyond the lesion to be ti-eated. A catheter 13 with a stent on balloon section is threaded on the guide wire 11 by means of a first lumen 17 in the catheter. In sorne cases the separate guide wire is inade of three sections of ciifferent flexibility, a stiff section 11 a, a more flexible section 11 b and most flexible and steerable section 1 le. The stent on balloon section is at the distal end oi~'the catheter 13 and includes a balloon 15 with a stent 2lcrinlped on it. A second lumen 19 is provided for inflating the balloon 15 in conventional fashion to expand the stent 21, once the stent and balloon have been guided to the lesion. There is a transition from catheter diameter to wire diameter at the tip 20 of the catheter 13 and it may undesirably latch on rough plaque or on struts of previously expanded stent when inserted through a stent. The catheter 13 with its own flexibility transition rides over the wire, with its variable flexibility, creating overall non-optimal flexibility.

An embodiment of the present invention is schematically illustrated in Fig. 2.
It has a delivery system whose forward tip 25 is made from a section of guide wire 27, which is like the tip of guide wire 11 of Fig. 1, combined with a catheter 29 with a lumen 19 only for inflating the balloon 15. A separate lumen for the guide wire is not needed. The flexibility transition is kept optimal, the profile of the system may be reduced and the problems of latching of the catheter tip are eliminated by a smooth transition in the tip 25. The wire 27 may typically be two to eight inches in length. Details of distal end of the catheter and stent on balloon section are not shown.
T h e s e m a y be c o n s t r u c t e d in c o n v e n t i o n a l f a s h i o n , f o r e x a m p l e , as s h o w n in EP 1 101445, the disclosure of which is hereby incorporated by reference.

In accordance with the embodiment of Fig. 2, a separate wire 27 is snapped or clipped on the catheter 29 at the distal end of the balloon 15. This wire may have areas of different flexibility just like the sections 11b and I lc of the embodiment shown in Fig. 1. Multiple wires 27, 27a, and 27b of different properties may be included with each catheter.
These may be, e.g., floppy wire, soft wire, hard wire, super-hard wire etc. or wires having sections made up of two or more of these types of wire. Thus, embodiments of the present invention provide a stent system that preserves the ability to choose different wires in an economical fashion.
An arrangement is provided to easily lock the short wire 27, 27a or 27b on the tip of the catheter 29. Specifically, in the illustrated embodiment, a receptacle into which said wires may be lockably inserted is provided.

Thus, in the illustrated arrangement, each of the wires of the set has a bead 33 on its end which snaps through a spring loaded member at the distal end of balloon 15 (it is to be understood that this is only one fast attachment mechanism and any other clip-on mechanism may be used in place of the one described above). Other manners of attachment will suggest themselves to those of skill in the art. A selection of multiple wires, (e.g.
three wires 27, 27a or 27b) of different properties may be included in a package containing the stent and the delivery catheter. This insures that the physician will be able to choose the right wire tip, according to the lesion and vessel to be treated, and attach it to the distal tip. of the balloon.

In use, once the proper wire tip has been selected, the physician inserts the catheter with the balloon, stent, and wire at its distal end into the vessel in the patient.
He moves the stent to the lesion and then inflates the balloon to expand and deploy the stent at the lesion. The balloon is then deflated and the catheter, now with only the balloon and wire at its distal end, is removed.

The present invention recognizes that a wire tip of just a 2 - 8 inches is inexpensive.
Thus, it may then be efficient to have the catheter and stertt crimped on a balloon and to provide
3-4 different wire tips in the same package. The physician will select the right wire tip and click it into posi-tion at the distal end of the balloon prior to use.

Compared with an arrangement like that in EP 1 101 445, this brings back the freedom to select the wire but by duplicating only an inexpensive component. It also gets away from a balloon combined with wire, as they are separate and for a good reason. It also makes the device much more useful and adaptable, but mainly much more acceptable to the potential user - the interventional cardiologist. The added price of a few wires is low enough to keep this solution within ecortomic range and the mechanism of locking a wire into the balloon end is simple and can be done quickly enough as not to add significantly to the time or complexity of the procedure.

There is a trend for balloons on catheters become more and more of high Rated Burst Pressure (RBP) type and insertion of stents is becoming much like that of a balloon alone. As a result, the percentage of direct stenting, where no pre-dilatation is required, is increasing and it is expected to exceed 50% of all cases. ln those cases there may not be a need for the insertion of rnore than one catheter. Thus, the advantage of having a wire in place on which to exchange catheters, as is the case now, should be diminished. Embodiments of the present invention are particularly well suited in such cases.

The wire 27, 27a or 27b at the forward section of the single operator stent system of the present invention may include a balloon or another device for distal protection. It may be expanded or deployed for protection against particles released during the deployment of the stent being swept downstream in a manner known in the art. These and other modifications can be made without departing from the spirit of the invention, which is intended to be limited solely by the appended claims.

Claims (74)

WHAT IS CLAIMED IS:
1. A stent system comprising:
a catheter with a lumen;
a balloon in communication with said lumen disposed at a distal end of said catheter;
a stent disposed over said balloon; and a locking mechanism disposed at a distal end of the balloon, wherein said locking mechanism enables choosing a set of wires to attach to said locking mechanism directly prior to insertion of the stent system.
2. The stent system according to claim 1 wherein said catheter has only one lumen.
3. The stent system according to claim 1 and further including multiple wires of different properties supplied along with the stent and catheter.
4. The stent system according to claim 3 wherein said multiple wires of different properties include a wire having areas of different flexibility.
5. The stent system according to claim 4 wherein said wire having areas of different flexibility has a stiff section, a more flexible section and most flexible section.
6. The stent system according to claim 5 wherein one of said areas is more steerable.
7. The stent system according to claim 4 wherein said multiple wires of different properties include wires selected from floppy wire, soft wire, hard wire, super-hard wire and wires having sections made up of two or more of these types of wire.
8. The stent system according to claim 4 and wherein said arrangement comprises a receptacle into which said wires are lockably insertable.
9. The stent system according to claim 8 wherein said receptacle includes a spring loaded member at the distal end of balloon, and the wires have a bead on an end thereof which snap through and are retained by said spring loaded member.
10. The stent system according to claim 9 wherein at least three different wires are provided.
11. The stent system according to claim 4 wherein said multiple wires include a wire tip of about 2 - 8 inches.
12. The stent system according to claim 1 wherein said balloon has a high Rated Burst Pressure (RBP).
13. The stent system according to claim 4 wherein at least one of said wires includes a device for distal protection.
14. The stent system according to claim 13 wherein said device for distal protection comprises a second balloon.
15. A stent system comprising:
a catheter with a lumen;
a balloon in communication with said lumen disposed at a distal end of said lumen;
a stent disposed over said balloon; and a short wire removably locked in place at a distal end of the balloon.
16. The stent system according to claim 15 wherein said catheter has only one lumen.
17. The stent system according to claim 15 comprising a receptacle into which said short wire is lockably inserted.
18. The stent system according to claim 17 wherein said receptacle includes a spring-loaded member at the distal end of balloon, and each wire has a bead on an end thereof which snaps through mid is retained by said spring-loaded member.
19. The stent system according to claim 15 wherein said short wire comprises a wire tip of about 2 - 8 inches.
20. The stent system according to claim 15 wherein said balloon has a high Rated Burst Pressure (RBP).
21. The stent system according to claim 15 wherein said short wire includes a device for distal protection.
22. The stent system according to claim 21 wherein said device for distal protection comprises an additional balloon.
23. A stent system kit comprising:
a catheter with a lumen;
a balloon in communication with said lumen disposed at a distal end of said lumen;
a stent disposed over said balloon;
a member at a distal end of the balloon for removably locking in place a short wire;
a plurality of short wires of different properties.
24. The stent system kit according to claim 23 wherein said catheter has only one lumen.
25. The stent system kit according to claim 23 wherein said plurality of short wires of different properties include a wire having areas of different flexibility.
26. The stent system kit according to claim 25 wherein said wire having areas of different flexibility has a stiff section, a more flexible section and most flexible section.
27. The stent system-kit according to claim 26 wherein one of said areas is more steerable.
28. The stent system kit according to claim 23 wherein said plurality of short wires of different properties include wires selected from floppy wire, soft wire, hard wire, superhard wire and wires having sections made up of two or more of these types of wire.
29. The stent system kit according to claim 23 wherein said member at the distal end of the balloon comprises a receptacle into which said wires are lockably insertable.
30. The stent system kit according to claim 29 wherein said receptacle includes a spring loaded member at the distal end of balloon, and each of the short wires has a bead on an end thereof which snaps through and is retained by said spring loaded member.
31. The stent system kit according to claim 23 wherein at least three different wires are provided.
32. The stent system kit according to claim 23 wherein each of said plurality of short wires comprise a wire tip of about 2 - 8 inches.
33. The stent system kit according to claim 23 wherein said balloon has a high Rated Burst Pressure (RBP).
34. The stem system kit according to claim 23 wherein at least one of said wires includes a device for distal protection.
35. The stent system kit according to claim 23 wherein said device for distal protection comprises an additional balloon.
36. A method of making a stent system, comprising: selecting a short wire; and locking said short wire in place at the distal end of a balloon disposed at the distal end of a catheter, with the stent disposed over the balloon.
37. The method according to claim 36 wherein said selecting is done based on the nature of a lesion and a vessel to be treated.
38. The method according to claim 37 wherein said lesion includes an occlusive mass and the properties of the different wires are selected based on the tortuosity of the vessel, the length and tortuosity of the lesion and the rate of occlusion and nature (hardness) of the occlusive mass.
39. The method according to claim 36 and further in including providing a plurality of short wires from which to select.
40. A stent system comprising:
a catheter with a lumen;
a balloon having an inside in communication with said lumen disposed at the distal end of said catheter, such that the balloon can be inflated by air pressure supplied through said lumen;
a stent disposed over said balloon; and a locking mechanism at the distal end of the balloon, and a wire removably locked to the distal end of the balloon.
41. The stent system according to claim 40 wherein said catheter has only one lumen.
42. The stent system according to claim 40 wherein said balloon has a high Rated Burst Pressure (RBP).
43. A stent system comprising:
a catheter with a lumen;
a balloon having an inside in communication with said lumen disposed at the distal end of said catheter;
a stent disposed over said balloon;
a locking mechanism at the distal end of the balloon;
multiple wires of different properties supplied along with the stent and delivery catheter;
and one of the multiple wires removably locked to the distal end of the balloon.
44. The stent system according to claim 43 wherein said multiple wires of different properties include a wire having areas of different flexibility.
45. The stent system according to claim 44 wherein said wire having areas of different flexibility has a stiff section, a more flexible section and most flexible section.
46. The stent system according to claim 45 wherein one of said areas is more steerable.
47. The stent system according to claim 44 wherein said multiple wires of different properties include wires selected from floppy wire, soft wire, hard wire, super-hard wire and wires having sections made up of two or more of these types of wire.
48. The stent system according to claim 44 and wherein said locking mechanism comprises a receptacle into which a proximal end of said wires may be removably and lockably inserted.
49. The stent system according to claim 44 wherein said multiple wires comprise a wire tip of about 2 - 8 inches.
50. The stent system according to claim 44 wherein at least one of said wires includes a device for distal protection.
51. The stent system according to claim 50 wherein said device for distal protection comprises a balloon.
52. A stent system comprising:
a catheter with a lumen;
a balloon having an inside in communication with said lumen disposed at the distal end of said catheter;
a stent disposed over said balloon;
a locking mechanism at the distal end of the balloon comprising a receptacle into which a proximal end of a wire may be removably and lockably inserted, said receptacle including a spring loaded member at the distal end of balloon; and a plurality of wires of different properties supplied along with the stent and delivery catheter, including a wire having areas of different flexibility, the wires having beads on their ends which snap through and are retained by said spring loaded member.
53. The stent system according to claim 52 wherein at least three different wires are provided.
54. A stent system comprising:
a catheter with a lumen;
a balloon having an inside in communication with said lumen disposed at the distal end of said lumen;
a stent disposed over said balloon; and a proximal end of a short wire removably locked to a locking mechanism at the distal end of the balloon,
55. The stent system according to claim 54 wherein said catheter has only one lumen.
56. The stent system according to claim 54 wherein the locking mechanism comprises a receptacle into which the proximal end of said short wire is lockably inserted.
57. The stent system according to claim 54 wherein said short wire comprises a wire tip of about 2-8 inches.
58. The stent system according to claim 54 wherein said balloon has a high Rated Burst Pressure (RBP).
59. The stent system according to claim 54 wherein said short wire includes a device for distal protection.
60. The stent system according to claim 59 wherein said device for distal protection comprises a balloon.
61. A stent system comprising:
a catheter with a lumen;
a balloon having an inside in communication with said lumen disposed at the distal end of said lumen;
a stent disposed over said balloon; and a proximal end of a short wire removably locked to a locking mechanism at the distal end of the balloon;
the locking mechanism comprising a receptacle into which the proximal end of said short wire is lockably inserted, said receptacle including a spring loaded member at the distal end of balloon and said wire having a bead on its end which snaps through and is retained by said spring-loaded member.
62. A stent system kit comprising:
a catheter with a lumen;
a balloon having an inside in communication with said lumen disposed at the distal end of said lumen;
a stent disposed over said balloon;
a locking mechanism at the distal end of the balloon for removably locking in place a proximal end of a short wire;
a plurality of short wires of different properties.
63. The stent system kit according to claim 62 wherein said catheter has only one lumen.
64. The stent system kit according to claim 62 wherein said plurality of short wires of different properties include a wire having areas of different flexibility.
65. The stent system kit according to claim 64 wherein said wire having areas of different flexibility has a stiff section, a more flexible section and most flexible section.
66. The stent system kit according to claim 65 wherein one of said areas is more steerable.
67. The stent system kit according to claim 62 wherein said plurality of short wires of different properties include wires selected from floppy wire, soft wire, hard wire, super-hard wire and wires having sections made up of two or more of these types of wire.
68. The stent system kit according to claim 62 wherein said locking mechanism at the distal end of the balloon comprises a receptacle into which the proximal end of said wires may be removably and lockably inserted.
69. The stent system kit according to claim 62 wherein at least three different wires are provided.
70. The stent system kit according to claim 62 wherein each of said plurality of short wires comprise a wire tip of about 2- 8 inches.
71. The stent system kit according to claim 62 wherein said balloon is a high Rated Burst Pressure (RBP).
72. The stent system kit according to claim 62 wherein at least one of said wires includes a device for distal protection.
73. The stent system kit according to claim 72 wherein said device for distal protection comprises a balloon.
74. A stent system kit comprising:
a catheter with a lumen;
a balloon having an inside in communication with said lumen disposed at the distal end of said lumen;
a stent disposed over said balloon;
a locking mechanism at the distal end of the balloon comprising a receptacle into which a proximal end of a wire may be removably and lockably inserted, said receptacle including a spring loaded member at the distal end of balloon; and a plurality of short wires of different properties, each of the short wires having a bead on its end which snaps through and is retained by said spring loaded member.
CA002399867A 2001-08-27 2002-08-27 Single operator stenting system Expired - Fee Related CA2399867C (en)

Applications Claiming Priority (2)

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US31467101P 2001-08-27 2001-08-27
US60/314,671 2001-08-27

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CA2399867C true CA2399867C (en) 2009-04-07

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JP (1) JP4277089B2 (en)
KR (1) KR20020077845A (en)
AT (1) ATE415900T1 (en)
AU (2) AU2002313586A1 (en)
BR (1) BR0203400A (en)
CA (1) CA2399867C (en)
CZ (1) CZ20022888A3 (en)
DE (3) DE10239229A1 (en)
EE (1) EE200200476A (en)
FI (1) FI20021522A (en)
IL (1) IL151484A (en)
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