Tissue cutting systems and methods
The disclosure provides various embodiments of systems to facilitate the cutting of luminal tissue structures percutaneously.
1 . A kit for performing an electrosurgical procedure comprising:
an electrosurgical guidewire including:
a core wire having a proximal end, and a distal end and being defined by an outer surface between the proximal end and the distal end of the core wire, said core wire having a centerline that traverses the length of the core wire from the proximal end to the distal end of the core wire;
a dielectric coating disposed about the core wire, wherein the proximal end and distal end of the core wire are electrically exposed and the proximal end of the core wire is configured to be coupled to an electrosurgical generator;
a radiopaque marker pattern disposed over the core wire to indicate a location proximate a middle section of the guidewire to be kinked and partially denuded by removing the dielectric coating to electrically expose the core wire; and a pair of guiding catheters, each said guiding catheter having a proximal end and a distal end and defining an elongate lumen along its length, wherein a distal opening defined in each guiding catheter is configured to receive the proximal end of the core wire therethrough or the distal end of the core wire therethrough;
a pair of grippers, each said gripper being configured to be coupled to a respective proximal end of each said guiding catheter, wherein each said gripper is further configured to be selectively coupled to the guidewire to permit the relative position of the guidewire and the guiding catheters to be fixed; and
a kinking and denuding device that is configured to kink and denude the core wire proximate the radiopaque marker.
2 . The kit of claim 1 , wherein the kinking and denuding device includes a first arm and a second arm joined at a rotatable hinge, wherein the kinking and denuding device is configured to hold the electrosurgical guidewire in place with respect to the first arm and second arm to permit the electrosurgical guidewire to be kinked when the first arm and second arm are folded at the rotatable hinge.
3 . The kit of claim 1 , wherein the kinking and denuding device includes visual indicia thereon to provide alignment with the radiopaque marker of the electrosurgical guidewire.
4 . The kit of claim 1 , wherein the kinking and denuding device includes an optical lens to magnify the radiopaque marker of the electrosurgical guidewire.
5 . The kit of claim 1 , wherein the kinking and denuding device includes a rotatably mounted blade configured to be rotated about a central axis, wherein successive revolutions of the rotatably mounted blade strip the dielectric coating from the electrosurgical guidewire.
6 . A method of using the kit of claim 1 to perform a valve leaflet cutting procedure, comprising:
coupling a proximal end of the core wire to an electrosurgical generator;
directing the distal end of the core wire into the patient's vasculature to a valve leaflet to be cut;
energizing the electrosurgical generator to energize the distal electrically exposed end of the core wire;
burning an opening through tissue of the valve leaflet with the electrically energized distal end of the core wire;
advancing a portion of the electrosurgical guidewire through the opening formed through valve leaflet;
capturing the distal end of the electrosurgical guidewire with a snare catheter; and
pulling the distal end of the guidewire out of the patient to externalize it alongside a proximal region of the electrosurgical guidewire.
7 . The method of claim 6 , further comprising forming a kink into the guidewire and denuding the radiopaque marker with the kinking and denuding device while the guidewire is located outside of the patient, and advancing the kinked, denuded portion of the guidewire into the patient's anatomy until the kinked portion of the guidewire is adjacent to the opening formed through the valve leaflet.
8 . The method of claim 7 , further comprising directing each of the guiding catheters over each portion of the externalized guidewire until the distal end of each guiding catheter is located proximate the valve leaflet.
9 . The method of claim 8 , further comprising using indicia formed onto the guidewire to maintain a predetermined spacing between the distal end of each said guiding catheter and the kinked denuded region of the guidewire to prevent electrical damage to the guiding catheters.
10 . The method of claim 9 , further comprising activating the electrosurgical power source, and burning through the tissue of the valve leaflet using the kinked denuded portion of the guidewire to complete a cut through the valve leaflet.