Guidewire for crossing occlusions or stenoses
Systems and methods for crossing stenosis, partial occlusions, or complete occlusions within a body lumen. The systems generally include an elongate member such as a hollow guidewire that houses a rotatable and translatable drive shaft. The drive shaft typically has a distal portion that is advanced to create a path in the occlusive material that is large enough to allow the hollow guidewire to cross the occlusive material.
1. A method of crossing an occlusion or stenosis within a blood vessel body lumen comprising:
providing a hollow guidewire having a distal end comprising a coil and a reinforcing wire connected to the coil;
shaping the coil at the distal end of the hollow guidewire, wherein the reinforcing wire retains the coil shape until it is reshaped to a different configuration;
positioning the hollow guidewire into the blood vessel with the shaped distal end thereof on a first side of the occlusion or stenosis, wherein the shaped distal end of the hollow guidewire is maintained and the hollow guidewire is manipulated to navigate the shaped distal end through the blood vessel;
rotating a drive shaft within an inner lumen of the hollow guidewire with a distal tip of the drive shaft extending distally beyond the hollow guidewire, wherein the coil and reinforcing wire retain their shapes while the driveshaft is being rotated; and
advancing the rotating distal tip of the drive shaft into the occlusion or stenosis in the blood vessel to create a path through and past the occlusion or stenosis to the other side.
2. The method of claim 1 , wherein advancing the distal tip comprises extending the drive shaft from a retracted configuration to an extended configuration.
3. The method of claim 2 , wherein the drive shaft is simultaneously extended and rotated.
4. The method of claim 2 , wherein the drive shaft is independently extended and rotated.
5. The method of claim 2 , wherein the drive shaft in the extended configuration creates a path at least as large as the perimeter of the distal end of the hollow guidewire.
6. The method of claim 2 , comprising maintaining a position of the hollow guidewire during the advancing of the distal tip of the drive shaft.
7. The method of claim 1 , wherein positioning the hollow guidewire is carried out without the use of a separate guidewire.
8. The method of claim 1 , comprising positioning a support system in the body lumen adjacent the occlusion or stenosis, wherein the hollow guidewire is sized to be received within an inner lumen of the support system.
9. The method of claim 8 , wherein positioning the support system comprises:
advancing a guidewire through the body lumen to the occlusion or stenosis;
advancing the support system over the guidewire;
removing the guidewire from the body lumen; and
advancing the hollow guidewire through the support system.
10. The method of claim 9 , comprising infusing or aspirating the body lumen through the inner lumen of the support system.
11. The method of claim 9 , comprising maintaining the position of the support system in the body lumen during the advancing of the distal tip.
12. The method of claim 9 , comprising using the support system to perform a balloon angioplasty, stent placement, ultrasound, or an atherectomy after the distal tip of the drive shaft has been advanced into the occlusion or stenosis in the body lumen.
13. The method of claim 1 , comprising infusing or aspirating the body lumen through the inner lumen of the hollow guidewire.
14. The method of claim 13 , wherein the infusing or aspirating is performed simultaneously with the creation of the path in the occlusion or stenosis.
15. The method of claim 13 , wherein infusing comprises delivering at least one of a therapeutic material, rinsing material, a dye, and a diagnostic material through the elongate member.
16. The method of claim 1 , comprising steering a distal end of the hollow guidewire by actuating a pull wire.