Recanalizing occluded vessels using controlled antegrade and retrograde tracking
A method and systems for treating chronic total occlusions, particularly those that are difficult to treat, is disclosed. In this approach, recanalizing the CTO is achieved using a combined antegrade and retrograde approach. The proximal end of the occlusion is penetrated using an antegrade wire, using a traditional approach. Using collateral vessels, the distal end of the occlusion is crossed in a retrograde fashion and by appropriately maneuvering each member, a continuous channel is created. Additional elements such as capture devices, dilators and injection catheters are also disclosed.
1. A method of recanalizing an occluded vessel comprising:
advancing in an antegrade fashion a first longitudinal member through a proximal end of an occlusion;
advancing in a retrograde fashion through a proximal end of a collateral channel a second longitudinal member to a distal end of the occlusion; and
creating a continuous channel through the occlusion between the proximal and distal ends.
2. The method of claim 1 , wherein at least one of the longitudinal members is tubular.
3. The method of claim 1 , wherein at least one of the longitudinal members is made of strands of wires.
4. The method of claim 1 , wherein at least one of the longitudinal members is a guidewire.
5. The method of claim 1 , wherein an interventional procedure is performed.
6. The method of claim 1 , wherein the collateral channel is chosen from an epicardial channel, inter-atrial channel, an intra-septal channel, or a bypass graft.
7. The method of claim 1 , wherein creating the continuous channel involves the use of a capture device.
8. The method of claim 1 , wherein the continuous channel is maintained open within the occlusion.
9. The method of claim 1 further comprising:
advancing a dilating device towards the occlusion, the dilating device having a tapered outer surface which gradually increases in diameter from a first end to a second end, the first end passing through the occlusion before the second end to create the channel.
10. The method of claim 9 , wherein the dilating device includes a plurality of helically shaped grooves on an outer surface which advance the dilating device through the occlusion.
11. The method of claim 9 , wherein the dilating device further comprises:
a central liner oriented within the dilating device between the first and second ends;
a plurality of wires located adjacent to the central liner and oriented within the dilating device between the first and second ends.
12. The method of claim 11 , wherein the plurality of wires further comprise:
a plurality of first wires disposed on an outer surface of the central liner and positioned diametrically opposed from one another with respect to the central liner, the first wires having a first diameter;
a plurality of second wires radially disposed on the outer surface of the central liner and positioned adjacent to another between the opposed first wires, the second wires having a second diameter, wherein the second diameter is smaller than the first diameter.
13. A method of recanalizing an occluded vessel comprising:
advancing in a retrograde fashion through a proximal end of a collateral channel a longitudinal member through a distal end of an occlusion;
advancing the longitudinal member through a proximal end of the occlusion; and
creating a continuous channel through the occlusion between the proximal and distal ends.
14. The method of claim 13 , wherein creating a continuous channel involves the use of a capture device.
15. The method of claim 13 , wherein an interventional procedure is performed.
16. The method of claim 13 , wherein the longitudinal member is tubular.
17. The method of claim 13 , wherein the longitudinal member is a guidewire.
18. The method of claim 13 , further comprising:
advancing towards the occlusion a dilating device having a tapered outer surface which gradually increases in diameter from a first end to a second end, the first end passing through the occlusion before the second end to create the channel.
19. The method of claim 18 , wherein the dilating device includes a plurality of helically shaped grooves on an outer surface which advance the dilating device through the occlusion.
20. The method of claim 18 , wherein the dilating device further comprises:
a central liner oriented within the dilating device between the first and second ends;
a plurality of wires located adjacent to the central liner and oriented within the dilating device between the first and second ends.
21. The method of claim 20 , wherein the plurality of wires further comprise:
a plurality of first wires disposed on an outer surface of the central liner and positioned diametrically opposed from one another with respect to the central liner, the first wires having a first diameter;
a plurality of second wires radially disposed on the outer surface of the central liner and positioned adjacent to another between the opposed first wires, the second wires having a second diameter, wherein the second diameter is smaller than the first diameter.
22. The method of claim 13 , wherein the longitudinal member is made of strands of wires.
23. The method of claim 13 , wherein the collateral channel is chosen from an epicardial channel, inter-atrial channel, an intra-septal channel, or a bypass graft.