Apparatus and methods for delivering prostheses to luminal bifurcations
A catheter for delivering luminal prostheses comprises a catheter body having an expandable member near a distal end. The prosthesis has a side hole, and a guidewire extends beneath a proximal portion of the prosthesis and over the exterior of the expandable member. A distal end of the guidewire is retracted proximally from the closest point on the side opening to reduce possible interference with catheter advancement.
1. A delivery catheter comprising:
a catheter shaft having a proximal end and a distal end;
an expansion member disposed near the distal end of the shaft;
an expandable prosthesis mounted over the expansion member; and
a guidewire structure disposed over the expansion member, beneath a proximal portion of the prosthesis, and extending to a holding location spaced proximally of a side hole of the prosthesis by a distance of at least 1 mm,
wherein the side hole of the prosthesis comprises an enlarged cell distinguishable from the adjacent or remaining structure of the prosthesis, and
wherein the side hole of the prosthesis is configured to bridge the circumference of a side branch ostium after the prosthesis is expanded in a main branch vessel.
2. A delivery catheter as in claim 1 , wherein the guidewire structure comprises a side guidewire slidably received in a passage of a guidewire tube.
3. A delivery catheter as in claim 1 wherein the guidewire structure comprises a side guidewire slidably received in a channel of an elongate slide.
4. A delivery catheter as in claim 1 , wherein the guidewire structure consists essentially of a guidewire which directly contacts an inner wall of the prosthesis and an outer surface of the expansion member.
5. A delivery catheter as in claim 1 , further comprising a central guidewire extending distally from the distal end of the catheter shaft.
6. A delivery catheter as in claim 5 , wherein the central guidewire is fixed.
7. A delivery catheter as in claim 5 , wherein the central guidewire is moveable.
8. A delivery catheter as in claim 1 , wherein the holding location is spaced at least 2 mm proximally of the side hole.
9. A delivery catheter as in claim 1 , wherein the holding location is spaced at least 3 mm proximally of the side hole.
10. A delivery catheter as in claim 1 , wherein the expandable prosthesis comprises a radiopaque marker adjacent the side hole of the prosthesis.
11. A delivery catheter as in claim 1 , wherein the catheter shaft is adapted to transmit torque such that rotating the proximal end rotates the expandable prosthesis disposed near the distal end.
12. A delivery catheter as in claim 1 , wherein the catheter shaft is adapted to self align as the shaft is advanced through the main branch vessel.
13. A delivery catheter as in claim 1 , wherein the catheter shaft comprises a distal section, an intermediate section, and a proximal section, wherein at least one of the distal and intermediate sections is more flexible than the proximal section.
14. A delivery catheter comprising:
a catheter shaft having a proximal end and a distal end;
an expansion member disposed near the distal end of the shaft;
an expandable prosthesis having a side mounted over the expansion member; and
a guidewire disposed over the expansion member and beneath at least a proximal portion of the prosthesis, said guidewire being advanceable through a side hole of the prosthesis, wherein a proximal portion of the shaft includes a split lumen for removably receiving a proximal portion of the guidewire,
wherein the side hole of the prosthesis comprises an enlarged cell distinguishable from the adjacent or remaining structure of the prosthesis, and
wherein the side hole of the prosthesis is configured to bridge the circumference of a side branch ostium after the prosthesis is expanded in a main branch vessel.
15. A delivery catheter as in claim 14 , further comprising a guidewire tube having a passage for slidably receiving a side guidewire.
16. A delivery catheter as in claim 14 , further comprising an elongate slide having a channel for slidably receiving the guidewire.
17. A delivery catheter as in claim 14 , wherein the guidewire is received directly between the inner wall of the prosthesis and an outer surface of the expansion member.
18. A delivery catheter as in claim 14 , further comprising a central guidewire extending distally from the distal end of the catheter shaft.
19. A delivery catheter as in claim 18 , wherein the central guidewire is fixed.
20. A delivery catheter as in claim 18 , wherein the central guidewire is moveable.
21. A delivery catheter as in claim 14 , wherein the expandable prosthesis comprises a radiopaque marker adjacent the side hole of the prosthesis.
22. A delivery catheter as in claim 14 , wherein the catheter shaft is adapted to transmit torque such that rotating the proximal end rotates the expandable prosthesis disposed near the distal end.
23. A delivery catheter as in claim 14 , wherein the catheter shaft is adapted to self align as the shaft is advanced through the main branch vessel.
24. A delivery catheter as in claim 14 , wherein the catheter shaft comprises a distal section, an intermediate section, and a proximal section, wherein at least one of the distal and intermediate sections is more flexible than the proximal section.
25. A delivery catheter comprising:
a catheter shaft having a proximal end and a distal end;
an expansion member disposed near the distal end of the shaft;
an expandable prosthesis mounted over the expansion member; and
a guidewire structure disposed over the expansion member, beneath a proximal portion of the prosthesis, and extending to a holding location spaced proximally of a side hole of the prosthesis by a distance of at least 1 mm,
wherein the side hole of the prosthesis comprises an enlarged cell distinguishable from the adjacent or remaining structure of the prosthesis, and
wherein the catheter shaft is resistant to torque such that rotating the proximal end rotates the expandable prosthesis disposed near the distal end.
26. A delivery catheter comprising:
a catheter shaft having a proximal end and a distal end;
an expansion member disposed near the distal end of the shaft;
an expandable prosthesis having a side mounted over the expansion member; and
a guidewire disposed over the expansion member and beneath at least a proximal portion of the prosthesis, said guidewire being advanceable through a side hole of the prosthesis, wherein a proximal portion of the shaft includes a split lumen for removably receiving a proximal portion of the guidewire,
wherein the side hole of the prosthesis comprises an enlarged cell distinguishable from the adjacent or remaining structure of the prosthesis, and
wherein the catheter shaft is resistant to torque such that rotating the proximal end rotates the expandable prosthesis disposed near the distal end.