Carotid sheath with entry and tracking rapid exchange dilators and method of use
Dilators and sheaths for use in minimally invasive vascular therapy are disclosed. In some embodiments, the dilators include a slot that accesses a guidewire lumen within the dilator. These slots facilitate rapid exchange of one dilator for another. In another embodiment, a dilator is sufficiently stiff to facilitate entry, but also designed to facilitate placement of the dilator along a tortuous path.
1. A method of manipulating a sheath assembly to place a sheath within the vasculature of a patient, the method comprising:
obtaining a sheath assembly comprising,
an elongate sheath;
an entry dilator comprising:
an elongate main body extending from a proximal end of the dilator to a distal end of the dilator, the elongate main body comprising:
a proximal portion extending longitudinally from the proximal end of the dilator; and
a distal portion directly adjacent to and extending longitudinally from a distal end of the proximal portion of the elongate main body to the distal end of the dilator;
a lumen disposed within the elongate main body, the lumen defining a distal opening at the distal end of the elongate main body; and
a slot extending from the lumen through a sidewall of the entry dilator, the slot extending longitudinally in a proximal direction from a proximal end of the distal portion of the dilator along the remaining length of the dilator;
wherein a lumen wall along the distal portion forms a continuous and unbroken ring; and
a tracking dilator comprising:
an elongate main body extending from a proximal end of the dilator to a distal end of the dilator, the elongate main body comprising:
a proximal portion extending longitudinally from the proximal end of the dilator; and
a distal portion directly adjacent to and extending longitudinally from a distal end of the proximal portion of the elongate main body to the distal end of the dilator;
a lumen disposed within the elongate main body, the lumen defining a distal opening at the distal end of the elongate main body;
a non-tapering cylindrical portion adjacent the distal end of the elongate main body; and
a slot extending from the lumen through a sidewall of the entry dilator, the slot extending longitudinally in a proximal direction from a proximal end of the distal portion of the dilator along the remaining length of the dilator;
wherein a lumen wall along the distal portion forms a continuous and unbroken ring;
inserting the entry dilator and sheath into the vasculature of a patient such that a first portion of a guidewire is disposed within the lumen of the entry dilator and a second portion of the guidewire is disposed proximal of the entry dilator;
removing the entry dilator from the vasculature of the patient without removing the first portion of the guidewire from the vasculature of the patient;
inserting the tracking dilator over the guidewire and into the sheath; and
advancing the tracking dilator and sheath into or within the vasculature of the patient.
2. The method of claim 1 , wherein
removing the entry dilator from the vasculature of the patient comprises decoupling the entry dilator from the second portion of the guidewire; and
the second portion of the guidewire is not longer than the entry dilator.
3. The method of claim 1 , wherein removing the entry dilator from the vasculature of the patient without removing the guidewire from the vasculature of the patient comprises decoupling the entry dilator from the guidewire via the slot of the entry dilator.
4. The method of claim 1 , wherein removing the entry dilator from the vasculature of the patient without removing the guidewire from the vasculature of the patient comprises maintaining direct contact with the second portion of the guidewire while the entry dilator is removed from the guidewire.
5. The method of claim 4 , wherein removing the entry dilator from the vasculature of the patient without removing the guidewire from the vasculature of the patient further comprises removing the first portion of the guidewire from the lumen of the entry dilator via the slot of the entry dilator.
6. A method of manipulating a sheath assembly, the method comprising:
inserting an entry dilator and sheath into the vasculature of a patient such that a first portion of a guidewire is disposed within a lumen of the entry dilator and a second portion of the guidewire is disposed proximal of the entry dilator, wherein the entry dilator comprises:
a proximal portion extending longitudinally from a proximal end of the dilator; and
a distal portion directly adjacent to and extending longitudinally from a distal end of the proximal portion of the elongate main body to a distal end of the dilator; wherein a lumen wall along the distal portion forms a continuous and unbroken ring;
removing the entry dilator from the vasculature of the patient without removing the first portion of the guidewire from the vasculature of the patient, wherein removing the entry dilator from the vasculature of the patient comprises decoupling the entry dilator from the second portion of the guidewire via a slot of the entry dilator, wherein the slot extends longitudinally in a proximal direction from a proximal end of the distal portion of the dilator along the remaining length of the dilator;
inserting a tracking dilator over the guidewire and into the sheath; and
advancing the tracking dilator and sheath into or within the vasculature of the patient.
7. The method of claim 6 , wherein
the second portion of the guidewire is not longer than the entry dilator.
8. The method of claim 6 , wherein removing the entry dilator from the vasculature of the patient without removing the guidewire from the vasculature of the patient comprises maintaining direct contact with the second portion of the guidewire while the entry dilator is removed from the guidewire.
9. The method of claim 8 , wherein removing the entry dilator from the vasculature of the patient without removing the guidewire from the vasculature of the patient further comprises removing the first portion of the guidewire from the lumen of the entry dilator via the slot of the entry dilator.
10. A method of placing a sheath within the vasculature of a patient, the method comprising:
inserting an entry dilator and sheath into the vasculature of a patient; the entry dilator including a first slot in a sidewall, wherein
the entry dilator comprises:
a proximal portion extending longitudinally from a proximal end of the dilator; and
a distal portion directly adjacent to and extending longitudinally from a distal end of the proximal portion of the elongate main body to a distal end of the dilator, wherein a lumen wall along the distal portion forms a continuous and unbroken ring;
the entry dilator is positioned over a guidewire; and
the first slot extends longitudinally in a proximal direction from a proximal end of the distal portion of the dilator along the remaining length of the dilator;
removing the entry dilator;
inserting a tracking dilator including a second slot in a sidewall into the sheath without removing the guidewire; and
advancing the tracking dilator and sheath into the vasculature.
11. The method of claim 10 , wherein the guidewire is partially removed from the entry dilator via the first slot.
12. The method of claim 10 , wherein the guidewire is partially removed from the tracking dilator via the second slot.