Guidewire capture
Assemblies and methods for capturing a guidewire advanced through a blood vessel in a retrograde direction are disclosed. An assembly can include a constraining catheter and a capture catheter. The constraining catheter can include a first longitudinal member and a tubular member; the tubular member can be eccentrically coupled with a distal end portion of the first longitudinal member. The capture catheter can include a second longitudinal member and a funnel member; the funnel member can be eccentrically coupled with a distal end portion of the second longitudinal member. The funnel member can be moved between a collapsed configuration and an expanded configuration through relative movement between the first and second longitudinal members. In the collapsed configuration, at least a portion of the funnel member is disposed within a lumen of the tubular member. In the expanded configuration, the portion of the funnel member projects from an end of the tubular member.
1. A method, comprising:
introducing a guide catheter into a blood vessel at a first entry site location;
advancing the guide catheter in an antegrade direction toward an upstream, proximal end of an occlusion;
introducing a capture catheter having a rapid exchange configuration into a proximal end portion of the guide catheter, the capture catheter including a longitudinal member having its distal end eccentrically coupled with a proximal end of an expandable member;
advancing the capture catheter to a distal end portion of the guide catheter;
deploying and expanding at least a portion of the expandable member of the capture catheter on the upstream, proximal end of the occlusion, including applying an advancing force, in a longitudinal direction and relative to the guide catheter, to a proximal end of the longitudinal member such that the expandable member is thereby advanced, in the longitudinal direction and relative to the guide catheter, to a position beyond the distal end portion of the guide catheter; and
advancing a guidewire, introduced into the blood vessel at a second entry site location different than the first entry site location, in a retrograde direction, including advancing the guidewire toward and through a downstream, distal end of the occlusion and subsequently into and through the deployed expandable member on the upstream, proximal end of the occlusion.
2. The method of claim 1 , wherein introducing the capture catheter into the proximal end portion of the guide catheter includes introducing an assembly including the capture catheter and a surrounding constraining catheter into the proximal end portion of the guide catheter.
3. The method of claim 2 , further comprising withdrawing the capture catheter from the guide catheter, leaving the constraining catheter in place, and advancing a distal end portion of a tubular member of the constraining catheter beyond the distal end portion of the guide catheter.
4. The method of claim 1 , wherein deploying and expanding at least the portion of the expandable member on the upstream, proximal end of the occlusion includes deploying and expanding at least a portion of a funnel member of the capture catheter.
5. The method of claim 4 , wherein deploying and expanding at least the portion of the funnel member of the capture catheter includes allowing the portion of the funnel member to expand and bear against a luminal wall of the blood vessel adjacent to, but not beyond, the upstream, proximal end of the occlusion.
6. The method of claim 4 , wherein advancing the capture catheter to the distal end portion of the guide catheter includes allowing blood flow through one or more perforations in each of a sidewall of the guide catheter and the funnel member of the capture catheter.
7. The method of claim 4 , wherein the funnel member includes a decreasing inner diameter starting at its distal end and moving proximally.
8. The method of claim 1 , wherein advancing the guidewire in the retrograde direction includes advancing the guidewire until a distal end portion of the guidewire is located outside the blood vessel.
9. The method of claim 8 , wherein advancing the guidewire until the distal end portion is located outside the blood vessel includes capturing the guidewire for externalization and exchange or subsequent use.
10. The method of claim 9 , further comprising:
introducing a treatment device over the distal end portion of the guidewire and into the proximal end portion of the guide catheter; and,
using the guidewire as a rail, advancing the treatment device in the antegrade direction to the occlusion for treatment thereof.
11. The method of claim 1 , wherein deploying and expanding at least the portion of the expandable member on the upstream, proximal end of the occlusion includes inflating a balloon on the upstream, proximal end of the occlusion.
12. The method of claim 1 , wherein advancing the guidewire in the retrograde direction includes receiving a distal end of the guidewire within a passage of the expandable member.
13. The method of claim 1 , wherein advancing the guidewire in the retrograde direction includes introducing a support catheter over a proximal end portion of the guidewire at the second entry site and using the support catheter to provide column support to the guidewire.
14. The method of claim 1 , wherein advancing the guidewire in the retrograde direction includes manipulating a distal end of the guidewire through the occlusion and creating a continuous channel between the occlusion's downstream, distal end and its upstream, proximal end.
15. The method of claim 1 , wherein advancement of the guidewire in the retrograde direction toward and through the downstream, distal end of the occlusion occurs after deployment of the expandable member on the upstream, proximal end of the occlusion.