Guidewire fixation
Percutaneous devices and methods for releasably engaging a guidewire against an inner surface of a tubular member are disclosed. A percutaneous device can include a tube member, a push member, and a fixation mechanism such as a fixation balloon. The tube member can define a lumen sized and shaped to receive one or more interventional medical devices therethrough and can have an outer diameter smaller than a lumen of a guide catheter. The push member can be attached at least to a proximal end portion of the tube member for slidably positioning a distal end portion of the tube member within and beyond a distal end of the guide catheter. The push member can include a lumen in fluid communication with an interior of the fixation balloon for delivering inflation fluid to, or removing fluid from, the balloon. The fixation balloon can be positioned on a portion of the push member and can be configured to engage a guidewire against the inner surface of the guide catheter or the tube member when inflated.
1. A percutaneous device for use with a guide catheter and a guidewire, comprising:
an elongate tube member defining a lumen and having a maximum outer diameter smaller than a diameter of a lumen of the guide catheter, the lumen of the tube member operable to receive a treatment device within and to pass through the lumen past a distal end of the tube member;
a push member operably coupled to a proximal end of the tube member and extending proximally therefrom for slidably positioning the distal end of the tube member within and partially beyond a distal end of the guide catheter, an entirety of the push member having a maximum outer diameter less than the maximum outer diameter of the tube member, and having a length that when combined with a length of the tube member forms a device that is longer than a length of the guide catheter; and
a fixation mechanism positioned on a distal end portion of the push member or positioned within the tube member and configured to engage the guidewire against (i) an inner surface of the guide catheter when the fixation mechanism changes size and/or shape and when a portion of the guidewire extends within the lumen of the tube member, or (ii) an inner surface of the tube member when the fixation mechanism changes size and/or shape and when a portion of the guidewire extends within the lumen of the tube member.
2. The percutaneous device of claim 1 , wherein the tube member is more flexible than the push member.
3. The percutaneous device of claim 1 , wherein the length of the tube member is 6 cm to 30 cm inclusive.
4. The percutaneous device of claim 1 , wherein a diameter of the lumen of the tube member is within one or two French sizes of the diameter of the lumen of the guide catheter.
5. The percutaneous device of claim 1 , wherein the tube member is movable between a first retracted position, in which the tube member is entirely positioned within the guide catheter, and a second extended position, in which a portion of the tube member extends beyond the distal end of the guide catheter.
6. The percutaneous device of claim 1 , wherein the tube member includes an inner polymer layer, an outer polymer layer, and a reinforcement member disposed between the inner and outer polymer layers.
7. The percutaneous device of claim 1 , wherein the push member is attached to a proximal end portion of the tube member.
8. The percutaneous device of claim 1 , wherein the push member is eccentrically-positioned relative to a transverse cross-section of the tube member.
9. The percutaneous device of claim 1 , wherein the fixation mechanism is a fixation balloon.
10. A percutaneous device for use with a guide catheter and a guidewire, comprising:
an elongate tube member defining a lumen and having a maximum outer diameter smaller than a diameter of a lumen of the guide catheter, the lumen of the tube member operable to receive a treatment device within and to pass through the lumen past a distal end of the tube member;
a proximal push member operably coupled to a proximal end of the tube member and extending proximally therefrom for slidably positioning a distal end of the tube member within and partially beyond a distal end of the guide catheter, the push member including a lumen, an entirety of the push member having a maximum outer diameter less than the maximum outer diameter of the tube member, and having a length that when combined with a length of the tube member forms a device that is longer than a length of the guide catheter; and
a fixation balloon in fluid communication with the lumen of the push member for receiving inflation fluid and configured to engage the guidewire against (i) an inner surface of the guide catheter when the fixation balloon is inflated and when a portion of the guidewire extends within the lumen of the tube member, or (ii) an inner surface of the tube member when the fixation balloon is inflated and when a portion of the guidewire extends within the lumen of the tube member.
11. The percutaneous device of claim 10 , wherein the push member includes a hypotube.
12. The percutaneous device of claim 10 , wherein a proximal end portion of the push member includes an inflation manifold couplable to a syringe or other inflation device.
13. The percutaneous device of claim 10 , wherein, when the fixation balloon is configured to engage the guidewire against the inner surface of the guide catheter, the fixation balloon is positioned proximal to the tube member and is wrapped about the push member.
14. The percutaneous device of claim 10 , wherein the fixation balloon includes an inner polymer layer and an outer polymer layer.
15. The percutaneous device of claim 10 , wherein the percutaneous device further comprises an inflation indicator bulb positioned on a proximal end portion of the push member, the indicator bulb in fluid communication with the interior of the fixation balloon.
16. The percutaneous device of claim 1 , wherein the percutaneous device further comprises a radiopaque marker positioned on or within the fixation mechanism.
17. The percutaneous device of claim 1 , wherein a coupling between the push member and the tube member is facilitated by a concave track defining a partially cylindrical opening leading into a fully-round portion of the tube member.
18. The percutaneous device of claim 17 , wherein a first segment of the concave track includes an arcuate cross-sectional shape.
19. The percutaneous device of claim 18 , wherein the arcuate cross-sectional shape extends for a length of at least 0.5 cm.
20. The percutaneous device of claim 18 , wherein the arcuate cross-sectional shape radially extends 25% to 40% of a cross-sectional circumference of the tube member.
21. The percutaneous device of claim 17 , wherein a second segment of the concave track includes a hemicylindrical cross-sectional shape.
22. The percutaneous device of claim 21 , wherein the hemicylindrical cross-sectional shape extends for a length of at least 0.5 cm.
23. The percutaneous device of claim 21 , wherein the hemicylindrical cross-sectional shape radially extends 40% to 70% of a cross-sectional circumference of the tube member.
24. The percutaneous device of claim 17 , wherein a support structure of the concave track transitions from the push member, in the form of a hypotube, to a lumen-less structure; and wherein a distal end of the hypotube and a proximal end of the lumen-less structure include mating non-perpendicular cuts, which are welded together.