Endovascular devices and methods
Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion with a lumen extending therein; inserting the device into the vascular lumen; positioning the distal portion in the vascular wall; and directing the distal portion within the vascular wall.
1. A method of treating an occlusion of a blood vessel, comprising:
advancing an intravascular device within a lumen of the blood vessel to a position proximate the occlusion, wherein the intravascular device comprises:
an elongate shaft defining a central longitudinal axis;
an inflatable balloon secured to the elongate shaft, the inflatable balloon including an expandable portion;
a first lumen; and
a second lumen extending coaxially with the central longitudinal axis to a distal opening positioned distal of the expandable portion of the inflatable balloon;
inflating the inflatable balloon to expand the expandable portion and orient a distal opening of the first lumen toward an intimal layer of a wall of the blood vessel;
advancing a subintimal device through the first lumen upon expansion of the expandable portion and through the intimal layer of the wall of the blood vessel.
2. The method of claim 1 , further comprising:
advancing the subintimal device distally within a subintimal space of the blood vessel.
3. The method of claim 2 , wherein the subintimal space is disposed outside of the intimal layer of the wall of the blood vessel and inside of a medial layer of the wall of the blood vessel.
4. The method of claim 1 , further comprising:
advancing the subintimal device concentrically around the occlusion of the blood vessel.
5. The method of claim 1 , wherein the distal opening of the second lumen is centered on the central longitudinal axis.
6. The method of claim 1 , wherein advancing the intravascular device within the lumen of the blood vessel further comprises advancing the intravascular device over a guidewire disposed within the second lumen.
7. The method of claim 1 , wherein the intravascular device includes a tubular distal tip defining the distal opening of the second lumen, the tubular distal tip being disposed distal of a distal end of the expandable portion.
8. The method of claim 1 , wherein the inflatable balloon has a substantially symmetrical outer profile.
9. The method of claim 1 , wherein the first lumen extends helically around the inflatable balloon.
10. A method of treating an occlusion of a blood vessel, comprising:
advancing an intravascular device within a lumen of the blood vessel to a position proximate the occlusion, wherein the intravascular device comprises:
an elongate shaft defining a central longitudinal axis;
an inflatable balloon secured to the elongate shaft, the inflatable balloon including an expandable portion;
a first lumen extending along an exterior surface of the expandable portion of the inflatable balloon; and
a second lumen extending coaxially with the central longitudinal axis to a distal opening positioned distal of the expandable portion of the inflatable balloon;
inflating the inflatable balloon to expand the expandable portion and orient a distal opening of the first lumen toward an intimal layer of a wall of the blood vessel;
advancing a subintimal device through the first lumen upon expansion of the expandable portion and through the intimal layer of the wall of the blood vessel.
11. The method of claim 10 , wherein the distal opening of the second lumen is located distally of the distal opening of the first lumen.
12. The method of claim 10 , wherein the second lumen is a guidewire lumen and the distal opening of the second lumen faces distally.
13. The method of claim 12 , wherein advancing the intravascular device within the lumen of the blood vessel further comprises advancing the intravascular device over a guidewire disposed within the guidewire lumen.
14. The method of claim 10 , wherein the first lumen is disposed externally to the elongate shaft.
15. The method of claim 10 , further comprising:
advancing the subintimal device distally of the occlusion of the blood vessel.
16. A method of treating an occlusion of a blood vessel, comprising:
advancing an intravascular device within a lumen of the blood vessel to a position proximate the occlusion, wherein the intravascular device comprises:
an elongate shaft defining a central longitudinal axis;
an inflatable balloon secured to the elongate shaft, the inflatable balloon including an expandable portion;
a first lumen; and
a second lumen extending coaxially with the central longitudinal axis to a distal opening positioned distal of a distal end of the expandable portion of the inflatable balloon;
wherein a distal opening of the first lumen is positioned intermediate a proximal end of the expandable portion and the distal end of the expandable portion;
inflating the inflatable balloon to expand the expandable portion and orient the distal opening of the first lumen toward an intimal layer of a wall of the blood vessel;
advancing a subintimal device through the first lumen upon expansion of the expandable portion and through the intimal layer of the wall of the blood vessel.
17. The method of claim 16 , wherein an outer profile of the expandable portion includes a tapered proximal section, a tapered distal section, and an intermediate section connecting the tapered proximal section and the tapered distal section.
18. The method of claim 16 , wherein the first lumen extends along an exterior surface of the elongate shaft and the inflatable balloon.
19. The method of claim 16 , wherein the distal opening of the second lumen is centered on the central longitudinal axis.
20. The method of claim 16 , further comprising:
advancing the subintimal device distally between the intimal layer and a medial layer of the wall of the blood vessel along the occlusion.