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 extend proximal 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 example, for delivering inflation fluid to, or removing fluid from, the balloon. The fixation balloon can be positioned can be positioned and configured to engage a guidewire against the inner surface of the guide catheter or of the tube member when inflated.
1. A method, comprising:
advancing a guide extension catheter comprising a push member, an elongate tube member including a lumen having a diameter larger than a maximum outer dimension of the push member, and a fixation mechanism into a guide catheter; and
inhibiting longitudinal movement of a guidewire relative to the guide catheter or the tube member, including increasing a size of the fixation mechanism to engage the guidewire against an inner surface of the guide catheter or against an inner surface of the tube member, wherein when the fixation mechanism is positioned proximal to the tube member, the guidewire is engaged against the inner surface of the guide catheter.
2. The method of claim 1 , further comprising identifying a position of the fixation mechanism relative to the guide catheter or relative to patient anatomy using a radiopaque marker positioned proximate the fixation mechanism.
3. The method of claim 1 , wherein inhibiting longitudinal movement of the guidewire relative to the guide catheter or relative to the tube member includes inhibiting longitudinal movement of a rapid exchange guidewire, having a length of 190 centimeters of less, relative to the guide catheter or relative to the tube member.
4. The method of claim 1 , wherein increasing the size of the fixation mechanism includes delivering inflation fluid to the fixation mechanism by way of a lumen in the push member.
5. The method of claim 4 , further comprising coupling an inflation device including the inflation fluid to an inflation manifold attached to a proximal end of the push member.
6. The method of claim 1 , wherein engaging the guidewire against the inner surface of the guide catheter or against the inner surface of the tube member includes engaging the distal end portion of the guidewire against the inner surface of the guide catheter or of the tube member.
7. The method of claim 1 , further comprising, prior to increasing the size of the fixation mechanism, withdrawing an interventional treatment device over the guidewire until its distal end is positioned proximal of the fixation mechanism.
8. The method of claim 1 , further comprising, after increasing the size of the fixation mechanism, releasing user contact with a proximal end portion of the guidewire.
9. The method of claim 8 , further comprising, after releasing user contact with the proximal end portion of the guidewire, withdrawing an interventional treatment device from the guide catheter.
10. The method of claim 1 , further comprising, after increasing the size of the fixation mechanism, advancing an interventional treatment device over the guidewire to a location proximal of the fixation mechanism.
11. The method of claim 10 , wherein advancing the interventional treatment device over the guidewire to the location proximal of the fixation mechanism includes advancing a balloon catheter or a stent catheter to the location proximal of the fixation mechanism.
12. The method of claim 10 , wherein advancing the interventional treatment device over the guidewire to the location proximal of the fixation mechanism includes exposing a proximal end portion of the guidewire from a lumen of the interventional treatment device.
13. The method of claim 12 , wherein exposing the proximal end portion of the guidewire from the lumen of the interventional treatment device includes exposing the proximal end portion of the guidewire from a full catheter length over-the-wire lumen of the interventional treatment device.
14. The method of claim 12 , wherein exposing the proximal end portion of the guidewire from the lumen of the interventional treatment device includes exposing the proximal end portion of the guidewire from a rapid exchange lumen of the interventional treatment device.
15. The method of claim 12 , further comprising grasping by the user of the exposed proximal end portion of the guidewire, decreasing the size of the fixation mechanism to disengage the guidewire from the inner surface of the guide catheter or of the tube member, and advancing one or both of the guidewire or the interventional treatment device through the tube member.
16. The method of claim 15 , wherein decreasing the size of the fixation mechanism includes deflating a fixation balloon.
17. The method of claim 1 , wherein advancing the guide extension catheter into the guide catheter includes positioning the tube member in coaxial alignment with the guide catheter with its distal end portion extending beyond a distal end of the guide catheter.
18. The method of claim 1 , wherein tube member is one French size smaller than the guide catheter.
19. A method, comprising
advancing a guide extension catheter comprising a push member, an elongate tube member including a lumen having a diameter larger than a maximum outer dimension of the push member, and a fixation mechanism into a guide catheter; and
inhibiting longitudinal movement of a guidewire relative to the guide catheter or the tube member, including increasing a size of the fixation mechanism to engage the guidewire against an inner surface of the guide catheter or against an inner surface of the tube member, wherein when the fixation mechanism is positioned within the tube member, the guidewire is engaged against the inner surface of the tube member.