Tissue excision, cutting, and removal systems and methods
The disclosure provides various embodiments of catheters having articulable ends that can be used for various procedures. Embodiments of methods are also provided that can be performed with catheters in accordance with the present disclosure.
1. A method of removing a valve leaflet in a beating heart comprising:
advancing a distal end of a guidewire through a patient's vasculature to a location of a valve leaflet to be removed;
directing the distal end of the guidewire through the valve leaflet;
capturing the distal end of the guidewire with a snare catheter after the distal end of the guidewire has traversed through the valve leaflet;
externalizing the distal end of the guidewire from the patient by withdrawing the snare catheter, wherein both a proximal portion of the guidewire and a distal portion of the guidewire are externalized from the patient, and a central region of the guidewire passes through the valve leaflet;
introducing a cutting catheter having a cutting snare loop over the proximal portion and the distal portion of the guidewire and advancing the cutting snare loop along proximal portion and the distal portion of the guidewire to the valve;
introducing the proximal and distal ends of the guidewire into a distal end of a tubular catheter, and advancing the distal end of the tubular catheter over the proximal portion and the distal portion of the guidewire to the location of the valve leaflet along the guidewire;
pulling valve leaflet tissue into the distal end of the tubular catheter by pulling on the proximal portion and the distal portion of the guidewire; and
cutting tissue of the valve leaflet extending out of the distal end of the tubular catheter with the cutting snare loop.
2. The method of claim 1 , further comprising removing the tubular catheter from the patient, wherein the tubular catheter includes valve tissue cut from the patient.
3. The method of claim 1 , further comprising disposing an outer catheter in the form of a tubular member having a proximal end and a distal end about the tubular catheter.
4. The method of claim 1 , further comprising rotating the tubular catheter about a longitudinal axis thereof to wind up tissue of the valve leaflet into a plug shape prior to the pulling step.
5. The method of claim 4 , wherein the tubular catheter is a twisting catheter having a first lumen and a second lumen, and wherein the proximal portion of the guidewire is directed through the first lumen and the distal portion of the guidewire is directed through the second lumen.
6. The method of claim 1 , wherein the distal end of the guidewire is directed through the valve leaflet approximately one third of the way from a free edge of the valve leaflet.
7. The method of claim 1 , wherein the valve leaflet tissue includes valve leaflet tissue removed from the aortic valve.
8. The method of claim 1 , wherein the valve leaflet tissue includes valve leaflet tissue removed from the mitral valve.
9. The method of claim 1 , wherein the valve leaflet tissue includes valve leaflet tissue removed from the tricuspid valve.
10. The method of claim 1 , wherein the valve leaflet tissue includes valve leaflet tissue removed from the pulmonic valve.
11. The method of claim 1 , further comprising forming a kink in the central region of the guidewire prior to introducing the central region of the guidewire into the patient.
12. The method of claim 11 , wherein the kink is marked with a marker on both sides of the kink to visibility under an imaging modality.
13. The method of claim 1 , wherein the valve leaflet tissue includes native tissue.
14. The method of claim 1 , wherein the valve leaflet tissue includes valve-in-valve tissue.
15. The method of claim 1 , wherein the distal end of the guidewire is electrified prior to directing the distal end of the guidewire through the valve leaflet.
16. The method of claim 1 , wherein the tubular catheter includes a basket disposed at a distal end thereof to receive the valve leaflet tissue.
17. The method of claim 16 wherein the tubular catheter further includes a snare that is configured to be tensioned to cause the distal end of the basket to collapse around the valve leaflet tissue, and further wherein the method includes collapsing the basket about the valve leaflet tissue by tensioning the snare of the tubular catheter.
18. The method of claim 1 wherein the cutting snare loop is electrified to facilitate cutting through the tissue of the valve leaflet.
19. The method of claim 18 wherein the cutting snare loop is surrounded by a layer of insulating material.
20. The method of claim 19 , wherein the layer of insulating material defines a gap to electrically expose the cutting snare loop in a predetermined location in order to direct electrical energy to a predetermined location.