Recanalizing occluded vessels using controlled antegrade and retrograde tracking

Abstract

A method and systems for treating chronic total occlusions, particularly those that are difficult to treat, is disclosed. In this approach, recanalizing the CTO is achieved using a combined antegrade and retrograde approach. The proximal end of the occlusion is penetrated using an antegrade wire, using a traditional approach. Using collateral vessels, the distal end of the occlusion is crossed in a retrograde fashion and by appropriately maneuvering each member, a continuous channel is created. Additional elements such as capture devices, dilators and injection catheters are also disclosed.

1 - 47 . (canceled) 
     
     
         48 . A catheter system for recanalizing an occluded vessel comprising:
 an antegrade longitudinal member with a distal end that is capable of being advanced through a proximal end of an occlusion;   a retrograde longitudinal member with a distal end that is capable of being advanced through a proximal end of a collateral channel to a distal end of the occlusion; and   wherein the distal ends of the antegrade longitudinal member and retrograde longitudinal member cooperate to form a continuous channel within the occluded vessel.   
     
     
         49 . The catheter system of  claim 48 , wherein at least one of the longitudinal members is capable of dilatation and retrieval. 
     
     
         50 . The catheter system of  claim 48 , wherein the catheter system further comprises a balloon catheter for performing an interventional procedure. 
     
     
         51 . The catheter system of  claim 48 , wherein the antegrade longitudinal member comprises one or more of the following: a guidewire, a dilating device, an injection device, and a capture device. 
     
     
         52 . The catheter system of  claim 48 , wherein the retrograde longitudinal member comprises one or more of the following: a guidewire, a dilating device, an injection device, and a capture device. 
     
     
         53 . The catheter system of  claim 48 , comprising means for maintaining an open space within the occlusion and mating the retrograde and antegrade longitudinal members to create a continuous channel. 
     
     
         54 . The catheter system of  claim 48 , wherein the collateral channel is chosen from an epicardial channel, inter-atrial channel, an intra-septal channel, or a bypass graft. 
     
     
         55 . A catheter system for recanalizing an occluded vessel comprising:
 an antegrade longitudinal member with a distal end that is capable of being advanced through a proximal end of an occlusion;   a retrograde longitudinal member with a distal end that is capable of being advanced through a distal end of the occlusion;   the distal end of the retrograde member having proximal and distal tips that are connected by compressible elements, wherein advancing the proximal tip towards the distal tip or advancing the distal tip towards the proximal tip enables the compressible elements to flare out and form a capture mechanism.   
     
     
         56 . The catheter system of  claim 55 , where upon deploying the compressible elements of the distal end of the retrograde member and advancing the antegrade member results in the distal end of the antegrade member becoming engaged in the capture mechanism, and pulling the proximal or distal tip of the retrograde distal end retracts the compressible elements, enabling the combined antegrade and retrograde members to be moved through the occlusion. 
     
     
         57 . The system of  claim 55 , wherein the compressible elements are in the form of ribs or wires. 
     
     
         58 . A catheter system for recanalizing an occluded vessel comprising:
 an antegrade longitudinal member with a distal end that is capable of being advanced through a proximal end of an occlusion;   a retrograde longitudinal member with a distal end that is capable of being advanced through a distal end of the occlusion;   the distal end of the antegrade member having proximal and distal tips that are connected by compressible elements, wherein advancing the proximal tip towards the distal tip or advancing the distal tip towards the proximal tip enables the compressible elements to flare out and form a capture mechanism.   
     
     
         59 . The catheter system of  claim 58 , where upon deploying the compressible elements of the distal end of the antegrade member and advancing the retrograde member results in the distal end of the retrograde member being engaged in the capture mechanism, and pulling the proximal or distal tip of the antegrade distal end retracts the compressible elements, enabling the combined antegrade and retrograde members to be moved through the occlusion. 
     
     
         60 . The system of  claim 58 , wherein the compressible elements are in the form of ribs or wires. 
     
     
         61 . A catheter system for recanalizing an occluded vessel comprising:
 an antegrade longitudinal member with a distal end that is capable of being advanced through a proximal end of an occlusion;   a retrograde longitudinal member with a distal end that is capable of being advanced through a distal end of the occlusion;   the distal end of the retrograde member comprising a coil which can be activated to cause the coil to flare out and form a capture element.   
     
     
         62 . The catheter system of  claim 61 , where upon activating the coil of the distal end of the retrograde member, advancing the antegrade member results in the distal end of the antegrade member being engaged in the deployed coil. 
     
     
         63 . A catheter system for recanalizing an occluded vessel comprising:
 an antegrade longitudinal member with a distal end that is capable of being advanced through a proximal end of an occlusion;   a retrograde longitudinal member with a distal end that is capable of being advanced through a distal end of the occlusion;   the distal end of the antegrade member comprising a coil which can be activated to cause the coil to flare out and form a capture element.   
     
     
         64 . The catheter system of  claim 63 , where upon activating the coil of the distal end of the antegrade member, advancing the retrograde member results in the distal end of the retrograde member being engaged in the deployed coil. 
     
     
         65 . A catheter system for recanalizing an occluded vessel comprising:
 an antegrade longitudinal member with a distal end that is capable of being advanced through a proximal end of an occlusion;   a retrograde longitudinal member with a distal end that is capable of being advanced through a distal end of the occlusion;   the distal end of the retrograde longitudinal member having a compressible basketlike capture mechanism capable of accepting the antegrade longitudinal member.   
     
     
         66 . The catheter system of  claim 65 , where upon deploying the basket-like structure and advancing the antegrade member results in the antegrade member being engaged in the 
       capture mechanism, enabling the antegrade and retrograde members to be moved through the occlusion. 
     
     
         67 . A catheter system for recanalizing an occluded vessel comprising:
 an antegrade longitudinal member with a distal end that is capable of being advanced through a proximal end of an occlusion;   a retrograde longitudinal member with a distal end that is capable of being advanced through a distal end of the occlusion;   the distal end of the antegrade longitudinal member having a compressible basketlike capture mechanism capable of accepting the retrograde longitudinal member.   
     
     
         68 . The catheter system of  claim 67 , where upon deploying the basket-like capture mechanism and advancing the retrograde member results in the retrograde member being engaged in the capture mechanism, enabling the antegrade and retrograde members to be moved through the occlusion.