High Torque, Low Profile Catheters and Methods for Transluminal Interventions

Abstract

Catheter devices having low profile shafts and laterally deployable members (e.g., cannulas, needles, etc.) that may be extended or advanced laterally from the catheter shaft. Also disclosed are methods for bypassing a vascular obstruction (e.g., a chronic total occlusion or other full or partial obstruction) wherein a guidewire is entrapped in a subintimal space adjacent to the obstruction. A catheter of the foregoing character is advanced over the entrapped guidewire and into the subintimal space. The laterally deployable member is then advanced or extended from the subintimal space back into the true lumen of the blood vessel distal to the obstruction. A second guidewire is then advanced through or along the laterally deployable member. The catheter and first guidewire are then removed and one or more working device(s) (balloons, atherectomy devices, stents, etc.) is/are advanced over the second guidewire and used to establish a subintimal bypass channel through which blood may flow around the obstruction.

1 . A catheter device comprising:
 an elongate catheter body, at least a portion of which comprises a) a core member having at least one lumen extending therethrough, b) a substantially cylindrical braided layer disposed about the core member and c) an outer layer disposed about said braided layer; and   a laterally deployable member that is advanceable or extendable laterally from the catheter body.   
     
     
         2 . A device according to  claim 1  wherein the core member comprises a material selected from the group consisting of machined or extruded polymers, polyethylene, high density polyethylene, ultra-high molecular weight polyethylene and polypropylene. 
     
     
         3 . A device according to  claim 1  wherein the braided layer comprises a braided material selected from the group consisting of metal ribbons, polymer fibers or filaments and wires. 
     
     
         4 . A device according to  claim 1  wherein the outer layer comprises a material selected from the group consisting of polymeric materials, metals and woven materials. 
     
     
         5 . A device according to  claim 1  wherein a side port if formed in the catheter body and wherein the laterally deployable member is advanceable out of said side port. 
     
     
         6 . A device according to  claim 1  wherein the laterally deployable member has a lumen extending therethrough. 
     
     
         7 . A device according to  claim 1  wherein the laterally deployable member has a distal tip that will penetrate through tissue. 
     
     
         8 . A device according to  claim 1  wherein the laterally deployable member comprises a cannula. 
     
     
         9 . A device according to  claim 1  wherein the laterally deployable member comprises a needle. 
     
     
         10 . A device according to  claim 1  wherein the laterally deployable member is moveable back and forth between a retracted position wherein it is substantially within the catheter body and an extended position wherein it extends laterally from the catheter body. 
     
     
         11 . A device according to  claim 10  further comprising a substantially tubular housing within which at least a portion of the laterally deployable member resides when in its retracted position. 
     
     
         12 . A device according to  claim 11  the housing comprises a curved housing and wherein the laterally deployable member is biased to a curved configuration. 
     
     
         13 . A device according to  claim 12  wherein the laterally deployable member exits from a side opening in the catheter body and the housing is curved in the direction of said side opening. 
     
     
         14 . A device according to  claim 12  or  13  wherein the housing is radiographically imageable. 
     
     
         15 . A device according to  claim 1  further comprising at least one imageable marker which generally indicates the direction in which the laterally deployable member will advance or extend from the catheter body. 
     
     
         16 . A device according to  claim 1  wherein the core member has a first lumen and a second lumen. 
     
     
         17 . A device according to  claim 16  wherein the first lumen has a side opening and wherein the laterally deployable member is moveable from a retracted position within the first lumen to an extended position where it extends out of the side opening. 
     
     
         18 . A device according to  claim 16  wherein the second lumen is useable as a guidewire lumen for tracking the catheter device over a guidewire. 
     
     
         19 . A device according to  claim 1  wherein the core member comprises an extruded polymer member. 
     
     
         20 . A device according to  claim 1  wherein at least the core member is formed substantially of a material selected form the group consisting of: polyethylene, high density polyethylene, ultra-high molecular weight polyethylene or polypropylene. 
     
     
         21 - 33 . (canceled) 
     
     
         34 . A device according to  claim 13  wherein the housing is radiographically imageable.