A tunneling catheter system for transluminal arterial angioplasty

Claim 2

A tunneling catheter system for percutaneous transluminal angioplasty, comprising: a centering means having an inner guide lumen and adapted to be advanced through a patient's arterial system to the vicinity of an arterial stenosis, said centering means for centering a distal portion of said inner guide lumen within said artery relative to the artery's inner surface; and a tunneling means having distal and proximal ends and adapted to slide within said inner guide lumen of said centering means, for tunneling through said arterial stenosis.

Claim 3

The apparatus of claim 1, further comprising means for permitting the flow of blood through said centering means.

Claim 4

The apparatus of claim 1, wherein said centering means further.comprises a plurality of deployable radially extendable members, each member extendable an essentially equal radial distance into engagement with said artery's inner surface, deployment of said radially extendable members centering a distal portion of said inner guide lumen within said artery.

Claim 5

The apparatus of claim 3, wherein said radially extendable members are spokes adapted to permit blood flow around said centering means.

Claim 6

The apparatus of claim 1, wherein said distal end of said tunneling means includes a cutting means for tunneling a bore through said arterial stenosis.

Claim 7

The apparatus of claim 5, wherein said tunneling means further comprises an ultrasonic means, operably coupled to said cutting means, for ultrasonically vibrating said cutting means thereby enhancing penetration of said cutting means into said arterial stenosis.

Claim 8

The apparatus of claim 5, wherein said tunneling catheter further comprises an electrocautery means, operably coupled to said cutting means, for applying an electrical cautery current to said cutting means, thereby enhancing penetration of said cutting means into said arterial stenosis.

Claim 9

The apparatus of claim 5, wherein said tunneling means further comprises an interior lumen extending from said proximal end of said tunneling means into fluid communication with said hollow tunneling cavity.

Claim 10

The apparatus of claim 8, further comprising a suction means, located external to said patient, and operably coupled to said proximal end of said tunneling means, for applying suction through said interior lumen into said hollow tunneling cavity, thereby pulling plaque cut by said cutting means into said hollow tunneling cavity.

Claim 11

The apparatus of claim 1, wherein said tunneling means is a tunneling catheter.

Claim 12

The apparatus of claim 3, wherein said centering means is operably coupled to a control means, located external to said patient, for controlling the deployment and retraction of said radially extendable members.

Claim 13

The apparatus of claim 6, wherein said tunneling means is operably coupled to a control means for controlling movement of said cutting means.

Claim 14

The apparatus of claim 10, wherein said centering means comprises: an outer tube having distal and proximal ends and having a hollow elongated bore; an inner tube located within said bore of said outer tube and having distal and proximal ends and adapted to slide longitudinally within said bore, said inner tube also having said inner guide lumen for guiding said tunneling catheter; and a deployment means associated with said inner and said outer tubes for deploying said radially extendable members when said distal end of said outer tube is displaced proximally from said distal end of said inner tube and for retracting said radially extendable members when displacement between said distal ends of said inner and outer tubes is decreased.

Claim 15

The apparatus of claim 1, wherein said tunneling means comprises a tunneling catheter having distal and proximal ends and adapted to slide within said inner guide lumen of said centering means, said tunneling catheter further comprising, a tube with distal and proximal ends and having an elongated interior lumen, said distal end of said tube adapted to be advanced to the vicinity of said arterial stenosis through said inner guide lumen of said centering means, the proximal end of said tube extending external to said patient, a distal section of said tube having a tunneling cavity, said tunneling cavity being in fluid communication with said proximal end of said tube through said interior lumen, said tunneling catheter further including a cutting edge located at said distal edge of said tube and forming a mouth of said tunneling cavity.

Claim 16

The apparatus of claim 14, wherein said proximal end of said tube is operably coupled to a suction means located external to said patient, for applying suction to said interior lumen and said tunneling cavity for pulling said cylindrical bore of plaque into said tunneling cavity.

Claim 17

The apparatus of claim 14, wherein said proximal end of said tube is operably coupled to a fluid injection means, located external to said patient, for injecting through said interior lumen and through said tunneling cavity radio-opaque dye into the vicinity of said arterial stenosis.

Claim 18

The apparatus of claim 14, wherein said proximal end of said tube is operably coupled to a control means, located external to said patient, for controlling advancement of said cutting edge longitudinally relative to said centering mean's distal end, thereby controlling cutting action of said cutting edge through said plaque.

Claim 19

A tunneling catheter for percutaneous transluminal angioplasty, comprising: a catheter with distal and proximal ends and having an elongated interior lumen, said distal end of said catheter adapted to be advanced to the vicinity of a patient's arterial stenosis, said proximal end of said catheter extending external to said patient, a distal section of said catheter having a tunneling cavity, said tunneling cavity being in fluid communication with said proximal end of said catheter through said interior lumen; and a cutting edge located at said distal edge of said catheter and forming a mouth of said tunneling cavity.

Claim 20

A tunneling catheter for percutaneous transluminal angioplasty, comprising: a catheter with distal and proximal ends and having an elongated interior lumen, said distal end of said catheter adapted to be advanced to the vicinity of a patient's arterial stenosis, said proximal end of said catheter extending external to said patient, a distal section of said catheter having a tunneling cavity, said tunneling cavity being in fluid communication with said proximal end of said catheter through said interior lumen; and a cutting edge located at said distal edge of said catheter and forming a mouth of said tunneling cavity.

Claim 21

The apparatus of claim 18, wherein said cutting edge is cylindrical for cutting a cylindrical bore of plaque from said arterial stenosis.

Claim 22

The apparatus of claim 19, wherein said proximal end of said catheter is operably coupled to a suction means located external to said patient, for applying suction to said interior lumen and said tunneling cavity for pulling said cylindrical bore of plaque into said tunneling cavity.

Claim 23

A tunneling electrocautery catheter for percutaneous transluminal angioplasty, comprising: a tunneling catheter with distal and proximal ends and having an elongated interior lumen, said distal end of said tunneling catheter adapted to be advanced to the vicinity of a patient's arterial stenosis, said proximal end of said tunneling catheter extending external to said patient; an active cylindrical electrode attached to said distal end of said tunneling catheter, said active cylindrical electrode's distal end tapered to a sharp cutting edge, said active cylindrical electrode having a tunneling cavity extending proximally to said sharp cutting edge, said tunneling cavity being in fluid communication with said interior lumen of said tunneling catheter; and a means for conducting electrical energy to said active cylindrical electrode.

Claim 24

A tunneling electrocautery catheter for percutaneous transluminal angioplasty, comprising: a tunneling catheter with distal and proximal ends and having an elongated interior lumen, said distal end of said tunneling catheter adapted to be advanced to the vicinity of a patient's arterial stenosis, said proximal end of said tunneling catheter extending external to said patient; an active cylindrical electrode attached to said distal end of said tunneling catheter, said active cylindrical electrode's distal end tapered to a sharp cutting edge, said active cylindrical electrode having a tunneling cavity extending proximally to said sharp cutting edge, said tunneling cavity being in fluid communication with said interior lumen of said tunneling catheter; and a means for conducting electrical energy to said active cylindrical electrode.

Claim 25

A procedure for percutaneous transluminal angioplasty comprising the steps of: advancing a guiding catheter having a hollow center through a patient's arterial system to the vicinity of a stenosis in an artery; sliding a centering catheter, having distal and proximal ends and having an inner guide lumen, through said hollow center of said guiding catheter to a position in contact with a proximal surface of said arterial stenosis, said distal end of said centering catheter having a centering means for centering said centering catheter relative to said artery's inner surface; centering said centering catheter by said centering means; passing a tunneling catheter having distal and proximal ends through said inner guide lumen of said centering catheter until said distal end of said tunneling catheter is aligned with said distal end of said centering means; and cutting a bore of plaque from said arterial stenosis by advancing said tunneling catheter a certain stroke distance, a distal portion of said tunneling catheter having a tunneling cavity and including a cutting means for cutting through said arterial stenosis and for retaining said bore of plaque in said tunneling cavity.

Claim 26

A procedure for percutaneous transluminal angioplasty comprising the steps of: advancing a guiding catheter having a hollow center through a patient's arterial system to the vicinity of a stenosis in an artery; sliding a centering catheter, having distal and proximal ends and having an inner guide lumen, through said hollow center of said guiding catheter to a position in contact with a proximal surface of said arterial stenosis, said distal end of said centering catheter having a centering means for centering said centering catheter relative to said artery's inner surface; centering said centering catheter by said centering means; passing a tunneling catheter having distal and proximal ends through said inner guide lumen of said centering catheter until said distal end of said tunneling catheter is aligned with said distal end of said centering means; and cutting a bore of plaque from said arterial stenosis by advancing said tunneling catheter a certain stroke distance, a distal portion of said tunneling catheter having a tunneling cavity and including a cutting means for cutting through said arterial stenosis and for retaining said bore of plaque in said tunneling cavity.

Claim 27

The procedure of claim 22, further including, after said cutting step, the step of: withdrawing said tunneling catheter from said centering catheter with said bore of plaque retained in said tunneling cavity.

Claim 28

The procedure of claim 23, further including the steps of: inserting a balloon catheter through said inner guide lumen of said centering catheter into a bore hole cut by said tunneling catheter; and, inflating said distal end of said balloon catheter to further enlarge said bore hole.

Claim 29

The procedure of claim 22, wherein said centering means comprises a plurality of deployable radially extendable members, for engagement with said artery's inner surface.

Claim 30

The procedure of claim 25, wherein said centering catheter further includes a control fixture means, located external to said patient, for controlling radial deployment of said radially extendable members, said procedure further including, subsequent to said sliding step, the step of deploying each of said radially extendable members an essentially equal radial displacement into engagement with said inner surface of said artery by adjusting said control fixture means and thereby centering a distal portion of said centering catheter within said artery.