Guidewire delivery catheter having an expandable anchor mechanism for use in the coronary sinus - Patents.com

Abstract

A mechanism (400) for fixing a catheter in place to facilitate puncturing a hole through a vessel wall is disclosed. The fixing mechanism (400) includes an expansion member (402) that expands when activated to press against the vessel wall (e.g., coronary sinus wall (30)). Activation of the fixing mechanism (400) occurs by removal of a restraint (e.g., cover (401)) or by pushing or pulling a wire. The expansion member (402) may be self-expanding or may be expanded by a spring within a mesh structure. Fixation mechanisms activated by pushing or pulling a wire expand as a result of movement of the wire itself or as a result of movement of a component attached to the wire and anchor member.

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This application claims priority to U.S. Provisional Patent Application No. 63 / 180,602, filed April 27, 2021, entitled “SECURING A GUIDEWIRE DELIVERY CATHETER IN THE CORONARY SINUS USING MATERIAL OR ADVANCEMENT MECHANISMS,” the complete disclosure of which is incorporated herein by reference in its entirety. [Background technology]

[0002] The present invention relates generally to the field of delivery devices, such as catheters, for medical procedures involving the coronary sinus.

[0003] Description of Related Art Heart failure is a common and potentially fatal condition affecting humans, and despite maximal treatment, suboptimal clinical outcomes often result in symptoms, morbidity and / or mortality. In particular, "diastolic heart failure" refers to the clinical syndrome of heart failure that occurs in the setting of preserved left ventricular systolic function (ejection fraction) and in the absence of major valvular disease. This condition is characterized by a stiff left ventricle with reduced compliance and impaired relaxation, which leads to increased end-diastolic pressure.

[0004] Symptoms of diastolic heart failure are due, at least in large part, to elevated pressure in the left atrium. Elevated left atrial pressure (LAP) is present in several abnormal cardiac conditions, including heart failure (HF). In addition to diastolic heart failure, several other medical conditions, including left ventricular systolic dysfunction and valvular disease, can result in elevated pressure in the left atrium. Both heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) can present with elevated LAP.

[0005] It may be beneficial to reduce the pressure rise in the left atrium. One way to do this is to shunt blood from the left atrium to the coronary sinus. By creating an opening between the left atrium and the coronary sinus, blood flows from the higher pressure of the left atrium to the lower pressure of the coronary sinus. An example of a method for shunting blood from the left atrium to the coronary sinus is described in U.S. Patent No. 9,789,294, entitled "Expandable cardiac Shunt," the entire contents of which are incorporated herein by reference.

[0006] Using a catheter-based instrument, the surgeon creates a puncture hole between the left atrium and the coronary sinus and places an expandable shunt into the puncture hole. To do this, one or more catheters are used to create the puncture hole, deliver the expandable shunt along a guidewire, and deploy the expandable shunt into the puncture hole. Once expanded, the shunt defines a blood flow passage that allows blood to flow from the left atrium to the coronary sinus when the LAP is elevated. Summary of the Invention

[0007] For purposes of summarizing the disclosure, certain aspects, advantages, and novel features have been described herein. It is to be understood that not all such advantages may necessarily be achieved in accordance with any particular embodiment. Thus, the disclosed embodiments may be practiced in a manner that achieves or optimizes one advantage or group of advantages as taught herein, without necessarily achieving other advantages that may be taught or suggested herein. [Means for solving the problem]

[0008] Some implementations of the present disclosure relate to a guidewire delivery catheter used to implant a shunt between the coronary sinus and the left atrium, the catheter including an anchoring mechanism including a removable cover coupled to a wire or hypotube, the anchoring mechanism including an expansion member that is activated by removal of the removable cover, the removable cover configured to be pulled by the wire or hypotube to expose the expansion member and expand the expansion member out of the catheter to anchor the distal end of the catheter in place within the coronary sinus.

[0009] In some embodiments, the expansion member comprises a mesh structure, in some embodiments, the expansion member comprises a malleable wire material, in some embodiments, the expansion member comprises a self-expanding bubble.

[0010] In some embodiments, the expansion member comprises a spring-loaded bubble, hi further embodiments, the spring is held in compression by a cover, and removal of the cover allows the spring to expand, thereby causing the spring-loaded bubble to expand and form a dome shape.

[0011] In some embodiments, the expansion member is configured to be retracted by re-advancing the removable covering over the expansion member, hi some embodiments, actuation of the expansion member presses the expansion member against the vessel wall, providing wall apposition to the catheter to facilitate puncture of the vessel wall.

[0012] Some implementations of the present disclosure relate to a guidewire delivery catheter used to implant a shunt between the coronary sinus and the left atrium, the catheter including an anchoring mechanism including an actuation member including a wire or hypotube, the anchoring mechanism including an expansion member actuated by the actuation member, the expansion member proximally coupled to a distal end of the actuation member, the expansion member configured to expand out of the catheter in response to distal advancement of the actuation member, thereby anchoring the distal end of the catheter in place within the coronary sinus.

[0013] In some embodiments, the expansion member comprises a mesh structure. In some embodiments, the expansion member comprises a malleable wire material. In some embodiments, the expansion member is configured to be retracted by pulling the actuation member proximally. In some embodiments, a distal portion of the expansion member is fixed to the catheter. In some embodiments, actuation of the expansion member presses the expansion member against the vessel wall, providing wall apposition to the catheter to facilitate puncturing the vessel wall. In some embodiments, the expansion member comprises a fabric covering that constrains a distal portion of the actuation member such that as the actuation member advances distally, the distal portion of the actuation member curves within the fabric covering, causing the fabric covering to form a dome shape.

[0014] Some implementations of the present disclosure relate to a guidewire delivery catheter used to implant a shunt between the coronary sinus and the left atrium, the catheter including an anchoring mechanism including an actuation member including a wire or hypotube coupled to a movable distal structure, the anchoring mechanism including an expansion member actuated by the actuation member, the expansion member including a fixed proximal structure and a movable distal structure having a pliable material forming a wall attached to the fixed proximal structure and the movable distal structure such that pulling the actuation member moves the movable distal structure toward the fixed proximal structure and bulges the wall outward, thereby anchoring the distal end of the catheter in place within the coronary sinus.

[0015] In some embodiments, the wall comprises a malleable wire material. In some embodiments, the expansion member is configured to be retracted by pushing the actuation member distally. In some embodiments, actuation of the expansion member presses the expansion member against the vessel wall, providing wall apposition to the catheter to facilitate puncture of the vessel wall. In some embodiments, the actuation member comprises a wire extending through the hypotube, the hypotube being surrounded by a fixed proximal structure. [Brief description of the drawings]

[0016] Various embodiments are shown in the accompanying drawings for illustrative purposes and should not be construed as limiting the scope of the present invention in any way. In addition, various features of different disclosed embodiments may be combined to form additional embodiments that are part of the present disclosure. Throughout the drawings, reference numbers may be reused to indicate correspondence between referenced elements. However, it should be understood that the use of similar reference numbers in relation to multiple drawings does not necessarily imply similarities between the respective embodiments associated therewith. Furthermore, it should be understood that features in the respective drawings are not necessarily drawn to scale, and that illustrated sizes are presented for the purpose of illustrating aspects of the invention. In general, some of the illustrated features may be relatively smaller than illustrated in some embodiments or configurations.

[0017] [Figure 1] FIG. 1 illustrates several access routes for manipulating guidewires and / or catheters in and around the heart to deploy a shunt. [Diagram 2] FIG. 2 illustrates one approach for deploying an expandable shunt, in which a guidewire is introduced through the subclavian or jugular vein, through the superior vena cava, and into the coronary sinus. [Diagram 3] 3A, 3B, 3C, and 3D show schematic diagrams of the process of making a puncture hole through the wall of the coronary sinus, looking down on a portion of the heart facing posteriorly downward. [Figure 4] 4A, 4B, and 4C show a first exemplary fixation mechanism including a self-expanding bubble and a cover. [Diagram 5] 5A, 5B, and 5C show a second exemplary fastening mechanism including a spring-loaded bubble and cover. [Figure 6] 6A, 6B, and 6C show a third exemplary fixation mechanism that includes a mesh structure and a wire that can be pushed to expand the mesh structure. [Figure 7]7A, 7B, and 7C show a fourth exemplary fixation mechanism including a flexible wall that expands when a wire is pulled for proximal movement of a distal moveable structure relative to a proximal fixed structure. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0018] The headings provided herein are for convenience only and do not necessarily affect the scope or meaning of the claimed invention.

[0019] Abstract Symptoms of diastolic heart failure result from elevated pressure in the left atrium, or elevated left atrial pressure (LAP). Other heart conditions may also present with elevated LAP. To reduce pressure in the left atrium, a pathway can be created between the left atrium and the coronary sinus. This allows blood to flow from the higher pressure left atrium to the lower pressure coronary sinus. The pathway can be created by puncturing a hole between the left atrium and the coronary sinus. Once the hole is created, a shunt can be placed in the hole to keep it open.

[0020] For example, a catheter-based instrument can be used to create the hole and deliver and deploy the shunt within the puncture hole. The catheter, sometimes referred to as a guidewire delivery catheter (GDC), can be used to puncture through the coronary sinus into the left atrium and place a guidewire into the left atrium. To puncture through tissue, the catheter has wall apposition to capture the needle directly against the coronary sinus-left atrial wall. Previous GDCs used an "anchor balloon" (saline inflated balloon) to secure the catheter when creating the puncture hole. The anchor balloon solution can rupture or become dislodged from position, which can harm the patient.

[0021] Therefore, described herein are materials and mechanisms for anchoring the GDC in place and allowing it to puncture the wall from the coronary sinus to the left atrium, which act as an alternative to an anchor balloon.

[0022] The term "catheter" is used herein according to its broad and ordinary meaning and may include any tube, sheath, steerable sheath, steerable catheter, and / or any other type of elongated tubular delivery device with an inner lumen configured to slidably receive an instrument, such as for positioning within the atrium or coronary sinus, including, for example, a delivery catheter and / or cannula. The term "hypotube" is used herein according to its broad and ordinary meaning and may include small diameter tubing, typically made of stainless steel or Nitinol, typically used in medical devices such as catheters, stents, etc. As used herein, a wire may be used as a general term to indicate an elongated, flexible structure, which may include a hypotube.

[0023] In some cases, the fixation mechanism may be comprised of a shape memory alloy (e.g., Nitinol) and / or may have a predefined shape and / or configuration. The fixation mechanism may be configured to be shaped and / or compressed to fit within and / or around the catheter. In some cases, the fixation mechanism may have an elongated shape that extends at least partially along the catheter in the delivery configuration and changes shape to provide wall apposition in the deployed configuration.

[0024] Some embodiments described herein provide methods and / or systems for anchoring a guidewire delivery catheter or other similar delivery device to provide wall apposition for puncturing a blood vessel wall. Although some embodiments may be directed to anchoring a catheter within the coronary sinus to puncture the wall between the coronary sinus and the left atrium, the devices described herein may be applicable to other regions of the body. For example, some devices described herein may be advantageously configured to anchor a catheter in a blood vessel other than the coronary sinus.

[0025] The following includes a general description of a method for delivering a guidewire delivery catheter to a target location in the coronary sinus. Figure 1 shows several access routes for manipulating a guidewire and / or catheter in and around the heart to deploy a shunt. For example, access can be from above via either the subclavian or jugular vein into the superior vena cava (SVC), the right atrium (RA), and from there into the coronary sinus (CS). Alternatively, an access route can begin in the femoral vein and pass through the inferior vena cava (IVC) into the heart. Other access routes can also be used, and each typically utilizes a percutaneous incision through which a guidewire and catheter are inserted into the vascular system, usually through a sealed introducer, from which the physician controls the distal end of the device from outside the body.

[0026] Figure 2 illustrates one approach for deploying an expandable shunt, in which a guidewire 10 is introduced through the subclavian or jugular vein, through the superior vena cava (SVC), and into the coronary sinus. Once the guidewire provides a pathway, an introducer sheath (not shown) may be routed along with the guidewire into the patient's vasculature, typically with the use of a dilator. Figure 2 illustrates a deployment catheter 12 extending from the SVC into the coronary sinus of the heart, with the deployment catheter 12 passing through the introducer sheath, which provides a hemostatic valve to prevent blood loss.

[0027] In some embodiments, the deployment catheter 12 may be approximately 30 cm long, and the guidewire 10 may be somewhat longer for ease of use. In certain embodiments, the deployment catheter 12 may function to prepare and create an opening in the wall of the left atrium, and a separate placement or delivery catheter may be used for delivery of the expandable shunt. In various embodiments, the deployment catheter may be used for puncture preparation and may also function as a fully functional shunt placement catheter. In this application, the terms "deployment catheter" and "delivery catheter" may be used to refer to catheters that provide one or both of these functions, or introducers.

[0028] Because the coronary sinus is largely continuous around the left atrium, there are a variety of possible acceptable placements for the stent. The site selected for placement of the stent may be within an area of ​​thin or low density tissue in a particular patient, as previously determined by non-invasive diagnostic means, such as CT scan or radiography, fluoroscopy or intravascular coronary vasculature echo (IVUS).

[0029] 3A-3D show schematic diagrams of the process of making a puncture hole through the wall of the coronary sinus, looking down on a portion of the heart with the posterior surface facing down. First, FIG. 3A shows a guidewire 20 being advanced from the right atrium through its ostium or opening into the coronary sinus. A puncture catheter 22 is then advanced over the guidewire 20, as shown in FIG. 3B. The puncture catheter 22 is introduced into the body through the proximal end of an introducer sheath (not shown). Conventionally, the introducer sheath provides access to a particular vascular pathway (e.g., the jugular or subclavian vein) and may have a hemostatic valve therein. While holding the introducer sheath in a fixed position, the surgeon manipulates the puncture catheter 22 to the implantation site.

[0030] In some embodiments, the distal end of the puncture catheter 22 has a slight built-in curvature, with an inner and outer radius, to conform to the curvature of the coronary sinus. The fixation mechanism 24 is exposed along the outer radial side of the catheter 22 adjacent to a distal segment 25, which may be thinner than the proximal extent of the catheter 22 or taper away from the proximal extent of the catheter 22 to be narrower. A radiopaque marker 26 on the catheter 22 may be used to assist the surgeon in determining the correct advancement distance for the desired placement of the fixation mechanism 24 within the coronary sinus. Desirably, the radiopaque marker 26 is a C-shaped band located on the sides of the proximal and distal ends of the fixation mechanism 24.

[0031] FIG. 3C illustrates the outward deployment of the fixation mechanism 24, which is considered a general structure that may be replaced by any of the fixation mechanisms disclosed herein and described with reference to FIGS. 4A-7C. The deployment of the fixation mechanism 24 presses the radially inner curve of the catheter against the luminal wall of the coronary sinus to provide wall apposition. Again, the fixation mechanism 24 is located adjacent to the distal segment 25 of the puncture catheter 22. In some embodiments, the fixation mechanism 24 extends opposite a needle port 28 formed in the radially inner wall of the catheter 22. As a result, the needle port 28 abuts the luminal wall and faces toward the tissue wall 30 between the coronary sinus and the left atrium. Guided by visualization of the radiopaque marker 26, the surgeon preferably advances the catheter 22 such that the needle port 28 is located within about 2-4 cm of the coronary ostium. This places the subsequent puncture approximately over the "P2" portion of the posterior leaflet of the mitral valve (as shown in FIG. 3B, the posterior leaflet has the P1-P2-P3 leaflets in a CCW orientation when viewed from the inflow side of the valve). The fixation mechanism 24 may be centered diametrically across the catheter 22 from the needle port 28, or may be offset proximally from the needle port 28 to improve leverage as shown, or may be offset distally from the needle port 28.

[0032] The curvature of the distal end of the puncture catheter 22 aligns with and "fits" the anatomical structure within the coronary sinus, orienting the needle port 28 inward, while the fixation mechanism 24 holds the catheter 22 in a fixed position relative to the coronary sinus. Then, as shown in FIG. 3D, a puncture sheath 32 with a sharp-tipped puncture needle 34 is advanced along the catheter 22 to exit the needle port 28 at an angle from the longitudinal direction of the catheter 22 and puncture through the wall 30 and into the left atrium. The puncture sheath 32 has an inherent curvature at its end that "aligns" with the curvature of the anatomical structure, ensuring that the needle 34 is oriented inward toward the left atrium. The fixation mechanism 24 provides rigidity to the system and holds the needle port 28 against the wall 30 (e.g., the fixation mechanism provides wall apposition). The puncture needle 34 has a flattened configuration that forms a straight cut and is preferably attached to the distal end of an elongated wire or flexible rod (not shown) that passes through the lumen of the puncture sheath 32 .

[0033] Fixing mechanism Described herein are mechanisms for anchoring a catheter within a blood vessel to facilitate puncturing the wall of the blood vessel with a needle extending from the catheter. The anchoring mechanisms described herein may be implemented in a catheter, such as catheter 22 described herein with respect to Figures 3A-3D. In addition, the anchoring mechanisms described herein provide the functionality of the general anchoring mechanism 24 described herein with respect to Figures 3A-3D. In other words, the anchoring mechanisms described below may be used in place of the anchoring mechanism 24 described herein with respect to Figures 3A-3D.

[0034] The disclosed fixation mechanism is a variation of the fixation mechanism 24 used to secure the guidewire delivery catheter in place to allow it to puncture the wall between the coronary sinus and the left atrium. In particular, the embodiments represent an improvement over saline-filled anchor balloons, as there is the potential for better catheter fixation without the risk of balloon rupture. With balloon implementations, if the balloon ruptures before the needle is deployed, the needle may be deployed in the wrong space, causing severe injury to the patient. Furthermore, a ruptured balloon may result in an embolism to the patient. The disclosed embodiments eliminate this risk, as they do not use a saline-inflated balloon, or other elements that require inflation using liquids or gases. Furthermore, the disclosed embodiments eliminate the need to deflate the balloon, thereby providing a more streamlined procedure.

[0035] The disclosed fixation mechanisms may include bubbles, meshes, flaps, or similar features that expand when activated and press against the wall of the coronary sinus. This force anchors the distal end of the guidewire delivery catheter, allowing the needle to puncture the wall of the coronary sinus. Activation of the disclosed fixation mechanisms may occur by removal of a restraint (e.g., a cover) or by pushing or pulling the wire. The disclosed fixation mechanism material may be a stretchable, malleable wire material and / or a mesh made of a shape memory material or a self-expanding material. An exemplary material may be a nickel-titanium alloy such as Nitinol, although other materials may be used. Fixation mechanisms activated by removal of a restraint may be self-expanding or may be expanded by a spring within the mesh structure. Fixation mechanisms activated by pushing or pulling the wire expand as a result of movement of the wire itself or as a result of movement of components attached to the wire and anchor member.

[0036] The disclosed anchoring mechanisms are configured for use with catheters, such as the guidewire delivery catheters described herein. Also disclosed herein are guidewire delivery catheters having an anchoring mechanism (or anchor member) that includes an actuation member and an expansion member actuated by the actuation member. The anchoring mechanism can be located on a side of the catheter opposite a needle port or similar feature to provide wall apposition upon puncturing through a vessel wall.

[0037] A first exemplary fixation mechanism includes a cover that is removed to allow a self-expanding bubble to expand out from the side of the catheter. A second exemplary fixation mechanism includes a cover that is removed to allow a spring-loaded bubble to expand out from the side of the catheter. A third exemplary fixation mechanism includes a wire that is pushed together and a mesh structure expands out from the side of the catheter. A fourth exemplary fixation mechanism has an expansion member that includes a fixed proximal structure, a movable distal structure, and a strip attached to the proximal and distal structures, and pulling the wire moves the distal structure toward the proximal structure and expands the strip outward. The expansion member of the disclosed fixation mechanism is configured to be activated without the use of a liquid or gas as an inflation means. That is, the disclosed fixation mechanism is not activated by inflation using a liquid or gas.

[0038] 4A-4C illustrate a first exemplary fixation mechanism 400. The first exemplary fixation mechanism 400 includes a self-expanding bubble 402 that is constrained by a cover 401 or other similar constraining portion, as shown in FIG. 4A. The fixation mechanism 400 can be guided into position as part of the catheter 22, for example, where the needle 34 will puncture the wall of the coronary sinus 30. The bubble 402 is constrained during delivery using a constraining structure, such as the cover 401. Once in position, the cover 401 can be removed, as shown in FIG. 4B. Removal of the cover 401 allows the self-expanding bubble structure 402 to expand out of the catheter 22, thereby fixing the distal end of the guidewire delivery catheter 22 in position against the wall 30, as shown in FIG. 4C. In the expanded or deployed state, the bubble 402 provides wall apposition against the coronary sinus wall 30 for the needle 34 to puncture the opposing coronary sinus wall 30.

[0039] In some embodiments, the bubble 402 can be within the catheter 22. In some embodiments, the cover 401 can be part of the outer wall of the catheter 22. In such embodiments, the fixation mechanism 400 is contained within the catheter 22 during delivery. In certain embodiments, the bubble 402 and the cover 401 are attached to the outer surface of the catheter 22. In various embodiments, the cover 401 is external to the catheter 22 and the bubble 402 is at least partially contained within the catheter 22.

[0040] The self-expanding bubble 402 may be made of a bundled material, such as a stretchy, malleable wire material. The material may be, for example, Nitinol. The self-expanding bubble 402 may be a mesh material that allows fluid to flow through it, as opposed to a balloon that contains a fluid (e.g., saline) used to inflate it. Beneficially, this allows fluid to flow through the vessel during the puncture procedure.

[0041] The self-expanding bubble 402 may be shaped such that when expanded, the self-expanding bubble 402 creates a dome shape. In some embodiments, the self-expanding bubble 402 is configured to expand rapidly once the cover 401 is removed. The self-expanding bubble 402 may be pulled back into the catheter 22 using a pull wire or hypotube, which draws the self-expanding bubble 402 into the catheter 22. Once the self-expanding bubble is retracted, the cover 401 may be advanced again to cover the self-expanding bubble 402. The cover 401 advantageously keeps the self-expanding bubble 402 within a containment zone, preventing the self-expanding bubble 402 from unfolding prior to cover removal, reducing the risk of damage during insertion.

[0042] 5A-5C illustrate a second exemplary fixation mechanism 500. The second exemplary fixation mechanism 500 includes a spring-loaded bubble 502 that expands when the restraint 501 is removed, the expansion being caused by a spring 503 contained within the bubble 502, as shown in FIG. 5A. The fixation mechanism 500 can be maneuvered into position as part of the catheter 22, for example, where the needle 34 will puncture the wall of the coronary sinus 30. Once in position, as shown in FIG. 5B, the restraint 501 can be removed. As shown in FIG. 5C, removal of the restraint 501 allows the compressed spring 503 within the bubble 502 to expand and expand the mesh bubble 502 out of the catheter 22, thereby fixing the distal end of the guidewire delivery catheter 22 in position against the wall 30. In the expanded or deployed state, the bubble 502 provides wall apposition against the coronary sinus wall 30 for the needle 34 to puncture the opposing coronary sinus wall 30. The bubble 502 may be a mesh material, such as a stretchable, malleable wire material, which advantageously allows fluid to flow through the container during the puncture procedure.

[0043] In some embodiments, bubble 502 can be within catheter 22. In some embodiments, restraint 501 can be part of the outer wall of catheter 22. In such embodiments, fixation mechanism 500 is contained within catheter 22 during delivery. In certain embodiments, bubble 502 and restraint 501 are attached to the outer surface of catheter 22. In various embodiments, restraint 501 is external to catheter 22 and bubble 502 is at least partially contained within catheter 22.

[0044] The spring-loaded bubble 502 is initially covered during delivery, and the constraint 501 is configured to keep the spring 503 in a compressed state. Thus, the constraint 501 is sufficiently elastic to maintain the spring 503 in a compressed state. The constraint 501 may be coupled to a pull wire or hypotube or other similar mechanism to withdraw the constraint 501 when the catheter 22 is in place at a desired location. When the constraint 501 is removed, the spring 503 expands, thereby expanding the mesh or bubble 502. When the bubble 502 is expanded by the spring 503, it forms a dome-like shape rather than a cylindrical shape, to more closely fit the spring 503. Thus, the material of the bubble 502 is sufficiently malleable to be compressed by the constraint 501 while being sufficiently rigid to form the target dome-like shape.

[0045] 6A-6C illustrate a third exemplary fixation mechanism 600. The third exemplary fixation mechanism 600 includes a mesh structure 601 having a proximal end attached to a wire 602, as shown in FIG. 6A. The fixation mechanism 600 can be guided into position as part of the catheter 22, i.e., where the needle 34 will puncture the wall 30 of the coronary sinus. Once in position, the wire 602 can be pushed to expand the mesh structure 601, as shown in FIG. 6B. Similarly, the mesh structure 601 can be retracted by pulling the wire 602, as shown in FIG. 6B. Pushing the wire 602 causes the mesh structure 601 to bunch and expand out of the catheter 22, thereby fixing the distal end of the guidewire delivery catheter 22 in position against the wall 30 of the coronary sinus, as shown in FIG. 6C. This provides wall apposition for the needle 34 to puncture the wall 30 of the coronary sinus. The mesh structure 601 can be a mesh material, such as a stretchable and malleable wire material. Beneficially, this allows fluid to flow through the vessel during the puncture procedure. A distal portion of mesh structure 601 may be attached to catheter 22. This may be done to facilitate bunching of mesh structure 601 as wire 602 is advanced (e.g., pushed distally). In some embodiments, mesh structure 601 is partially or completely contained within catheter 22 during delivery. In certain embodiments, mesh structure 601 forms part of the outer wall of catheter 22.

[0046] In some embodiments, the mesh structure 601 includes a fabric covering a wire that advances and forms a dome shape. In such embodiments, the fabric is expanded by the wire, which is then constrained within the fabric, thereby affecting the shape of the wire. This interaction between the fabric covering and the wire creates a dome shape that presses against the coronary sinus wall 30 to provide apposition to the needle 34.

[0047] The wire 602 may extend from the proximal end of the mesh structure 601 to the proximal end of the catheter 22. In some embodiments, the wire 602 may be attached to the mesh structure 601 using a ring around the wire 601. In such embodiments, the ring has sliding capabilities. In some embodiments, the wire 601 is a hypotube that may be advanced and retracted independently of the guidewire of the catheter 22. Thus, when the catheter 22 is in place, the hypotube may be pushed to expand the mesh structure 601 to facilitate puncturing the wall 30, and after puncturing the wall 30, the hypotube may be pulled to retract the mesh structure 601.

[0048] 7A-7C illustrate a fourth exemplary fixation mechanism 700. The fourth exemplary fixation mechanism 700 includes a flap, strip, or wall (continuous or discontinuous) 703 having a proximal end attached to a fixed proximal structure 701 (e.g., a cylinder) and a distal end attached to a movable distal structure 702 (e.g., a cylinder), as shown in FIG. 7A, and a wire 704 passing through the fixed proximal structure 701 and attached to the movable distal structure 702. The fixation mechanism 700 can be guided to a fixed position as part of the catheter 22, i.e., where the needle 34 punctures the wall 30 of the coronary sinus. Once in position, the wire 704 can be pulled. Pulling the wire 704 moves the distal structure 702 proximally toward the fixed proximal structure 701, as shown in FIG. 7B. This relative movement causes the flap or wall 703 to bulge outwardly away from the catheter 22, thereby fixing the distal end of the guidewire delivery catheter 22 in position against the wall 30 of the coronary sinus, as shown in FIG. 7C. The flap or wall 703 can be any suitable material, such as a stretchy, malleable wire material. In some embodiments, the wire 704 extends through the hypotube, and the wire 704 and hypotube are surrounded by the proximal structure 701 and the wall 703.

[0049] Each of the fixation features 400, 500, 600, and 700 may include a marker band that is radiopaque to indicate the location of the fixation feature when visualized using fluoroscopy. In such an embodiment, the marker band may be opposite the needle 34 to ensure that the needle is located in the desired location before extending the needle to puncture the wall 30.

[0050] Additional Embodiments Depending on the embodiment, certain acts, events, or functions of any of the processes or algorithms described herein may be performed in a different order, added, combined, or omitted entirely, and thus, in a particular embodiment, not all described acts or events are required to practice a process.

[0051] In particular, conditional language used herein, such as "can," "could," "might," "may," "eg," and the like, unless specifically stated otherwise or understood otherwise within the context of use, is intended to have its ordinary meaning and is generally intended to convey that certain embodiments include certain features, elements, and / or steps, but not other embodiments. Thus, such conditional language is generally not intended to imply that features, elements, and / or steps are required in any way by one or more embodiments, or that one or more embodiments necessarily include logic, with or without author input or prompting, for determining whether those features, elements, and / or steps are included or performed in any particular embodiment. Terms such as "comprising," "including," "having," and the like, are synonymous and used in their ordinary sense and are used in an inclusive, non-limiting manner and do not exclude additional elements, features, acts, operations, etc. Also, the term "or" is used in its inclusive sense (and not its exclusive sense), so that, for example, when used to connect a list of elements, the term "or" means one, some, or all of the elements in the list. Conjunctive language such as "at least one of X, Y, and Z" is understood with the context as being used generally to convey that an item, term, element, etc., can be either X, Y, or Z, unless specifically stated otherwise. Thus, such conjunctive language is not generally intended to imply that a particular embodiment requires that at least one of X, at least one of Y, and at least one of Z, respectively, be present.

[0052] In the above description of the embodiments, it should be understood that various features may be grouped together in a single embodiment, figure, or description thereof for the purpose of streamlining the disclosure and aiding in the understanding of one or more of the various inventive aspects. However, this method of disclosure should not be interpreted as reflecting an intention that any claim requires more features than are expressly recited in that claim. Moreover, any component, feature, or step illustrated and / or described in a particular embodiment herein may be applied to or used in conjunction with any other embodiment. Moreover, no component, feature, step, or group of components, features, or steps is necessarily required or essential to each embodiment. Thus, it is intended that the scope of the invention herein disclosed and claimed below should not be limited by the specific embodiments described above, but should be determined solely by a fair reading of the following claims.

[0053] It should be understood that certain sequential terms (e.g., "first" or "second") may be provided for ease of reference and do not necessarily imply physical characteristics or order. Thus, as used herein, sequential terms (e.g., "first," "second," "third," etc.) used to modify elements, such as structures, components, operations, etc., do not necessarily indicate a priority or order of the element relative to any other elements, but rather may generally distinguish the element from other elements having a similar or identical name (other than the use of sequential terms). In addition, as used herein, the indefinite articles ("a" and "an") may indicate "one or more" rather than "one." Furthermore, an action that is performed "based on" a condition or event may also be performed based on one or more other conditions or events not expressly recited.

[0054] Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by those skilled in the art to which the exemplary embodiments belong. Furthermore, terms such as those defined in commonly used dictionaries should be interpreted as having a meaning consistent with their meaning in the context of the relevant art, and are not to be interpreted in an idealized or overly formal sense unless expressly defined herein.

[0055] Although certain preferred embodiments and examples are disclosed below, the subject matter of the invention extends beyond the specifically disclosed embodiments to other alternative embodiments and / or applications, as well as modifications and equivalents thereof. Thus, the scope of claims that may arise from this specification is not limited by any of the specific embodiments described below. For example, in any method or process disclosed herein, the acts or operations of the method or process may be performed in any suitable order and are not necessarily limited to any particular disclosed order. Although various operations may be described sequentially as multiple separate operations in a manner that may be useful for understanding a particular embodiment, the order of description should not be construed as implying that these operations are order dependent. In addition, the structures, systems, and / or devices described herein may be embodied as integrated components or as separate components. For purposes of comparing various embodiments, certain aspects and advantages of these embodiments are described. Not all such aspects or advantages are necessarily achieved by any particular embodiment. Thus, for example, various embodiments may be implemented in a manner that achieves or optimizes one advantage or group of advantages as taught herein, without necessarily achieving other aspects or advantages that may also be taught or suggested herein.

[0056] Spatially relative terms such as "outside," "inside," "top," "bottom," "upper," "vertical," "horizontal," and similar terms may be used herein for ease of description to describe the relationship between one element or component and another element or component as illustrated in the drawings. It should be understood that the spatially relative terms are intended to encompass different orientations of the device in use or operation in addition to the orientation depicted in the drawings. For example, if the device shown in the drawings is turned over, a device that is positioned "below" or "directly below" another device may be positioned "above" another device. Thus, the illustrative term "below" may include both a lower and upper position. Devices may also be oriented in other directions, and thus the spatially relative terms may have different interpretations depending on the orientation.

[0057] Unless expressly stated otherwise, comparison and / or quantitative terms such as "less," "more," "greater than," and the like are intended to encompass the notion of equality. For example, "less" can mean "less than" as well as "less than" in the strict mathematical sense.

[0058] The delivery systems described herein may be used to position a catheter tip and / or catheter in various regions of the human heart. For example, the catheter tip and / or catheter may be configured to pass from the right atrium to the coronary sinus. However, the description may refer to or generally apply to positioning of a catheter tip and / or catheter from a first body chamber or lumen to a second body chamber or lumen, where the catheter tip and / or catheter may be bent when positioned from the first body chamber or lumen into the second body chamber or lumen. A body chamber or lumen may refer to any one of a number of fluid channels, blood vessels, and / or organ chambers (e.g., heart chambers). Additionally, references herein to "catheters," "tubes," "sheaths," "deliverable sheaths," and / or "deliverable catheters" may generally refer to or apply to any type of elongated tubular delivery device that includes an inner lumen configured to slidably receive an instrument, such as for positioning within the atrium or coronary sinus, including, for example, a delivery catheter and / or cannula. It will be understood that other types of medical implant devices and / or procedures can be delivered to the coronary sinus using the delivery systems described herein including, for example, ablation procedures, drug delivery and / or placement of coronary sinus leads.

Claims

1. 1. A delivery catheter for forming a shunt between the coronary sinus and the left atrium, said delivery catheter comprising: a removable cover coupled to the wire; an expansion member activated by removal of the removable cover, the expansion member configured to be pulled by the wire to expose the expansion member and expand the expansion member out of the delivery catheter to secure a distal end of the delivery catheter in place within the coronary sinus; the delivery catheter includes a needle port; The delivery catheter, wherein the dilating member is located on a side of the delivery catheter opposite the needle port to provide wall apposition upon puncturing a vessel wall with a needle.

2. The delivery catheter of claim 1 , wherein the expansion member comprises a mesh structure.

3. The delivery catheter of claim 1 , wherein the expansion member comprises a flexible wire material.

4. The delivery catheter of claim 1 , wherein the expansion member comprises a self-expanding bubble.

5. The delivery catheter of claim 1 , wherein the expansion member comprises a spring-loaded bubble.

6. 6. The delivery catheter of claim 5, wherein the spring is held in compression by the cover, and removal of the cover allows the spring to uncoil, thereby causing the spring-loaded bubble to expand and form a dome shape.

7. The delivery catheter of claim 1 , wherein the expansion member is configured to be retracted by re-advancing the removable covering over the expansion member.

8. The delivery catheter of claim 1 , wherein actuation of the expansion member presses the expansion member against a vessel wall to provide wall apposition to the delivery catheter to facilitate puncture of the vessel wall.

9. The delivery catheter of claim 1 , wherein the wire comprises a hypotube.

10. The delivery catheter of claim 1 , wherein the expansion member is not actuated by inflation with a liquid or gas.

11. 1. A guidewire delivery catheter for use in implanting a shunt between the coronary sinus and the left atrium, said guidewire delivery catheter comprising: an actuation member including a wire; a fixation mechanism comprising: an expansion member actuated by the activating member, the expansion member proximally coupled to a distal end of the activating member, the expansion member configured to expand out of the guidewire delivery catheter in response to distal advancement of the activating member, the expansion member thereby fixing the distal end of the guidewire delivery catheter in a predetermined position within the coronary sinus.

12. The guidewire delivery catheter of claim 11 , wherein the expansion member comprises a mesh structure.

13. The guidewire delivery catheter of claim 11 , wherein the expansion member comprises a flexible wire material.

14. The guidewire delivery catheter of claim 11 , wherein the expansion member is configured to be retracted by pulling the motive member proximally.

15. The guidewire delivery catheter of claim 11 , wherein a distal portion of the expansion member is fixed to the guidewire delivery catheter.

16. The guidewire delivery catheter of claim 11 , wherein actuation of the expansion member presses the expansion member against a vessel wall to provide wall apposition to the guidewire delivery catheter to facilitate puncture of the vessel wall.

17. 12. The guidewire delivery catheter of claim 11, wherein the expansion member comprises a fabric covering that constrains a distal portion of the motive member such that as the motive member advances distally, the distal portion of the motive member curves within the fabric covering, causing the fabric covering to form a dome shape.

18. The guidewire delivery catheter of claim 11 , wherein the wire comprises a hypotube.

19. The guidewire delivery catheter of claim 11 , wherein the expansion member is not actuated by inflation with a liquid or gas.

20. 1. A guidewire delivery catheter for use in implanting a shunt between the coronary sinus and the left atrium, said guidewire delivery catheter comprising: an actuation member including a wire coupled to a movable distal structure; a movable distal structure having a pliable material forming a wall attached to the fixed proximal structure and the movable distal structure such that pulling the motive member moves the movable distal structure toward the fixed proximal structure and bulges the wall outward, thereby fixing the distal end of the guidewire delivery catheter in place within the coronary sinus;

21. The guidewire delivery catheter of claim 20 , wherein the wall comprises a flexible wire material.

22. The guidewire delivery catheter of claim 20 , wherein the expansion member is configured to be retracted by pushing on the actuation member.

23. 21. The guidewire delivery catheter of claim 20, wherein actuation of the expansion member presses the expansion member against a vessel wall to provide wall apposition to the guidewire delivery catheter to facilitate puncture of the vessel wall.

24. The guidewire delivery catheter of claim 20 , wherein the actuation member comprises a wire extending through a hypotube, the hypotube being surrounded by the fixed proximal structure.

25. The guidewire delivery catheter of claim 20 , wherein the wire comprises a hypotube.

26. The guidewire delivery catheter of claim 20 , wherein the expansion member is not actuated by inflation with a liquid or gas.

Images