Guidewire, and method based on guidewire

Abstract

To provide an adjuster for translating a guidewire along an axis of the guidewire.SOLUTION: An adjuster 40 for translating a guidewire 44 along an axis of the guidewire comprises: a first wheel 56 which on rotation translates a guidewire positioned in the adjuster along an axis of the guidewire; a port 102 distal to the first wheel and configured to accept the guidewire; and a slot to retain a rotation axis of the first wheel. In the absence of pressure on the first wheel from a finger of a physician, the rotation axis of the first wheel is situated in a prescribed position in the slot, and the first wheel does not engage with the guidewire. When the finger of the physician applies pressure to the first wheel, the rotation axis of the first wheel moves within the slot so as to engage the first wheel with the guidewire, so that the physician's finger manipulation to rotate the first wheel translates the guidewire along the axis of the guidewire.SELECTED DRAWING: Figure 6

Description

[Technical field]

[0001] The present invention relates generally to sinus surgery, and more particularly to the operation of instruments used in sinus surgery. [Background technology]

[0002] Balloon sinus surgery can be used by ear, nose and throat surgeons to treat blocked nasal passages. The procedure involves inserting a balloon over a guidewire into the sinus. After insertion, the balloon is inflated to open up the sinus walls.

[0003] The documents incorporated by reference into this patent application are to be considered as part of this application, except that if any term is defined in those incorporated documents in a manner that contradicts the definition given herein, either expressly or impliedly, then only the definition given herein shall be considered. Summary of the Invention [Means for solving the problem]

[0004] An embodiment of the present invention provides a manipulator, the manipulator comprising: an elongated chassis including a U-shaped path defining a distal direction and a proximal direction; and an adjuster configured to slide within the U-shaped path, the adjuster comprising: a first wheel that, when rotated, translates a guidewire disposed within the adjuster along an axis of the guidewire; a second wheel that, when rotated, rotates a guidewire disposed within the adjuster about an axis of the guidewire; The first and second wheels have openings distal thereto that are configured to accommodate a tubular balloon and a guidewire.

[0005] Typically, the first wheel has a first wheel axle and the adjuster further has a retention slot configured to receive the first wheel axle such that as the first wheel rotates about the first wheel axle, the first wheel slides within the retention slot to engage the guidewire.

[0006] In a disclosed embodiment, the second wheel rotates about a second wheel axis, and the adjuster further includes a plurality of cylinders housed in the second wheel and having respective axes parallel to the second wheel axis, such that as the second wheel rotates about the second wheel axis, the cylinders move perpendicular to their axes and engage the guidewire. The second wheel may include an open triangular portion, and the plurality of cylinders includes three cylinders located at respective vertices of the triangular portion. Typically, as the second wheel rotates about the second wheel axis, the cylinders are pushed inward by each side of the triangular portion to engage the guidewire.

[0007] In a further disclosed embodiment, the balloon is attached in a fluid-tight manner to an opening at the proximal end of the balloon.

[0008] In a further disclosed embodiment, the manipulator further comprises a balloon retaining tube that passes through the opening and is attached to the distal end of the balloon.

[0009] In another embodiment, the U-shaped pathway includes a passageway configured to restrict the balloon and guidewire from escaping the pathway. Typically, as the adjuster slides within the U-shaped pathway, the balloon translates along the pathway.

[0010] Yet another embodiment has a rigid tube removably attached to the elongated chassis, the rigid tube configured to house the tubular balloon and the guidewire. Typically, the rigid tube is attached in a non-aligned position with the elongated chassis.

[0011] There is further provided, in accordance with an embodiment of the present invention, a guidewire comprising: a plastic tube having a length and configured to be inserted into the paranasal sinus, the plastic tube defining an internal lumen; A braid embedded in a plastic tube; A metal wire is disposed within the lumen and along the length of the plastic tube.

[0012] In a disclosed embodiment, the plastic tube has a first plastic tube joined to a second plastic tube, the lumen being common to the first and second tubes. The first and second plastic tubes may have different flexibility from one another. The first and second plastic tubes may have different thickness from one another.

[0013] According to an embodiment of the present invention, there is further provided a method, the method comprising: providing an elongated chassis including a U-shaped path defining a distal direction and a proximal direction; and sliding the adjuster in a U-shaped path, the adjuster comprising: a first wheel that, when rotated, translates a guidewire disposed within the adjuster along an axis of the guidewire; a second wheel that, when rotated, rotates a guidewire disposed within the adjuster about an axis of the guidewire; The first and second wheels have openings distal thereto that are configured to accommodate a tubular balloon and a guidewire.

[0014] According to an embodiment of the present invention, there is further provided a method, the method comprising: forming a lumen in a plastic tube having a length and configured to be inserted into a paranasal sinus; incorporating a braid into a plastic tube; and placing a metal wire within the lumen and along the length of the plastic tube.

[0015] A more complete understanding of the present disclosure will be obtained from the following detailed description of the embodiments of the present disclosure when read in conjunction with the drawings. [Brief description of the drawings]

[0016] [Figure 1] 1 is a schematic perspective view of a sinus surgery guidewire and a balloon manipulator according to an embodiment of the present invention. FIG. [Diagram 2] FIG. 2 is a partial exploded view of a manipulator in accordance with an embodiment of the present invention. [Diagram 3] FIG. 2 is an enlarged top view of the exploded view according to the embodiment of the present invention. [Figure 4] FIG. 2 is an enlarged bottom view of the exploded view according to the embodiment of the present invention. [Diagram 5] FIG. 13 illustrates an adjuster of a manipulator, according to an embodiment of the present invention. [Figure 6] FIG. 13 illustrates an adjuster of a manipulator, according to an embodiment of the present invention. [Figure 7] FIG. 2 is a schematic cross-sectional view showing a wheel of an adjuster according to an embodiment of the present invention. [Figure 8] FIG. 2 is a schematic cross-sectional view showing a balloon attached to an adjuster, in accordance with an embodiment of the present invention. [Figure 9] 13A-13C illustrate straight paths in a U-shaped path of a manipulator, according to an embodiment of the present invention. [Figure 10] FIG. 2 illustrates a distal portion of a manipulator, according to an embodiment of the present invention. [Figure 11] FIG. 2 is a partial exploded view of the distal portion according to an embodiment of the present invention. [Figure 12] 1 is a schematic diagram of a guidewire, in accordance with an embodiment of the present invention. [Figure 13] 1 is a schematic diagram of a guidewire, in accordance with an embodiment of the present invention. [Figure 14] 1 is a schematic diagram of a guidewire, in accordance with an embodiment of the present invention. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0017] FIG. 1 is a schematic perspective view of a sinus surgery guidewire and balloon manipulator 20 according to an embodiment of the present invention. FIG. 2 is a partially exploded view of the manipulator according to an embodiment of the present invention. FIG. 3 is an enlarged top view of the exploded view according to an embodiment of the present invention. FIG. 4 is an enlarged bottom view of the exploded view according to an embodiment of the present invention. As described in more detail below, the manipulator 20 is configured to allow a sinus surgery procedure physician to use one hand to manipulate the procedure's guidewire and advance and retract a balloon utilized in the procedure. A distal portion 22 of the manipulator is also described below.

[0018] The manipulator 20 comprises an elongated, generally U-shaped chassis 24 to which a chassis retainer 28 is movably attached. In one embodiment, the chassis 24 is formed of two mirror image sections 24A and 24B joined together. The retainer 28 is designed to be held by a physician in a finger-friendly manner. The retainer can be positioned and secured proximally / distally relative to the chassis by sliding along ridges 32 formed on the outer base of the chassis 24.

[0019] A guidewire position adjuster 40 is held within a U-shaped passageway 36 in the chassis. The passageway defines the distal and proximal directions of the chassis. As will be described in more detail below, the adjuster 40 allows a physician holding the manipulator to translate and rotate a guidewire 44 passing through the adjuster. The guidewire can be translated either distally or proximally along its axis, as indicated by double arrow 48. The guidewire can be rotated about its axis, as indicated by double arrow 52. Translation and rotation can be accomplished with the thumb or one of the fingers of the physician holding the manipulator. As will be described below, the adjuster 40 allows a physician to translate and inflate a sinus surgery balloon attached to the adjuster. Typically, the adjuster includes a passageway for inflation. Inflation may be accomplished by a device such as a pump connected to the adjuster.

[0020] Adjuster 40 has three wheels: a first wheel 56 rotatable about an axis perpendicular to the axis of guidewire 44, a second wheel 60 rotatable about an axis parallel to the axis of the guidewire, and a third wheel 72 having an axis of rotation parallel to the axis of wheel 56. Wheel 72 is not shown in Figures 1 to 4 because it is provided inside adjuster 40, but is shown in Figure 6, which will be described later.

[0021] 5 and 6 show the adjuster 40 according to an embodiment of the present invention. In Fig. 5, the second wheel 60 itself is omitted, and the internal structure of the second wheel 60 is shown. Fig. 6 is a diagram showing a portion including the adjuster 40 and a part of the manipulator 20, and shows the internal structure related to the first wheel 56.

[0022] As shown in FIG. 5, adjuster 40 includes a slot 64 that holds an axle 68 (FIG. 6) of wheel 56. Slot 64 allows the axle, and corresponding wheel, to move perpendicularly relative to the guidewire. In a condition where there is no pressure from the physician's finger, axle 68 is at the top of the slot and wheel 56 contacts but does not engage the guidewire. In this condition, the guidewire is movable relative to wheel 56.

[0023] When the physician applies pressure to wheel 56, for example by rotating the wheel with a thumb or other finger, axle 68 moves down within slot 64 and wheel 56 engages guidewire 44, i.e., pressing the guidewire against rotatable wheel 72. Thus, when the physician applies pressure to rotate wheel 56, the guidewire translates along its own axis in the direction of arrow 48 (FIG. 1). On the other hand, if the physician does not apply pressure to rotate wheel 56, the guidewire is not engaged by the wheel and is therefore not constrained in the axial direction by the wheel.

[0024] Wheel 60 (FIG. 3) performs a function generally similar to that of wheel 56. That is, when wheel 60 is rotated by pressure from the physician, it rotates the guidewire about its own axis in the direction of arrow 52 (FIG. 1), but in the absence of pressure, the wheel does not engage the guidewire, as will be described below.

[0025] Inside the wheel 60 there are three roughly identical cylinders 76 built into the wheel, with their axes parallel to the axis of the wheel 60. Each cylinder 76 is located at the apex of an equilateral triangle and is held in place by ends 80 and 84 which also serve to hold the wheel 60.

[0026] FIG. 7 is a schematic cross-sectional view showing two states of a wheel 60 according to an embodiment of the present invention. As shown in both views 88 and 92, the interior 96 of the wheel 60 has a triangular open cross-sectional shape. View 88 shows a schematic of the first state of the wheel 60, the "open" state. In this state, the wheel 60 does not rotate, and the cylinder 76 may contact the guidewire 44 due to gravity, but the guidewire experiences little or no frictional force to prevent it from moving along its axis. View 92 shows the second state of the wheel, the rotating state. In this state, the cylinder 76 is pushed inward by the sides of the triangular portion 96 and moves perpendicular to their axis to engage the guidewire 44. This engagement causes the guidewire to rotate.

[0027] 6, the adjuster 40 is also attached in a watertight manner to the tubular balloon for paranasal sinus surgery 100. As described later, the distal end side of the balloon is stretched by supplying a fluid to the balloon.

[0028] FIG. 8 is a schematic cross-sectional view of a balloon 100 attached to an opening 102 in an adjuster 40 according to an embodiment of the present invention. The opening 102 is at the distal end of the adjuster 40 and therefore distal to the wheels 56 and 60. A guidewire 44 exits the adjuster and passes through a central lumen 104 of the tubular balloon 100. The balloon 100 is attached in a gas / liquid (fluid) sealed manner to an opening 102 at the proximal end of the balloon. The balloon is further attached at its distal end to a balloon retention tube 106, which passes through the opening 102 and is attached at its proximal end to the adjuster 40. The balloon may be filled with compressed air or a liquid such as saline via a passage 108 built into the adjuster 40 (the opening 102, the tube 106, and the passage 108 are also shown in FIG. 6). The view at 112 shows the balloon and guidewire in a deflated balloon state. The diagram designated 116 shows the balloon and guidewire in a state in which the balloon has been inflated by injecting a fluid (liquid or air) into the balloon via passage 108. For ease of illustration, other elements of manipulator 20, described below, have been omitted from FIG.

[0029] 9 illustrates a straight passageway 120 within the U-shaped passageway 36, according to an embodiment of the present invention. (Passageway 120 is also shown in FIG. 3.) The balloon 100 fits within the passageway 120, which is configured to restrict the balloon and guidewire 44 from escaping the passageway. The adjuster 40 is configured to be translatable along the U-shaped passageway 36 in either the distal or proximal direction. It will be understood that such translation also causes the balloon 100 to translate within the passageway 120.

[0030] FIG. 10 illustrates a distal portion 22 of the manipulator 20 according to an embodiment of the present invention. FIG. 11 illustrates a partial exploded view of the distal portion according to an embodiment of the present invention. The portion 22 includes a rigid tube 124. The rigid tube 124 is coupled to the chassis 24 such that the distal end is aligned with the distal end of the passageway 120, as described below. The distal end 128 of the tube 124 is formed with an interlocking connection portion 132 that can be curved and straightened by turning a knurled knob 136 clockwise or counterclockwise. The portion 132 may be coupled to the knob 136 in any suitable manner known in the art. US Patent Application Publication No. 15 / 155,850 describes a method of coupling the portion 132 to the knob 136 such that the bending and straightening as described herein can be achieved. In the method, a metallic ribbon having a curved cross-sectional shape is used to connect the portion 132 to the knob 136. Rotation of the knob thereby translates the ribbon distally and proximally along tube 124. Optionally, tube 124 includes an orifice 126 through which irrigation fluid may exit the tube.

[0031] Tube 124 is fitted and secured within tube housing 140. The tube may be removed from the housing, thereby exposing cylindrical element 139, as shown in FIG. 11. The tube may then be rotated and reinserted into element 139. After insertion into the housing, the tube and element 139 may be locked in place by lock 172. This removal and reinsertion allows any orientation of curvature of portion 132 of distal end 128 relative to the axis of tube 124 to be selected.

[0032] 10 and 11, the tube 124 extends in a straight line with the chassis 24. However, the tube can be rotated to one or more fixed positions out of the extension of the chassis while the proximal end of the tube and the distal end of the passageway 120 are aligned. To achieve this rotation, the distal portion 148 of the chassis 24 is provided with a protruding axle 152 that extends perpendicular to the axis of the tube 124. The axle 152 is further configured to rotatably fit into a round hole 156 in the distal portion 160 of the chassis 24. A tooth 164 of the housing 140 can fit into one of several receiving recesses 168 in the distal portion 160. When the tooth 164 is fitted into one of the recesses 168, the lock 144 can prevent the tube 124 from rotating about the axle 152.

[0033] The ability of tube 124 to rotate relative to chassis 24 enhances the use of manipulator 20 in sinus surgery procedures, which, as is known, typically require the use of endoscopes and other instruments in confined areas such as a patient's nostrils.

[0034] Figures 12, 13 and 14 show schematic diagrams of guidewire 44 in accordance with an embodiment of the present invention. Figure 12 shows the inside of guidewire distal section 200 and a portion of guidewire proximal section 204. In one embodiment, guidewire 44 has a total length of about 1.3 m and distal section 200 has a length of about 0.2 m. In other embodiments, the total length and / or distal section lengths may be different.

[0035] The proximal section 204 and distal section 200 each have a cylindrical plastic tube 208, 212 that are joined together to form an internal common lumen 216. A nitinol wire 220 is disposed within lumen 216 and typically extends the entire length of the guidewire, although in some embodiments it may be shorter than the guidewire.

[0036] Tubes 208 and 212 are typically formed of a plastic such as polyimide or polyamide. Each tube is reinforced, for example by incorporating a braid. Typically, the braid is a stainless steel braid. Alternatively, the braid may include a polymer braid, and the polymer may also be formed of a polyimide.

[0037] Typically, distal portion 200 is constructed to be slightly more flexible than proximal portion 204. This flexibility difference can be achieved by forming each portion from a plastic having different appropriate properties. Additionally / alternatively, tube 208 can be constructed to be thicker than tube 212.

[0038] 13 is a schematic cross-sectional view along guidewire axis 224 showing tubes 208 and 212. Tube 208 incorporates braid 228. Tube 212 incorporates braid 232. A wire 236 within lumen 216 extends the entire length of the guidewire, the function of which will be described below.

[0039] FIG. 14 shows a schematic of the distal end 240 of the distal section 200. The end 240 includes a uniaxial coil 244 that functions as a position sensor. The coil 244 is wrapped around a polyimide tube 246 through which the Nitinol wire 220 passes. A wire 236 (shown as a cylinder in FIG. 14) is connected to the uniaxial coil and transmits a signal generated by the coil to the manipulator 20 and further to a processor (not shown). An alternating magnetic field passing through the coil generates a signal in the coil that allows the processor to determine the position and orientation of the coil. Such systems are known and are employed, for example, in the Carto system manufactured by Biosense Webster, Technology Drive, Irvine, Calif. 92618, USA.

[0040] Distal end 240 is sealed at its tip with a biocompatible cement plug 252, which makes lumen 216 water- and air-tight.

[0041] In one embodiment, the nitinol wire 220 is slightly bent, typically around 15°, so that the distal end 240 is also bent relative to the rest of the guidewire.

[0042] The inventors have determined that a Nitinol wire within one or more plastic tubes and a braid incorporated into the tube prevents tangling of the guidewire.

[0043] It will be understood that the above-described embodiments are given by way of example, and that the present invention is not limited to what has been particularly shown and described above. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof not disclosed in the prior art that would occur to one skilled in the art upon reading the foregoing description.

[0044] [Embodiment] (1) A manipulator comprising: an elongated chassis including a U-shaped path defining a distal direction and a proximal direction; and an adjuster configured to slide within the U-shaped path, the adjuster comprising: a first wheel that, when rotated, translates a guidewire disposed within the adjuster along an axis of the guidewire; a second wheel that, when rotated, rotates the guidewire disposed within the adjuster about the axis of the guidewire; A manipulator having an opening distal to the first and second wheels, the opening configured to accommodate a tubular balloon and the guidewire. (2) The manipulator of embodiment 1, wherein the first wheel has a first wheel axis and the adjuster further has a retention slot configured to accommodate the axis, such that when the first wheel rotates about the first wheel axis, the first wheel slides within the retention slot to engage the guide wire. (3) A manipulator as described in embodiment 1, wherein the second wheel rotates around a second wheel axis, and the adjuster further comprises a plurality of cylinders incorporated in the second wheel and having respective axes parallel to the second wheel axis, whereby when the second wheel rotates around the second wheel axis, the cylinders move perpendicular to their axes and engage with the guide wire. (4) A manipulator as described in embodiment 3, wherein the second wheel includes an open triangular portion and the plurality of cylinders includes three cylinders positioned at respective vertices of the triangular portion. (5) A manipulator as described in embodiment 4, wherein when the second wheel rotates about the second wheel axis, the cylinder is pushed inward by each side of the triangular portion to engage with the guide wire.

[0045] (6) A manipulator as described in embodiment 1, wherein the balloon is attached to the opening at the proximal end of the balloon in a fluid-tight manner. (7) A manipulator as described in embodiment 1, having a balloon holding tube passing through the opening and attached to the distal end of the balloon. (8) A manipulator as described in embodiment 1, wherein the U-shaped path includes a passageway configured to restrict the balloon and the guide wire from escaping from the passageway. (9) The manipulator of embodiment 8, wherein the balloon translates along the passage when the adjuster slides within the U-shaped path. (10) The manipulator of embodiment 1, further comprising a rigid tube removably attached to the elongated chassis, the rigid tube configured to accommodate the tubular balloon and the guidewire.

[0046] (11) The manipulator of claim 10, wherein the rigid tube is attached in a position that is not aligned with the elongated chassis. (12) A guidewire comprising: a plastic tube having a length and configured to be inserted into the paranasal sinus and defining an internal lumen; a braid embedded in the plastic tube; a metallic wire disposed within the lumen and along the length of the plastic tube. (13) The guidewire of embodiment 12, wherein the plastic tube comprises a first plastic tube joined to a second plastic tube, the lumen being common to the first and second tubes. (14) The guidewire of embodiment 13, wherein the first and second plastic tubes have different flexibilities. (15) The guidewire of embodiment 13, wherein the first and second plastic tubes have different thicknesses.

[0047] (16) A method comprising the steps of: providing an elongated chassis including a U-shaped path defining a distal direction and a proximal direction; and sliding an adjuster within the U-shaped path, the adjuster comprising: a first wheel that, when rotated, translates a guidewire disposed within the adjuster along an axis of the guidewire; a second wheel that, when rotated, rotates the guidewire disposed within the adjuster about the axis of the guidewire; and an opening distal to the first and second wheels, the opening configured to accommodate a tubular balloon and the guidewire. (17) The method of embodiment 16, wherein the first wheel has a first wheel axle, and the adjuster further has a retention slot configured to receive the axle, such that when the first wheel rotates about the first wheel axle, the first wheel slides within the retention slot to engage the guide wire. (18) The method of embodiment 16, wherein the second wheel rotates about a second wheel axis, and the adjuster further comprises a plurality of cylinders mounted on the second wheel and having respective axes parallel to the second wheel axis, such that as the second wheel rotates about the second wheel axis, the cylinders move perpendicular to their axes and engage the guide wire. (19) The method of claim 18, wherein the second wheel includes an open triangular portion, and the plurality of cylinders includes three cylinders positioned at respective vertices of the triangular portion. (20) The method of embodiment 19, wherein when the second wheel rotates about the second wheel axis, the cylinder is pushed inward by each side of the triangular portion to engage the guide wire.

[0048] 21. The method of claim 16, further comprising attaching the balloon to the opening at a proximal end of the balloon in a fluid-tight manner. (22) The method of embodiment 16, further comprising attaching a balloon retention tube to a distal end of the balloon through the opening. (23) The method of embodiment 16, wherein the U-shaped pathway includes a passageway, and the method includes restraining the balloon and the guidewire from escaping from the passageway. (24) The method of claim 23, further comprising translating the balloon along the passageway as the adjuster slides within the U-shaped path. (25) The method of claim 16, further comprising removably attaching a rigid tube to the elongated chassis, the tube configured to house the tubular balloon and the guidewire.

[0049] (26) The method of claim 25, wherein the rigid tube is attached in a position that is not aligned with the elongated chassis. (27) A method comprising the steps of: forming a lumen in a plastic tube having a length and configured to be inserted into a paranasal sinus; incorporating a braid into the plastic tube; and placing a metallic wire within the lumen and along the length of the plastic tube. 28. The method of claim 27, wherein the plastic tube comprises a first plastic tube joined to a second plastic tube, the lumen being common to the first and second tubes. 29. The method of claim 28, wherein the first and second plastic tubes have different flexibilities. 30. The method of claim 28, wherein the first and second plastic tubes have different thicknesses.

Claims

1. an adjuster for translating a guidewire along an axis of the guidewire, a first wheel that, when rotated, translates the guidewire disposed within the adjuster along an axis of the guidewire; an opening distal to the first wheel, the opening configured to receive the guidewire; a slot for holding the rotation axis of the first wheel; an adjuster, wherein when no pressure is applied to the first wheel by a physician's finger, the axis of rotation of the first wheel is at a predetermined position within the slot and the first wheel is not engaged with the guidewire, and when pressure is applied to the first wheel by a physician's finger, the axis of rotation of the first wheel moves within the slot and the first wheel engages with the guidewire, such that rotation of the first wheel by manipulation of the physician's finger causes the guidewire to translate along the axis of the guidewire.

2. a second wheel that, when rotated, rotates the guidewire disposed within the adjuster about the axis of the guidewire; when no pressure is applied to the second wheel from the physician's finger, the second wheel is not engaged with the guide wire, and when pressure is applied to the second wheel from the physician's finger, the second wheel is engaged with the guide wire; The adjuster of claim 1 , wherein the opening is located distal to the second wheel.

3. A manipulator comprising: an elongated chassis including a U-shaped path defining a distal direction and a proximal direction; and an adjuster according to claim 1 or 2, configured to slide within the U-shaped path.

4. A manipulator comprising: an elongated chassis including a U-shaped path defining a distal direction and a proximal direction; and the adjuster of claim 2 configured to slide within the U-shaped path. A manipulator wherein the second wheel rotates around a second wheel axis, the adjuster further has a plurality of cylinders built into the second wheel and an open triangular portion, the plurality of cylinders including three cylinders positioned at each vertex of the triangular portion, and when the second wheel rotates around the second wheel axis, the plurality of cylinders rotate, rotating the guide wire around the axis of the guide wire.

5. The manipulator of claim 3 , further comprising a rigid tube removably attached to the elongated chassis, the rigid tube configured to accommodate the guidewire.

6. The manipulator of claim 5 , wherein the rigid tube is attached in a non-aligned position with the elongated chassis.

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