Radially Clocked Steerable Catheter

Abstract

The steerable catheter includes a catheter shaft having a lumen defined by a catheter wall, a proximal portion, a distal portion, and a length extending therebetween, and at least one pull wire extending along the length of the catheter shaft and coupled to the catheter wall. The at least one pull wire has a proximal section extending along the proximal portion of the catheter shaft at a first radial location, a distal section extending along the distal portion of the catheter shaft at a second radial location, and a transition zone connecting the proximal and distal sections. The second radial location is circumferentially offset from the first radial location.

Description

[Technical Field]

[0001] TECHNICAL FIELD The present disclosure relates to medical devices, and more particularly to steerable catheters and methods of using such medical devices. [Background technology]

[0002] A wide variety of intracorporeal medical devices have been developed for medical applications, such as intravascular applications. Some of these devices include guidewires, catheters, medical device delivery systems (e.g., for stents, grafts, replacement valves), and the like. These devices can be manufactured by any one of a variety of different manufacturing methods and used according to any one of a variety of different methods. Each of the known medical devices and methods has certain advantages and disadvantages. There is a continuing need to provide alternative medical devices and alternative methods of manufacturing and using medical devices. Summary of the Invention

[0003] The present disclosure provides medical device designs, materials, manufacturing methods, and alternative uses. An exemplary medical device includes a steerable catheter comprising a catheter shaft having a lumen defined by a catheter wall, the catheter shaft having a proximal portion, a distal portion, and a length extending therebetween, and at least one pull wire extending along the length of the catheter shaft and coupled to the catheter wall. The at least one pull wire has a proximal section extending along the proximal portion of the catheter shaft at a first radial location, a distal section extending along the distal portion of the catheter shaft at a second radial location, and a transition zone connecting the proximal and distal sections, the second radial location being circumferentially offset from the first radial location.

[0004] Alternatively or additionally to the above embodiment, the at least one pull wire extends within the catheter wall. Alternatively or additionally to any of the above embodiments, the catheter wall is at least partially defined by a plurality of braided or woven filaments, and the at least one pull wire is braided or woven into the plurality of braided or woven filaments.

[0005] Alternatively or additionally to any of the above embodiments, the transition zone has a length of 13 mm to 51 mm (0.5 inches to 2.0 inches). Alternatively or additionally to any of the above embodiments, the transition zone is 51 mm to 127 mm (2.0 inches to 5.0 inches) from the distal tip of the catheter shaft.

[0006] Alternatively or additionally to any of the above embodiments, the second radial position is offset from the first radial position by 10% to 50% of the circumference of the catheter shaft.

[0007] Alternatively or additionally to any of the above embodiments, the second radial position is offset from the first radial position by between 20 and 190 degrees. Alternatively or additionally to any of the above embodiments, the second radial position is offset from the first radial position by between 45 degrees and 135 degrees.

[0008] Alternatively or additionally to any of the above embodiments, the steerable catheter further comprises an outer shaft having a lumen defined by a shaft wall, the outer shaft having a steering member extending longitudinally within the shaft wall, the steering member configured to articulate a distal region of the outer shaft, the catheter shaft being movable within the lumen of the outer shaft.

[0009] Alternatively or additionally to any of the above embodiments, at least the distal portion of the catheter shaft is configured to extend distally from the outer shaft.

[0010] Alternatively or additionally to any of the above embodiments, the steering member and the at least one pull wire are separately actuatable to articulate the outer shaft and the catheter shaft independently of one another.

[0011] Alternatively or additionally to any of the above embodiments, the outer shaft is articulatable to have a first curve that lies in a first plane, and the distal portion of the catheter shaft extending distally from the outer shaft is articulatable to have a second curve that lies in a second plane, the first and second planes being different.

[0012] Alternatively or additionally to any of the above embodiments, the second plane is at an angle of between 45 degrees and 135 degrees to the first plane. Another exemplary steerable catheter assembly includes an outer sheath having a distal end, a proximal end, and a lumen extending therebetween, the outer sheath having an articulation region adjacent the distal end, the articulation region configured to articulate to a first curve in a first plane, an inner shaft slidable within the lumen of the outer sheath, the inner shaft having a lumen defined by an inner shaft wall, the inner shaft having a proximal portion, a distal portion, and a length extending therebetween, the inner shaft having a pull wire extending along the length of the inner shaft and coupled to the inner shaft wall, the pull wire configured to articulate the distal portion of the inner shaft to a second curve in a second plane when the distal portion is moved distally out of the outer sheath, the second plane being at an angle of 45 degrees to 135 degrees with respect to the first plane.

[0013] Alternatively or additionally to the above embodiment, the pull wire has a proximal section extending along the proximal portion of the inner shaft at a first radial position, a distal section extending along the distal portion of the inner shaft at a second radial position, and a transition zone connecting the proximal and distal sections, wherein the second radial position is circumferentially offset from the first radial position.

[0014] Alternatively or additionally to any of the above embodiments, the inner shaft is at least partially defined by a plurality of braided or woven filaments, and the pull wire is braided or woven into the plurality of braided or woven filaments.

[0015] Alternatively or additionally to any of the above embodiments, the transition zone has a length of 13 mm to 51 mm (0.5 inches to 2.0 inches) and is located 51 mm to 127 mm (2.0 inches to 5.0 inches) from the distal end of the inner shaft.

[0016] Alternatively or additionally to any of the above embodiments, the second radial position is offset from the first radial position by between 20 and 190 degrees. Alternatively or additionally to any of the above embodiments, the outer sheath includes a steering member extending longitudinally within a wall of the outer sheath, the steering member configured to articulate the articulation region into a first curve, and the steering member and the pull wire are separately actuatable to articulate the outer sheath and the inner shaft independently of one another.

[0017] Another exemplary steerable catheter assembly includes an outer sheath having a distal end, a proximal end, and a lumen extending therebetween, the outer sheath having an articulation region adjacent the distal end; a steering member configured to articulate the articulation region into a first curve in a first plane; and an inner shaft slidable within the lumen of the outer sheath, the inner shaft having a proximal portion, a distal portion, and a length extending therebetween, the inner shaft having a pull wire coupled thereto, the pull wire being oriented in a first radial position. The outer sheath includes a proximal section extending along the proximal portion of the inner shaft, a distal section extending along the distal portion of the inner shaft at a second radial position, and a transition zone connecting the proximal and distal sections, the second radial position being circumferentially offset from the first radial position, and the pull wire is configured to articulate the distal portion of the inner shaft into a second curve in a second plane when the distal portion is moved distally out of the outer sheath, the second curve being different from the first plane and the second plane.

[0018] The above summary of some embodiments, aspects, and / or examples is not intended to describe each embodiment or every implementation of the present disclosure. The figures and the detailed description that follow more particularly exemplify these embodiments. [Brief explanation of the drawings]

[0019] The present disclosure may be more fully understood from the following detailed description of various embodiments, taken in conjunction with the accompanying drawings. [Figure 1A] 1 shows the proximal end of a steerable catheter with a conventional pull wire. [Figure 1B] 1B shows the catheter of FIG. 1A illustrating the steering curve obtained by pulling the pull wire. [Figure 2A] 2 shows the first pull wire of the catheter of FIG. 1 being pulled. [Figure 2B]2B shows the curves operating within the catheter of FIG. 2A. [Figure 3A] 2 shows the second pull wire of the catheter of FIG. 1 being pulled. [Figure 3B] 3B shows the curves operating within the catheter of FIG. 3A. [Figure 4] 1B shows the standard steerable catheter of FIG. 1A with the inner standard steerable catheter extended distally and actuated. [Figure 5] FIG. 1 is a perspective view of an exemplary steerable catheter assembly in which an inner catheter is steered in a plane different from the plane of the outer catheter. [Figure 6] FIG. 6 is a cross-sectional view of the heart with the catheter of FIG. 5 inserted. [Figure 7] This is a view of FIG. 6 rotated by 90 degrees. [Figure 8] FIG. 6 is an end view of the steerable catheter assembly of FIG. 5. [Figure 9] FIG. 1 is a perspective view of a portion of another exemplary steerable catheter. [Figure 10] FIG. 10 is a perspective view of the steerable catheter of FIG. 9 bent at a 90 degree angle. [Figure 11] FIG. 11 is a first end view of the steerable catheter of FIG. 10. [Figure 12] FIG. 11 is a second end view of the steerable catheter of FIG. 10. [Figure 13] FIG. 11 is a top view of the steerable catheter of FIG. [Figure 14] FIG. 11 is a side view of the steerable catheter of FIG. [Figure 15A] 15A, 15B, and 15C are cross-sectional views of another exemplary steerable catheter at different positions along the catheter. [Figure 15B] Same as above. [Figure 15C] Same as above. [Figure 16] FIG. 1 is a partial perspective view of a further exemplary steerable catheter. [Figure 17]FIG. 17 is a cross-sectional view taken along line 17-17 of FIG. 16. [Figure 18] 6 illustrates operation of the steerable catheter assembly of FIG. 5. DETAILED DESCRIPTION OF THE INVENTION

[0020] While aspects of the present disclosure are susceptible to various modifications and alternative forms, specifics thereof have been shown by way of example in the drawings and will be described in detail. It is to be understood, however, that it is not intended to limit aspects of the present disclosure to the particular embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the present disclosure.

[0021] Detailed Description For the following defined terms, these definitions shall be applied, unless a different definition is given in the claims or elsewhere in this specification.

[0022] As used herein, all numerical values ​​are deemed to be modified by the term "about," whether explicitly stated or not. The term "about" in the context of numerical values ​​generally refers to a range of numerical values ​​that one of ordinary skill in the art would consider equivalent to the stated value (e.g., having the same function or result). In many cases, the term "about" may include numerical values ​​that are rounded to the nearest significant figure. Other uses of the term "about" (e.g., in non-numeric contexts) can be understood from and assumed to have the ordinary and customary definition consistent with the context of the specification, unless otherwise specified.

[0023] The recitation of numerical ranges by upper and lower limits includes all numbers within that range, inclusive of the limits (e.g., 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.80, 4, and 5). Although several suitable dimensions, ranges, and / or values ​​for various components, features, and / or specifications are disclosed, one of ordinary skill in the art, inspired by this disclosure, will recognize that desired dimensions, ranges, and / or values ​​may deviate from those expressly disclosed.

[0024] As used in this specification and the appended claims, the singular forms "a," "an," "the," and "said" include plural referents unless the content clearly dictates otherwise. As used in this specification and the appended claims, the term "or" is used in its general sense including "and / or" unless the content clearly dictates otherwise. For ease of understanding, it should be noted that certain features of the present disclosure may be described in the singular even if they are multiple or repeated within a disclosed embodiment. Each instance of a feature may comprise and / or be encompassed by a single disclosure unless expressly stated to the contrary. For purposes of simplicity and clarity, not every element of the present disclosure is necessarily shown in every figure or described in detail below. However, it will be understood that the following description may apply equally to any and / or all of a plurality of components unless expressly stated to the contrary. Moreover, for clarity, not every instance of some element or feature may be shown in every figure.

[0025] Relative terms such as "proximal," "distal," "advance," "retract," and variations thereof are typically considered with respect to the positioning, orientation, and / or operation of various elements relative to a user / operator / manipulator of a device, where "proximal" and "retract" indicate or refer to being closer to or toward the user, and "distal" and "advance" indicate or refer to being further from or away from the user. In some cases, the terms "proximal" and "distal" may be assigned arbitrarily to facilitate understanding of the present disclosure, and such examples will be readily apparent to those skilled in the art. Other relative terms, such as "upstream," "downstream," "inflow," and "outflow," refer to the direction of fluid flow within a lumen, such as within a body lumen, blood vessel, or device.

[0026] The term "range" may be understood to mean the maximum measurement of a stated or specified dimension; however, if the range or dimension is preceded by or identified as "minimum," it may be understood to mean the minimum measurement of the stated or specified dimension. For example, an "outer range" may be understood to mean the maximum outer dimension, a "radial range" may be understood to mean the maximum radial dimension, and a "longitudinal range" may be understood to mean the maximum longitudinal dimension. Examples of "range" may vary (e.g., axially, longitudinally, laterally, radially, circumferentially, etc.) and will be apparent to those skilled in the art from the context of the particular usage. Typically, a "range" is considered the maximum possible dimension measured according to the intended use, while a "minimum range" is considered the smallest possible dimension measured according to the intended use. In some cases, a "range" may typically be measured orthogonally in a plane and / or cross-section, but may also be measured differently, such as (but not limited to) angularly, radially, or circumferentially (e.g., along an arc), as apparent from the particular context.

[0027] The terms "monolithic" and "single" shall generally refer to an element made from or consisting of a single structure or basic unit / element. Monolithic and / or single element shall not include structures and / or features made from multiple individual elements assembled or otherwise joined together.

[0028] References herein to "one embodiment," "some embodiments," "other embodiments," etc., indicate that the described embodiment may include a particular feature, structure, or characteristic, but it should be noted that not all embodiments necessarily include that particular feature, structure, or characteristic. Moreover, such phrases do not necessarily refer to the same embodiment. Furthermore, if a particular feature, structure, or characteristic is described in connection with one embodiment, unless expressly stated to the contrary, it is within the knowledge of one of ordinary skill in the art to enable that particular feature, structure, or characteristic in connection with other embodiments, whether explicitly stated or not. That is, it is contemplated that various individual elements described below, even if not explicitly shown in specific combinations, can be combined or arranged with one another to form other or additional embodiments, or to supplement and / or enrich the described embodiments, as would be understood by one of ordinary skill in the art.

[0029] For purposes of clarity, certain distinguishing numerical nomenclature (e.g., first, second, third, fourth, etc.) may be used throughout this specification and / or claims to name and / or distinguish various features described and / or claimed. It should be understood that the numerical nomenclature is not intended to be limiting, but is merely exemplary. In some embodiments, variations and departures from previously used numerical nomenclature may be made for brevity and clarity. That is, a feature identified as a "first" element may later be referred to as a "second," "third," etc., or may be omitted entirely, and / or a different feature may be referred to as the "first" element. The meaning and / or name in each instance will be apparent to one of ordinary skill in the art.

[0030] The following description should be read with reference to the drawings, which are not necessarily to scale and in which similar elements in different drawings are numbered the same. The detailed description and drawings are for illustrative purposes only and are not intended to limit the present disclosure. Those skilled in the art will recognize that the various elements described and / or illustrated can be arranged in various combinations and configurations without departing from the scope of the present disclosure. The detailed description and drawings illustrate exemplary embodiments of the present disclosure. However, for clarity and ease of understanding, not all features and / or elements may be shown in each drawing, although it can be understood that such features and / or elements are present unless otherwise specified.

[0031] Diseases and / or conditions affecting the cardiovascular system are widespread worldwide. Traditionally, cardiovascular treatments have often been performed by directly accessing the affected portion of the cardiovascular system. For example, treatment of blockages in one or more coronary arteries has traditionally been treated using coronary artery bypass surgery. As can be readily appreciated, such treatments are highly invasive for the patient and require significant recovery time and / or treatment. More recently, minimally invasive treatments have been developed (e.g., angioplasty) that allow blocked coronary arteries to be accessed and treated via a percutaneous catheter, for example. Such treatments have gained widespread acceptance among patients and clinicians.

[0032] The heart of some mammals (e.g., humans) is equipped with four heart valves: the tricuspid valve, the pulmonary valve, the aortic valve, and the mitral valve. Relatively common medical conditions may involve or result in inefficiency, ineffectiveness, or malfunction of one or more of these valves within the heart. Treating defective heart valves presents additional challenges, as it often requires repair or complete replacement of the defective valve. Such treatments can be highly invasive to the patient. Disclosed herein are systems, devices, and / or methods that can be used within portions of the cardiovascular system to diagnose, treat, and / or repair one or more heart valves or other components. At least some of the systems, devices, and / or methods disclosed herein can be used percutaneously and, therefore, can be much less invasive to the patient, although other surgical methods and approaches can also be used. The systems, devices, and / or methods disclosed herein can also provide many additional desirable features and advantages, as described in more detail below.

[0033] For purposes of this disclosure, the following discussion is directed to the treatment of a native mitral valve and is so described for brevity. However, this is not intended to be limiting, and those skilled in the art will recognize that the following discussion may be applied to other heart valves or regions of the heart with no or minimal change to the structure and / or scope of the present disclosure. Similarly, the medical devices disclosed herein may be applied to and used in other portions of a patient's anatomy, such as, but not limited to, arteries, veins, and / or other body cavities.

[0034] Accessing regions of the heart often requires steering catheters to complex positions. For example, a procedure may involve articulating and / or steering a catheter in a second plane opposite a first plane in which the catheter is already articulated and / or steered. One such example is mitral valve treatment, which requires multiple steerable, telescopic catheters that must be steered in opposing planes. It may be desirable to articulate an outermost steerable catheter 90 degrees to 180 degrees or more in one plane to center the mitral valve. It may be desirable to pay out an innermost steerable catheter from the outermost catheter and then steer it approximately 90 degrees in a plane perpendicular to the steering plane of the outermost catheter. A problem with conventional steering mechanisms is that steering of the outermost catheter is biased, affecting the steerable plane in which the innermost catheter articulates. The outermost catheter predefines the plane in which the innermost catheter can articulate. Because the outermost catheter predefines this steerable plane relative to the innermost catheter, the innermost catheter loses the ability to be steered out of plane and torque relative to the outermost catheter.

[0035] A typical prior art steerable catheter may include one or more pull wires embedded in the catheter wall, as shown in Figures 1A-3B. In the example shown in Figure 1A, a catheter shaft 10 has two pull wires 12 extending along opposite sides of the catheter shaft. When steering the catheter shaft, the pull wires are pulled, causing the catheter shaft to bend / flex within the plane in which the pull wires are located, as shown by the dashed curves in Figure 1B. When articulating the catheter shaft 10, the pulled pull wire 12 will always be inside the bend radius and take the shortest path. Figure 2A shows one pull wire 12 being pulled, and Figure 2B shows the resulting curvature of the catheter shaft 10. Figure 3A shows the opposite pull wire 12 being pulled, and Figure 3B shows the resulting curvature of the catheter shaft 10.

[0036] Figure 4 shows the result of steering the inner catheter 14 inside an articulated outer catheter 10, where the inner catheter 14 is steered using standard pull wires as described above. When the outer steerable catheter 10 is articulated, any steerable catheter translating within it will attempt to align itself in the plane driven by the outer catheter 10. This is caused by the pull wires being pulled, biasing them to the inside of the bend radius of the outer catheter 10 as they attempt to take the shortest path. Because the inner catheter 14 has already traversed the bend radius defined by the outer catheter 10, steering from standard pull wires within the inner catheter 14 will result in the inner catheter 14 being steered in the same plane as the outer catheter, as shown in Figure 4.

[0037] For some treatments, articulating the inner catheter in the same plane as the outer catheter (as shown in FIG. 4 ) does not provide the access necessary to perform the procedure. Instead, the inner catheter must bend in a plane opposite that of the outer catheter. FIG. 5 illustrates an exemplary steerable catheter assembly 50 with the desired actuation of the inner catheter 16 relative to the outer catheter 10. In some instances, such as for administering treatment to a heart valve, it may be desirable for the inner catheter to be steerable in a plane different from that of the outer catheter. FIGS. 6 and 7 illustrate a desired position of the inner catheter 16 within the heart 5 to access the mitral valve. Treatments performed on the mitral valve may require access to a location below the posterior leaflet, the leaflet behind the catheter. To access such a location, it may be desirable to center the mitral valve by articulating the distal region of the outermost steerable catheter 10 in a 180-degree curve in a first plane, as shown in FIG. 6 . As shown in FIG. 7, it may be desirable to unwind the innermost steerable catheter shaft 16 from the outermost catheter 10 and then steer it approximately 90 degrees in a second plane perpendicular to the steering plane of the outermost catheter. The outermost catheter 10 and innermost steerable catheter shaft 16 may be independently actuable. For example, the outermost catheter 10 may be actuated first, and then the innermost steerable catheter shaft 16 may be actuated while extending partially out of the outermost catheter 10. For other procedures, it may be desirable to articulate the outer catheter 10 through a curve of 45 degrees to 270 degrees, and the inner catheter 16 through a curve of 45 degrees to 180 degrees. Additionally, it may be desirable to articulate the inner catheter 16 through a second plane of approximately 45 degrees to 135 degrees relative to the plane of the outer catheter 10.In some examples, the outer catheter 10 and inner catheter 16 may be 5 to 6 feet long, the outer catheter 10 may have an outer diameter of 0.10 to 0.30 inches and an inner diameter of 0.075 to 0.20 inches, and the inner catheter 16 may have an outer diameter of 0.05 to 0.175 inches. In one example, the outer catheter 10 may have an outer diameter of 0.245 inches and an inner diameter of 0.175 inches, and the inner catheter 16 may have an outer diameter of 0.106 inches.

[0038] Figure 8 shows the distal portion of the outer catheter 10 articulated to curve in a first plane P1. In some examples, as shown in Figure 8, the inner catheter 16 is actuated to curve in a second plane P2 that is perpendicular to the first plane P1 of the outer catheter 10. In other examples, the second plane P2 may be at an angle of 45 to 135 degrees relative to the first plane P1.

[0039] 9 and 10 show an exemplary steerable catheter shaft 160 disposed within a standard steerable outer catheter, such as the catheter 10 with the pullwire 12 described above, and structured to be steered in a different plane than the outer catheter when extended distally. The catheter shaft 160 has a lumen 161 defined by a catheter wall 162 and includes a proximal section 164, a distal section 166, and a transition section 168 between the proximal and distal sections 164 and 166. In the example shown in FIGS. 9 and 10, the catheter shaft 160 is formed by one or more woven or braided filaments 169. In other examples, the catheter shaft 160 may be a cylindrical structure with a solid wall. The catheter shaft 160 may include at least one pullwire 120 extending along the length of the catheter shaft 160 and coupled to the catheter wall 162. The pullwire 120 has a proximal section 124 extending along the proximal portion 164 of the catheter shaft, a distal section 126 extending along the distal portion 166 of the catheter shaft, and a transition zone 128 connecting the proximal section 124 and the distal section 126. The proximal section 124 of the pullwire 120 can extend to a first radial location 121, and the distal section 126 can extend to a second radial location 123 circumferentially offset from the first radial location 121, with the transition zone 128 angled to connect the proximal section 124 and the distal section 126.

[0040] 11-14 illustrate a first radial position 121 of the proximal section 124 of the pull wire 120 and a second radial position 123 of the distal section 126. FIG. 11 is a view looking down on the proximal portion 164 of the catheter shaft 160, showing the proximal section 124 of the pull wire 120 at approximately the 2 o'clock position. The distal section 126 of the pull wire 120 is seen extending along the top of the catheter shaft 160. This is more clearly shown in FIG. 12, where the catheter shaft 160 has been rotated to look down on the distal portion 166. The distal section 126 of the pull wire 120 is clearly shown at approximately the 12 o'clock position. Comparing FIGS. 11 and 12 shows that the first radial position 121 of the proximal section 124 of the pull wire 120 is circumferentially offset from the second radial position 123 of the distal section 126. A portion of the transition zone 128 of the pull wire 120 is shown in Figure 12, but is more clearly seen in Figure 13, which shows the transition zone 128 of the pull wire 120 looking through the rear of the catheter shaft 160, and in Figure 14, which shows a side view of the catheter shaft 160. The transition zone 128 extends at an angle relative to both the proximal section 124 and the distal section 126.

[0041] In some examples, the second radial position 123 is offset 10% to 50% around the circumference of the catheter shaft from the first radial position 121. This means that the second radial position 123 of the distal section 126 is offset approximately 36 degrees to 180 degrees from the first radial position 121 of the proximal section 124 of the pull wire 120. In other examples, the second radial position 123 may be offset 20 degrees to 190 degrees from the first radial position 121. In further examples, the second radial position 123 may be offset 45 degrees to 135 degrees from the first radial position 121. In some examples, the angle between the proximal section 124 and the transition zone 128 of the pull wire 120 may be the same as the angle between the transition zone 128 and the distal section 126. In other examples, these angles may be different.

[0042] A shorter transition zone 128 may be desirable to achieve a tighter curve as the catheter shaft 160 exits the outer catheter, but its length must be long enough to avoid bending the catheter shaft 160. In some examples, the transition zone 128 may have a length of 13 mm to 51 mm (0.5 inches to 2.0 inches). The distal end of the transition zone 128 may be 51 mm to 127 mm (2.0 inches to 5.0 inches) from the distal tip of the catheter shaft 160. In examples with two pull wires 120, the angles of each pull wire 120 at the transition zone 128 may be the same or different. Furthermore, the length and location of the transition zone 128 relative to the distal tip of each catheter shaft 160 may be the same or different.

[0043] The transition section 168 of the catheter shaft 160 is the portion of the catheter shaft 160 through which the pullwire transition zone 128 passes. In some examples, the transition section 168 of the catheter shaft 160 is more flexible than one or both of the proximal section 164 and the distal section 166. For woven or braided catheter shafts, the PIC number (crossovers per inch) can affect the bend radius and flexibility. A higher PIC number increases flexibility, while a lower PIC number increases longitudinal stiffness. For example, the woven or braided catheter shaft 160 may have a PIC number of 75 in the distal section 166 and decrease across the transition section 168 to 45 in the proximal section 164. The catheter shaft 160 may be made of a polymer and may or may not include multiple woven or braided filaments. The durometer of the polymer may also be varied to achieve different flexibility profiles in various sections of the catheter. For example, a catheter shaft 160 comprising a polyether block amide such as Pebax® may have a durometer that increases from 35D in the distal section 166, through 55D in the transition section 168, to 70D in the proximal section 164. In other examples, different polymers may be used in different sections of the catheter shaft 160. For example, the distal section 166 and the transition section 168 may comprise one or more polymers such as Pebax® with varying durometers (35D in the distal section, 55D and 70D in the transition section), while the proximal section 164 may be made of a polymer with a higher hardness modulus, such as Grilamid® TR55LX (Shore D81). In other examples, the catheter shaft 160 may be a hypotube, and the distal section 166 and / or the transition section 168 may include multiple cuts, grooves, or notches of various angles and / or depths that provide areas of increased flexibility.

[0044] 15A, 15B, and 15C are cross-sectional views of another example catheter shaft 260 showing the circumferential positions of the pull wire 220. FIG. 15A shows the position of the pull wire 220 at a first radial position 221 in the proximal section. FIG. 15B shows the position of the pull wire 220 in the transition section, and FIG. 15C shows the pull wire 220 at a second radial position 223 in the distal section. The position of the pull wire 220 at the first radial position 221 in the proximal section (FIG. 15A) is offset circumferentially by approximately 135 degrees from the position at the second radial position 223 in the distal section (FIG. 15C).

[0045] In the example shown in Figures 9-15, the catheter shaft 160 has a single pull wire 120 extending longitudinally along the length of the catheter shaft 160 from the proximal end to a position adjacent to or at the distal end. In other examples, there may be multiple pull wires. The pull wire may be bonded to the catheter wall using an adhesive or the like. In a catheter shaft with a solid wall, the pull wire may be disposed within the wall, as in the standard steerable catheter 10 shown in Figure 1A. In a catheter shaft 160 formed from one or more woven or braided filaments 169, the pull wire 120 may be bonded to the inner surface of the catheter wall, as shown in Figures 9-15C. In other examples, the pull wire 120 may be woven or braided into the multiple woven or braided filaments 169 forming the catheter wall 162, as shown in Figure 16. Thus, the pull wire 120 is disposed beneath some filaments 169 and above others, as shown in the cross-sectional view of Figure 17.

[0046] FIG. 18 illustrates the operation of the steerable catheter assembly 50. The outer catheter 10 (shown as transparent) can have a standard pull wire 12, as described above with respect to FIGS. 1A-3B. The distal portion 13 of the outer catheter 10 can define an articulation region adjacent its distal end, configured to articulate to a first curve in a first plane, where pulling on the pull wire 12 causes the first curve to include a first half curve 15 and a second half curve 17. The inner catheter shaft 160 includes a pull wire 120, as described above with respect to FIGS. 9-17. When the outer catheter 10 is actuated and articulated to a desired first curve and position, the inner catheter shaft 160 can be moved distally until the distal portion 166 extends distally from the outer catheter 10 and the inner catheter transition portion 168 remains within the second half curve 17 of the outer catheter 10. The pull wires 120 in the inner catheter shaft 160 are then actuated, and the transition section 168 cooperates with the outer catheter 10 to actuate the distal section 166 into a second curve that is in a plane that is at an angle to the plane of the first curve of the outer catheter 10. Separate actuation of the pull wires that steer the outer catheter 10 and the pull wires 120 that actuate the inner catheter shaft 160 allows the first and second curves to be formed in different planes.

[0047] In some examples, a marker (not shown) may be provided at the proximal end of the inner catheter shaft 160 to indicate to a user when the transition portion 168 of the inner catheter shaft 160 is within the second half curve 17 of the outer catheter 10. In other examples, a fluorescent or radiopaque marker (not shown) may be provided in the transition portion 168 of the inner catheter shaft 160 or on the transition zone 128 of the pullwire 120 to indicate when the transition portion 168 of the inner catheter shaft 160 is within the second half curve 17 of the outer catheter 10. Markers may also be provided on the distal portion 166 of the inner catheter shaft 160.

[0048] It will be understood that the dimensions and angles described in connection with the above examples are merely exemplary, and other dimensions and angles of the transition zone are contemplated. The various components of the steerable catheter (and / or other systems or components disclosed herein) and the materials that may be used for the various elements disclosed herein may include materials commonly associated with medical devices. For brevity, the following description refers to the steerable catheter assembly 50 (and variations, systems, or components disclosed herein). However, this is not intended to limit the devices and methods described herein, and the discussion may apply to other elements, members, components, or devices disclosed herein.

[0049] In some embodiments, the steerable catheter assembly 50 (and its variations, systems, or components disclosed herein) can be made from metals, metal alloys, polymers (some examples of which are disclosed below), metal-polymer composites, combinations thereof, or other suitable materials. Some examples of suitable metals and metal alloys include stainless steels, such as 444V, 444L, and 314LV stainless steel; mild steel; nickel-titanium alloys, such as linear elastic and / or superelastic nitinol; cobalt-chromium alloys, titanium and its alloys, alumina, metals with diamond-like coatings (DLC) or titanium nitride coatings, other nickel alloys, such as nickel-chromium-molybdenum alloys (e.g., UNS: N06625, e.g., INCONEL® 625, UNS: N06022, e.g., HASTELLOY®). HASTELLOY® C-22, UNS:N10276, e.g., HASTELLOY® C276, other HASTELLOY® alloys, etc.), nickel-copper alloys (e.g., UNS:N04400, e.g., MONEL® 400, NICKELVAC® 400, NICORROS® 400, etc.), nickel-cobalt-chromium-molybdenum alloys (e.g., UNS:R44035, e.g., MP35-N, etc.), nickel-molybdenum alloys (e.g., UNS:N10665, e.g., HASTELLOY® ALLOY B2, etc.), other nickel-chromium alloys, other nickel-molybdenum alloys, other nickel-cobalt alloys, other nickel-iron alloys, other nickel-copper alloys, other nickel-tungsten or tungsten alloys, etc.; cobalt-chromium alloys; cobalt-chromium-molybdenum alloys (e.g., UNS:R44003, e.g., ELGILOY®, PHYNOX®, etc.); high platinum stainless steel; titanium; platinum; palladium; gold; combinations thereof; etc.; or other suitable materials.

[0050] As alluded to herein, there is a category of commercially available nickel-titanium or Nitinol alloys referred to as "linear elastic" or "non-superelastic." These may be chemically similar to traditional shape memory or superelastic varieties, but may exhibit unique and useful mechanical properties. Linear elastic and / or non-superelastic Nitinol can be distinguished from superelastic Nitinol in that its stress-strain curve does not exhibit a substantial "superelastic plateau" or "flag region" like superelastic Nitinol. Instead, in linear elastic and / or non-superelastic Nitinol, as recoverable strain increases, stress continues to increase in a substantially or somewhat linear relationship (not necessarily a perfectly linear relationship), or at least a relationship that is more linear than the superelastic plateau and / or flag region seen in superelastic Nitinol, until plastic deformation begins. Therefore, for purposes of this disclosure, linear elastic and / or non-superelastic Nitinol may also be referred to as "substantially" linear elastic and / or non-superelastic Nitinol.

[0051] In some cases, linear elastic and / or non-superelastic nitinol may also be distinguished from superelastic nitinol in that linear elastic and / or non-superelastic nitinol can accommodate strains of up to about 2-5% while remaining substantially elastic (e.g., before plastically deforming), whereas superelastic nitinol can accommodate strains of up to about 8% before plastically deforming. Both of these materials may be distinguished from other linear elastic materials, such as stainless steel (which may also be distinguishable based on composition), which can only accommodate strains of about 0.2-0.44 percent before plastically deforming.

[0052] In some embodiments, linear elastic and / or non-superelastic nickel-titanium alloys are alloys that do not exhibit any martensite / austenite phase change detectable by differential scanning calorimetry (DSC) and dynamic metal thermal analysis (DMTA) over a wide temperature range. For example, in some embodiments, linear elastic and / or non-superelastic nickel-titanium alloys may not exhibit any martensite / austenite phase change detectable by DSC and DMTA analysis over a range of about -60 degrees Celsius (°C) to about 120°C. Thus, the mechanical bending properties of such materials may generally be temperature-independent over this very wide temperature range. In some embodiments, the mechanical bending properties of linear elastic and / or non-superelastic nickel-titanium alloys at ambient or room temperature are substantially the same as those at, for example, body temperature, and do not exhibit a superelastic plateau and / or flag region at that temperature. For example, over a wide temperature range, linear elastic and / or non-superelastic nickel-titanium alloys maintain their linear elastic and / or non-superelastic properties and / or characteristics.

[0053] In some embodiments, the linear elastic and / or non-superelastic nickel-titanium alloy may be in the range of about 50 to about 60 weight percent nickel, with the remainder essentially titanium. In some embodiments, the composition is in the range of about 54 to about 57 weight percent nickel. One example of a suitable nickel-titanium alloy is FHP-NT alloy, commercially available from Furukawa Techno Material Co., Ltd., Kanagawa Prefecture, Japan. Other suitable materials include ULTANIUM™ (available from Neo-Metrics) and GUM METAL® (available from Toyota). In some other embodiments, a superelastic alloy, such as superelastic nitinol, can be used to achieve the desired properties.

[0054] In at least some embodiments, some or all of the steerable catheter assembly 50 (and its variations, systems, or components disclosed herein) may be doped with, made of, or otherwise include a radiopaque material. A radiopaque material is understood to be a material capable of producing a relatively bright image on a fluoroscopy screen or other imaging technique during a medical procedure. This relatively bright image aids the user in determining the location of the steerable catheter assembly 50 (and its variations, systems, or components disclosed herein). Some examples of radiopaque materials include, but are not limited to, gold, platinum, palladium, tantalum, tungsten alloys, polymeric materials loaded with radiopaque fillers, and the like. Additionally, other radiopaque marker bands and / or coils can be incorporated into the design of the steerable catheter assembly 50 (and its variations, systems, or components disclosed herein) to achieve the same results.

[0055] In some embodiments, the steerable catheter assembly 50 (and variations, systems, or components thereof disclosed herein) and / or portions thereof may be made from or include a polymer or other suitable material. Some examples of suitable polymers include polytetrafluoroethylene (PTFE), ethylene tetrafluoroethylene (ETFE), fluorinated ethylene propylene (FEP), polyoxymethylene (POM, e.g., DELRIN® available from DuPont), polyether block esters, polyurethanes (e.g., polyurethane 85A), polypropylene (PP), polyvinyl chloride (PVC), polyetheresters (e.g., ARNITEL® available from DSM Engineering Plastics), ether- or ester-based copolymers (e.g., butylene / poly(alkylene ether) phthalates and / or other polyester elastomers, e.g., HYTREL® available from DuPont), polyamides (e.g., DURETHAN® or Elf® available from Bayer), and the like. CRISTAMID™ available from Atochem), elastomeric polyamides, block polyamide / ethers, polyether block amides (PEBA, available, for example, under the trade name PEBAX®), ethylene vinyl acetate copolymer (EVA), silicone, polyethylene (PE), Marlex® high density polyethylene, Marlex® low density polyethylene, linear low density polyethylene (e.g., REXELL®), polyester, polybutylene terephthalate (PBT), polyethylene terephthalate (PET), polytrimethylene terephthalate, polyethylene naphthalate (PEN), polyether ether ketone (PEEK), polyimide (PI), polyetherimide (PEI), polyphenylene sulfide (PPS), polyphenylene oxide (PPO), polyparaphenylene terephthalamide (e.g., KEVLAR®), polysulfone, nylon, nylon-12 (EMS AmericanExamples of suitable materials include PET, PET-based, and PET-based polymers, such as GRILAMID® available from Grilon, perfluoro(propyl vinyl ether) (PFA), ethylene vinyl alcohol, polyolefins, polystyrene, epoxies, polyvinylidene chloride (PVdC), poly(styrene-b-isobutylene-b-styrene) (e.g., SIBS and / or SIBS 50A), polycarbonates, ionomers, polyurethane-silicone copolymers (e.g., Elast-Eon™ from Aortech Biomaterials or ChronoSil™ from AdvanSource Biomaterials), biocompatible polymers, other suitable materials, or mixtures, combinations, copolymers, polymer / metal composites, and the like. In some embodiments, the sheath can be blended with a liquid crystal polymer (LCP). For example, the mixture can include up to about 6 percent LCP.

[0056] It will be understood that this disclosure is in many respects merely illustrative. Changes may be made in details, particularly in matters of shape, size, and arrangement of steps, without exceeding the scope of the disclosure. This may include, to the extent appropriate, using any of the features of one illustrative embodiment in other embodiments. The scope of the disclosure is, of course, defined in the language of the appended claims.

Claims

1. A steerable catheter, a catheter shaft having a proximal portion, a distal portion, and a length extending therebetween, the catheter shaft having a lumen defined by a catheter wall defined at least in part by a plurality of braided or woven filaments; a single pull wire extending along the length of the catheter shaft and coupled to the catheter wall, the single pull wire having a proximal section extending along the proximal portion of the catheter shaft at a first radial location, a distal section extending along the distal portion of the catheter shaft at a second radial location, and a transition zone connecting the proximal and distal sections, the second radial location being circumferentially offset from the first radial location; wherein the single pull wire extends within the catheter wall and is braided or woven into the plurality of braided or woven filaments, and the single pull wire is the only pull wire present in the catheter shaft.

2. The steerable catheter of claim 1 , wherein the transition zone has a length of 13 mm to 51 mm (0.5 inches to 2.0 inches).

3. 10. The steerable catheter of claim 1, wherein the transition zone is 51 mm to 127 mm (2.0 inches to 5.0 inches) from the distal tip of the catheter shaft.

4. 2. The steerable catheter of claim 1, wherein the second radial position is offset from the first radial position by 10% to 50% of the circumference of the catheter shaft.

5. The steerable catheter of claim 1 , wherein the second radial position is offset from the first radial position by between 20 degrees and 190 degrees.

6. 6. The steerable catheter of claim 5, wherein the second radial position is offset from the first radial position by between 45 degrees and 135 degrees.

7. 7. The steerable catheter of claim 1, further comprising an outer shaft having a lumen defined by a shaft wall, the outer shaft having a steering member extending longitudinally within the shaft wall, the steering member configured to articulate a distal region of the outer shaft, the catheter shaft being movable within the lumen of the outer shaft.

8. The steerable catheter of claim 7 , wherein at least the distal portion of the catheter shaft is configured to extend distally from the outer shaft.

9. 9. The steerable catheter of claim 8, wherein the steering member and the single pull wire are separately actuatable to articulate the outer shaft and the catheter shaft independently of one another.

10. 10. The steerable catheter of claim 9, wherein the outer shaft is articulatable to a first curve that lies in a first plane and the distal portion of the catheter shaft extending distally from the outer shaft is articulatable to a second curve that lies in a second plane, the first plane and the second plane being different.

11. 11. The steerable catheter of claim 10, wherein the second plane is at an angle of between 45 degrees and 135 degrees relative to the first plane.

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