Guide system with suction

Abstract

A guide catheter for use in treating sinuses, the catheter including a catheter shaft configured to provide suction about a balloon catheter and a distal portion shaped for navigating body anatomy. In one embodiment, the guide catheter includes a valve for sealing the balloon catheter and a vent for controlling suction.

Claims

1. A method for advancing a flexible device into a paranasal sinus, the method comprising: (a) inserting a guide catheter into a head of a patient, wherein the flexible device is either preloaded into the guide catheter or advanced into the guide catheter during or after insertion of the guide catheter into the head of the patient; (b) moving a distal end of the guide catheter within the head of the patient such that the distal end is proximal relative to the paranasal sinus; (c) while the distal end of the guide catheter is proximal relative to the paranasal sinus, generating a suction force proximally through the guide catheter, around the flexible device, and within the head of the patient, via a suction source attached to the guide catheter, wherein the step of generating the suction force is performed while the flexible device is disposed within the guide catheter; and (d) advancing the flexible device out of the distal end of the guide catheter into the paranasal sinus.

2. The method of claim 1, wherein the act of moving the distal end of the guide catheter within the head of the patient occurs before advancing the flexible device out of the distal end of the guide catheter into the paranasal sinus.

3. The method of claim 1, further comprising retracting the flexible device through the distal end of the guide catheter.

4. The method of claim 3, further comprising inserting a flexible irrigation catheter through the distal end of the guide catheter and distributing irrigation fluid into the paranasal sinus of the patient via the flexible irrigation catheter.

5. The method of claim 4, further comprising generating the suction force while distributing irrigation fluid into the paranasal sinus of the patient.

6. The method of claim 1, wherein the distal end of the guide catheter defines a curved profile.

7. The method of claim 1, wherein the guide catheter comprises a shaft extending into the distal end, wherein the distal end is more flexible than the rest of the guide catheter.

8. The method of claim 1, wherein a hub is connected to a proximal end of the guide catheter.

9. The method of claim 8, wherein the hub is formed from two pieces.

10. The method of claim 8, wherein a valve is housed within the two pieces of the hub.

11. The method of claim 1, wherein the flexible device comprises a guidewire.

12. The method of claim 1, wherein the flexible device comprises a balloon catheter, wherein the method further comprises inflating the balloon catheter.

13. The method of claim 1, further comprising creating an artificial opening into the paranal sinus, wherein the flexible device is inserted through the artificial opening.

14. The method of claim 1, further comprising suctioning debris from the head of the patient.

15. A method for advancing a flexible device into a paranasal sinus, the method comprising: (a) inserting a distal end of a guide catheter into a head of a patient, wherein the flexible device is either preloaded into the guide catheter or advanced into the guide catheter via an instrument port during or after insertion of the guide catheter into the head of the patient; (b) moving the distal end of the guide catheter within the head of the patient to position the distal end of the guide catheter adjacent to the paranasal sinus; (c) generating a suction force proximally through the guide catheter, around the flexible device, and within the head of the patient via a suction source coupled to a suction port while the distal end of the guide catheter is adjacent to, yet spaced away from, the paranasal sinus; and (d) advancing the flexible device out of the distal end of the guide catheter within the paranasal sinus while the step of generating the suction force is being performed.

16. The method of claim 15, further comprising generating the suction force after advancing the flexible device out of the distal end of the guide catheter within the paranasal sinus.

17. The method of claim 15, wherein a seal is placed between the instrument port and the suction port.

18. The method of claim 15, further comprising irrigating the paranasal sinus after advancing the flexible device out of the distal end of the guide catheter.

19. The method of claim 15, wherein the flexible device comprises a balloon catheter, wherein advancing the flexible device out of the distal end of the guide catheter within the paranasal sinus further comprises inflating the balloon catheter is dilate an ostium.

20. A method for advancing a flexible device into a paranasal sinus, the method comprising: (a) inserting a guide catheter into a head of a patient, wherein the flexible device is either preloaded into the guide catheter or advanced into the guide catheter during or after insertion of the guide catheter into the head of the patient; (b) advancing a distal end of the guide catheter within the head of the patient and further positioning the distal end of the guide catheter proximally adjacent to the paranasal sinus such that the guide catheter is spaced away from the paranasal sinus; (c) generating a suction force proximally through the guide catheter, around the flexible device, and within the head of the patient, via a suction source attached to the guide catheter, wherein the step of generating the suction force is performed while the distal end of the guide catheter is proximally adjacent to the paranasal sinus; and (d) advancing the flexible device out of the distal end of the guide catheter into the paranasal sinus.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) FIG. 1 shows a schematic diagram of a system for catheter-based minimally invasive sinus surgery of the present invention being used to perform a sinus surgery procedure on a human patient.

(2) FIG. 1A is an enlarged view of portion “1A” of FIG. 1.

(3) FIGS. 2A through 2D are partial sagittal sectional views through a human head showing various steps of a method for gaining access to a paranasal sinus using a guide and thereafter dilating or remodeling the ostial opening into a sphenoid paranasal sinus.

(4) FIGS. 3A through 3D are coronal sectional views through a human head showing various steps of a method for gaining access to a paranasal sinus using a guide and thereafter dilating or remodeling the ostial opening into a maxillary paranasal sinus.

(5) FIGS. 4A through 4D are partial coronal sectional views through a human head showing various steps of a method of accessing a maxillary paranasal sinus through an artificially created opening of the paranasal sinus and then dilating the artificially created opening, the natural paranasal sinus ostium or both.

(6) FIG. 5A shows a perspective view of a tubular guide equipped for optional suctioning.

(7) FIG. 5B shows a side view of an alternative embodiment of a tubular guide with a pinch tube.

(8) FIG. 6 depicts a partial cross-sectional view of a guide catheter system including a balloon catheter and suction structure.

(9) FIG. 7 shows a distal portion of the guide catheter system depicted in FIG. 6.

(10) FIGS. 8 through 11 depict treating a sinus cavity with a guide catheter system.

(11) FIG. 12 shows an alternative distal portion for a guide catheter.

(12) FIG. 13 depicts a cross-section of a distal terminal end portion of a guide catheter system.

(13) FIGS. 14A through 14C shows various views of a distal terminal end portion of a guide catheter system.

(14) FIGS. 15A and 15B show a distal terminal end portion of an alternative guide catheter system.

(15) FIG. 16 shows another alternative terminal end portion of a guide catheter.

(16) FIGS. 17A and 17B depict another approach to a terminal end portion.

(17) FIGS. 18A and 18B show a further approach to a terminal end.

(18) FIGS. 19A through 19D depict yet further terminal end portions for a guide catheter system.

(19) FIGS. 20A and 20B show views of an additional approach to a distal end portion of a guide catheter.

(20) FIGS. 21A through 21C depict various views of a terminal end portion for guide catheter system which include an angled surface.

(21) FIGS. 22A and 22B show another guide catheter system with an oval terminal end opening.

(22) FIG. 23 depicts another alternative terminal end portion of a guide catheter system.

(23) FIGS. 24A-1 through 24C depict various configurations for a sealing structure for a guide catheter.

(24) FIGS. 25A and 25B are partial cross-sectional views depicting alternative approaches to a hub assembly for a guide catheter.

(25) FIG. 26 depicts a guide catheter hub including a suction connection.

(26) FIGS. 27A and 27B show a partial cross-sectional view of an auxiliary device connecting with a guide catheter hub.

DETAILED DESCRIPTION

(27) The following detailed description, the accompanying drawings and the above-set-forth Brief Description of the Drawings are intended to describe some, but not necessarily all, examples or embodiments of the invention. The contents of this detailed description do not limit the scope of the invention set forth in the claims.

(28) A number of the drawings in this patent application show anatomical structures of the ear, nose and throat. In general, these anatomical structures are labeled with the following reference letters:

(29) TABLE-US-00001 Nasal Cavity NC Nasopharynx NP Frontal Sinus FS Sphenoid Sinus SS Sphenoid Sinus Ostium SSO Maxillary Sinus MS

(30) FIGS. 1 and 1A illustrate a patient on an operating table with a minimally invasive surgery system in position to perform a dilation procedure on one or more paranasal sinuses. The system shown includes a C-arm fluoroscope 1000, a first introducing device 1002 (e.g., a guide catheter or guide tube), a second introducing device 1004 (e.g., a guidewire or elongate probe) and a working device 1006 (e.g., a balloon catheter, other dilation catheter, debrider, cutter, etc.).

(31) In some embodiments, the devices 1002, 1004, 1006 may be radiopaque and/or may incorporate radiopaque markers such that C-arm fluoroscope 1000 may be used to image and monitor the positioning of the devices 1002, 1004, 1006 during the procedure. In addition to, or as an alternative to, the use of radiographic imaging, the devices 1002, 1004, 1006 may incorporate and/or may be used in conjunction with one or more endoscopic devices, such as the typical rigid or flexible endoscopes or stereo endocscopes used by otolaryngologists during FESS procedures. Also, in addition to or as an alternative to radiographic imaging and/or endoscopic visualizations, some embodiments of the devices 1002, 1004, 1006 may incorporate sensors which enable the devices 1002, 1004, 1006 to be used in conjunction with image guided surgery systems or other electro-anatomical mapping/guidance systems including but not limited to: VectorVision (BrainLAB AG); HipNav (CASurgica); CBYON Suite (CBYON); InstaTrak, FluoroTrak, ENTrak (GE Medical); StealthStation Treon, iOn (Medtronic); Medivision; Navitrack (Orthosoft); OTS (Radionics); VISLAN (Siemens); Stryker Navigation System (Stryker Leibinger); Voyager, Z-Box (Z-Kat Inc.) and NOGA and CARTO systems (Johnson & Johnson). Commercially available interventional navigation systems can also be used in conjunction with the devices and methods. Further non-fluoroscopic interventional imaging technologies including but not limited to: OrthoPilot (B. Braun Aesculap); PoleStar (Odin Medical Technologies; marketed by Medtronic); SonoDoppler, SonoWand (MISON); CT Guide, US Guide (UltraGuide) etc. may also be used in conjunction with the devices and methods. Guidance under magnetic resonance is also feasible if the catheter is modified to interact with the system appropriately.

(32) The devices and methods of the present invention relate to the accessing and dilation or modification of sinus ostia or other passageways within the ear nose and throat. These devices and methods may be used alone or may be used in conjunction with other surgical or non-surgical treatments, including but not limited to the delivery or implantation of devices and drugs or other substances as described in copending U.S. Patent Application Ser. No. 10/912,578 entitled Implantable Devices and Methods for Delivering Drugs and Other Substances to Treat Sinusitis and Other Disorders filed on Aug. 4, 2004, issued as U.S. Pat. No. 7,361,168 on Apr. 22, 2008, the entire disclosure of which is expressly incorporated herein by reference.

(33) FIGS. 2A-2D are partial sagittal sectional views through a human head showing various steps of a method of gaining access to and treating a paranasal sinus using a guide catheter. Although FIGS. 2A-2D demonstrate a method for accessing and treating a sphenoid paranasal sinus, in alternative embodiments this or analogous methods and devices may be used to access and treat any of the other paranasal sinuses (maxillary, frontal and/or ethmoid).

(34) In FIG. 2A, a first introducing device in the form of a guide catheter 200 is introduced through a nostril and through a nasal cavity NC to a location close to an ostium SSO of a sphenoid sinus SS. The guide catheter 200 may be flexible. Flexible devices are defined as devices with a flexural stiffness less than about 200 pound-force per inch over a device length of one inch. The guide catheter 200 may be straight or it may incorporate one or more preformed curves or bends. In embodiments where the guide catheter 200 is curved or bent, the deflection angle of the curve or bend may be in the range of up to 135°. Examples of specific deflection angles formed by the curved or bent regions of the guide catheter 200 are 0°, 30°, 45°, 60°, 70°, 90°, 120° and 135°. Guide catheter 200 can be constructed from suitable elements like PEBAX, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, metals like stainless steel and fluoropolymers like PTFE, PFA, FEP and EPTFE. Guide catheter 200 can have a variety of surface coatings e.g. hydrophilic lubricious coatings, hydrophobic lubricious coatings, abrasion resisting coatings, puncture resisting coatings, electrically or thermal conductive coatings, radiopaque coatings, echogenic coatings, thrombogenicity reducing coatings and coatings that release drugs.

(35) In FIG. 2B, a second introduction device comprising a guidewire 202 is introduced through the first introduction device (i.e., the guide catheter 200) so that the guidewire 202 enters the sphenoid sinus SS through the ostium SSO. Guidewire 202 may be constructed and coated as is common in the art of cardiology.

(36) In FIG. 2C, a working device 204, for example a balloon catheter, is introduced over guidewire 202 into the sphenoid sinus SS. Thereafter, in FIG. 2D, the working device 204 is used to perform a diagnostic or therapeutic procedure. In this particular example, the procedure is dilation of the sphenoid sinus ostium SSO, as is evident from FIG. 2D. However, the present invention may also be used to dilate or modify any other sinus ostium or other man-made or naturally occurring anatomical opening or passageway within the nose, paranasal sinuses, nasopharynx or adjacent areas, including but not limited to natural paranasal sinus ostia of the maxillary, frontal and/or ethmoid sinuses. After the completion of the procedure, guide catheter 200, guidewire 202 and working device 204 are withdrawn and removed. In this or any of the procedures described in this patent application, the operator may additionally advance other types of catheters or of the present invention, a guidewire 202 may be steerable (e.g. torquable, actively deformable) or shapeable or malleable. Guidewire 202 may comprise an embedded endoscope or other navigation or imaging modalities including but not limited to fluoroscopic, X-ray radiographic, ultrasonic, radiofrequency localization, electromagnetic, magnetic, robotic and other radiative energy based modalities. In this regard, some of the figures show optional scopes SC is dotted lines. Such optional scopes SC may comprise any suitable types of rigid or flexible endoscopes and such optional scopes SC may be separate from or incorporated into the working devices and/or introduction devices of the present invention.

(37) Optionally, the methods disclosed herein may also comprise the step of cleaning or lavaging anatomy within the nose, paranasal sinus, nasopharynx or nearby structures including but not limited to irrigating and suctioning. The step of cleaning the target anatomy can be performed before or after a diagnostic or therapeutic procedure.

(38) The methods of the present invention may also include one or more preparatory steps for preparing the nose, paranasal sinus, nasopharynx or nearby structures for the procedure, such as spraying or lavaging with a vasoconstricting agent (e.g., 0.025-0.5% phenylephyrine or Oxymetazoline hydrochloride (Neosynephrine or Afrin) to cause shrinkage of the nasal tissues, an antibacterial agent (e.g., provodine iodine (Betadine), etc. to cleanse the tissues, etc.

(39) As shown in FIGS. 3A-3D, in one embodiment a maxillary sinus may be treated by dilating an ostium thereto. As shown in FIG. 3A, a guide catheter 290 may be advanced into a patient's nostril to position a distal end thereof adjacent the maxillary sinus ostium. As shown in FIG. 3B, a guidewire 294 may then be advanced through the guide 290 and through the maxillary sinus ostium, into the maxillary sinus. Next, as shown in FIG. 3C, a balloon catheter 302 may be advanced through the guide catheter 290 over the guidewire 294, to position an expandable balloon 304 of the balloon catheter 302 within the maxillary ostium. Then, as shown in FIG. 3D, the expandable balloon 304 may be inflated to dilate the natural paranasal sinus ostium of the maxillary sinus. When the dilation procedure is complete, the guide catheter 290, guidewire 294 and balloon catheter 302 may all be removed from the patient. In an alternative embodiment, the guide catheter 290 and/or the guidewire 294 may be left in the patient, the balloon catheter 302 may be removed, and another flexible device (not shown in the figures) may be advanced over and/or through the guide catheter and/the guidewire 294 into the maxillary sinus to perform an additional procedure. For example, in one embodiment, an irrigation catheter may be advanced through the guide catheter 290 and used to irrigate the sinus. Such an irrigation catheter may be advanced without a guidewire 294 or using a guidewire 294 in alternative embodiments.

(40) FIGS. 4A-4D are partial coronal sectional views through a human head showing various steps of a method of accessing a maxillary paranasal sinus through an artificially created opening into the sinus and dilating the artificial opening, the natural paranasal sinus ostium or both. In some embodiments, rather than accessing a paranasal sinus via the natural sinus ostium, an artificial opening may be made into a sinus. In some embodiments, a guide may be used to then guide a balloon catheter or other dilator (with or without guidewire) through the artificial opening, into the sinus. The dilator may then be advanced to the natural paranasal sinus ostium and used to dilate the natural ostium, may be used to dilate the artificial opening, or both.

(41) In FIG. 4A, a puncturing device 300 is inserted through a nostril and used to create an artificial opening in a maxillary sinus. Examples of such puncturing devices include but are not limited to straight needles, needles with bent shafts, dissectors, punches, drills, corers, scalpels, burs, scissors, forceps and cutters. In FIG. 4B, puncturing device 300 is withdrawn and a working device, for example a balloon catheter 302, is introduced through the artificial opening into the maxillary sinus. In FIG. 4C, balloon catheter 302 is used to dilate the artificially created opening in the maxillary sinus. After this step, the balloon catheter 302 is withdrawn. In another embodiment, as shown in FIG. 4D, the balloon catheter 302 may be advanced through the artificial opening into the maxillary sinus and then advanced farther into the maxillary sinus to position the balloon of the catheter 302 in the natural paranasal sinus ostium. In some embodiments, this advancement to the natural ostium may be performed after dilating the artificial opening. Alternatively, the balloon catheter 302 may be advanced in some embodiments without dilating the artificial opening.

(42) In some embodiments, a balloon catheter 302 may be advanced over a guidewire to the natural paranasal sinus ostium. Alternatively, the balloon catheter 302 may be advanced without the use of a guidewire in other embodiments. In some embodiments, the puncturing device 300 may have a lumen through which an introduction device (e.g., a guidewire or other elongate probe or member), may be inserted into the maxillary sinus, and the puncturing device 300 may then be removed, leaving such introduction device (e.g., a guidewire or other elongate probe or member) in place. In such cases, the working device (e.g., balloon catheter 302) may incorporate a lumen or other structure that allows the working device (e.g., balloon catheter 300) to be advanced over the previously inserted introduction device (e.g., a guidewire or other elongate probe or member). In some embodiments, the piercing device may include a lumen, and the balloon catheter 302 may be advanced through the piercing device into the maxillary sinus, either with or without a guidewire in various embodiments. Again, similar methods and devices may be used to access and treat other paranasal sinuses in alternative embodiments.

(43) In another alternative embodiment (not shown in FIGS. 4A-4D), a piercing device may be used to create an opening into a maxillary sinus at a different location, and a guide catheter may be used to access the sinus through the opening. For example, in one embodiment the artificial opening may be made through a canine fossa into a maxillary sinus. In another embodiment, a trephine incision may be made into a frontal paranasal sinus. In other embodiments, an artificial opening may be formed into an ethmoid or sphenoid sinus. In some embodiments, a guide may then be placed through the artificial opening and used to access the natural paranasal sinus ostium. In other embodiments, the guide catheter may remain outside the sinus, near the artificial opening, and used to guide a guidewire and/or other device(s) into the sinus. In alternative embodiments, the artificial opening may be dilated, the natural paranasal sinus ostium may be dilated, or both. These methods may be applied to any paranasal sinus. As will be described in greater detail below, any of these guide catheters, whether used to access a paranasal sinus via a natural or artificial opening, may be provided with suction capabilities according to various embodiments of the present invention.

(44) Any of the guide catheters or other luminal devices disclosed herein may have suction capabilities and thus can comprise an arrangement for suctioning an anatomical region through the distal end of the guide catheter or device. In some embodiments, a guide catheter may be provided along with an adapter to attach the guide to a suction source. In another embodiment, a guide catheter may have an integrated or built-in suction attachment, so that an adapter is not necessary. Currently, physicians use a traditional suction device to clear the surgical field when using surgical devices in the nasal cavity and paranasal sinuses. This requires the surgeon to frequently exchange devices, picking up and putting down the traditional suction device many times per case. Allowing the surgeon to suction through the guide catheter while simultaneously passing guidewires, balloons, irrigation catheters and/or the like through the guide catheter can simplify the surgical procedure. A suction adapter can attach to a proximal end of the guide catheter. It can include a valve in-line with an axis of the guide catheter shaft, the valve allowing devices such as guidewires, balloons, and irrigation catheters to be passed through the suction adapter and guide catheter while maintaining suction through the lumen of the guide catheter. Extension tubing can be configured to run offset from the body of the suction adapter. The extension tubing may terminate in a stepped adapter and/or an on-off valve to improve ease of use.

(45) To connect to the guide catheter, a male slip-fit luer can be used. This provides a mechanically secure and airtight seal while allowing for easy rotational adjustment of the guide catheter with respect to the suction adapter. Moreover, a hole through the body of the suction adapter allows for easy control of the amount of suction through the guide catheter. When the hole is not occluded, there is little or no vacuum at the distal end of the guide catheter. The surgeon can partially or fully occlude the hole with his finger to increase the vacuum at the tip of the guide catheter. An on/off switch can be further provided to control suction activation. The switch is placed to “on” and then the hole is occluded to initiate suctioning. Further, a silicone or polyisoprrene valve can be used to maintain a seal around guidewires, balloons or irrigation catheters. The valve is fully closed when no device is present. Extension tubing in the form of lightweight tubing can be used to connect the suction adapter to heavier gauge tubing used commonly in operating rooms. The tubing has sufficient wall thickness to prevent collapse under vacuum but does not add mass or ergonomic challenges to the guide catheter.

(46) For example, FIG. 5A shows a guide with a proximal adapter for attaching to suction. More specifically, the guide catheter 500 can comprise an elongate tube 502 that may be made of suitable biocompatible materials, including but not limited to metals such as stainless steel, titanium, Nickel-titanium alloy (e.g., Nitinol), etc.; plastics such as PEBAX, PEEK, Nylon, polyethylene, etc. The distal region of elongate tube 502 may comprise a curved, bent or angled region. In some embodiments, the distal end of elongate tube 502 may comprise an atraumatic tip 504. Although various modes of construction may be used, in the example shown, an elongate hypotube 506 is disposed on the outer surface of elongate tube 502 and the proximal end of guide catheter 500 comprises a branched or Y-connector 508. The proximal region of Y-connector 508 comprises a straight arm 510 and a side arm 512. The proximal end of straight arm 510 comprises a suitable hub 514. In one embodiment, hub 514 is a female luer hub. In another embodiment, hub 514 comprises a rotating hemostasis valve such as a Touhy-Borst adapter. The proximal end of side arm 512 comprises a suitable hub 516. In one embodiment, hub 516 comprises a rotating hemostasis valve such as a Touhy-Borst adapter to adjust the amount of suction. Hub 516 is connected to a suction tube 518 that provides suction to guide catheter 500. Thus, guide catheter 500 can be used to provide suction as well as introduce one or more diagnostic, therapeutic or access devices into the anatomy.

(47) In an alternative approach, the guide catheter can be further equipped with a pinch tube 550 (See FIG. 5B). The pinch tube is connected to a proximal end of the Y-connecter 508 and can be formed from silicone or another flexible material. Further, a proximal end of the elongate tube 502 can be configured with a female luer 552 which mates with a male luer 554 attached to the Y-connector 508. In use, the pinch tube 550 is pinched closed by a physician about a guidewire 551 or other device to occlude the lumen extending through the guide to thereby facilitate suctioning. As before, suction forces are applied through the side arm 512.

(48) Turning now to FIGS. 6 and 7, in one embodiment, a guide catheter system 600 may include a guide catheter 601 having a shaft 610 and a hub assembly 604 disposed at the proximal end of the shaft 610. The shaft 610 may include a proximal portion 603 having a first diameter, a terminal end portion 602 having a second, smaller diameter, a tapering transition 614 between the two, and a lumen 608 extending through the length of the shaft 610 and through the hub assembly 604. (The internal portion of the hub assembly 604 may be a lumen, a chamber or the like in fluid communication with the lumen 608 of the catheter shaft 610.) In some embodiments, the guide catheter system 600 may further include a guidewire 612 and/or a balloon catheter 606, as shown in FIG. 6. In some embodiments, the guide catheter system 600 may further include a suction device, such as suction tubing 633.

(49) The outer profile of the shaft 610 is configured for advancement into a nasal cavity so that one or more devices may be advanced through the lumen 608 into a paranasal sinus. The tapering transition 614 is provided between the shaft proximal portion 603 and the distal portion 602 such that the distal portion 602 has a smaller cross-section than the proximal portion 603. In this way, a balloon catheter 606 can reside in the proximal portion 603 while suction forces are passed through the lumen 608, around the balloon catheter 606 structure. This configuration may be useful, for example, in advancing the guide catheter system 600 into a nostril of a patient with the balloon catheter 606 preloaded into the guide lumen 608 and allowing for suction during advancement and positioning of the guide catheter 601. Suction during advancement and positioning of the guide catheter 601 is advantageous because it allows for the removal of blood and mucus from the field in which the surgeon is working, thus facilitating visualization of the area and access to a paranasal sinus.

(50) The shaft distal terminal portion 602 of the guide catheter 601 defines a specific curved profile intended to direct one or more devices advanced through the lumen 608 into a natural or manmade opening of a paranasal sinus. In one embodiment, the most distal tip 616 of the terminal end portion 602 is more flexible than the rest of the shaft 610. Accordingly, PEBAX is one contemplated material for the distal tip 616. An intermediate portion 618 of the shaft 610, which may include the tapering transition 614, may be made of a flexible material as well, but in one embodiment this material may be less flexible than material used to form the distal tip 616. For example, in one embodiment, the intermediate portion 618 may be formed of a nylon material. The proximal portion 603 of the shaft 610 proximal to this intermediate portion 618 may be formed of a more rigid material, such as but not limited to a more rigid polymer and/or a stainless steel hypotube 619.

(51) One advantage of the flexible distal tip 616 is that it causes less trauma to soft mucosal tissue lining the nasal cavity as the guide catheter 601 is advanced, manipulated and retracted. For example, when the guide catheter 601 is advanced into the nasal cavity, the tip 616 may often contact the ethmoid bulla, and a flexible tip 616 will cause less trauma than a rigid one. In some embodiments, the distal tip 616 may also expand as a deflated balloon catheter 606 is drawn back into the guide catheter after a balloon dilation procedure has been performed. This expansion (or “give”) may reduce the amount of force required to pull the balloon catheter 606 back into the guide catheter 601 after a procedure, thus making use of the balloon catheter 606/guide catheter 601 system easier. This also allows the distal tip 616 diameter to be made smaller than it otherwise would, which further reduces trauma during use and also facilitates positioning of the distal tip 616 at a desired location in the anatomy. The tip 616 may also be provided with an expandable radiopaque band to aid in tracking positioning during an interventional procedure as well as to maintain an atraumatic profile.

(52) Further, the PEBAX distal tip 616 is shaped relative to the adjacent proximal portion 618 for navigation through and about nasal cavity structures. For instance, in one embodiment, the curved shape of the tip portion 616 facilitates navigating about an ucinate process, so that one or more devices may be navigated into a maxillary sinus. In one embodiment, a junction between the distal tip 616 and the adjacent intermediate portion 618 is slanted. This slanted connection increases the area of the distal tip 616 portion relative to the intermediate portion 618, thus increasing the area of the most flexible portion of the shaft 610, which enhances the prevention of soft tissue trauma. The angled shape of the terminal end portion 602 is retained in part due to the more rigid nylon of the intermediate portion 618 and its slanted junction with the distal tip portion 616.

(53) In various alternative embodiments, a guide device such as the one described above and below may have any suitable angled configuration. For example, embodiments may be provided with different angles to facilitate access to maxillary, frontal, sphenoid and ethmoid paranasal sinuses. In various embodiments, the distal tip 616 may be angled relative to the rest of the shaft 610 at angles from approximately 0° to approximately 180°. In some embodiments, a combination of guide catheters 601 having different angled configurations may be provided, such as a set of guide catheters 601 having angles of 0°, 30°, 70° and 110°. A surgeon may then select a guide catheter 601 with a desired angle for accessing a given paranasal sinus. In various embodiments, any angle or guides with any combination of angles may be provided.

(54) In various embodiments, the outer an inner diameters of the shaft 610, including the terminal end portion 602, tapering transition 614 and proximal portion 603, may have a number of different sizes, as long as the shaft 610 is configured for advancement into the nasal cavity. The terminal end portion 602 and distal tip portion 616, in particular, may be sized to facilitate positioning near an opening to a paranasal sinus. In one embodiment, for example, the distal tip 616 can have an inner diameter of approximately 0.093 inches. This diameter structure can extend longitudinally from the tip 616 and to the catheter portion distal to the taper 614 and can define a relatively long dimension. A tip envelop 620 of the terminal end portion 602, however, can assume a relatively short dimension so that it can more easily pass through nasal anatomy and thus potentially engaging less structure as it is inserted, for example, past a middle turbinate. The “tip envelope,” for the purposes of this application, is defined as the length of a line drawn perpendicularly from the extreme distal end of the distal tip 616 to an oppositely facing surface of the straight portion of the terminal end portion 602, as shown in FIG. 7.

(55) As shown in FIGS. 6 and 7, in one embodiment, the extreme distal end of the distal tip 616 may have a bevelled shaped. The bevelled shape also facilitates insertion and positioning relative to nasal cavity anatomy, such as directing the guide catheter 601 around the ucinate process to gain access to the maxillary sinus ostium. Moreover, the particular configuration of the beveled tip 616 permits an operator to view the opening of the tip when the device is placed within a nostril. This is due to the opening of the bevelled structure pointing back toward the operator. Such direct viewing of the opening of the tip 616 can aid in device manipulation and positioning.

(56) In some embodiments, the lumen 608 in the terminal end portion 602 may have an inner diameter sized so that when the balloon catheter 606 is advanced within that portion of the lumen 608, suction is no longer possible, since an interference fit is created between the inner wall of the lumen 608 of the distal terminal end portion 602 and the outer surface of the balloon. In an alternative embodiment, it may still be possible to draw suction through the lumen 608 and around the balloon catheter 606, even in this advanced position, though the amount of suction force will be less when the balloon resides in the terminal end portion 602 compared with when it resides in the proximal shaft portion 603. Suction force may then be resumed again when the balloon catheter 606 is advanced distally beyond the tip 612 to perform an interventional procedure, although in some cases the primary use of suction may be during initial advancement and positioning of the guide catheter system 600 in the nasal cavity.

(57) A proximal valve 624 is provided within the guide lumen 608 (or chamber of the hub 604). In one embodiment, the valve 624 forms a seal about the balloon catheter 606 to thereby facilitate the application of suction forces within the lumen 608. In one embodiment, the valve can be configured so that it also may form a seal around a guidewire 612. However, in an alternative embodiment, the valve does not form a seal about a guidewire 612, so that suction is only created when the balloon catheter 606 or another flexible device having a larger diameter than the guidewire 612 is positioned within the lumen 608.

(58) The hub 604 of the guide catheter 601 further includes a vent 628 and a suction port 630. A most proximal portion is equipped with a flange 631 shaped for easy gripping by an operator. In one embodiment, for example, the flange 631 may be used by a surgeon to grip the guide catheter 601 like a syringe and advance the balloon catheter 606 through the guide catheter 601 with the same hand. In alternative embodiments, either standard or custom suction tubing 632 can be attached to the suction port 630 to create the desired suction force. Moreover, the suction port 630 is angled proximally so that a guidewire 612 advanced through the hub 604 will not exit the suction port 630.

(59) The vent 628 is sized and positioned to accept an operator's finger, so that suction provided through the suction port 630 will be applied at the distal tip 616 of the guide catheter 601. In some embodiments, the vent 628 can define a short tubular path from an outer surface of the hub 604 to an inner wall of the hub 604 and can be directed proximally in a manner similar to the suction port 630, to prevent a guidewire 612 from passing through the vent 628. In one alternative embodiment, the vent 628 may also or alternatively be covered with a grate-like structure to prevent a guidewire 612 from passing therethrough.

(60) With reference now to FIGS. 8-11, a method of using the guide catheter system 600 is described. Although FIGS. 8-11 show use of the guide catheter system 600 in accessing and treating a frontal paranasal sinus, this or other embodiments may be used to access and treat any of the other paranasal sinuses, including maxillary, sphenoid and ethmoid paranasal sinuses.

(61) Referring to FIG. 8, in one embodiment of the method, a guide catheter 601 is first advanced into a nasal cavity and positioned so that the terminal end portion 602 of the guide catheter 601 is located at or near an opening into a paranasal sinus. In the example shown in FIG. 8, the terminal end portion 602 is positioned near the frontal recess, which is a pathway leading to the frontal sinus ostium (the natural opening into the frontal sinus). The guide catheter 601 may be positioned in a desired location using an endoscope for visualization and/or fluoroscopy, however, in most cases an endoscope alone will suffice. In some embodiments, the guide catheter 601 is advanced into the nasal cavity with a guidewire 612 and/or a balloon catheter 606 preloaded into the guide catheter lumen 608. During advancement and/or positioning of the guide catheter 601, suction may be applied by applying suction force through a suction tube coupled with the hub apparatus 604 and by placing a thumb or other finger over the vent 628 to remove blood, mucus and/or other fluids from the area of the terminal end portion This use of suction will typically enhance a surgeon's ability to visualize the nasal cavity using an endoscope and thus facilitate location of a target paranasal sinus ostium.

(62) Still referring to FIG. 8, once the guide catheter 601 is positioned in a desired location in the nasal cavity, the surgeon then advances the guidewire 612 out of the distal opening of the catheter 601 and through the natural ostium 650 of a paranasal sinus into the sinus cavity 652. In some embodiments, the guidewire 612 may be an illuminating guidewire. Such an illuminating guidewire may be used to create a transillumination spot on an external surface of the patient during and/or after advancement of the guidewire 612 to confirm that the distal end of the guidewire 612 has entered and resides in the desired paranasal sinus. (See, for example, U.S. patent application Ser. Nos. 11/522,497, issued as U.S. Pat. No. 7,559,925 on Jul. 14, 2009 and 11/803,695, issued as U.S. Pat. No. 9,554,691 on Jan. 31, 2017, the full disclosures of which are hereby incorporated by reference.) In other embodiments, a non-illuminating guidewire 612 may be used. In either the illuminating or non-illuminating guidewire embodiment, fluoroscopy may be used to visualize the guidewire 612 in the paranasal sinus for further confirmation of its location.

(63) Next, as shown in FIG. 9, the balloon catheter 606 is advanced over the guidewire 612 and is positioned and then expanded within the paranasal sinus ostium 650. (In the case of the frontal sinus, as in these Figures, the balloon of the balloon catheter 606 may be positioned and inflated within the ostium, the frontal outflow tract or both.) An inflation device (not shown) is provided to inflate the balloon. Thereafter, the balloon catheter is deflated and withdrawn within the distal terminal end portion 602. In one embodiment, rather than immediately withdrawing the balloon catheter 606, instead the balloon may be repositioned and inflated again to further expand the ostium, expand a portion of the frontal sinus outflow tract and/or the like. Optionally, the balloon catheter 606 may be further withdrawn into the guide catheter 601, and a suction force may be applied to remove substances from the paranasal sinus cavity or outflow tract or from the nasal cavity.

(64) With reference now to FIG. 10, in an optional step, in some embodiments, the balloon catheter 606 may be removed from the patient via the guide catheter, and a flexible irrigation catheter 654 may then be passed through the guide catheter 601 (either over the guidewire 612 or without a guidewire, in alternative embodiments), into the paranasal sinus. Irrigation fluid 652, such as saline solution, may then be passed out of the irrigation catheter 654 to flush or irrigate the sinus. In some embodiments, the irrigation fluid 652 may simply be allowed to flow out of the sinus without applying suction force. In other embodiments, suction may be applied via the suction guide catheter 601 to assist in removal of the fluid 652.

(65) At the end of a procedure, as in FIG. 11, the guide catheter 601 and any remaining devices are removed from the patient. The ostium 650 is left in a dilated state, which ideally will facilitate normal drainage of the sinus and help treat the patient's sinusitis.

(66) As shown in FIG. 12, an alternate approach to a guide catheter 700 may include a distal terminal end portion 702 which includes multiple turns or bends. A first bend 704 can be positioned distally with respect to a second bend 706, where the first bend 704 defines a smaller angle than the second bend 706. This “double-bend” configuration may facilitate insertion of the guide catheter 700 into a nostril in a tip-down orientation and then allow the catheter 700 to be rotated to position its distal tip 716 at or near a maxillary sinus ostium.

(67) In other alternative embodiments, the terminal end portion 702 of a guide catheter 700 may be configured to facilitate other processes or manipulations within the nasal cavity. For example, in one embodiment the terminal end portion 702 may be configured to facilitate pushing an ucinate process (or other anatomy) out of the way during an interventional procedure while a distal tip 716 is positioned as desired relative to the treatment site. The “double-bend” approach shown in FIG. 12 may help lower insertion and retraction forces required to advance and retract a balloon catheter through the guide 700. For example, double bends of fifty and sixty degrees can be subjected to less such forces than a single bend of one hundred ten degrees.

(68) Turning now to FIGS. 13-23, a number of alternative embodiments of distal end configurations for guide catheters are shown. Each embodiment may have advantages in facilitating advancement and/or positioning of a guide catheter within a nasal cavity and/or advancement or retraction of a balloon catheter or other device(s) into and out of the guide catheter's distal end. As shown in FIG. 13, in one embodiment, a terminal end tip 750 of a guide catheter may embody an eye-shaped extrusion or molding 752, including a round inner diameter 754. Integrated wings 756 are provided to help gain access to and traverse nasal cavity anatomy. For example, the wings 756 may facilitate positioning the distal end of the guide catheter behind an uncinate process to access a maxillary sinus ostium. The wings 756 may allow a surgeon to tease the uncinate anteriorly, thus exposing an open pathway for guide access to the maxillary sinus ostium.

(69) Some of the guide catheter distal ends in FIGS. 13-23 also include an oval cross-section. This oval shape may help to minimize the dimension of he guide in the orientation of anatomic restriction. Because the uncinate process can often be tight against the ethmoid bulla (in an anterior-posterior direction), the guide is ovalized such that the smaller dimension is oriented between the uncinate and the ethmoid bulla. Various embodiments may include such an oval cross-section with or without wings 756. The soft distal tip material of some embodiments of the guide catheters allow the cross-sectional shape of the guide tip to change relative to the forces it encounters. Therefore, a soft tip with a round cross-sectional shape may ovalize while it is being placed behind the uncinate, thereby reducing the force required to achieve a desired position.

(70) In other approaches, distal terminal end portions of a guide catheter can include flanged wings of various configurations. Wings can be positioned at the top, midline or bottom of a tip and the wing can be short, long, flat or curved. Also, the wings can be flared to form a single price of material and can be made of any suitable flexible or non-flexible material in various embodiments, such as but not limited to any number of metals or polymers, such as aluminum foil, stainless steel, hard plastic or soft plastic. In one specific approach (FIGS. 14A-14C), a distal terminal end portion 750 of a guide catheter can include wings 756 formed by aluminium foil. Such wings are again intended to facilitate navigation through sinus anatomy such as for the purpose of slipping behind an ucinate process. Similarly configured wings formed from PEBAX are shown in FIGS. 15A and 15B. Yet another approach to facilitating navigation is shown in FIG. 16 which depicts a hard plastic covering 758 formed about a portion the distal terminal end 750 of a guide catheter.

(71) Moreover, as shown in FIGS. 17A-17B, navigating wings 757 can also be formed of a stainless steel bar configured across the terminal end generally perpendicular to a distal opening formed therein. Another approach to a PEBAX wing structure 756 is shown in FIGS. 18A and 18B. Yet further different approaches are depicted in FIGS. 19A-19D, 20A-20B, 21A-21C, 22A-22B and 23, respectively. Of particular note are the angled tip approach with underside wings 756 shown in FIG. 19A and the angle cut tips of FIGS. 21A-21C. Various shaped openings at the terminal ends of the guides are also contemplated such as those depicted in FIGS. 21A-21C, 22A-22B and 23.

(72) As shown in FIGS. 24A-24C, various different approaches to a valve 624 for sealing a balloon catheter 606 within a guide catheter system are contemplated. In a first approach, a flat circular gasket 800 with a center sealing through hole 802 (FIG. 24A). Alternatively, a valve 810 defined by a through hole with a double taper 812 can be employed within a guide catheter system. Further, as shown in FIG. 24C, the valve 624 can embody a one-way valve 820 with internal flap structure 822.

(73) Turning now to FIGS. 25A and 25B, there are shown alternative approaches to a hub assembly 604 of a guide catheter system 600. By splitting the hub into first 830 and second 840 parts, an improved approach to attaching a valve seal 624 to a catheter shaft 610 is contemplated. In a first approach, the valve 624 is affixed to the shaft 610 and the two parts are positioned within the second part of the hub 604. The first part of the hub 830 is then inserted in the second part to complete the hub assembly. In an alternate approach (FIG. 25B), the valve 624 is captured in the second part 840 of the hub assembly and the end of the catheter shaft 610. The first part 830 of the hub is configured with flanges 842 which traps the valve 624 in place. Such approaches are intended for ease of assembly.

(74) As shown in FIG. 26, the hub assembly 604 can further include a suction port 630 including barbs 850. The attachment for a suction tube must be one that allows for ease of attaching and removal, yet also from a tight seal to provide sufficient suction rates with little to no leakage. The barbs 850 facilitate such a desirable connection and also define a profile which does not interfere with an operator during use whether the suction feature is being employed or not.

(75) Additionally, as shown in FIGS. 27A and 27B, the hub assembly 604 can include a proximal opening 860 which can be provided for connecting the hub 604 to other devices. A ridge 862 can be formed within the opening 860 and can be sized and shaped to lockingly engage within a cut-out formed on an end of an auxiliary device 866. In this way, an audible click can be created by the engagement of the ridge 862 to thereby confirm a proper register of the hub 604 with auxiliary devices. With the cut-out 864 to thereby identify a full engagement of the ports. Additionally, some resistance is also provided between the ports to help avoid incidental release.

(76) Although the present invention has been illustrated and described with respect to several preferred embodiments thereof, various changes, omissions and additions to the form and detail thereof, may be made therein, without departing from the spirit and scope of the invention.