GUIDE CATHETER EXTENSION SYSTEM WITH A DELIVERY MICRO-CATHETER CONFIGURED TO FACILITATE PERCUTANEOUS CORONARY INTERVENTION

Abstract

The subject guide catheter extension system with a micro-catheter delivery catheter includes an outer sheath, an inner member extending within the sheath, and a mechanism for engagement/disengagement of the inner member to/from the sheath. Several mechanisms of engagement/disengagement between the inner and outer members are provided including a friction mechanism, threaded mechanism, pull away sheath, and engagement/disengagement mechanism for pusher's handles. The sheath and the inner member are modified for different engagement/disengagement mechanisms operation. A micro-catheter delivery system provides for an improved atraumatic crossability to the treatment site in an expedited and simplified fashion. During a procedure, a guidewire along with a guide catheter are advanced to the vicinity of the treatment site within a blood vessel. Subsequent thereto, the subject guide catheter extension system is manipulated to advance the micro-catheter along the guidewire inside the guide catheter towards and beyond the site of interest. Once the micro-catheter is in place, the outer sheath slides along the micro-catheter until reaching the lesion, and then the inner member is removed from the sheath, and the sheath then is ready for passing the treatment catheter (stent/balloon) towards the lesion to be treated.

Claims

1. An intravascular system equipped with a guide catheter extension sub-system cooperating with a guide wire, the intravascular system comprising: a guide wire removably advanceable in a blood vessel of interest to at least a treatment site; and a guide catheter extension sub-system configured for controllable displacement along the guide wire, said guide catheter extension sub-system having a proximal portion, a distal portion, and a middle junction portion interconnected between said proximal and distal portions thereof, wherein said guide catheter extension sub-system comprises: an outer member formed by a flexible substantially cylindrically contoured elongated sheath defining a sheath lumen having a proximal end and a distal end, said sheath extending between said middle junction and distal portions of said guide catheter extension sub-system; an inner member having an elongated body defining an internal channel extending along the longitudinal axis thereof, said inner member extending internally along said sheath lumen in a controllably displaceable relationship with said sheath, wherein said inner member has a distal end configured with a tapered delivery micro-catheter having an elongated body of a predetermined length, said tapered delivery micro-catheter being displaceable along said guide wire beyond said distal end of said sheath; and an interconnection mechanism disposed in an operative coupling with said inner and outer members of said guide catheter extension sub-system and controllably actuated to operate said guide catheter extension sub-system in an engaged or disengaged modes of operation; wherein, in said engaged mode of operation, said inner and outer members of said guide catheter extension sub-system are engaged for a controllable common displacement along the guide wire, and wherein, in said disengaged mode of operation, said inner and outer members are disengaged for a controllable individual linear or rotational displacement relative one another.

2. The intravascular system of claim 1, wherein said micro-catheter is formed of a flexible material having differential flexibility along the length thereof, wherein the flexibility of said micro-catheter increases towards the distal end thereof.

3. The intravascular system of claim 2, wherein said micro-catheter includes a flat wire helical coil extending along said predetermined length of said micro-catheter, and wherein the pitch of said flat wire helical coil changes along the length of said micro-catheter to increase the flexibility of the micro-catheter towards the distal end thereof.

4. The intravascular system of claim 1, wherein said predetermined length of said micro-catheter exceeds 2 cm.

5. The intravascular system of claim 1, wherein a diameter of said micro-catheter at a distal end thereof is below 1 mm.

6. The intravascular system of claim 1, wherein said sheath, at the distal end thereof, is configured with a tapered outer tip, wherein said inner member, at said distal end thereof, is configured with a tapered distal tip, said tapered distal tip of said inner member interfacing, at the outer surface thereof, with an inner surface of said tapered outer tip of said sheath, and wherein a dimensional transition between the outer diameter of said outer tip of said sheath and the outer diameter of said distal tip of said inner member is below 0.006, thus forming a substantially flush transition therebetween.

7. The intravascular system of claim 1, wherein said guide catheter extension sub-system further comprises: an inner member pusher coupled, at a distal end thereof, to a proximal end of said inner member, and an outer member pusher coupled, at a distal end thereof, to said proximal end of said outer member; wherein said inner and outer member pushers are formed at said proximal portion of said guide catheter extension sub-system and are actuated to control displacement of said inner and outer member along the guide wire.

8. The intravascular system of claim 7, wherein said guide catheter extension sub-system further includes: an inner member pusher handle, and an outer member pusher handle; wherein said inner member pusher is attached, at a proximal end thereof, to said inner member pusher handle, and wherein said outer member pusher is attached, at a proximal end thereof, to said outer member pusher handle.

9. The intravascular system of claim 8, wherein said interconnection mechanism is operatively coupled to said inner and outer member pusher handles, said interconnection mechanism including tabs extending at opposite sides of one of said inner and outer member pusher handles, and notches formed at respective sides of another one of said inner and outer member pusher handles, said tabs disengageably cooperating with said notches, thus forming a snap-based interconnection mechanism.

10. The intravascular system of claim 1, wherein said interconnection mechanism includes a friction-based mechanism created between an outer surface of said inner member and an inner surface of said sheath of said outer member.

11. The intravascular system of claim 1, wherein said interconnection mechanism includes a threaded engagement/disengagement mechanism configured with at least one engagement button extending above an external surface of said inner member, and at least one engagement slot configured at least at said proximal end of said sheath of said outer member, said at least one engagement button being removably engaged in said at least one engagement slot in said engaged mode of operation for locking said inner and outer member one to another.

12. The intravascular system of claim 11, wherein said at least one engagement slot is configured with a first channel and a second channel extending substantially in perpendicular one to another, and a third channel extending in communication with said first and second channels in an angled relationship therewith.

13. The intravascular system of claim 1, wherein said interconnection mechanism includes: (a) a pull-away sheath formed with a substantially cylindrically shaped body having a wall defining an internal channel for receiving said inner and outer member pushers therein in said engaged mode of operation, said wall being pre-treated for collapsing therealong, and (b) a cord in operative coupling, at one end thereof, with said wall, said cord being pullable to break said wall in said disengaged mode of operation, thus disengaging said inner member pusher from said outer member pusher, thereby unlocking said inner member from said outer member.

14. The intravascular system of claim 1, wherein said guide catheter extension sub-system further includes a flat wire helical coil member forming at least a portion of respective walls of a member selected from a group including said sheath and said micro-catheter.

15. The intravascular system of claim 7, wherein said inner and outer member pushers are solid wires, wherein a distal end of said inner member pusher is tapered, and wherein said inner member includes, at the proximal end thereof, a tubular member having a proximal opening and an internal channel aligned with said inner channel of said inner member, and wherein the guide wire and said tapered distal end of said inner member pusher are received in said internal channel of said tubular member through said proximal opening for extending along said internal channel of said tubular member substantially in parallel relationship.

16. The intravascular system of claim 15, wherein said tubular member includes a reinforced portion formed with a flat wire helical coil embedded in a wall of said tubular member and extended circumferentially around said internal channel of said tubular member.

17. The intravascular system of claim 14, wherein said flat wire helical coil is formed with a shape memory alloy including Nitinol.

18. The intravascular system of claim 14, wherein said flat wire helical coil is formed of a radio-opaque material.

19. The intravascular system of claim 1, further including radio-opaque markers attached to at least said distal end of said sheath and a distal end of said micro-catheter.

20. The intravascular system of claim 8, wherein said inner member pusher is formed in a tubular configuration having an internal channel extending along the longitudinal axis of said inner member pusher, wherein said inner member pusher handle includes an entrance channel communicating with said internal channel of said inner member pusher, and wherein the guide wire enters into said internal channel of said inner member at said proximal end thereof through said entrance channel of said inner member pusher handle in communication with said internal channel of said inner member pusher.

21. The intravascular system of claim 7, wherein said distal end of said outer member pusher has a tapered arcuated configuration cooperating with a contour of said inner member at said proximal end thereof, said distal end of said outer member pusher being fixedly attached to said sheath at said proximal end thereof.

22. A method for intravascular treatment using a guide catheter extension system, comprising the steps of: (a) assembling a guide catheter extension system having: an outer member formed by a flexible substantially cylindrically contoured elongated sheath defining a sheath lumen having a proximal end and a distal end, an inner member having an elongated body defining an internal channel extending along the longitudinal axis thereof, wherein said inner member has a distal end configured with a tapered delivery micro-catheter having an elongated body of a predetermined length, said inner member extended in said sheath lumen in a controllably displaceable relationship with said sheath, and an interconnection mechanism disposed in an operative coupling with said inner and outer members of said guide catheter extension system and controllably actuated to operate said guide catheter extension system in an engaged or disengaged modes of operation; wherein, in said engaged mode of operation, said inner and outer members of said guide catheter extension system are engaged for a controllable common displacement, and wherein, in said disengaged mode of operation, said inner and outer members are disengaged for a controllable individual linear or rotational displacement relative to one another; (b) extending a guide wire along said internal channel of said inner member with a proximal end of the guide wire extending beyond a proximal end of said internal body and a distal end of the guide wire extending beyond a distal end of said delivery micro-catheter; (c) advancing the distal end of the guide wire into a blood vessel of interest towards a treatment site; (d) controlling said interconnection mechanism to establish said engaged mode of operation; (e) advancing said guide catheter extension system along the blood vessel of interest with said micro-catheter sliding along the guide wire towards the treatment site until being brought at least in alignment with or beyond the treatment site; (f) controlling said interconnection mechanism to switch to said disengaged mode of operation; (g) subsequently thereto, advancing said sheath along said micro-catheter toward the treatment site until said distal end of said sheath is brought in substantial alignment with the distal end of said micro-catheter; (h) removing said inner member from said sheath leaving said sheath with said distal end thereof in alignment with or beyond the treatment site; and (i) advancing a treatment system to or beyond the treatment site inside said sheath lumen.

23. The method of claim 22, further comprising: coupling an inner member pusher, at a distal end thereof, to said proximal end of said inner member, coupling an outer member pusher, at a distal end thereof, to said proximal end of said outer member, and controlling displacement of said inner and outer members in said engaged and disengaged modes of operation, by actuating said inner and outer member pushers.

24. The method of claim 23, further comprising: attaching inner and outer member pusher handles to said inner and outer pushers, respectively, operatively coupling said interconnection mechanism to said inner and outer member pusher handles, and configuring said interconnection mechanism with tabs extending at opposite sides of one of said inner and outer member pusher handles and with notches formed at respective sides of another one of said inner and outer member pusher handles in cooperation with said tabs, thus forming a snap-based interconnection mechanism.

25. The method of claim 22, further comprising: configuring said interconnection mechanism as a friction-based mechanism between an outer surface of said inner member and an inner surface of said sheath of said outer member.

26. The method of claim 23, further comprising: configuring said interconnection mechanism with a threaded engagement/disengagement mechanism including at least one engagement button extending above an external surface of said inner member, and at least one engagement slot formed at the proximal end of said sheath of said outer member, and actuating, at least one of said inner and outer member pushers to result in a displacement of said inner and outer member relative one another, thus removably engaging said at least one engagement button in said at least one engagement slot for locking said inner and outer members one to another.

27. The method of claim 26, further comprising: configuring said engagement slot with a first channel and a second channel extending substantially in perpendicular one to another, and a third channel communicating with said first and second channels and extending in an angled relationship therewith.

28. The method of claim 22, further comprising: configuring said interconnection mechanism with a pull-away sheath formed with a substantially cylindrically shaped body having a wall defining an internal channel for receiving said inner and outer member pushers therein, pre-treating said wall at at least one predetermined area for collapsing therealong, operatively coupling a cord, at one end thereof, with said wall, and pulling said cord to collapse said wall along said at least one predetermined area, thus disengaging said inner member pusher from said outer member pusher, thereby unlocking said inner member from said outer member.

29. The method of claim 22, further comprising: forming at least a portion of respective walls of a member with a flat wire helical coil, said member selected from a group consisting of said sheath and said micro-catheter.

30. The method of claim 23, further comprising: forming said inner and outer member pushers as solid wires, configuring said inner member, at the proximal end thereof, with a tubular member, said tubular member having a proximal opening and an internal channel aligned with an inner channel of said inner member, tapering said distal end of said inner member pusher, and extending the guide wire and said distal end of said inner member pusher substantially in parallel relationship in said internal channel of said tubular member through said proximal opening.

31. The method of claim 30, further comprising: reinforcing said tubular member at a reinforced portion thereof with a flat wire helical coil embedded in a wall of said tubular member and extended circumferentially around said internal channel of said tubular member.

32. The method of claim 29, further comprising: forming said flat wire helical coil with a shape memory alloy including Nitinol.

33. The method of claim 29, further comprising: forming flat wire helical coil of a radio-opaque material.

34. The method of claim 22, further comprising: marking said distal end of said sheath and a distal end of said micro-catheter with radio-opaque markers.

35. The method of claim 29, further comprising: forming said micro-catheter with a differential flexibility along the length thereof, wherein the flexibility increases towards said distal end of said micro-catheter.

36. The method of claim 35, further comprising: extending said flat wire helical coil along the length of said micro-catheter, and changing the pitch of said flat wire helical coil along the length of said micro-catheter to increase flexibility of the micro-catheter towards said distal tip thereof.

37. The method of claim 23, further comprising: forming said inner member pusher in a tubular configuration having an internal channel, attaching an inner member pusher handle to said inner member pusher, forming said inner member pusher handle with an entrance channel communicating with said internal channel of said inner member pusher, and entering said guide wire into said proximal end of said inner member through said inner member pusher handle in communication with said internal channel of said inner member channel.

38. The method of claim 23, further comprising: configuring said distal end of said outer member pusher in a tapered arcuated configuration and fixedly attaching said distal end of said outer member to the proximal end of said sheath.

39. The method of claim 22, further comprising: forming said micro-catheter with a length exceeding 2 cm and a diameter at said distal end thereof below 1 mm.

40. The method of claim 22, further comprising: configuring said sheath, at the distal end of said guide catheter extension system, with a tapered outer tip, configuring said inner member with a tapered distal tip, interfacing said tapered distal tip of said inner member, at the outer surface thereof, with an inner surface of said tapered outer tip of said sheath, and forming a dimensional transition between the outer diameter of said outer tip of said sheath and the outer diameter of said distal tip of said inner member below 0.006, thus forming a substantially flush transition therebetween.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0075] FIG. 1 shows schematically the subject guide catheter extension system advanced to the area of interest within a coronary artery;

[0076] FIG. 2 shows schematically the subject guide catheter extension system;

[0077] FIG. 3 is representative of the proximal end of the subject system;

[0078] FIG. 4 is representative of a middle junction of the subject system with FIG. 4A being a cross-section of the tubular part in the inner member, taken along Lines A-A of FIG. 4, FIG. 4B being a cross-section of the interconnection unit taken along Lines B-B of FIG. 4, and, FIG. 4C being a cross-section of the interconnection unit taken along Lines C-C of FIG. 4;

[0079] FIG. 5 depicts the middle junction of FIG. 3, detailing the brake reinforcement system;

[0080] FIG. 6 depicts a distal end of the subject system;

[0081] FIG. 7 depicts the proximal end of an alternative embodiment of the subject guiding catheter system;

[0082] FIG. 8 details the middle junction of the subject system in its alternative embodiment;

[0083] FIG. 9 shows the longitudinal cross-section of the distal end of the subject system;

[0084] FIG. 10 depicts the middle junction of the subject system with an alternative engagement mechanism (between the inner and outer members), with FIG. 10A depicting a cross-section of the interconnection unit taken along Lines A-A of FIG. 10;

[0085] FIG. 11 shows the outer sub-assembly (sheath) of the middle junction configured for cooperation with the inner sub-assembly of FIG. 10;

[0086] FIGS. 12A and 12B depict the threaded assembly of the middle junction of the subject system in its locked position (FIG. 12A) and unlocked position (FIG. 12B);

[0087] FIG. 13 depicts the alternative embodiment of the middle junction of the subject system designed with a modified engagement mechanism;

[0088] FIG. 14 depicts a peel-away embodiment of the subject system;

[0089] FIG. 15 shows schematically the details of the peel-away embodiment of the subject system;

[0090] FIGS. 16A-16B show the snap-together hubs alternative embodiment of the subject system with FIG. 16A depicting the inner and outer pusher hubs disengaged, and FIG. 16B depicting the inner and outer usher hubs engaged; and

[0091] FIGS. 17A-17E illustrate schematically a sequence of steps during the cardiac intervention procedure using the subject guide catheter extension system.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0092] FIG. 1 depicts a subject guide catheter extension system 10 which is used in conjunction with a guide catheter 11. At the initial stage of the procedure, the guide catheter 11 is advanced through a blood vessel 12 (such as the aorta) to a position adjacent to the ostium 14 of the coronary artery 16. A guidewire 18 is used during the cardiac procedure to guide the guide extension system 10 within the artery 16 toward a target location 20, as will be detailed in following paragraphs.

[0093] Subsequent to positioning of the distal end of the guide extension system 10 at the target location 20, a treatment system, such as a balloon catheter or stent system, may be advanced through the guide extension system 10 into the coronary artery 16 to the target location 20 to perform an intended cardiac treatment.

[0094] In order to reliably reach the target location, and even pass beyond the target location 20, the subject guide extension system 10 extends through the guide catheter 11 and beyond a distal end 24 of the guide catheter 11 deep into the coronary artery 16. The subject guide extension system 10, by extending beyond the distal end 24 of the guide catheter 11, provides an adequate reachability to the target location 20, and, by extending beyond the ostium 14 of the coronary artery 16, stabilizes the positioning of the guide catheter 11 and allows for an improved accessibility into the coronary artery 16 and to the target site 20.

[0095] As shown in FIG. 2, the subject guide extension system 10 includes a proximal end 26, a distal end 28, and a middle junction portion 30, interconnected between the proximal end 26 and the distal end 28 of the guide extension catheter system 10. The subject wire extension catheter system 10 is shown being extended within a lumen (internal channel) 32 of the guide catheter 11. The guide wire 18 is shown extending internally the guide extension system 10 along the longitudinal axis 168 thereof, and exits the system 10 beyond the outermost end 132 of the distal end 28 and between the proximal end 26 and the middle junction 30 in a manner detailed in further paragraphs.

[0096] Referring to FIGS. 2 and 3, the proximal end 26 of the subject guide extension system 10 is represented by a proximal handle 34 of an inner member 36 (to be detailed in further paragraphs) and a proximal handle 38 of an outer member 40 (to be detailed in following paragraphs).

[0097] An inner member pusher 42 is connected, at the proximal end 44 thereof, to the proximal handle 34 of the inner member 36. An outer member pusher 46 is connected, at the proximal end 48 thereof, to the proximal handle 38 of the outer member 40.

[0098] During the procedure, the proximal handle 34 of the inner member 36 and the proximal handle 38 of the outer member 40 are manipulated by a surgeon (operator) performing the coronary intervention procedure to position the guide extension catheter system 10 at the desired location 20, as well as to advance or retract the inner member 36 and the outer member 40 relative to the guide catheter 10 as required by the coronary intervention procedure.

[0099] Referring now to FIGS. 1, 2, 3, and 4, representative of one of the embodiments of the present guide extension catheter system 10, both inner and outer pushers 42 and 46 are made as solid wire members.

[0100] Referring to FIGS. 1, 2, 4, 4A-4C, and 5, the subject guide extension catheter system 10 includes the inner member 36 which is built, at the middle junction 30, with an interconnection unit 50 and a tubular part 52 connected, at the end 54 thereof, to a proximal end 56 of the interconnection unit 50. The interconnection unit 50 represents a cylindrically-shaped unit having, as shown in FIGS. 4B-4C, a lumen 58 formed therein along its longitudinal axis (which coincides with the longitudinal axis 168 of the guide catheter extension system 10).

[0101] As shown in FIGS. 4 and 4A-4C, the tubular part 52 is provided with a lumen 60 which is aligned, at the end 62 of the tubular part 52, with the lumen 58 at the proximal end 56 of the interconnection unit 50.

[0102] At the end 54 thereof, the tubular part 52 has an RX notch (Rapid Exchange Notch) 64 configured to receive the end 66 of the inner member pusher 42, as represented in FIG. 4A. Being received and extending through the lumen 60 of the tubular part 52, the end 66 of the inner member pusher 42 reaches the proximal end 56 of the interconnection unit 50 and is coupled (glued, welded, or otherwise fixedly attached) to the interconnection unit 50 to ensure that by manipulating the inner member pusher 42, a surgeon (operator) can control the positioning of the interconnection unit 50 (as well as the inner member 36 in its entirety).

[0103] The outer member 40 includes a sheath 70 made with a cylindrically shaped tubular body 72 extending substantially the entire length 138 of the subject system 10 and covering the middle junction 30 and the distal end 28 thereof. By manipulating the inner and/or outer member pusher(s) 42 and/or 46, a surgeon actuates a required linear and/or rotational displacement of the inner member 36 with regard to the sheath 70 of the outer member 40 (as will be detailed in further paragraphs), to advance or retract, the interconnection unit 50 to or from the guide catheter 11 by displacing the inner member 36 relative to the outer member 40, as required by the procedure performed.

[0104] The guidewire 18 extends through the RX notch 54 of the tubular part 52 at the end 54 thereof and extends along the lumen 60 of the tubular part 52 in parallel with the inner member pusher 42 as shown in FIGS. 4 and 4A. The guidewire 18 also extends through the lumen 58 of the interconnection unit 50 (as depicted in FIGS. 4, and 4B-4C), and through the lumen 130 in the distal end 28 of the subject guide extension catheter system 10, as shown in FIG. 9, to be further described.

[0105] As shown in FIGS. 4 and 5, illustrating the middle junction portion 30 of the subject guide extension catheter system 10, the outer member 40 is represented by the sheath 70 having the tubular body 72, the inner surface 74 of which, at its proximal end 76, interconnects with the outer surface 78 or the interconnection unit 50.

[0106] The subject guide catheter extension system 10 may operate in an inner/outer member engagement mode and in an inner/outer member disengagement mode.

[0107] There are several mechanisms envisioned in the subject guide extension catheter system 10 for controllable engagement/disengagement between the inner member 36 and the outer member 40, particularly, the sheath 70.

[0108] For example, as shown in FIGS. 4 and 5, in one of the embodiments, the interconnection unit 50 and the inner surface 74 of the sheath 70 are interconnected by a friction mechanism. The friction mechanism is used in the guide catheter extension system 10 to lock the inner member 36 and the outer member 40 together (when required by the cardiac procedure) to provide integral manipulation of the inner and outer members 36, 40, by actuating the inner and/or outer member pushers 42, 46, respectively, during the cardiac intervention procedure.

[0109] A similar friction-based engagement/disengagement mechanism may be provided at other locations along the length 138 of the inner/outer members interface, for example, at the distal end 28.

[0110] Alternative interconnecting mechanisms between inner and outer members 36, 40, will be presented in detail in following paragraphs.

[0111] The interconnecting mechanism may be controlled by a surgeon during the cardiac procedure to disengage the inner member 36 from the outer member 40 where a relative displacement of one with respect to another is required. Such disengagement of the inner and outer member is required during the cardiac procedure when the distal end 132 of the inner member 36 is to be advanced beyond the distal end 98 of the sheath 70 (as shown in FIGS. 6 and 17C), or when the inner member 36 is to be retracted from the sheath 70 and removed from the guide catheter 11 (as shown in FIG. 17D) prior to entering the balloon/stent catheter 230 to the lesion site 20 through the sheath 70 (as shown in FIG. 17E).

[0112] In order to provide enough room within the lumen 60 of the tubular part 52 for the guidewire 18, the inner member pusher 42 is somewhat tapered at its end 66, as shown in FIGS. 4 and 4A. Thus, the guide wire 18 has a sufficient room within the lumen 60 in the tubular part 52 to extend therealong.

[0113] The outer member pusher 46 is also tapered at its end 80, and is welded (glued, adhered, or otherwise fixedly attached) to the proximal end 76 of the tubular body 72 of the sheath 70. As shown in FIG. 4B, the tapered end 80 of the outer member pusher 46 may have a somewhat curved configuration in order to snugly cradle the portion of the outer surface 78 of the interconnection unit 50 in order to form a smooth surface at their interconnection, as well as to consume as little space within the sheath 70 as possible.

[0114] Referring to FIG. 5, the middle junction portion 30 of the subject guide extension catheter 10 may be manufactured with a braid reinforcement structure. The braid reinforcement member 84 includes a braid reinforced tube 86 that creates a somewhat flexible tubing connected to the interconnection unit 50 of the inner member 36, and a plastic tubing 88 that is connected to the proximal end 90 of the braid reinforced tubing 86 and bonded to the inner member pusher 42, as shown in FIG. 5.

[0115] The RX (rapid exchange) notch 92 for passing the guide wire 18 therethrough is formed through the wall 93 of the braid reinforced tubing 86. The braid reinforcement mechanism 84 may be configured with metallic patterns or wires within the braid reinforced tubing 86 to prevent kinking and which would give the braid reinforced tubing 86 a longitudinal stiffness. The metal braid portion 94 is embedded in the braid reinforced tubing 86 to add an increased flexibility thereto simultaneously with the stiffness required for advancing and retracting the inner member 36 relative to the sheath 70 during the procedure. A flat wire helical coil (made, for example, from a shape memory alloy, such as Nitinol) with a wire thickness of approximately 1 mil to 3 mils may be embedded in the braid portion 94. This coil may be formed with a very thin coating of plastic placed onto its inner and outer surfaces, which facilitates the reduction of the wall thickness of the tubing 86 to less than 7 mils and preferably to approximately 5 mils.

[0116] The principles of reinforcing tubular members by a flat wire helical coil or forming the tubular member from the flat wire helical coil may be applied in the subject guide catheter system 10 to the sheath 70, as well as to the micro-catheter 106. In the sheath 70 and/or the micro-catheter 106, such flat wire helical coil may be embedded in predetermined positions along the length of the walls thereof, for example, at the proximal and or distal ends. Alternatively, the entire length of the sheath 70 and/or micro-catheter 106 may be formed from the flat wire helical coil. The pitch between the coils may be changed to provide the flexibility gradient along the length of the tubular member (sheath 70 and or micro-catheter 106) increasing to the distal end thereof to facilitate atraumatic operation. The flat wire helical coil 135 is schematically depicted in FIGS. 6, 8, and 11. The length of the micro-catheter may exceed 2 cm.

[0117] Specifically, the subject guide catheter extension system 10 may be configured with a differential in micro-catheter flexibility with greater flexibility in the distal portion, by either changing the durometer of the plastic components from the sheath's proximal portion to its distal portion (i.e., higher durometer in the proximal rather than the distal portion), and/or changing the winding frequency (pitch) of the helical coil of wire in the micro-catheter 106 in the direction from the proximal portion to distal portion, such that the distal portion of the micro-catheter 106 is more flexible and trackable than the proximal portion of the micro-catheter delivery device, and has a substantially lower profile and more flexible than even the distal portion of the guide extension catheter (sheath).

[0118] The system 10 could also include wires that have radio-opacity such that the guide extension system (sheath) is easily visualized using fluoroscopy. It is also envisioned that both the tip 132 of the micro-catheter delivery portion 106 and the tip 98 of the sheath 70 will have one or more radio-opaque markers 99, 133 (shown schematically in FIG. 6) at or near the distal tip in order to permit an operator to distinguish between the two, which is particularly important as the obstructive lesion is crossed over with the micro-catheter, and the micro-catheter is held in place to allow the advancement of the tip of the sheath over the micro-catheter to the appropriate and ideal position, beyond, or in some cases just proximal, to the lesion to be treated.

[0119] As shown in FIGS. 2 and 6, the sheath 70 extends between its proximal end 76 at the middle junction 30 and its distal end 98 at the distal end 28 of the subject system 10 along the entire length 138 of the subject guide catheter extension system 10. As shown in FIG. 6, at the distal end 28 of the subject guide catheter extension system 10, the inner member 36 includes a distal tip 102 and a micro-catheter 106 (which may have a cylindrical configuration or a tapered cone-contoured configuration) formed integrally with the distal tip 102. At the distal end 98, the sheath 70 is formed with an outer tip 100 which may have a tapered cone-contoured configuration which may be frictionally (or through an alternative engagement/disengagement mechanism) interconnected with the distal tip 102 of the inner member 36.

[0120] As shown in FIGS. 2, 6, and 9, the distal tip 102 has a tapered configuration which changes gradually from the point of interconnection with the outer tip 100 of the sheath 70 to the distal end 104 of the distal tip 102. The micro-catheter 106 extends from the distal end 104 of the distal tip 102 of the inner member 36 in integral connection therewith and terminates in the distal end 132. The diameter of the micro-catheter 106 at the distal end 132 does not exceed 1 mm.

[0121] As shown in FIGS. 2 and 9, the guide wire 18 extends from the proximal end 26 of the subject guide extension catheter system 10 through the internal lumen 108 in the inner member 36 within the sheath 70 and through the distal tip 102 of the inner member 36, and exits at the distal end 132 of the micro-catheter 106 of the inner member 36.

[0122] In order to provide passage to the guidewire 18, the inner member 36 has an internal lumen 108 extending along the entire inner member 36 from its proximal end 56 of the interconnection unit 50 along the internal lumen 128 extending within the sheath 70, through the length of the distal tip 102 and the length of the micro-catheter 106.

[0123] The outer tip 100 of the sheath 70 is a cone-shaped configuration made of a flexible material to facilitate a relative movement of the distal tip 102 (including the micro-catheter 106) of the inner member 36 when the inner member 36 is to be retracted into the outer sheath 70 through the outer tip 100 thereof, as required by the cardiac procedure.

[0124] As presented in FIGS. 6 and 9, the distal tip 102 of the inner member 36 which interfaces with the outer tip 100 of the sheath 70 is provided with notches 110 formed along the distal tip 102's surface so that the distal part of the outer tip 100 of the sheath 70 can be snugly received in the notches 110 of the distal tip 102 to provide a smooth transition between the outer surface of the sheath 70 and the outer surface of the distal tip 102 of the inner member 36. The notches 110 may extend along the entire length of the inner member 36, i.e., from the distal tip 102 to (and including) on the outer surface of the interconnection unit 50, or a portion of the length of the inner member 36. When the inner member 36 is pulled into the sheath 70, as required by the procedure, the flexible end 111 of the outer tip 100 stretches, and the distal tip 102 of the inner member 36, along with the micro-catheter 106 can be retracted into the outer member 40.

[0125] In addition to the mono-rail design embodiment of the subject guiding extension catheter extension system 10 shown in FIGS. 2, in an alternative over-the-wire (OTW) embodiment of the subject system 10, the guidewire 18 extends at the proximal end 26 of the system 10 in parallel to the inner pusher 42, as presented in FIGS. 7 and 8.

[0126] As shown in FIGS. 7 and 8, the proximal end 26 of the subject system 10 includes an inner pusher 120 formed as a tubular member having a hollow passage 121 formed therealong. In this embodiment, the inner member proximal handle 122 is configured with a passage 124 cooperating with the hollow passage 121 within the inner member pusher 120. The guidewire 18 enters the passage 124 in the inner member proximal handle 122 and extends through the hollow passage 121 of the inner member pusher 120.

[0127] The middle junction portion 30 (shown in FIG. 8) of the subject guide extension catheter system 10 is modified in comparison with the middle junction portion 30 of the system 10 shown in FIGS. 4 and 5. As shown in FIG. 8, a tubular member 126 receives the inner member pusher 120 in its internal channel for passage therealong, and leads the pusher 120 into the lumen 58 of the interconnection unit 50. The guidewire 18 extends internally (along the hollow passage 121) in the the pusher 120, within the tubular member 126, inside the interconnection member 50, and further within the inner member 36's length 138 inside the sheath 70 to the distal end 28 of the system 10, and egresses the micro-catheter 106 at the distal tip 102 of the inner member 36 similar to the guide extension catheter system 10, as shown in FIGS. 2, 6, and 9.

[0128] Referring again to FIG. 9, which shows a cross-section of the distal end 28 of the subject guide extension catheter system 10 on a somewhat enlarged scale, as well as to FIG. 6, the distal tip 102 of the inner member 36 extends along the inner channel 128 of the tubular body 72 of the sheath 70 and beyond the distal end 98 of the sheath 70. As shown, the distal tip 102 of the inner member 36 has a tapered conical configuration decreasing in diameter beginning from the distal end 98 of the sheath 70 to the distal end 104 of the distal tip 102 and is integral with the micro-catheter 106 extending beyond the distal end 104 of the distal tip 102.

[0129] As shown in FIGS. 2 and 9, the inner member 36 has an internal channel 108 which extends from the end 54 of the tubular part 52 through the length 138 of the inner member 36, through the distal tip 102 of the inner member 336, and along the micro-catheter 106 at the distal end 28 and ends at the distal end 132. The internal channel 108 of the inner member 36 thus is formed by the lumen 60 of the tubular part 52 (shown in FIGS. 4 and 4A), followed by the lumen 58 of the interconnection unit 50 (shown in FIGS. 4 and 4B-4C), as well as the internal channel 130 of the distal tip 102 and the internal channel 136 of the micro-catheter 106, and by the channel extending the length 138 (shown in FIG. 2) of the inner member 36.

[0130] The guidewire 18 is received within the internal channel 108 of the inner member 36 and extends, as required by the procedure, from the proximal end 26 through the middle junction 30 and through the distal tip 102 of the inner member 36 and along the micro-catheter 106, where it exits from the micro-catheter 106 at its distal end 132.

[0131] The distal end 98, as well as the outer tip 100 of the sheath 70, are formed of a flexible material which permits easy extension and retraction of the distal tip 102 of the inner member 36 therethrough. The flat wire helical coil may be used for the distal end 98 and the outer tip 100 of the sheath 70.

[0132] The distal tip 102 of the inner member 36 at its wider diameter has the same dimension as the diameter of the outer tip 100 of the sheath 70 in order to form a substantially smooth outer surface at the distal end 28 of the system 10. An important aspect of the subject system is that for a transition between the outer diameter of the outer tip 100 of the sheath 70 and the outer diameter of the distal tip 102 of the inner member 36 is equal to or less than 0.0006 to form substantially flush transition therebetween.

[0133] As can be seen in FIG. 9, the interface 111 between the outer tip 100 of the sheath 70 and the distal tip 102 of the inner member 36 is chamfered to facilitate displacement of the distal tip 102 of the inner member 36 relative to the outer tip 100 of the sheath 70 and basically to facilitate extension of the distal tip 102 beyond and removal from relative to the outer tip 100 of the sheath 70, as required by the cardiac procedure.

[0134] Shown in FIG. 9, it is important that the interface 111 between the outer tip 100 of the sheath 70 and the distal tip 102 of the inner member 36 has an approximate 45 chamfer. Additionally, the interface 111 has an approximate 60 chamfer formed between the outer tip 100 of the sheath 70 and the distal tip 102 of the inner member 36. The angled chamfer is for easing the displacement of the inner member 36 into the distal end 98 of the sheath 70.

[0135] As shown in FIGS. 2, 4, 5, and 8, the guide extension catheter system 10 includes interconnection unit 50 which is frictionally engaged with the inner surface 74 of the tubular body 72 of the sheath 70 at its proximal end 76. A similar frictional engagement mechanism may be provided also between the outer tip 100 of the sheath 70 and the distal tip 102 of the inner member 36 at the distal end 28 of the guide extension catheter system 10. This frictional interconnection between the inner member 36 and the outer member 40 permits the integral manipulation of both the inner member 36 and outer member 40, as required by the cardiac procedure.

[0136] Referring to FIGS. 10, 10A, 11, and 12A-12B, an alternative embodiment of the middle junction portion 30 of the subject system includes a threaded engagement between the interconnection unit 140 and the sheath 148. In the embodiment shown in FIGS. 10, 10A, 11 and 12A-12B, the interconnection unit 140 (which replaces the interconnection unit 50 supporting the friction engagement mechanism) is configured with an engagement button 142 extending beyond the surface 144 of the interconnection unit 140. In order to interface the interconnection unit 140 and to provide the threaded engagement between its surface 144 and the sheath 148, the proximal end 149 of the sheath 148 is modified (as compared to the sheath 70 adapted for the frictional engagement) and is configured with a system of flexible ribs 150 separated by respective inter-rib spaces 152 which extend in a somewhat arcuated configuration reflecting the cylindrical configuration of the sheath 148 and are adapted to embrace the cylindrically shaped outer surface 144 of the unit 140.

[0137] One of the inter-rib spaces 152, specifically, the slot-like portion 154 is shaped with an exit channel 156 angularly cooperating at one of its ends 158 with the engagement slot 160.

[0138] In the arrangement shown in FIGS. 10, 10A, 11, and 12A-12B, when the inner member 36 is to be engaged with the outer member 40, specifically by coupling the interconnection unit 140 to the proximal end 149 of the sheath 148, the interconnection unit 140 is extended (by a surgeon forward-pushing the inner member pusher 42) into the lumen 162 of the sheath 148 at its proximal end 149, so that the engagement button 142 on the surface 144 of the interconnection unit 140 moves along the exit channel 156 to the end 158 thereof. At this instance, a surgeon (operator) turns the inner member 36 in clockwise direction toward its end 164 (by manipulating the inner member pusher 42) to advance the engagement button 142 along the engagement slot 160 as shown in FIG. 12A for locking the inner member 36 with the outer member (i.e., the sheath 148). When the engagement button 142 is placed at the end 164 of the engagement slot 160, the inner and outer members, 36 and 40, respectively, are placed in the locked position, as shown in FIG. 12A.

[0139] In order to unlock (disengage) the inner member 36 from the outer member 40, as shown in FIG. 12B, the engagement button 142 is displaced (by a surgeon manipulating the inner member pusher 42) from the end 164 along the engagement slot 160 towards the end 158 of the exit channel 156 (by a surgeon manipulating the pusher 42 to make a counter-clockwise rotation of the inner member 36 relative to the outer member 40). Subsequently, the inner member 36 is pulled from the sheath 148 (by pulling the inner member pusher 42) with the engagement button 142 moving along the exit channel 156 from the end 158 thereof in the direction shown by the arrow 166. When the engagement button 142 is removed from the exit channel 156, the inner member 36 is disengaged (or unlocked) from the sheath 148, as depicted in FIG. 12B.

[0140] In order to linearly displace the interconnection unit 140 into or from the sheath 148, or to rotate the interconnection unit 140 in clockwise or counter-clockwise direction about the longitudinal axis 168 of the system, a surgeon (operator) uses the inner member pusher 42 which is either molded (glued, welded, or otherwise fixedly attached to the interconnection unit 50 or 140, as presented in the embodiments of FIGS. 4-4C, 5, and 10), or which is attached to the internal lumen of the interconnection unit 140, similar to the embodiment shown in FIG. 8.

[0141] FIG. 13 shows a further alternative embodiment of the proximal end 149 of the sheath 148 which is shown slightly modified in comparison with FIGS. 11 and 12A-12B. Specifically, the exit channel/engagement slot 160 shown in FIGS. 12A and 12B is replaced with an engagement channel 170 where the substantially perpendicular relationship between the exit channel 156 and the engagement slot 160 is replaced with a somewhat 45 angled configuration where the exit channel 172 and the ending engagement slot 174 are connected by a substantially flat interconnection channel 176. The interconnection channel 176 is similarly angled about 45 with relation to the exit channel 172 and the ending engagement slot 174. This arrangement provides a mechanical advantage for engaging the engagement button 142 in the engagement channel 170, and prevents accidental disengagement of the engagement button 142 from the engagement channel 170.

[0142] In another embodiment of the engagement/disengagement mechanism between the inner member 36 and outer member 40, shown in FIGS. 14-15, in the engaged mode of operation, the inner member pusher 42 and the outer member pusher 46 are positioned in a single peel away sheath 180 having a channel 182 where both inner and outer pushers extend in connection one with another. The peel away sheath 180 is connected to the peel away handle 184 by a cord 183. The sheath 180 (as shown in FIG. 15) is pre-cut at its sides 188, and the sides are held together, to form the channel 182, by a wire/suture 200 embedded therein. The wire/suture 200 is operatively connected to the handle 184 by a cord 183.

[0143] When disengagement of the inner and outer members 36, 40 is required (in the case of extending the inner member 36 with regard to the outer member 40, or pulling the inner member 36 into and from the outer member 40), a surgeon manipulates a peel away handle 184 to pull the cord 183. Having been pulled, the cord 183 applies the force to a wire/suture 200 embedded in the side(s) 186, 188 of the sheath 180. As a result, the wire/suture 200 breaks, and the sheath 180 opens at the side(s) 186, 188. At this moment, the peel away sheath 180 is divided into two halves when the side 186 is separated from the side 188, and the inner and outer member pushers 42, 46 are freed from the sheath 180, and can be manipulated independently of each other. As a result, the inner member 36 is disengaged from the outer member 40 (i.e., the sheath 70) for a controlled displacement relative thereto.

[0144] The peel away sheath 180 may also have several serrations 202 along its surface 204 for facilitating an easy splitting of the sides 186, 188 (or at other locations along the surface 204) of the peel away sheath 180.

[0145] Referring to FIGS. 16A-16B, an additional embodiment of the engagement/disengagement mechanism includes the handles 34 and 38 of the inner and outer member pushers 42, 46, respectively, which may be attached, as shown in FIG. 16B to provide an integral motion together as a single unit during the procedure. As shown in FIG. 16A, the handles 34, 38 are disengaged to provide a relative displacement of the inner and outer members 36, 40, respectively, as required during the cardiac procedure.

[0146] In order to provide an engagement/disengagement of the inner member 36 and the outer member 40, respectively, the handles are provided with a snap mechanism 206. The snap mechanism 206 may include two tabs 208 formed on the sides of the handle 34 for the inner member 36 to be engageable with the notches 210 formed on the companion handle 38 for the outer member 40. The handles' snap mechanism 206 is just one exemplary mechanism of many envisioned for engagement/disengagement between the inner and outer members in the subject system.

[0147] In operation, as shown in FIG. 17A, for performing the cardiac procedure, a proximal end of the coronary guidewire 18 is extended through the inner channel 108 of the inner member of the subject system 10. Subsequent thereto, the guide catheter 11, along with a guidewire 18 therewithin, is inserted and advanced into the blood vessel 16 of interest. At this stage, the distal end 24 of the guide catheter is not placed at the lesion location 20.

[0148] Subsequently, the sheath 70, locked with the inner member 36 therewithin, is advanced within the guide catheter 11 towards the treatment site 20 and reaches the distal end 24 of the guide catheter 11.

[0149] Further, as shown in FIG. 17B, the guidewire 18 which extends beyond the distal end 24 of the guide catheter 11, serves as a guide along which the micro-catheter 106 slides towards the treatment site 20. During this step of the cardiac procedure, the sheath 70 is disengaged from the inner member 36 by any mechanism described in previous paragraphs. Thus, the distal tip 102 (particularly, the micro-catheter 106) of the inner member 36 is advanced beyond the distal end of the sheath 70, along the blood vessel 16 towards (or beyond) the lesion 20 to be treated, as shown in FIG. 17C.

[0150] Subsequently, as shown in FIG. 17D, the sheath 70 is pushed by the surgeon to slide inside the guide catheter 11 along the micro-catheter 106 towards or beyond the lesion 20. Once the distal end 98 of the sheath 70 reaches or passes beyond the lesion 20, the inner member 36 is removed from the sheath 70. At this stage, the distal end 98 of the sheath 70 (within the guide catheter 11) is positioned in alignment or beyond the lesion 20 and remains within the guide catheter 11.

[0151] As further shown in FIG. 17E, upon removal of the inner member 36, a stent delivery system or a balloon catheter 230 can be delivered to the lesion 20 for a subsequent treatment.

[0152] Another embodiment of this same invention describes the use of a similar micro-catheter delivery system that is placed inside a balloon expandable guide extension tube to allow one to deliver the micro-catheter tip and a low profile guide extension catheter to an area beyond a lesion of interest and then to use a balloon contained on the outer aspect of the micro-catheter to mechanically expand a metal reinforced but balloon expandable guide extension tube after it has been already delivered at a lower profile diameter to the area at or distal to a lesion to be treated. In this way, one can deliver a guide extension system that is 4-5 French (1.3-1.6 mm) in outer diameter and 3-4 French in inner diameter, and then balloon expand this tubular structure to be 5-6 French (1.6-2.0 mm) in inner diameter after it has been delivered as a lower profile catheter to the appropriate distal location.

[0153] Although this invention has been described in connection with specific forms and embodiments thereof, it will be appreciated that various modifications other than those discussed above may be resorted to without departing from the spirit or scope of the invention as defined in the appended claims. For example, functionally equivalent elements may be substituted for those specifically shown and described, certain features may be used independently of other features, and in certain cases, particular locations of elements, steps, or processes may be reversed or interposed, all without departing from the spirit or scope of the invention as defined in the appended claims.