WO2011129915A2 - Reperméation de vaisseaux corporels obstrués à l'aide d'une force de blocage élevée - Google Patents

Reperméation de vaisseaux corporels obstrués à l'aide d'une force de blocage élevée Download PDF

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Publication number
WO2011129915A2
WO2011129915A2 PCT/US2011/024810 US2011024810W WO2011129915A2 WO 2011129915 A2 WO2011129915 A2 WO 2011129915A2 US 2011024810 W US2011024810 W US 2011024810W WO 2011129915 A2 WO2011129915 A2 WO 2011129915A2
Authority
WO
WIPO (PCT)
Prior art keywords
occlusion
catheter
guidewire
suction
lumen
Prior art date
Application number
PCT/US2011/024810
Other languages
English (en)
Other versions
WO2011129915A3 (fr
Inventor
Wayne Ogata
Osamu Katoh
Original Assignee
Retrovascular Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Retrovascular Inc. filed Critical Retrovascular Inc.
Priority to US13/042,411 priority Critical patent/US20110218528A1/en
Publication of WO2011129915A2 publication Critical patent/WO2011129915A2/fr
Publication of WO2011129915A3 publication Critical patent/WO2011129915A3/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22001—Angioplasty, e.g. PCTA
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A61B2017/22047—Means for immobilising the guide wire in the patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22051—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A61B2017/22065—Functions of balloons
    • A61B2017/22068—Centering
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22094—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for for crossing total occlusions, i.e. piercing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/30—Surgical pincettes without pivotal connections
    • A61B2017/306—Surgical pincettes without pivotal connections holding by means of suction

Definitions

  • This invention relates generally to methods and devices for recanalizing occluded body vessels, and in particular to using suction or negative pressure to stabilize a catheter tip on an occlusion in order to penetrate the occlusion using a guidewire.
  • CTO Chronic total occlusion
  • PTCA percutaneous trans-luminal coronary angioplasty
  • a small incision is typically made in the groin.
  • a guiding catheter over a guidewire is introduced into the femoral artery and advanced to the occlusion. Frequently, with gentle maneuvering, the guidewire is able to cross the stenosis.
  • a balloon-tipped angioplasty catheter is advanced over the guidewire to the stenosis. The balloon is inflated, separating or fracturing the atheroma.
  • a stent is subsequently placed.
  • U. S. Pub. No. 2007/0208368A1 by Katoh et al. discloses a technique to treat CTOs by using a combined antegrade and retrograde approach.
  • one of the guidewires is advanced through the occlusion in an antegrade fashion while another guidewire is advanced in retrograde manner.
  • the two guidewires are configured to engage with each other to recanalize the body vessel.
  • slipping or deviation of the guidewires into the subintimal space or into the inner walls of the body vessel can occur.
  • a more effective treatment of coronary chronic total occlusions with increased safety remains a challenge.
  • the present embodiments provide methods and devices for effectively recanalizing an occluded body vessel by providing means to stabilize a catheter so that subsequent advancement of a guidewire through the occlusion can be readily performed.
  • a catheter is inserted into or near an occluded body vessel, the catheter comprising a proximal end, a distal end, and a suction lumen therebetween.
  • the catheter is further configured for advancement of a guidewire therethrough.
  • the distal end of the catheter is stabilized on the occlusion by applying suction or negative pressure through the suction lumen.
  • the guidewire is advanced through the stabilized catheter to penetrate the occlusion and recanalize the body vessel.
  • a catheter or catheter system for recanalizing an occluded body vessel comprises a catheter in combination with a guidewire for insertion into a body vessel.
  • the catheter comprises a proximal end, a distal end, and a suction lumen therebetween.
  • the catheter is configured for advancement of a guidewire therethrough.
  • the suction lumen is used for stabilizing the distal end of the catheter that is in contact with the occlusion, and the guidewire is advanced through the stabilized catheter and through the occlusion to recanalize the body vessel.
  • the catheter used in the recanalization process could be a single lumen catheter.
  • the catheter could be a multi-lumen catheter.
  • the lumens may be arranged in a coaxial manner, or in a non-coaxial manner, such as side-by-side.
  • the catheter lumens could be defined by surfaces that are made of sufficiently strong polymer material to withstand suction pressures. Such surfaces may have a coiled structure, a braided structure, or other reinforced structure.
  • the catheter may include a balloon at its distal end to aid in targeted entry of the guidewire into the occlusion.
  • the catheter may include modified tips to enhance stability of the catheter.
  • Embodiments of methods and devices of the present invention may be used to recanalize an occlusion by approaching the occlusion in a retrograde or in an antegrade direction.
  • FIG. 1 A shows a portion of a body vessel with an occlusion.
  • FIG. IB shows a guidewire being deflected by a distal cap of an occlusion into a subintimal space.
  • FIG. 2 shows a three dimensional view of a catheter body.
  • FIG. 3 shows a flow diagram of various steps involved in performing the recanalization of the body vessel.
  • FIG. 4 is a flow diagram illustrating a method for recanalizing an occluded body vessel in an antegrade direction.
  • FIGS. 5A-5F show various stages of recanalization of the body vessel in an antegrade direction.
  • FIG. 6 is a flow diagram illustrating a method for recanalizing an occluded body vessel in a retrograde direction.
  • FIGS. 7A-7G show various stages of recanalization of the body vessel in a retrograde direction.
  • FIGS. 8A-8E show various cross-sectional views of a recanalization catheter comprising a suction lumen.
  • FIG. 1 A A schematic diagram of a portion of an occluded body vessel BDL is shown in FIG. 1 A.
  • the body vessel BDL could be any vessel or artery in which blood flows through the hollow tubular cavity.
  • An occlusion OCL within the body vessel BDL may obstruct the blood flow and could have fatal consequences.
  • treatment procedures may involve approaching the occlusion from an antegrade and/or a retrograde direction.
  • the occlusion OCL comprises a distal cap DC, a proximal cap PC, and an occlusion body BO therebetween.
  • the distal cap DC is typically approached from a retrograde direction whereas the proximal cap PC is typically approached from an antegrade direction.
  • the occlusion OCL could be atheromatous plaque, old thrombus, or similar other deposit.
  • One method of recanalizing the occlusion OCL is by using guidewire techniques, wherein a guidewire penetrates the occlusion OCL and a catheter recanalizes the vessel.
  • the distal cap DC of the occlusion may be composed of dense, fibrous tissue with fibrocalcific regions.
  • a guidewire of sufficient rigidity it may be necessary to use a guidewire of sufficient rigidity to successfully penetrate the distal cap DC.
  • the penetration of the subintimal space SIS by a guidewire GW may lead to the puncturing of the wall of the body vessel, which may cause bleeding as well as other undesirable side effects. Furthermore, by penetrating the subintimal space SIS instead of the distal cap DC, it is substantially more difficult for a catheter to advance into the distal true lumen DTL to complete the recanalization.
  • the present embodiments are configured to reduce the likelihood of a guidewire slipping away from a portion of the occlusion, such as the distal cap DC, into the subintimal space SIS in the process of recanalization of an occluded body vessel.
  • the present embodiments may employ suction force to stabilize the distal end of a catheter on a portion of the occlusion, such as an interior or exterior surface of the distal cap DC of the occlusion.
  • a guidewire may be advanced to penetrate the occlusion.
  • a catheter may be advanced through the occlusion to recanalize the body vessel.
  • FIG. 2 One embodiment of a system for recanalizing an occluded vessel is shown in FIG. 2.
  • a catheter 100 comprises a distal end 110, a proximal end 120, and a suction lumen 130 therebetween.
  • the embodiment shown in FIG. 2 further comprises a guidewire lumen 140 disposed within the suction lumen 130.
  • the guidewire lumen 140 may be configured to advance a guidewire 150 through the catheter 100.
  • the guidewire lumen 140 comprises an opening 160 at the distal end 110 of the catheter 100 for further passage of the guidewire into a body lumen.
  • the guidewire lumen may be disposed outside of the suction lumen, or the suction lumen itself may also serve as a guidewire lumen, as will be described in further detail below.
  • the catheter 100 is configured to attach to a hub 180.
  • the hub 180 comprises a suction port 170 configured to communicate suction to the suction lumen 130. Using the suction port 170, suction force may be applied to a portion of the occlusion to stabilize the catheter 100 within the body.
  • the hub 180 may further comprise a guidewire port 190 configured to introduce the guidewire 150 into the guidewire lumen 140 of catheter 100.
  • a recanalization method is shown schematically as a flow diagram in FIG. 3, according to one embodiment.
  • catheter 100 is inserted into an occluded body vessel.
  • the distal end 110 of the catheter is placed on a portion of the occlusion, such as the distal cap DC or proximal cap PC of the occlusion.
  • suction is applied through suction port 170 connected to the suction lumen 130. Due to the force exerted by suction, the catheter 100 is stabilized on the occlusion.
  • the guidewire 150 is advanced through the catheter to penetrate the portion of the occlusion.
  • the catheter 100 may be advanced through the occlusion to recanalize the body vessel.
  • the suction port 170 is connected to a locking syringe (not shown) which generates negative pressure to create the suction applied to the portion of the occlusion through the suction lumen 130.
  • the suction port 170 may be connected to a mechanized vacuum pump system (not shown) acting through an isolation valve, wherein the mechanized vacuum pump system generates the suction force. It is further contemplated that suction may be achieved by using various other means known in the art to create a pressure differential between the suction lumen 130 and the portion of the occlusion.
  • stabilization of the distal end 110 of the catheter 100 on the portion of the occlusion reduces the possibility of guidewire 150 slipping away from the portion of the occlusion or being deflected into the subintimal space SIS. Additionally, the stabilization of the distal end 110 of the catheter 100 provides increased back-up force to allow the guidewire 150 to more effectively penetrate the occlusion.
  • the catheter 100 approaches the occlusion OCL by first advancing through the body vessel BDL in an antegrade direction towards the proximal cap PC of the occlusion OCL. The catheter 100 then crosses the proximal cap PC, advances through the body BO of the occlusion, and exits the occlusion OCL through the distal cap DC of the occlusion to achieve recanalization of the vessel BDL.
  • the guidewire 150 is inserted into the occluded body vessel BDL. Thereafter, the catheter 100 is inserted into the body vessel, tracking the guidewire 150 until the catheter 100 is positioned near or at the proximal cap PC of the occlusion OCL (FIGS. 5A-5B).
  • the guidewire 150 and catheter 100 advance through to penetrate the proximal cap PC of the occlusion and move through the body BO of the occlusion until the distal end 110 of the catheter is placed on an interior surface of the distal cap DC of the occlusion.
  • suction is applied to the interior surface of the distal cap DC of the occlusion to stabilize the distal end 110 of the catheter on the distal cap DC (FIGS. 5C-5D).
  • the guidewire 150 advances through the now stabilized catheter 100 to penetrate the distal cap DC of the occlusion (FIG. 5E).
  • the catheter advances through the penetrated distal cap DC of the occlusion and thereby recanalizes the body vessel BDL (FIG. 5F). Step 450 may optionally be performed after releasing suction.
  • the catheter 100 approaches the occlusion OCL by first advancing through the body vessel BDL in a retrograde direction towards the distal cap DC of the occlusion OCL. The catheter then crosses the distal cap DC, advances through the body BO of the occlusion, and exits the occlusion OCL through the proximal cap PC of the occlusion to achieve recanalization of the vessel BDL.
  • the retrograde approach is shown schematically as a flow diagram in FIG. 6, with reference to FIGS. 7A-7E.
  • the guidewire 150 and catheter 100 are inserted and advanced until they are positioned near an exterior surface of the distal cap DC of the occlusion (FIG. 7A).
  • suction is applied to the exterior surface of the distal cap DC of the occlusion to stabilize the distal end 110 of the catheter on the exterior surface of the distal cap DC (FIG. 7B).
  • the guidewire 150 advances through the catheter 100 to penetrate the distal cap DC of the occlusion (FIG. 7C).
  • the guidewire 150 advances through the penetrated distal cap DC of the occlusion and traverses through the body BO of the occlusion (FIG. 7D).
  • the guidewire 150 penetrates the proximal cap PC of the occlusion (FIG. 7E), and at optional step 660 the catheter may advance through the occlusion and recanalize the body vessel (FIGS. 7F-7G).
  • the catheter 100 may be placed anywhere along or outside the occlusion to provide the suction force or back-up force to stabilize the distal end 110 of the catheter 100 such that the guidewire 150 penetrates the occlusion.
  • the present embodiments may be further configured to access the distal true lumen DTL in the event the guidewire 150 enters the subintimal space SIS.
  • the catheter 100 may be advanced and repositioned against the occlusion from the subintimal space SIS. Thereafter, suction force or back-up force may be applied to stabilize the catheter 100 and the guidewire 150 is used to penetrate an intimal layer back into the occlusion OCL.
  • the suction force or the back-up force may be applied to stabilize the catheter 100 and the guidewire 150, such that the guidewire 150 may advance back into the distal true lumen DTL to complete the recanalization.
  • the suction lumen and the guidewire lumen may be combined or may be separate, and several examples are shown in cross-sectional view in FIGS. 8A-8E.
  • the suction lumen and the guidewire lumen are configured as a single combined lumen 801.
  • the suction lumen 811 and the guidewire lumen 812 are configured as separate but coaxial lumens, as shown by the concentric circles in the cross-sectional view.
  • the suction lumen 821 and the guidewire lumen 822 are configured as separate side-by-side lumens.
  • FIG. 8A-8E the suction lumen and the guidewire lumen may be combined or may be separate, and several examples are shown in cross-sectional view in FIGS. 8A-8E.
  • the suction lumen and the guidewire lumen are configured as a single combined lumen 801.
  • the suction lumen 811 and the guidewire lumen 812 are configured as separate but coaxial lumens, as shown by the concentric circles in the cross-sectional view.
  • the suction lumen 831 and the guidewire lumen 832 are separate, and they are not concentric, with the guidewire lumen 832 disposed off-axis from the catheter axis.
  • the catheter may comprise more than two lumens.
  • FIG. 8E shows a cross-sectional view of one embodiment of a four lumen configuration, with three suction lumens 841 shown disposed around a guidewire lumen 842. It is noted that these embodiments are exemplary, and that the catheter may comprise one or more suction lumens and/or guidewire lumens of various configurations.
  • the catheter may comprise a balloon attached to the distal end of the catheter.
  • the catheter may be positioned with the distal end of the catheter on the surface of the occlusion.
  • the balloon may then inflated through a separate inflation lumen to align the catheter with the axis of the occluded body vessel.
  • suction may be applied through the suction lumen to stabilize the catheter on the occlusion and the guidewire may be advanced through the occlusion, as described above.
  • the catheter may comprise a modified tip to enhance stability of the catheter.
  • examples include a metallic tip, a sharpened or tapered tip, a serrated tip, a screw tip, or a soft tip.
  • the suction lumen may be subject to a large force, as applied at the suction port.
  • the walls surrounding the lumen may be made of a suitable high strength polymer, such as polyimide.
  • the walls may comprise reinforcing fibers or wires arranged structurally in coiled or braided configurations.
  • the exterior of the catheter may be coated or configured as a helical surface or a smooth surface to aid in advancement of the catheter through an occlusion.
  • the catheter may be configured to be compatible with a variety of guidewires, for example guidewires having a diameter of 0.010 inches, 0.014 inches, 0.018 inches, 0.035 inches, 0.038 inches, or guidewires having other diameters.
  • the catheter may be configured to be compatible with a smaller or larger diameter guidewire.
  • the catheter or catheter system as described herein may be used in combination with other devices such as various endoscopic devices, angioplasty devices, etc.
  • the catheter or catheter system may comprise additional lumens, and/or lumens of sufficient diameter or size, to accommodate various elements such as visualization elements, therapeutic agent delivery elements, etc., to increase treatment effectiveness.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Vascular Medicine (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Media Introduction/Drainage Providing Device (AREA)

Abstract

L'invention concerne des procédés et des systèmes pour la reperméation sûre et précise de vaisseaux corporels présentant des occlusions dures, fibreuses ou calcifères. Un cathéter comprenant une lumière de succion est stabilisé au niveau d'une occlusion par l'application d'une force de succion. L'extrémité distale du cathéter étant fermement stabilisée sur l'occlusion, un fil-guide est avancé pour pénétrer dans l'occlusion et reperméer le vaisseau corporel. La stabilisation de l'extrémité distale du cathéter sur l'occlusion réduit la chance de déviation du fil-guide de l'occlusion à l'espace sous-intimal du vaisseau corporel.
PCT/US2011/024810 2010-01-30 2011-02-14 Reperméation de vaisseaux corporels obstrués à l'aide d'une force de blocage élevée WO2011129915A2 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
US13/042,411 US20110218528A1 (en) 2010-03-05 2011-03-07 Anatomical structure access and penetration

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US29997210P 2010-01-30 2010-01-30
US61/299,972 2010-01-30

Publications (2)

Publication Number Publication Date
WO2011129915A2 true WO2011129915A2 (fr) 2011-10-20
WO2011129915A3 WO2011129915A3 (fr) 2012-01-26

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2017145139A1 (fr) * 2016-02-22 2017-08-31 Capsos Medical Limited Dispositif et procédé de guidage d'un outil de perçage, un fil-guide ou un instrument en prise avec une occlusion dans un vaisseau ou une paroi du vaisseau dans le corps d'un sujet humain ou animal
US10245050B2 (en) 2016-09-30 2019-04-02 Teleflex Innovations S.À.R.L. Methods for facilitating revascularization of occlusion
US10729454B2 (en) 2014-09-10 2020-08-04 Teleflex Life Sciences Limited Guidewire capture

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20030109837A1 (en) * 1998-03-13 2003-06-12 Mcbride-Sakal Marcia Brush to clear occluded stents
US20070060888A1 (en) * 2005-09-06 2007-03-15 Kerberos Proximal Solutions, Inc. Methods and apparatus for assisted aspiration
US20080306499A1 (en) * 2006-02-13 2008-12-11 Retro Vascular, Inc. Recanalizing occluded vessels using controlled antegrade and retrograde tracking
US20100191279A1 (en) * 2007-01-23 2010-07-29 Cv Devices, Llc Devices, systems, and methods for percutaneous trans-septal left atrial appendage occlusion
US20100204672A1 (en) * 2009-02-12 2010-08-12 Penumra, Inc. System and method for treating ischemic stroke
EP2236168A2 (fr) * 2005-07-05 2010-10-06 Angioslide Ltd. Catheter à ballonet

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20030109837A1 (en) * 1998-03-13 2003-06-12 Mcbride-Sakal Marcia Brush to clear occluded stents
EP2236168A2 (fr) * 2005-07-05 2010-10-06 Angioslide Ltd. Catheter à ballonet
US20070060888A1 (en) * 2005-09-06 2007-03-15 Kerberos Proximal Solutions, Inc. Methods and apparatus for assisted aspiration
US20080306499A1 (en) * 2006-02-13 2008-12-11 Retro Vascular, Inc. Recanalizing occluded vessels using controlled antegrade and retrograde tracking
US20100191279A1 (en) * 2007-01-23 2010-07-29 Cv Devices, Llc Devices, systems, and methods for percutaneous trans-septal left atrial appendage occlusion
US20100204672A1 (en) * 2009-02-12 2010-08-12 Penumra, Inc. System and method for treating ischemic stroke

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10729454B2 (en) 2014-09-10 2020-08-04 Teleflex Life Sciences Limited Guidewire capture
WO2017145139A1 (fr) * 2016-02-22 2017-08-31 Capsos Medical Limited Dispositif et procédé de guidage d'un outil de perçage, un fil-guide ou un instrument en prise avec une occlusion dans un vaisseau ou une paroi du vaisseau dans le corps d'un sujet humain ou animal
US10856899B2 (en) 2016-02-22 2020-12-08 Capsos Medical Limited Device and a method for guiding a boring tool, a guide wire or an instrument into engagement with an occlusion in a vessel or a wall of the vessel in the body of a human or animal subject
US10245050B2 (en) 2016-09-30 2019-04-02 Teleflex Innovations S.À.R.L. Methods for facilitating revascularization of occlusion

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