In general, guidewires for medical procedures such as angioplasty, are made with stainless steel wire (SS) which, when ground in a series of tapers and straights, generally decreases from a proximal core body diameter of 0.014 inches down to a distal diameter of approximately 0.002 inches. A portion of this ground section of core, possibly including a ribbon wire, will be covered with one or more coils.
Some disclosures describe guidewire with nitinol distal portions that yield at a desired set shape (U.S. Pat. No. 5,238,004) and consist of a SS proximal section attached to a linear elastic distal section. (The teachings of the '004 patent are incorporated herein by reference). This layout of the '004 patent has a lower kink resistance than the proposed invention.
Other disclosures (e.g., U.S. Pat. No. 6,592,570) involve a SS proximal section and a distal portion that is entirely superelastic. (The teachings of the '570 patent are incorporated herein by reference). This superelastic distal tip restricts shapeability and can cause placement of the guidewire into a vessel to be difficult. The guidewire of the present invention is kink resistant, yet it has a shapeable tip that will assist the user in negotiation of a vessel.
A stainless steel body proximal guidewire gives exceptional column strength to push, support catheters, and torque the distal end of the guidewire through the vessel. A nitinol ground middle to distal section is flexible enough to avoid damaging the vessel during advancement of the guidewire. The shortcoming of a stainless steel distal section is that SS can bend and kink during advancement, making it difficult to advance into the chosen vessel. Current guidewires made of a SS proximal portion and superelastic nitinol distal portion have a transition in a step or discrete fashion, making for potentially difficult navigation. Other guidewires made of a SS proximal section and a linear elastic nitinol distal section transition more smoothly, but are less kink resistant at the distal tip. For these reasons a kink resistant guidewire that decreases gradually in stiffness from the proximal to the distal end i.e., a variable or gradually decreasing stiffness guidewire, is ideal.
By attaching a nitinol distal ground section to the stainless steel proximal core wire or element of a guidewire the propensity of the distal flexible section to bend and kink is reduced. This invention includes a highly torqueable, pushable guidewire with a relatively stiff proximal (preferably in one embodiment), stainless steel (SS) section and kink resistant nitinol medial to distal section attached to shapeable SS, in one embodiment, (such as a SS ribbon) distal tip. The very distal SS tip will have the ability to be shaped by the end user in order to facilitate entry into the chosen vessel.
It is the purpose of this invention to provide an improved, kink resistant guidewire. This is best achieved by gradually decreasing the stiffness from the proximal to the distal end by using, for example, a combination of SS and variably heat-treated nitinol.
The novelty of this invention involves the combination of different metals and elementally similar metals in different phases to attain ideal guidewire characteristics.
Thus, in one embodiment, the present invention is a variable stiffness guidewire comprising: a core element extending along a longitudinal axis, the core element comprising a first sidewall of a first diameter extending distally to a tapered section meeting a second sidewall of a second diameter, the second diameter being less than the first diameter; and a distal atraumatic tip; a first spring coil extending from a first spring coil proximal portion to a first spring coil distal end, wherein the first spring coil proximal portion contacts at least the first sidewall of the first diameter of the core element, and wherein the first spring coil distal end is proximal the distal end of the core element; and a second spring coil extending from a second spring coil proximal portion to a second spring coil distal end, wherein the second spring coil proximal portion contacts the first spring coil distal end at a spring coil connection, and wherein the second spring coil extends distally beyond the distal end of the core element with the second spring coil distal end connected to the distal atraumatic tip. Extending radially from the longitudinal axis of the core wire to the spring coil connection, the first and second spring coils are spaced from and circumferentially unsupported by the distal core portion at the spring coil connection.
In another embodiment, the present invention is variable stiffness guidewire comprising: a core element or core wire having proximal and distal portions, the distal portion having proximal and distal segments, the distal segment of the core element comprising nitinol, the nitinol being at least partially linear elastic in the proximal segment of the distal portion, and super elastic in the distal segment of the distal portion.
In a further embodiment, the present invention is a variable stiffness guidewire comprising a core element or wire having a proximal portion and a distal portion, the distal portion having distal and proximal segments and the proximal portion having distal and proximal segments: the core element proximal portion comprising stainless steel; the core element distal portion comprising; a superelastic distal segment and a linear elastic proximal segment, the core element having attached to its extreme distal end; and an atraumatic tip.
In yet another embodiment, the present invention is a variable stiffness guidewire comprising a core element having proximal and distal portions comprising different materials: the proximal portion including a reduced-diameter distal section; the distal portion including a reduced-diameter proximal section; a hollow coupler connecting the reduced-diameter distal section of the proximal portion to the reduced-diameter proximal segment of the distal portion, wherein the proximal portion comprises a non-super elastic alloy; and the distal portion comprises nitinol in a linear elastic state on its proximal segment and a nitinol in super elastic reduced-diameter distal segment.
Stiffness is variable or is gradually decreased or decreasing by assembling a SS proximal section to a nitinol distal section, which is attached to an independent or attached SS tip. More specifically, the nitinol distal portion comprises a linear elastic nitinol proximal segment and a super elastic nitinol distal segment. The nitinol distal segment is attached to, e.g., an SS proximal portion or segment. This graduation from linear elastic nitinol to superelastic nitinol creates an advantageous, gradual, and controlled or controllable reduction or decrease in guidewire stiffness (in accordance with this invention) when moving distally from the proximal segment to the distal segment to create a kink resistant guidewire. The combination of this two-phase, distal nitinol section and the stiff proximal 304 stainless steel section along with the optional shapeable SS distal portion (i.e., a shaping ribbon) creates the ideal torqueable, pushable, and steerable guidewire having varying or distally-decreasing stiffness.
This invention is, in one embodiment, a Dual Phase Nitinol PTCA Guidewire (see attached
The invention encompasses a range of constructions from floppy to extra support grind configurations. The invention preferably is built in 190 cm length and 300 cm length configurations with a preferred maximum diameter of 0.014 inches. The proximal core segment 1 is preferably PTFE coated and the distal segment 2 preferably is coated with a separate lubricious coating e.g., silicone, or other hydrophilic coating. The hydrophilic coating commercially available from Surmodics Corp. is preferred. The invention contemplates an optional extension system to be used with the 190 cm wire version having a proximal connector structure 6. A platinum distal marker coil 7 is threaded into a coil spring 5 and optional proximal depth marks on the optional PTFE-coated proximal section 8 are placed using e.g., an emulsion ink.
The nitinol middle section “C” will consist of a proximal linear elastic segment 9, which will graduate into a superelastic (heat-treated) segment 10 indicated by shading in all the FIGURES. The superelastic segment 10 is created by placing the desired length of core wire segment in an oven at about 1000° F. for 20 minutes. There will be a slight transition created between the linear elastic and superelastic segments that will aid in a gradual transition of lowered stiffness contributing to the variable stiffness feature of this invention. One skilled in this art will appreciate that either or both of the time of treatment or temperature of treatment of the core wire may be adjusted to obtain the requisite superelasticity. This transition length can be easily optimized to improve the overall properties of the guidewire. Other linear elastic sections may be heat-treated at lower temperatures to create more elasticity/less stiffness and a more gradual transition. (See attached test data for stiffness variations)
It has also been determined that the nitinol wire section 2 included in this invention has the ability to be straightened mechanically or by providing tension during the heat-treatment. These operations also create variable elasticity and could be used in the gradual reduction of stiffness along the guidewire.
A process has been developed that involves the heat treatment of linear elastic NiTi. The linear elastic core is placed in an oven at about 950° F. for 25 minutes with no longitudinal tension which causes the extreme distal portion of the guidewire to become superelastic. The oven is constructed in a way so that there is a void or hole in the wall of the oven where a wire can be placed. The NiTi core is inserted in to the void so that the desired length of super elastic NiTi is fully inside the oven. The heat dissipation leaving the void of the oven produces a smooth stiffness and elasticity transition from the linear to superelastic region. Stress vs. strain results have been measured and a gradual drop in stiffness from the linear elastic region to the superelastic region is clearly apparent using the above-described process. In this manner, the overall stiffness of the guidewire may be controlled by controlling the length of the core wire superelastic segment.
Thus, there is shown at
In
The proximal portion (approximately the “G” dimension minus the “B” dimension) and distal segment 2 are shown to be coupled by a hypotube connector 3, each such segments having reduced diameter portions 22, 23 which are inserted into opposite ends of the hypotube connector 3 and are bonded thereto e.g., by the use of solder or glue. The hypotube connector 3 may comprise stainless steel, linear elastic or superelastic alloys depending upon design preference. Other equivalent means of creating a coupler between a stainless steel proximal segment and a linear elastic/super elastic distal segment will occur to one skilled in this art in view of the present disclosure c.f., U.S. Pat. No. 5,341,818 Abrams et al., the teachings of which are incorporated by reference herein.
There are other guidewire optional features shown in
It is to be understood that the controllable or variable stiffness of a guidewire of the present invention may also be varied or adjusted by employing one or more distal tapers. The guidewires in
It is also to be understood that the dimensions shown for the guidewires in
The above invention has been described with particular reference to the use of a nickel/titanium alloy to create the guidewire of variable stiffness herein described. The present invention should not be understood to be limited only to the use of nickel/titanium alloys. In fact, any alloy exhibiting the superelastic/linear elastic characteristics of nickel/titanium alloys employed herein is clearly contemplated. Thus, the present invention is not, and should not, be construed to be limited to the preferred nickel/titanium alloys extensively discussed herein.