Steerable endoluminal punch

摘要

A transseptal punch with a steering mechanism within the punch, such that punch can be steered and deflected within a guide catheter during delivery, to avoid skiving of the guide catheter inner wall by passage of the punch tip through the guide catheter. The punch can be advanced through a body lumen in its straight configuration and then be selectively articulated or curved to permit negotiation of tortuous curvature or to permit optimal approach or access to a puncture site. The punch is able to create holes in the atrial septum of the heart or other structures and is easier to use than punches that are pre-curved near their distal tip since it is easier to advance through accessory catheters.

主权项

1. A method of punching a hole in a body lumen or hollow organ wall comprising the steps of:
advancing a guide catheter into a patient's body lumen and routing the guide catheter to a location near a target site, wherein the target site is an organ or body lumen wall, wherein the guide catheter is an axially elongate structure having a proximal end, a distal end, and a lumen extending therethrough; providing an axially elongate punch comprising an inner tube fixed to a distal end of an outer tube, said punch further comprising an integral deflecting mechanism comprising a control rod extending from a proximal end of the punch to a distal end of the punch, said control rod operable to steer the punch without resort to deflection caused by any steering of the guide catheter; inserting the axially elongate punch into the lumen of the guide catheter and routing the punch to the target site, wherein the punch is substantially straight and uncurved; deflecting, with the integral deflecting mechanism, a region near the distal end of the punch so that the punch and surrounding guide catheter are substantially curved at the distal end and oriented toward and against the target site, said deflecting step being performed after completing the step of inserting the axially elongate punch into the guide catheter and routing the punch to the target site; punching a hole in the body lumen or hollow organ wall; advancing the punch through the body lumen or hollow organ wall; and removing the punch and the integral deflecting mechanism from the guide catheter.