Deflectable tip guide in guide system

Abstract

Guide catheters which can be used in percutaneous myocardial revascularization (PMR) to deliver therapeutic catheters to difficult to reach heart chamber wall regions. Some guide catheters include distal regions which can be bent under control from the proximal region of the catheter. One steerable guide catheter has a flexible distal region, a more proximal, less flexible intermediate region, a first lumen for receiving a therapeutic catheter, and an elongate manipulation member slidably disposed in a second, blind lumen. The elongate manipulation member can be secured off-center near the distal end of the flexible distal region. The distal region can be bent by retracting the manipulation member and straightened by pushing the manipulation member. Controllably bendable guide catheters according to the present invention can be nested inside other, similar guide catheters. The invention also includes means for resisting free rotation of guide catheters relative to other adjacent catheters or tubes.

What is claimed is:  
     
         1 . A system for performing myocardial revascularization comprising: 
 a first elongate tube having a distal region, a distal end, a proximal region, a first lumen therethrough, means for bending said distal region, and means for controlling said distal region bending from said proximal region; and    a therapeutic catheter having a distal end slidably disposed within said first tube lumen.    
     
     
         2 . A system for performing myocardial revascularization as recited in  claim 1 , wherein said therapeutic catheter distal end has a distal tip having a first position extending distally from said first tube distal end, a second position retracted proximally within said first tube distal end, and means for urging said therapeutic catheter distal end between said first and second positions.  
     
     
         3 . A system for performing myocardial revascularization as recited in  claim 1 , wherein said therapeutic catheter distal end includes means for penetrating said myocardium.  
     
     
         4 . A system for performing myocardial revascularization as recited in  claim 1 , wherein said first tube has an intermediate region proximal of said distal region and said distal region is more flexible than said intermediate region.  
     
     
         5 . A system for performing myocardial revascularization as recited in claim  1 , wherein said first tube distal region has a longitudinal center axis and an off-center location disposed off said center axis, and said means for bending includes means for pulling and pushing on said off-center location.  
     
     
         6 . A system for performing myocardial revascularization as recited in  claim 5 , wherein said means for pushing and pulling includes an elongate manipulation member operably coupled to said off-center location and extending proximally at least to said proximal region.  
     
     
         7 . A system for performing myocardial revascularization as recited in  claim 6 , wherein said first tube has a second lumen therein and said elongate manipulation member is disposed in said second lumen.  
     
     
         8 . A system for performing myocardial revascularization as recited in  claim 1 , further comprising a second tube having a distal region, a proximal region, a distal end, and a second lumen therethrough, said second tube having said therapeutic catheter disposed within said second lumen, said second tube being disposed within said first tube first lumen.  
     
     
         9 . A system for performing myocardial revascularization as recited in  claim 8 , wherein said second tube has means for bending said second tube distal region and means for extending said second tube distal region distally from said first tube distal end.  
     
     
         10 . A system for performing myocardial revascularization as recited in  claim 9 , wherein said second tube further comprises means for controlling said second tube distal region bending from said second tube proximal region.  
     
     
         11 . A system for performing myocardial revascularization as recited in  claim 10 , wherein said second tube means for controlling bending includes a second elongate manipulation member disposed within said second tube.  
     
     
         12 . A guiding catheter system for performing myocardial revascularization comprising: 
 a first guide tube having a proximal region and a first lumen therethrough, said first lumen having an inside surface;    a second guide tube having a proximal region and a second lumen therethrough, said second guide tube being disposed at least partially in said first tube first lumen and having an outer surface opposing said first tube inside surface; and    means for resisting free rotation between said first and second tubes.    
     
     
         13 . A guiding catheter system for performing myocardial revascularization as recited in  claim 12 , wherein said means for resisting free rotation is-disposed on said opposing surfaces.  
     
     
         14 . A guiding catheter system for performing myocardial revascularization as recited in  claim 13 , wherein said means for resisting free rotation includes a plurality of teeth disposed on at least one of said opposing surfaces and at least one tooth on the other said opposing surfaces for engaging said plurality of teeth.  
     
     
         15 . A guiding catheter system for performing myocardial revascularization as recited in  claim 14 , wherein said plurality of teeth is disposed on said first tube outer surface and said at least one tooth is disposed on said second tube inner surface.  
     
     
         16 . A guide catheter for performing myocardial revascularization comprising: 
 an elongate tube having a distal region, a distal end, a proximal region, a first lumen therethrough, and a longitudinal center axis;    a second lumen extending from said proximal region to at least said distal region; and    an elongate manipulation member disposed in said second lumen, being accessible from said proximal region, and being operably secured to said tube distal region at a location off-center from said tube longitudinal center axis, such that said-tube distal region can be bent by proximally pulling on said manipulation member.    
     
     
         17 . A guide catheter for performing myocardial revascularization as recited in  claim 16 , wherein said tube has an intermediate region proximally near said distal region, and said distal region is more flexible than said intermediate region.