Deflectable telescoping guide catheter

Abstract

A catheter employs an inner guide with a pre-formed distal tip, an outer guide with a predetermined deflection location, and a proximal actuator. The inner guide can be longitudinally extended and axially rotated relative to the outer guide. The proximal actuator can adjustably change a bend angle of the predetermined deflection location. The catheter can be deployed with the inner guide retracted inside the distal end of the outer catheter. The extensible and rotatable inner catheter can be combined with the adjustable bend angle of the outer guide to provide an improved system for accessing and cannulating venous structures.

1 . A catheter, comprising: 
 an outer guide comprising an outer guide lumen, a distal end, a proximal end, a predetermined deflection location proximal to the distal end, and a deflection member coupled to the outer guide distal to the predetermined deflection location;    an inner guide comprising an inner guide lumen, a pre-formed distal end, and a proximal end, the inner guide movable within the outer guide lumen and displaceable beyond the distal end of the outer guide; and    an actuator mechanism located at a proximal end of the catheter and coupled to the deflection member, the actuator mechanism configured to change a bend angle at the predetermined deflection location of the outer guide in response to a proximally directed force applied to the deflection member, and the proximal end of the inner guide accessible at the proximal end of the catheter permitting adjustable axial displacement of the pre-formed distal end of the inner guide relative to the distal end of the outer guide.    
   
   
       2 . A catheter according to  claim 1 , wherein at least 2 centimeters of the inner guide can be axially displaced beyond the distal end of the outer guide.  
   
   
       3 . A catheter according to  claim 1 , wherein the pre-formed distal end of the inner guide is deformable such that the inner guide is retractable within the distal end of the outer guide.  
   
   
       4 . A catheter according to  claim 1 , wherein the bend angle is defined relative to a longitudinal axis of the outer guide proximal to the predetermined deflection location.  
   
   
       5 . A catheter according to  claim 4 , wherein the bend angle is adjustable from a minimum angle of about 0 degrees to a maximum angle of about 150 degrees.  
   
   
       6 . A catheter according to  claim 1 , wherein a bend radius of the predetermined deflection location is greater than about six times an outer diameter of the outer guide.  
   
   
       7 . A catheter according to  claim 1 , further including at least one deflection member coupled to the inner guide proximate to the pre-formed distal end.  
   
   
       8 . A catheter according to  claim 7 , wherein the actuator mechanism produces a tensile force acting on the at least one deflection member coupled to the inner guide to impart a change in the bend angle at the predetermined deflection location of the outer guide.  
   
   
       9 . A catheter according to  claim 1 , wherein the deflection member coupled to the outer guide comprises at least one steering tendon.  
   
   
       10 . A catheter according to  claim 1 , further comprising an occlusion balloon affixed at the distal end of the outer guide.  
   
   
       11 . A catheter according to  claim 1 , further including a seal disposed between the inner guide and the outer guide.  
   
   
       12 . A catheter according to  claim 1 , further including: 
 an electrode located at distal end of at least one of the inner guide and outer guide; and    an electrical conductor coupled to the electrode, the electrical conductor extending through the inner guide or outer guide to a proximal section of the catheter.    
   
   
       13 . A catheter according to  claim 1 , further including: 
 a plurality of band electrodes disposed at a distal section of at least one of the inner and outer guides; and    at least one electrical conductor connected to the band electrodes, the at least one electrical conductor extending through the inner guide or outer guide to a proximal section of the catheter.    
   
   
       14 . A catheter, comprising: 
 an outer guide comprising an outer guide lumen, a distal end, a proximal end, a predetermined deflection location proximate the distal end, and a deflection member coupled to the outer guide distal to the predetermined deflection location;    an inner guide movable within the outer guide lumen and displaceable beyond the distal end of the outer guide, the inner guide comprising an inner guide lumen dimensioned to receive a cardiac lead, a distal end having a pre-formed deflection proximate the distal end, and a proximal end; and    an actuator mechanism located at a proximal end of the catheter and coupled to the deflection member, the actuator mechanism configured to change a bend angle at the predetermined deflection location of the outer guide in response to a proximally directed force applied to the deflection member, and the proximal end of the inner guide accessible at the proximal end of the catheter permitting adjustable axial displacement of the distal end of the inner guide relative to the distal end of the outer guide.    
   
   
       15 . The catheter of  claim 14 , wherein the inner guide lumen is dimensioned to receive a cardiac lead configured for implantation in a coronary sinus of a heart of a patient.  
   
   
       16 . The catheter of  claim 15 , wherein the cardiac lead comprises a cardiac pacing lead.  
   
   
       17 . A catheter according to  claim 14 , wherein the pre-formed distal end of the inner guide is deformable such that the inner guide is retractable within the distal end of the outer guide.  
   
   
       18 . A catheter according to  claim 14 , wherein the bend angle is defined relative to a longitudinal axis of the outer guide proximal to the predetermined deflection location, wherein the bend angle is adjustable from a minimum angle of about 0 degrees to a maximum angle of about 150 degrees.  
   
   
       19 . A catheter according to  claim 14 , further including at least one deflection member coupled to the inner guide proximate the pre-formed distal end.  
   
   
       20 . A catheter according to  claim 14 , wherein a bend radius of the predetermined deflection location is greater than about six times an outer diameter of the outer guide.