Deployment of Stents within Bifurcated Vessels

Abstract

Systems and methods for deploying stents within bifurcated vessels in a true pantaloons configuration (Kamat technique) are disclosed. A device including a balloon catheter and a stent surrounding the catheter is inserted into a bifurcated blood vessel. The catheter includes a first lumen configured to accept a first guide wire, which exits the device at a distal end. The device is advanced within a main branch using the first guide wire until it reaches the carina, thus causing the second guide wire to enter a second side branch. The second wire exits the device at a tapered edge of the catheter from under the stent. The stent may then be deployed within the main branch. The stent may then be splayed across the carina with kissing balloons and the procedure may be completed with the kissing balloon deployment of two stents accurately at the carina in each side branch.

1 . A method, comprising:
 inserting a device into a bifurcated blood vessel, the device including a balloon catheter and a stent, the stent surrounding at least a portion of the balloon catheter, the balloon catheter including a first lumen configured to accept a first guide wire, the first guide wire exiting the device at a distal end of the balloon catheter, and the bifurcated blood vessel including a main branch, a first side branch, a second side branch, and a carina region between the first and second side branches;   advancing the device within the main branch of the bifurcated blood vessel using the first guide wire until the device reaches the carina region, the advancing causing a second guide wire to enter the second side branch, the second guide wire exiting the device at a tapered edge of the balloon catheter from under the stent, wherein the tapered edge is at a point of transition between a horizontal surface and a tapered surface of the balloon catheter; and   deploying the stent within the main branch of the bifurcated blood vessel.   
     
     
         2 . The method of  claim 1 , wherein the stent is a closed-cell stent. 
     
     
         3 . The method of  claim 2 , wherein the device is pre-assembled with the stent, the method further comprising, prior to inserting the device into the bifurcated blood vessel:
 sliding the stent off of the balloon catheter after having inflated the balloon catheter;   placing the second guide wire in direct contact with an inner surface of the stent and an outer surface of the balloon catheter; and   sliding the stent back onto the balloon catheter, a distal edge of the stent positioned at a proximal edge of a distally located tapered portion of the balloon catheter.   
     
     
         4 . The method of  claim 1 , wherein the stent is an open-cell stent. 
     
     
         5 . The method of  claim 4 , wherein the device is pre-assembled with the stent, the method further comprising, prior to inserting the device into the bifurcated blood vessel:
 sliding the stent off of the balloon catheter without having previously inflated the balloon catheter;   placing the second guide wire in direct contact with an inner surface of the stent and an outer surface of the balloon catheter; and   sliding the stent back onto the balloon catheter, a distal edge of the stent positioned at a proximal edge of a distally located tapered portion of the balloon catheter.   
     
     
         6 . The method of  claim 1 , wherein the balloon catheter includes a second lumen, the second lumen configured to accept the second guide wire. 
     
     
         7 . The method of  claim 6 , wherein the first guide wire is configured to exit the first lumen at a center of the distal portion of the balloon catheter, and wherein the second guide wire is configured to exit the second lumen at a proximal edge of a distally located tapered portion of the balloon catheter for stent delivery proximal to the carina. 
     
     
         8 . The method of  claim 6 , wherein the first guide wire is configured to exit the first lumen at a center of the distal portion of the balloon catheter, and wherein the second guide wire is configured to exit the second lumen at a distal edge of a proximally located tapered portion of the balloon catheter for stent delivery distal to the carina. 
     
     
         9 . The method of  claim 1 , wherein deploying the stent within the main branch of the bifurcated blood vessel includes inflating the balloon catheter to deploy the stent while maintaining access to both of: (a) the first side branch of the bifurcated blood vessel via the first guide wire or (b) the second side branch of the bifurcation via the second guide wire. 
     
     
         10 . The method of  claim 9 , wherein deploying the stent within the main branch of the bifurcated blood vessel includes applying a first kissing balloon technique to splay the stent. 
     
     
         11 . The method of  claim 9 , further comprising:
 employing a kissing stent procedure to deploy another stent within the first side branch of the bifurcated blood vessel using the first guide wire and to deploy another stent within the second side branch of the bifurcated blood vessel using the second guide wire.   
     
     
         12 . A device, comprising:
 a balloon catheter including a first lumen and a second lumen, the first lumen configured to receive a first guide wire and the second lumen configured to receive a second guide wire, the first lumen having a first exit at a center of a distal end of the balloon catheter, and the second lumen having a second exit at a proximal edge of a distal tapered portion of the balloon catheter, wherein the proximal edge is at a point of transition between a cylindrical portion and a tapered portion of the balloon catheter.   
     
     
         13 . The device of  claim 12 , wherein, upon being inflated, at least one of the proximal or distal tapered portions of the balloon catheter assumes a conical shape. 
     
     
         14 . The device of  claim 13 , further comprising:
 a stent surrounding the balloon catheter, a distal edge of the stent aligned with the proximal edge of the distal tapered portion of the balloon catheter, for deployment of the stent proximal to the carina with the distal edge of the stent exactly at the carina, and the proximal edge of the stent located at the distal edge of a proximal tapered portion of the balloon catheter, for deployment of the stent distal to the carina with the proximal edge of the stent exactly at the carina.