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 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.   
     
     
         2 . The device of  claim 1 , wherein, upon being inflated, at least one of the proximal or distal tapered portions of the balloon catheter assumes a conical shape. 
     
     
         3 . The device of  claim 2 , 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.   
     
     
         4 . A device, comprising:
 a first balloon catheter;   a stent positioned around the first balloon catheter;   a first lumen in the first balloon catheter and configured to house a first guide wire; and   a second lumen configured to house a second guide wire.   
     
     
         5 . The device of  claim 4 , wherein the opening for the second lumen is positioned to prevent the second guide wire from passing through struts of the stent. 
     
     
         6 . The device of  claim 4 , wherein when the first guide wire is positioned in a first vessel and the second guide wire is positioned in a second vessel such that the first and second vessel form a carina, the opening for the second lumen positioned so that the device may be advanced along the first guide toward the carina until the second guide wire prevents further advancement beyond a point where a distal edge of the stent is adjacent to the carina. 
     
     
         7 . The device of  claim 4 , wherein the second lumen is positioned between an inner surface of the stent and an outer surface of the first balloon catheter. 
     
     
         8 . The device of  claim 4 , further comprising:
 a first opening in the second lumen, the first opening positioned at a proximal edge of the stent.   
     
     
         9 . The device of  claim 4 , further comprising:
 a first opening in the second lumen, the first opening positioned at a proximal edge of the stent; and   a second opening in the second lumen, the second opening positioned at a distal edge of the stent.   
     
     
         10 . The device of  claim 4 , wherein the second lumen is positioned within an outer surface of the first balloon catheter, the second lumen having an opening positioned at a distal edge of the stent. 
     
     
         11 . The device of  claim 4 , further comprising:
 an opening in the second lumen, the opening positioned at a distal edge of the stent; and   a third lumen having an opening positioned at a proximal edge of the stent.   
     
     
         12 . The device of  claim 4 , further comprising:
 an opening in the second lumen, the opening positioned at a distal edge of the stent; and   a third lumen having an opening positioned at the distal edge of the stent.   
     
     
         13 . The device of  claim 4 , wherein the second lumen is separate from the first balloon catheter and is positioned between an inner surface of the stent and an outer surface of the first balloon catheter, the second lumen having an opening positioned forward of a distal tapered region of the first balloon catheter relative to the stent. 
     
     
         14 . The device of  claim 4 , further comprising:
 a second balloon catheter, wherein the second lumen is positioned in the second balloon catheter and wherein the stent is positioned around both the first and second balloon catheters.   
     
     
         15 . The device of  claim 14 , further comprising:
 a second stent positioned around the first balloon catheter; and   a third stent positioned around the second balloon catheter.   
     
     
         16 . A device, comprising:
 an inner shaft;   a self-expanding stent positioned around the inner shaft;   an outer sheath positioned around the self-expanding stent and configured to prevent the self-expanding stent from expanding;   a first lumen formed in the inner shaft and configured to house a first guide wire; and   a second lumen formed in the inner shaft and configured to house a second guide wire, the second lumen having an opening adjacent to a leading edge of the self-expanding stent.   
     
     
         17 . The device of  claim 16 , wherein the main lumen is located in the axial center of the inner shaft. 
     
     
         18 . The device of  claim 16 , wherein the opening for the second lumen is positioned to prevent the second guide wire from passing through struts of the self-expanding stent. 
     
     
         19 . The device of  claim 16 , wherein when the first guide wire is positioned in a first vessel and the second guide wire is positioned in a second vessel such that the first and second vessel form a carina, the opening for the second lumen positioned so that the device may be advanced along the first guide toward the carina until the second guide wire prevents further advancement beyond a point where the distal edge of the self-expanding stent is adjacent to the carina. 
     
     
         20 . The device of  claim 16 , wherein the self-expanding stent is configured to expand when the outer sheath is removed.