Methods for crossing and treating an occlusion

Abstract

A device and method for treating a patient with total or near total occlusion is provided. The device can be positioned in a blood vessel at a treatment site. An occlusion at the treatment site is enlarged by a catheter. The catheter can be advanced over a guidewire into the occlusion. One or more of [a] compression or torsion applied to the guidewire or [b] compression or torsion applied to the catheter body expands or creates a path through the occlusion. The expansions or creation of the access path can be by cutting or abrading the occlusion or by a shoe-horn effect.

What is claimed is: 
     
         1 . A method of treating a patient with an occlusion, the occlusion being a total or near total occlusion, comprising:
 accessing a blood vessel of a patient at an access location using a catheter technique;   advancing a guidewire into the patient and to the occlusion;   advancing a catheter over the guidewire into apposition with a proximal portion of the occlusion, the catheter having a lumen therethrough and a rigid ring at a distal end thereof; and   rotating the catheter body in a reciprocating clockwise and counterclockwise fashion to move an active end of the rigid ring across the proximal face of the occlusion to gently enlarge a lumen through the occlusion by removing matter from the occlusion;   wherein the lumen comprises an inner size that is no more than about 10% greater than the outer diameter of the guidewire.   
     
     
         2 . The method of  claim 1 , further comprising, after rotating the catheter body, axially moving a distal portion of the guidewire relative to the lumen further into the occlusion. 
     
     
         3 . The method of  claim 2 , further comprising, after axially moving the distal portion of the guidewire, repeating at least one of rotating the catheter body and axially moving the guidewire until the lumen across the occlusion has been enlarged. 
     
     
         4 . The method of  claim 1 , further comprising advancing a balloon catheter through the lumen of the catheter body. 
     
     
         5 . The method of  claim 1 , wherein advancing comprises advancing the rigid ring uncovered in the vasculature from the access location to the occlusion. 
     
     
         6 . The method of  claim 1 , further comprising exchanging the guidewire for a stiff wire and advancing the stiff wire into the occlusion. 
     
     
         7 . The method of  claim 1 , further comprising exchanging the catheter body for a second catheter body after the catheter body is loaded with matter separated from the occlusion. 
     
     
         8 . A method of treating a patient, comprising:
 accessing a blood vessel of a patient at an access location using a catheter technique;   advancing a guidewire into the patient and to a treatment site, the treatment site having a total or near total occlusion;   advancing a catheter over the guidewire into apposition with a proximal portion of the occlusion, the catheter having a lumen therethrough and an anchor face at a distal end thereof; and   moving a distal portion of the guidewire relative to the lumen further into the occlusion while supporting the guidewire against buckling.   
     
     
         9 . The method of  claim 8 , wherein supporting the guidewire against buckling comprises applying a compressive force to the catheter body to securely engage the anchor face with the proximal face of the occlusion. 
     
     
         10 . The method of  claim 8 , wherein the lumen comprises an inner size that is no more than about 10% greater than the outer diameter of the guidewire such that the guidewire is supported against buckling. 
     
     
         11 . The method of  claim 8 , further comprising exchanging the guidewire for a stiff wire and advancing the stiff wire into the occlusion. 
     
     
         12 . The method of  claim 8 , further comprising exchanging the catheter body for a second catheter body after the catheter body is loaded with matter separated from the occlusion. 
     
     
         13 . A method of treating a patient, comprising:
 accessing a blood vessel of a patient at an access location using a catheter technique;   advancing a guidewire into the patient and to a treatment site, the treatment site having an occlusion;   advancing a catheter over the guidewire into apposition with a proximal portion of the occlusion, the catheter having a lumen therethrough and an anchor face at a distal end thereof; and   applying one or more of [a] compression or torsion to the guidewire or [b] compression or torsion to the catheter body to expand or create an access path through the occlusion.   
     
     
         14 . The method of  claim 13 , further comprising placing a sheath through the skin and intervening tissues into an artery wall at the access location, the guidewire being advanced through the sheath to the treatment site. 
     
     
         15 . The method of  claim 14 , wherein placing the sheath comprises placing the sheath adjacent to the access location and wherein advancing the catheter over the guidewire comprises advancing the catheter out of the distal end of the sheath adjacent to the access location and further comprising delivering the anchor face out of the distal end of the sheath to a proximal portion of the occlusion. 
     
     
         16 . The method of  claim 13 , wherein when the anchor face is in contact with the occlusion, a circumferential periphery of a distal portion of the catheter is exposed to the vessel wall. 
     
     
         17 . The method of  claim 13 , further comprising advancing a guide catheter in the patient, the guidewire being advanced through the guide catheter to the treatment site.