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    US9486611B2

    Copyright:

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    9 views30 pages

    US9486611B2

    Uploaded by

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    US9486611B2

    Copyright:

    © All Rights Reserved
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    2) United States Patent oy oy m 3) en @ 6s) (0) on (2) 68) Petersen et al. GUIDE EXTENSION HETER Applicant: BOSTON SCIENTIFIC SCIMI INC., Maple Grove, MN (US) Inventors: Erle M. Petersen, Maple Grove, MN (US); Steven R Larsen, Lino Lakes, MN (US); Wayne Falk, Minneapolis, MN (US): Joel M. Wasdyke, Eden Prarie, MN (US): Huisun Wang, Maple Grove, MN (US) Assignee: BOSTON SCIENTIFIC SCIMED, INC.. Maple Grove, MN (US) Notice: Subject to any disclaimer, the team ofthis, patent is extended or adjusted under 35 USC. 154() by 108 days, Appl. Nos 131969,390 Filed: Aug. 16, 2013, ‘ior Publication Data US 201410052097 Al Feb, 20, 2014 Related U.S. Application Data Provisional aplication No. 61/684,591, filed on Aug. 17, 2012 1. Ch AGIM 2501 (2006.01) AGIM 2509 (2005.01), (2006.01) 61M 25/00 AGIM 25/01 (2013.01); AGIM 25/0023 (2013.01); A61¥f 25/0069 2013.01); AOL 25/0074 (2013.01); AGIM 2509 (2013.01) “461M 25/007 (2013.01) (Continved) Field of Classification Search cre AGIM 2510172; AGIM 25/0023: 'US009486611B2 (10) Patent No.: (4s) Date of Patent: US 9,486,611 B2 Nov. 8, 2016 AGIM 2510074; AGIM 2025/0175; AGIM 2025/018, AGIM 202510025. 61M 2025/0183; ASIN 25/0562; AGIM 25/006: AGIM 25/01; AGIM 25/09: A6IM 25/0069: AGIM 25/0052; AGIM 2510013; 61M 251007; AGIM 25/0035; A6IM 2025/0004 usec GO4/103.04, 164.03, 523, 528, 151, {604/168,08, 180, 198, 600/385 for complete search history See application fi 66) References Cited US. PATENT DOCUMENTS 4504014 11986 Fogarty etal 101986 Simon Continved) POREIGN PATENT DOCUMENTS DE ssig372 Cl 1990 (Continved) Andrew Gilbert Amber Stiles Seayer, Tule & Primary Examiner Assistant Examiner (74) Awornes. Agent, oF Firm Wiekbem, LLP on ABSTRACT Medical devices and methods for making and using medical evices are disclosed. An example medical device may jnclude & guide extension catheter, The guide extension catheter may include an elongate tubular member having & proximal region, a distal region, and a slot formed in the tubular member between the proximal region and the distal region. The proximal region of the tmbular member may be configured 10 shift between a first configuration and a collapsed configuration, The guide extension esacter may also include an elongate shift for shifting the proxiasal region between the fist configuration and the collapsed configuration 11 Claims, 19 Drawing Sheets 216 — US 9,486,611 B2 Page 2 (2) US.CL cee 66) 4762.19 $02.02 Stus.ass 5120333 Sosnaas S23s.008 5207982 Sass Seals S370 S772'609 07's 06626 6439310 osusans S7s98% es70246 a8 268 608705, 1566:720 sosast Sood hoo Ta16678 THI 899 7702984 AGLM 25/0013 (2013.01); 461M 25/0085 (2013.01), A6iM 25/0052 (2013.01); A614 2025/0004 (2013.01); 461M 2035/0025 BEREREE oreo ror eoee o> 2) Bae B BD B (01301) References Cited USS. PATENT DOCUMENTS. 98s 41992 ae S992 S095 109) 121993 oes 95 S96 S098 121599 S200 102000 a3 2003 ‘52003 vous ‘22004 F004 10.2003 112007 10a? 12008 s2010 72010 Bonzel Dror ASIF 2958 (4103.02 Scots Shockey tl Bonz Sshatjian etal Syleanewiez tan ‘taunt tt ‘ans a Suuyen Agro tal conn eal Palermo ona ot a app eta Jacoheen Brennan rctbsee Paterson ot Eidenschink on Hoffann .... A6IBI722 ‘04524 Nash ot Bowe etal Kuroyama et a So4s.032 supa 8292850 20030021 aunn0ns9co 200310069522 Samui 200s 0116832 204 0181174 20060079859 2ngearssass. 2n0710260219| soownisii74 200910099550 20090999550 aonurrTi29 do1o004197| 2o1Lont2ses 2011016083 20110301502 21800857665 | wm m Be bP Ale ae AL ale AL a2 att aut AL AL Ate aie at at ww201 32012 2012 02012 2003, 32003 42003 $2008 ‘62004 5/2008 4006 112006 192007 73008 400) 42009 7200 vo, 2011 eno 122001 22013 Frc et Davis Elkins Belson Root al. Cho Cecile Carat tal. ‘ockaaa sta Sansoucy Wolt ‘Aggetholm Gill tak Hote couse ‘ells V9 12109 04 101.08 Asi 25)0029 ou'sss SIM 2500 03:508 As1M 2500032 foto 04523 SID 1018 604528 couse ‘Asi 250009 oss9 AGI 2956 e211 |AsIM 25\0069 ‘604980 POREIGN PATENT DOCUMENTS BP 64804 At wo ‘3049798 AP wo 2005018728 A? * cited by examiner ro11993 ‘62003 Samos U.S. Patent Nov. 8 2016 Sheet 1 of 19 US 9,486,611 B2 U.S. Patent Nov. 8 2016 Sheet 2 of 19 US 9,486,611 B2 Figure 2 US 9,486,611 B2 Sheet 3 of 19 Nov. 8, 2016 U.S. Patent € anit, 8@— or— ge ve US 9,486,611 B2 Sheet 4 of 19 Nov. 8, 2016 U.S. Patent PF aunhit, Ge oz 91 z- a 81 | NY x EME ES Ss fey \ A F Qo eel \ 4 zz: a coe a 4 “food ul X : RN oe: ge 08 ze ve oo? w | U.S. Patent Nov. 8 2016 Sheet 8 of 19 US 9,486,611 B2 U.S. Patent Nov. 8 2016 Sheet 9 of 19 US 9,486,611 B2 42 (" a 150 Figure 9 "oS | @ U.S. Patent Nov. 8, 2016 Sheet 10 of 19 US 9,486,611 B2 | 3 & Se * a : my S Se 5 7 = & 8 g & NS tr 8 § U.S. Patent Nov. 8, 2016 Sheet 11 of 19 US 9,486,611 B2 ed] 8 & xs 3 & < =) 5 ry : N — = & Ss es N 3 \ 8 , 4 1 PR \ g a U.S. Patent Nov. 8 2016 Sheet 12 of 19 US 9,486,611 B2 8 See 7 e a XY q g s = & = 1 5 : 4 N I. a —~ B oe ae US 9,486,611 B2 Nov. 8, 2016 Sheet 13 of 19 U.S. Patent &1 anit, Se , Sz t= U.S. Patent Nov. 8 2016 Sheet 14 of 19 US 9,486,611 B2 Figure 15 Figure 14 U.S. Patent Nov. 8 2016 Sheet 15 of 19 US 9,486,611 B2 ty > © Fs = 2X s 3 ~ = sy Ne 3 8 | i ! rt 6 i 8) 14 1 Ty Lt§ U.S. Patent Nov. 8 2016 Sheet 16 of 19 US 9,486,611 B2 a g MS . a \Q S $ S q TR = a — & 8 eee i ! ! iT |g . US 9,486,611 B2 Sheet 17 of 19 Nov. 8, 2016 U.S. Patent gt anh, a woe! U.S. Patent Nov. 8 2016 Sheet 18 of 19 US 9,486,611 B2 426 464- Figure 19 416: U.S. Patent Nov. 8 2016 Sheet 19 of 19 US 9,486,611 B2 526 564- et Figure 20 514 ~ 516- US 9,486,611 B2 1 GUIDE EXTENSION CATHETER CROSS-REFERENCE TO RELATED 'APPLICATIONS. ‘This epplicaton claims priority under 35 USC. §119 t0 US. Provisional Application Ser. No. 61/684, 591, filed Avg. 17, 2012, the entirety of whieh is incorporated herein by reference, ‘TECHNICAL FIELD “The present disclosure perisins to medical devices, and methods for manufacturing medical devices. More partic- Jarl, the present disclosure pertains to elongated intrcor- poreal medical devices including a guide extension catheter. BACKGROUND A wide varity of intracomporeal medical devices have been developed for medical use, for example, intravascular use. Some of these devices inchude guidewires, catheters ‘nd the like, These devices are manufactured by any’ one of 8 variety of different manufacturing methods and may be used according to any one ofa variety of methods. OF the Known medical devices and methods, each has certain advantages and disadvantages. There is an ongoing need 10 provi alternative medical devices ax well as allemative methods for manufacturing and using medical devices, [BRIEF SUMMARY ‘This disclosure provides design, material, manufocturing method, and use’ altematives for medical devices, Aa ‘example medical device may include # guide extension catheter The guide extension catheter may include an elon: ‘gate tubular member having a proximal region, a distal region, anda slot formed inthe tubular member between the proximal region and the distal rion. The proximal region ‘of the tubular member may be configured to shift between a first configuration and a collapsed configuration. The guide ‘extension catheter may also include an elongate shaft for shilling the proximal region between the fist configuration and the collapsed configuration ‘A method for using « guide extension catheter is also ‘disclosed. The method may include providing a guide cathe ‘eter, advancing the guide catheter through a body lumen (0 2 position adjacent to an area of interest, and advancing a puide extension catheter though the puide catheter. The aukle extension catheter may include an elongate tubular ‘member having proximal region, a distal region, anda sot formed in the tubular member between the proximal region ‘and the distal region. The proximal region of the tubular rember may be configured to shift between a fist configi- ration and a collapsed configuration. The guide extension ‘etheter may also include an elongate shat for shifting the prosimal region between the first configuration and the Collapsed configuration. The method may include shifting the proximal region fom the frst coafiguration to the ‘collapsed configuration and advancing a treatment through the distal gion ofthe tubular member to a position adjacent to the area of interest A guide extension catheter system is also diselosed. The system may inelude a guide catheter and « guide extension catheter configured to extend through the guide eatheter, The ‘Buide extension catheter may include an elongate tubs member having a proximal region, a distal region, anda slot 0 o 2 {ormed in the tubular member between the proximal region ‘and the distal region, The proximal region of the tubular ‘member may be configured to shift between a fist config- ration and a collapsed configuration. The guide extension catheter may also include an elongate shaft for shifting the proximal region between the first configuration and the collapsed configuration, The system may also include treatment catheter configured 19 extend through the guide catheter ad tough the distal region of the wbular member "Another example guide extension eatheter may include 3 tubular body having & proximal portion and a distal portion ‘The proximal portion may include a partially circumferent arcuate wall. The distal portion may inelude a fully czcum- {erential arcuate wall Another example guide extension catheter may include a proximal shaft having proximal outer diameter. distal sheath may be attached 0 the proximal shaft, The distal sheath may have a distal outer diameter grester than the proximal outer diameter A collar may be attached t0 the prowimal shaft an! to the distal sheath, The colar may have platy of slo formed therein, The above summary of some embodiments is not intended to deseribe each diselosed embodiment or every implemen- tation of the present invention. The Figures, and Detailed Description, which follow, more particularly exemplify these embodiments, BRIEF DESCRIPTION OF THE DRAWINGS ‘The invention may be more completely understood in consideration ofthe following detsiled deseription of vari- ‘ous embodiments of the invention in connection with the fsccompanying deswings, in which FIG. 1 isa plan view illustrating an example guide catheter advanced through the aorta to the ostium of ‘oronaty’ artery IG. 2 is a plan view illustrating an example guide ‘extension catheter used in conjunction with a guide catheter FIG. 3 isa cross-sectional side view of a portion of an ‘example guide extension catheter, FIG. 4 is a cross-sectional side view of a portion of the example guide extension eatheter shown in FIG. 3 and a suid catheter, FIG. § is a perspective view of an example collar, PIG. 6 is a perspective view of another example collar FIG. 7 isa perspective view of an example collar having, a ribbon portion coupled thereto: FIG, Bisa perspective view of an example collar having. «ribbon portion coupled thereto and having a distal sheath coupled thereto: FIG. 9 is a schematic view of fluid flow through aa example collar: FIG. 10 is side view of « portion of another example aide extension catheter FIG. 11 isa side view of a portion ofthe example guide extension catheter shown in FIG. 10 and a guidewire FIG. 12 is a side view of a portion ofthe example guide extension catheter shown in FIGS. 10-11 snd a shat for shift the guide extension eatheter between a first configuration to «collapsed configuration; FIG, 13 is aside view of a portion ofthe example guide extension catheter shown in FIGS. 10-12 with the guide extension eatheter shifted to a collapsed configuration; FIG. 14 is eross-sectional view taken through line 1 in FIG. 13 FIG. 1S is. crost-scctional view taken throvgh line 15-15, in FIG. 1%; 4 US 9,486,611 B2 3 FIG, 16 is a side view of the example guide extension catheter showa in FIGS, 10-15 ina collapsed configuration; FIG, 17 is a side view of the example guide extension catheter shown in FIGS. 10-16 along with an example teeatment device: FIG. 18 isa side view of another example guide extension catheter FIG. 19 sa side view of another example guide extension ceatbter TIG. 20 isa side view of another example guide extension catheter ‘While the invention is amenable to various modifications ‘and alternative forms, specifies thereof have been shown by ‘way of example in the drawings and will be described ia detail. 1 should be understood, hovsever, that the intention is not to limit the invention to the particular embodiments described. On the contrary, the intention is to cover all, modifications, equivalents, and altomaives falling within the spirit and scope of the invention DETAILED DESCRIPTION For the following defined terms, these definitions shall be applied, unless a different definition is given inthe claims or ‘elsewhere in this specification “All numeri values are herein assumed 0 be modiied by the tem “about,” whether or not explicitly indicated. The ‘erm “about” generally refers toa range of numbers that one ‘of skill in the ar woud consider equivalent to the recited value (ie, having the same fnetion or result) In many instances, the tems “about” may’ incude numbers that are rounded to the nearest significant figure “The recitation of numerical ranges by endpoints incdes all numbers within that range (eg. 1 to $ includes 1,15, 2, 2.75, 3, 380, 4, and 5) AS used in this spesifiction and the appended claims, the singular forms “a”, “an”, and “the” include plural referents unless the content clearly dictates otherwise. As use in this specification and the appended claims, the term “ot” is zenerlly employed in it sense including “and/or” unless the content clearly dictates otherwise. The following detailed description shoul! be read with reference to the drawings in which similar elements ia different drawings are numbered the same. The drawings, Which are not necessarily 10 scale, depict illustative ‘embosiiments and are not intended to limit the scope ofthe ‘Minimally invasive cardiac interventions such as perew taneous transluminal coronary angioplasty are widely uti lized throughout the world These procedures may include the use ofa guide catheter. For example, a guide catheter 10 may beadvanced through blood vessel uch as the aorta A ton adjacent tothe ostium O of a (ex, lel andlor right) coronary artery CA as illustrated in FIG. 1. When s0 positioned, a treatment catheter (eg, balloon catheter tent livery system, ete.) may be advanced through guide catheter 10 and? into the coronary artery CA to a tant Jocation where the treatment catheter may be used t0 per orm the appeopriate cardiac intervention, ‘In order forthe weatment catheter to efficiently reach the Jnended target locaton, maintaining the position of guide ceatheter 10 atthe ostium O of the coronary artery CA may be desirable. For example, given that the heart may be beating during the intervention (and/or other factors), the uide catheter 10 may lose its positioning or otherwise be shifted so that it a longer is positioned to efiiently guide the treatment catheter 10 the’ coronary arteries, This my 0 o 4 include a distal end 12 of guide catheter 10 being shifted ‘away from the ostium O ofthe coronary artery CA. Because of the shift away from the ostium O, access fo the coronary faneries CA may require repositioning of gud catheter 10 in ‘order to bring the distal end 12 hack into engagement with the ostium O of the coronary artery CA Disclosed herein are medical devices and methods for making and using medical devices that may improve aecess to the coronary arteries CA. For example, FIG. 2 illustrates ‘guide extension catheter 14 extending through guide catheter 10 and beyond distal end 12 of guide catheter 10 into the coronary anery CA. Because, for example, guide extension catheter 14 may extend beyond distal end 12 of guide catheter 10, guide extension catheter 14 may extend beyond the ostium O of the coronary adery CA and into @ portion of the coronary artery CA. By extending beyond the ‘ostium O; the extension catheter 14 may stabilize the pos tioning of guide catheter 10 and allow for improved access to the coronary artery CA for a number of earise interven- TFIG. 3 is a cross-sectional side view of guide extension catheter 14. Here it can be seen that guide extension catheter 14 may include a proximal shaft oF member 16, Proximal member 16 may include a proximal portion 18 and a distal ‘or nibbon portion 20, Proximal portion 18 may have a lumen 22 defined therwa, In some embodiments, umen 2 extends ‘long the entire length of proximal portion 18. In other ‘embodiments, lumen 22 extends slong ouly a portion ofthe Jength of proximal portion 18. In still other embodiments, ribbon portion 20 may be a solid member or ribbon that Jacks a lumen. In sdldtion, proximal portion 18 may inelude both proximal and distal openings (e... positioned at the proximal and distal end of proximal portion 18) such that Tumen 22 is “open” on both ends. Altematively, one or both of the ends of proximal portion 18 may be closed or otherwise sealed, For example, the distal end of proximal portion 18 may be closed. In some of these and in other embodiments, proximal portion 18 may have an opening or port (not shown) formed inthe wall of proximal portion 18 And spaced from the proximal and/or distal end of proximal portion 18, The port may or may not bein Bid coma ation with lumen 22. A hob 24 may be attached to proximal portion 18 A distal sheath 26 may be attached to proximal member 16. Sheath 26 may have @ lumen 28 formed therein. In general, lumen 28 (andor te inner diameter of distal sheath 26) may be larger than lumen 22 (andor the inner diameter ‘of proximal portion 18) and may be larger than the ower ‘Gamter of proximal member 16. Accordingly, lumen 28 ‘may be suficiently lange so as to allow a therapeutic catheter (ex, halloon catheter, stent delivery system, etc.) 10 pass therethrough. For example, when guide extension catheter 14 is positioned within guide catheter 10, the therapeutic catheter may extend within guide catheter 10 alongside proximal member 16 nnd through lumen 28 of distal sheath 2s, isto sheath 26 may'inclode a body portion 30, In atleast some embodiments, body portion 30 may inchide one or ‘more polymers including any of those disclosed herein. This may inelude the use of polymers with a differing durometer along the Iength of body portion 30, For example,» more proximal section of body portion 30 may inelude a polymer ‘with a higher durometer and a more distal seetion of body portion 30 may include « polymer with a lower durometer Portions ofall of the length of body portion may be loaded with of otherwise inelide © radiopage material. Body portion 30 may also include a reinforcement member 32 US 9,486,611 B2 5 The form of reinforcement member 32 may vary. For ‘example, reinforcement member 32 may include a braid, ‘oil, mesh, oF the lke "An inner liner or layer 34 may be disposed along an inner surface of body portion 30, The form of Hiner 34 may vary For example liner 34 may be a lubricious liner or otherwise include a lubricious material such a6 polyteteatfuoroethyl- ‘ene. tip member 36 may he attached body portion 30, for ‘example ata distal end of body portion 30. In some ‘embodiments, tip member 36 may be a single layer of ‘material. Alternatively tip member 36 may inelude an outer layer 38 and an inner layer 40. In at least some embodi- ments, tip member 36 may be configured to be generally raumatie and may include a relatively soft high compli nce material or structure, which may include a polymer oF ‘composite material. Outer layer 38 and inner layer 40 may be formes rom the same material. In some of these embod ments outer layer 38 and inner layer 40 may include the same polymeric material and each be loaded withthe same ‘or dilereat radiopaque materials, For example, inace ayer 40° may include’ a polyether block amide loaded with approximately 75.95% (eg, about 90%) by weight tungsten fand outer layer 38 may include a polyether block amide Joaded with approximately 30-50% (eg. 40%) by weight bismuth subearbonate. These are just example. In other > ‘embodiments, outer layer 38 and inner layer 40 may be ‘made from diferent materials Distal sheath 26 may be attached fo ribbon portion 20 of proximal member 16. The arangement and/or onfiguration ‘of the attachment between ribbon portion 20 and distal sheath 26 may vary. For example, distal sheath 26 may have ‘an opening oF lumen formed in tbe wall thereof and ribbon. portion 20 may be disposed within the opening. This may include necking, skiving, or pinching dow: ribbon portion 20 and inserting the necked down portion into the opening, In some embodiments, inserting ribbon portion 20 into the opening may secure proximal member 16 to «sta sheath 26 vin a mechanical bond. In some ofthese and ‘nother embodiments, additional andioraltemative bonding may be utilized including those bonding mechanisms com monly used for medical devices (eg., adhesive bonding. ‘welding, thermal bonding, brazing, et.) Other attachment mechanisms are also contemplated for atteching proximal ‘mete 16 o distal sheath 26 including diret bonding (¢. ‘adhesive bonding, thermal bonding, welding, brazing, ete) bonding that is facilitated by a thd component such as @ mtal or polymer collar 42 that may be boned hesween the ribbon portion 20 and distal sheath 26, For example, cone 42 may be bonded to ribbon portion 20 vin welding, thenmal bonding, adhesive bonding, or the like. Collar 42 may be bonded to distal sheath 26 using these same methods. For ‘example, collar 42 may be thermally bonded to distal sheath 26 by disposing collar 42 betwoen liner 4 and body portion 30 Guide extension catheter 14 may also include a number of ‘coatings that_may, for example, reduce fiction. For ‘example, proximal member 16 andior distal sheath 26 may have an inner andior outer coating that includes a hydro- philic polymer that may reduce friction during tracking. An ‘example coating may include BAYER CL-100, BIOSLIDE,, NG-HPC, SLIP COAT, MDX, paralyene, othe like. These just examples. Other materials are contemplated incl ing those disclosed herein TIG. 4 illustrates guide extension catheter 14 disposed within guide eatheter 10 (eg. disposed within a lumen 44 ‘defined within guide catheter 10).As shown, distal sheath 26, ‘ay be arranged to extend distally out from distal ead 12 of 6 uide catheter 10. When so arrange, distal sheath 26 may fengage the ostium O andlor extend within a portion of the joronary artery CA to help maintain the position of guide fatheter 10 and improve access to the coranary artery CA. Proximal member 16 may be designed to be sulficiem}y small (wile stil being suficiently sized and configured for pushabiity) so ast take up relatively’ lite space within the interior or lumen 44 of guide catheter 10, Accordingly. the 2 of guide extension catheter 14 allows fora therapeutic catheter or medical device to be advanced through fide catheter 10 in order to reaeh the desired target location for the intervention. In some embodiments, proximal member 16 may contact the inner wall surface of guide catheter 10, Which may provide even more space. ‘While a structure such as collar 42 may'be used to attach proximal member 16 to distal sheath 26, other structures are contemplated. For example, FIG. 5 illustrates another ‘example collar 142 that may be similar inform and function ‘0 other collar disclosed herein. Collar 142 may be designed to provide a relatively easy connection point between proxi- ‘mal member 16 and distal sheath 26. In addition, because collar 142 may be designed tobe structural supportive (ep collapse andior kink resistant) while having a desired level of exiilty, collar 142 may allow guide extension catheters tobe manufactured that do not include a reinforeing member (ex reinforcing member 32) such as a reinforcing braid a reinforcing coil, or both. This may desirably impact man- ‘acturing of guide extension eaetes, Collar 142 may inchade « proximal or base portion 144. In at Teast some embodiments, base portion 144 may have a oth of cutout 146 formed thercin. Notch 146 may be ormed in base portion 14 using a suitable procedure such as loser cutting. Other processes are contemplated. The use ‘of a laser cuting process may be desirable for a number of reasons. For example, laser cuting may allow for a wide variety of structures, shapes, and configurations to be used for notch 146. For example, FIG. 6 illustrates collar 142 ‘having base portion 14 witha ridge or pocket region 152° ‘where a portion ofthe wall thickness of base portion 144" is removed. Other configurations are contemplated for base portions 144/144 ‘Base portion 144 (andor base portion 148°) may be secured fo ribbon portion 20 of proximal member 16 as shown in FIG. 7. For example, ribbon portion 20 may be inserted into note 146 and then secured to Base portion 144 (andor base portion 144’) using an appropriate bonding technique (e.g, welding, thermal bonding, adhesive bond- ‘ng, and the like), Securing ribbon portion 20 to base portion 144 may include coining or otherwise machining ribbon portion 20 so that it has a shape corresponding tb pocket ‘egion 182' so ast allow ribbon portion 20 and base portion 144" to have a corresponding or mating relationship. This say failitae bonding Collar 142 may also include a distal portion 148, In at Ieast some embodiments, dist portion 148 may have a plurality of slots 150 formed thervin. The precise form, ‘mangement, and/or configuration of slots 180 may vary. At least some of the configurations contemplated for slo 150 are disclosed herein. In peneral, slots 150 may be configured to provide a desirable level of flexibility slong distal portion 148. This may include, for example, varying the arrange- ‘ment andlor configuration of slots 180 slong distal portion 148. For example, the number of slots 180 ean vary along the length of distal portion 148 so that the flexibility tran- sitions from being less exible at the proximal end (@ ewer slots 150 per nit length) to more Bexible atthe distal end (eg, more slots 150 per unt length) of distal portion US 9,486,611 B2 7 148, Other variations in the arangement andor configura- tion of slots 180 may also be utilized to vary the Mexibility of distal portion 148 (eg., variations in slot depth, slot shape, slot arrangement, and the like) slong its length (eg. Jess flexible adjacent to the proximal end and more flexible adjacent tothe distal end). Like notch 146, slots 180 may be formed in distal portion 148 using 2 laser cutting process. While distal portion 148 is illustrated as having slots 150 ormed therein, other configurations are contemplsted. For ‘example, distal portion 148 may have a stent-lke structure ‘or mesh configuration, may include one or more helical sles for grooves, or the like Distal portion 148 may be secured to distal sheath 26 as shown in FIG. 8. This may inclnde disposing distal portion 148 between liner 34 and outer layer 38 and then securing distal portion 148 to distal sheath 26 using an appropriate bonding technique such as thermal bonding. In addition to providing desirable lexibilty characteris tie, slots 150 may be desirable for a number of additional reasons, For example, slots 180 may allow for perfusion thorthrough as illstrated in FIG. 9. In order to facilitate perfusion, openings may also be formed in portions of distal Sheath (¢. liner 34 and/or oer layer 38) so that uid may be permitted to pass between locations along the interior of ‘collar 142 an locations along the exterior of collar 142. This, may desirably provide benefits to a numberof interventions including interventions within small vessels. “The interior surface, the exterior sufice, oF both of collar 142 may include one or more coatings including those coatings disclosed herein (eB, BAYER CL-100, BIO SLIDE, NG-HPC, SLIP COAT, MDX, paralyene, or the Tike) Such a coating may be disposed on collar 142 using a suitable process sich as chemieal vapor deposition or the Tike, Int least some embodiments, the coating may replace portions or all of liser 34 andor outer layer 38 of body Portion 30. For example, a paralyene coating may be dis- posed along the interior of collar 142. This eoating may be ‘sed instead of Finer 4, The use of a paralvene liner may be desirable fora numberof reasons. For example, a paalyene Tiner may be thinner than typical inner liners (e.g, PTFE liners) which may desiable impact the profile of the guide ‘extension catheter TIG, 10 is a side view of a portion of guide extension ceatheter 214, Here it can be seen that guide extension ‘catheter 214 may include or otherwise tke the form of an ‘elongate tubular member 284. In genera, the use of tubular member 284 may be desirable for a number of reasons. For ‘example, tubular member 254 may provide enhanced push ability that allows guide extension eatheter 244 to more ‘easily be positioned within guide catheter 10. In addition, tubular member 284 may provide increased resistance t© kinking or otherwise provide enhanced contol. Collectively, these and other desimble features may allow a user to position guide extension eatheter 214 a5 desired within the vasculature “Tubular member 284 may have a proximal region 216 and ‘9 distal region 226, A slot or slit 286 may Be formed in tubular member and may generally be positioned between proximal region 216 and distal repion 226. In some embodi- nents, slot 256 may be positioned approximately balf way down the length of tubular member 254 (ex, so that proximal region 216 and distal region 226 have epprox mately the same length) or distally therefrom, oF slot 256 ‘may be positioned approximately one third ofthe way down the leagth of tubular member (e., so that proximal region 216 accounts for about two-thirds the length of tubal member 284) or distally therefrom, or slot 286 may be 0 o 8 positioned approximately one fourth of the way down the Jength of tubular member (eg. so that proximal region 216 ‘accounts for about three-fourths the length of tubular mem- ber 284) or distally thereirom, or any ether suitable position. In addition, slot 286 may extend through about 10-85% of the diameter of tubular member 254, or about 25-75% ofthe ameter of tubular member 254, or about 35-65% of the ameter of tubular member 254, or about 50% of the ameter of tubular member 254. These are just examples In general, guide extension eatheter 214 inay be conlig- ured 80 tht proximal region 216 can shift between a first configuration and a second or collapsed configuration. This may he desirable for a number of reasons. For exampl collapsing proximal region 216 may allow another devi (ext, a treatment device such asa catheter) to be advanced ‘throdgh guide eatheter 10 along proximal region 216. Distal region 226 my generally maintain is tubular shape so that ‘tear be positioned within guide catheter 10 so that a portion thereol extends distally from distal end 12 of guide catheter 10 (eg. as shown in FIG. 2). Accordingly, the teatment ddovice can be advanced throvgh distal region 226 and to @ position adjacent an area of interest (e.., Within the eoro- ary artery CA). Shifting proximal region 216 from the frst configuration to the collapsed configuration may occur in a variety of dierent ways, One way of shifting proximal region 216 10 the collapsed configuration is illustrated in FIGS. H-13. For example FIG. 11 illustrates guide extension catheter 214 along witha guidewire 288. In tis example, guidewire 288 extends along an exterior or outer surface of tubular member 254 (eg. along the ovter surface of proximal region 216), through Slot 286, and along an inner surface oF lumen of distal region 226, Such positioning may be accomplished {or example, by threading distal epion 226 over guidewire 258 and pulling guidewire 258 through slot 256 FIG. 12 illustrates a shaft or generally rigid member 260, being advanced over guidewire 258, In at least some embodiments, shaft 260 may take the form of a catheter, tube, elongated balloon, oF mandrel that ean be advanced ‘over guidewire 258 and substantially engage or otherwise Seflect proximal region 216. Tor example, as shaft 260 advances over guidewire 258, shait 260 will engage slot 256. As shalt 260 is further advanced over guidewire 258, shaft 260 may exert a foree upon proximal region 216 that ‘ill shift proximal region 216 from the first configuration to the collapsed configuration as illustrated in FIG. 13. The ree exerted on proximal region 216 may be result of shaft 260 being directed into distal region 226 (which, in atleast Some embodiment, may include a more rigid matecal than proximal region 216). Alternatively, the force exerted on proximal region 216 may be “active”. For example, shalt 260 may include a balloon (gan elongated balloon) that deflects proximal region 216 when inflated. While in the collapsed configuration, proximal region 216 may be co lapsed upon itself and penerally have a curved or “U-shape” as shown in FIG. 14. Conversely, shaft 260 will extend ‘through distal region 226 so that distal region 226 will retain its generally tubular shape as shown in FIG. 18. a at least some embodiments, proximal region 216 is {formed from or otherwise includes a material that plastically deforms when collapsed by sh 260, Thus, advancing shaft 260 over guidewire 258 may plastically deform or “perma- rently” collapse proximal region, The resultant eonfigura- tion may be guide extension catheter 214 having tubular istal region 226 and a collapsed proximal region 216 as shown in FIG, 16. When so configired, «treatment devi 262 can be advanced over guidewire 288 as shown in FIG. US 9,486,611 B2 9 17, This may include advancing the treatment device 262 slong proximal region 216 and through distal region 226 to ' positon adjacent to an area of interest I ean be appeeci- rd that the form of the treatment device may vary t0 include a variety of devices including, but not limited to, catheters, angioplasty balloons andior catheters, stents oF sent delivery systems, ablation catheters, oF the like, of other suitable devices FIG. 18 illustrates another example guide extension cath= ‘eter 314 that may be similar in form and fanetion to other auide extension catheters disclosed herein, Guide extension ‘catheter 314 may include tubular member 384 having proxi- mal region 316, distal region 326, and slot 386, According ‘o this embodiment, proximal region 316 may be configured to be biased into the eollapsed configuration. Shaft 360 may be disposed within proximal region 316, distal region 326. ‘or bath. When doing so, shaft 360 overcomes the bias and expands” or otherwise holds proximal region 316 in aa ‘expanded configuration. Proximal retraction of shaft 360, may allow prosimal region 316 10 collapse and tke @ ‘configuration similar to that of guide extension catheter 214 ‘5 shown in FIG. 16. Thereafter, a treatmeat device may be ‘advanced along proximal region 316 and through distal region 326 to a position adjacent to an area of interest IG. 19 illustrates another example guide extension cathe ‘eter 414 that may be similar in form and function to other Buide extension catheters disclosed herein. Guide extension ‘calliter 414 may’ inchude tubular member 484 having rox! ral portion 416 and distal portion 426. In genoral,tuhul member 454 may be described as a continuous tubular member with a partially circular (andlor panially circum ferential) oF semicieular proximal portion 416, Proximal portion 416 may also be deseihed as being arcuate, curve, ‘and/or ribbon-like, Tubulie member 454 may also include distal portion 426 that may be cylindrical andlor flly ‘circumferential, The continuous wall surface of tubulae member 454 may allow for a relatively smooth transition ‘along the length thereof and through a port oF opening 464 that may be disposed between proximal portion 416 and «ist portion 426, Port 464 may allow a therapeutic medical device to he passed therethrough, ito distal orton 426, and ‘w/a postion adjacent to an area of interest. The continvous nature of tubular member 484 may form a smooth transition in Mexbility while reducing the likelihood of kinking. In ‘addition, because the wal surface is continuous, uneven oF raised surfaces may be reduced, reducing the ikelihood of catching ‘While guide extension catheter 414 is show with 9 par- tially circumferential proximal portion 416 and a generally cylindrical distal portion 426, other configurations are con= templated. For example, proximal portion 416 may be enerally cylindrical and distal portion 426 may be partially unferential In adition, one or more aional partially reumferental andor generally eylindrieal portions may be

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