Abstract:
The present disclosure concerns a delivery system for delivering a medically useful payload through the vasculature to a site of interest in the patient&#39;s body. The medically useful payload may be a therapeutic device, such as a stent, and it may be a diagnostic tool, such as an imaging device. Owing to its structural attributes, the presently-inventive delivery system is well suited for carrying medical payload to and through vessel curvature and to branched regions (i.e., bifurcations) in same. Also, the device is well-suited to traveling through a vessel over a guiding element, such as a guidewire, which itself exhibits curvature.

Description:
CROSS REFERENCE TO RELATED APPLICATION  
       [0001]     This application is reclaims priority under 35 U.S.C. § 119 (e) to U.S. provisional patent application No. 60/757,123, filed Jan. 6, 2006. 
     
    
     FIELD OF THE INVENTION  
       [0002]     The present disclosure concerns a delivery system for delivering a medically useful payload through a channel in the patient&#39;s body, such as the vasculature or a lumen, to a site of interest. The medically useful payload may be a therapeutic device, such as a stent, or it may be a diagnostic tool, such as a camera. Owing to its structural or shape attributes, the presently-inventive delivery system is well suited for carrying medical payloads to and through vessel curvature and to branched regions (e.g., bifurcations) in same. Also, the device is well-suited to traveling through a vessel over a guiding element, such as a guidewire, which itself exhibits curvature.  
       BACKGROUND OF THE INVENTION  
       [0003]     Diseases of the vasculature, such as stenoses, strictures or aneurysms in blood vessels and other body vessels can be treated or diagnosed by locating a payload, such as a stent, graft, imaging device, or the like, at the site of disease. Such payload can be carried to the site of implantation by a delivery device having a catheter for carrying and activating the payload. The catheters can be expected to carry the payload over a relatively long distance, often from an incision in the patient&#39;s groin area, through the vasculature, to a location where action is required. For example, a site in the vicinity of the patient&#39;s heart may be the target for payload deployment.  
         [0004]     From incision to deployment site, the path is defined by the interior of a vessel that the catheter must travel. The vessel may have segments that are difficult to traverse. Curves or bifurcations in vessels exemplify two particular kinds of segments that can present such difficulties. Likewise, the deployment site may be curved, or a bifurcation may be present at the site of deployment.  
         [0005]     A bifurcation in a vessel is a location where the vessel divides into two branches or parts. Vascular bifurcations generally have circumferential asymmetry. That is, bifurcated vessels generally exhibit asymmetry around their circumference at the point where the main vessel divides into two branches. Thus, the opening in the side branch vessel where the side branch vessel joins the main branch vessel may be asymmetrical. The side branch vessel may join the main branch vessel at an oblique angle, which may contribute to the asymmetry of the bifurcation cross-section.  
         [0006]     One kind of prior art bifurcation delivery device employs multiple guidewires and/or the clinician to orient and manipulate the device relative to the bifurcation. For example, attempts have been made to accomplish this solely through the use of two wires or wire-like elements (one in each branch of bifurcation) to force rotation of the device to match the vessel anatomy. This approach has shortcomings. First, by requiring delivery of the medical device to the location of the bifurcation over two wires (for substantially the entire delivery), the chance of wire wrapping is greatly increased. This prevents complete delivery of the device and can result in the clinician having to withdraw a wire and rewire the vessels, causing significant procedural delay and patient risk. Second, reliance on two wires for device orientation is typically insufficient to guarantee full and proper alignment of the entire medical device with the side branch ostium (particularly the portion of the device proximal to the carina (or apex) of the bifurcation). Even when both branches of the bifurcation are wired and the medical device is seated on the carina, the wires are typically not able to exert enough rotational influence on the device to align the whole length of the payload.  
         [0007]     In any event, carrying the payload through a vessel curvature, a bifurcation, or otherwise deploying the payload at such locations can present challenges in terms of traversing or accessing the site. Furthermore, where the payload needs to be in a specific orientation (such as for maximizing the therapeutic effect or diagnostic purpose of the payload), achieving the desired orientation in such curvature or bifurcation presents yet another challenge to the person of skill in the art.  
         [0008]     U.S. Pat. No. 6,544,218, entitled “Catheter With Biased Shaft” is disclosed as a reference of interest.  
       SUMMARY OF THE INVENTION  
       [0009]     The present invention is directed to a system and method for the delivery of a medically useful payload to a target site within a patient&#39;s body. By way of example, the system may be a flexible catheter, and the medically useful payload may be a stent or atherectomy device. In these instances, the medically useful payload is delivered to a site of disease within a blood vessel of a patient. In yet other examples the medically useful payload may be a camera, a light, or both, which can be carried to a site where observation is warranted for purposes of making a medical diagnosis. In one aspect of the present invention, an orienting region exhibiting a curved shape is located at a distal end of the delivery device. The curved shape facilitates rotation of the payload into a desired position during delivery according to its preferential orientation. That is, the orienting distal region is curved or bent in a preferred direction that causes the device to rotate in accordance with the shape of the vessel or guidewire (if possessing a curved segment) on which the delivery device may be tracked in order to achieve desired orientation of the payload.  
         [0010]     Thus, the delivery device of the present invention is adapted to deliver medical payloads (such as stents) to vessels that are curved and/or bifurcated, or other vessel configurations, such as those with eccentric lesions that are better serviced by deploying oriented devices. That is, there are occasions where the device should be oriented in a specific fashion relative to the bifurcation, curvature, or other vessel feature, or even oriented in response to a bend in the guidewire. Such orientation can be achieved with the present invention.  
         [0011]     In another aspect of the present invention, the orienting member having a curved shape is distally located on the delivery device and is coupled thereto to allow a degree of torsional movement of the orienting member, relative to other parts of the device. That is, the orienting member is attached to the delivery device in a manner that allows the orienting member to rotate as necessary to orient the member and conform the distal end of the device, where the member is located, to the shape of the vasculature, in order to deploy or carry the payload so the payload can be properly oriented.  
         [0012]     In a further aspect of the present invention, the payload can be co-located with the orienting member. For example, a stent can be positioned in or over the orienting member. In an alternative arrangement, the payload is not co-located with the orienting member, yet is coupled to the orienting member through sufficient intervening structure so as to undergo rotation in response to the orientation of the orienting member.  
         [0013]     A specific aspect of the present invention includes a device for carrying a medically useful payload positioned upon the device to a location of interest relative to a non-linear path in a body lumen. The device comprises an elongate intralumenal member having proximal and distal end portions. The intralumenal member is sized and dimensioned to travel to a location of interest in a body lumen. The device further includes an orienting member positioned along the distal end portion of the elongate intralumenal member. The orienting member exhibits a curved shape and is configured to rotate in response to the non-linear path.  
         [0014]     The curved shape imparted to the orienting member of the present invention facilitates orientation of the device as it travels through (1) curves or bifurcations in the vessel, (2) curves or bends in the guidewire, or (3) other eccentricities located within the vessel that create a curved path. So long as the orienting member possesses a sufficient degree of freedom to rotate, it will assume the path of least resistance in the course of its travels, and thereby rotate/orient itself to conform to the curve in the vessel in a unique, repeatable and predictable manner. Thus, by linking or associating a payload with the orienting member in a known relative position, orientation of the payload can be attained as a result of the rotational action exhibited by the orienting member.  
         [0015]     Aside from being adapted to pass relatively easily through bends and curves in the vasculature, the self-orienting member can be used in a number of beneficial ways. Stents deployed at the site of or in the vicinity of a bifurcation may have asymmetrical design features intended to conform to the bifurcation, and in particular, the side branch ostium. Such stents must be deployed in the proper orientation, a result that can be obtained by coupling such stents to the orienting member, and then allowing the member to orient itself in the vessel. Likewise, a camera or other diagnostic tool, such as an ultrasound transducer (IVUS), pressure transducer, infrared sensor, endoscope lens coupled to the orienting member could be properly oriented as a result of orienting member orientation. Furthermore, the self-orienting nature is useful where the curve, so to speak, is imparted by the guidewire that passes through the catheter. For instance, the orienting member may travel over a guide wire passed into a bifurcation side branch, allowing a stent to be deployed, in its proper orientation, in the side branch. In yet another example, a guidewire having a pre-bent or curved section can be used to effect orientation of the orienting member in situations where vessel characteristics are not of an orientation-producing nature. In other words, by positioning the bend in the guidewire at the desired location, the orienting member will orient itself as it traverses the bend. This arrangement is advantageous where it is desirable to achieve orientation in a relatively straight vessel segment. In any event, with these arrangements, rotation of the orienting member for positioning of payload, whether for deployment or other medically useful purpose is facilitated. Further, it should be understood that with the orienting member of the present invention, it is not just the payload that is properly oriented. For example, in the case of a bifurcated vessel, the side branch guidewire exit port can be oriented to face the ostium of the side branch vessel. In other words, as the orienting member rotates, the side branch guidewire exit port aligns according to the orienting member orientation, with the side branch guidewire element facing the side branch ostium. This arrangement makes it possible for the orienting member to properly orient to the side branch anatomy when the device is seated at the carina of the bifurcation. This arrangement also makes it easier for the side branch guide wire to be advanced out of the delivery catheter and into the side branch.  
         [0016]     The inducement of a curved shape in the orienting member along the distal end of the catheter may be made at any time before or during the delivery process, but is preferably done prior to advancement of the device to the bifurcation. Accordingly, the delivery system may include an element capable of inducing a curved shape along the orienting member assist in controlling the orientation of the catheter  10  and payload. The elements may be active component elements or passive component elements.  
         [0017]     Chemical, electrical/thermal or mechanical means can be used to actively modify the orienting member so the orienting member can be transversely displaced, resulting in a preferred curvature. For example, the orienting member may be provided with a curve by the manual placement or displacement of a bent or bendable member within the orienting member.  
         [0018]     Passive components may be part of or incorporated into the delivery device or orienting member to allow the delivery device or orienting member to be plastically deformed into a curved shape. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0019]      FIG. 1  is a perspective view illustrating a delivery device according to one embodiment of the present invention.  
         [0020]      FIG. 2  is a cross-sectional view illustrating the delivery device shown in  FIG. 1  according to one embodiment of the present invention.  
         [0021]      FIG. 3  is a cross-sectional view illustrating the delivery device shown in  FIG. 1  according to one embodiment of the present invention.  
         [0022]      FIG. 4A  is a cross-sectional view illustrating another aspect of the present invention.  
         [0023]      FIG. 4B  is a cross-sectional view illustrating another aspect of the present invention.  
         [0024]      FIG. 5A  is a side view illustrating the distal end of the delivery system, particularly the delivery catheter, having an orienting member attached along the distal end according to one embodiment of the present invention.  
         [0025]      FIG. 5B  is a cross-sectional view illustrating the distal end of the delivery system, particularly the delivery catheter, having an orienting member attached along the distal end according to one embodiment of the present invention.  
         [0026]      FIG. 6A  is a perspective view illustrating a delivery device having a shaped balloon (in an un-inflated configuration) located along the orienting member according to one embodiment of the present invention.  
         [0027]      FIG. 6B  is a perspective view illustrating a delivery device having a shaped balloon (in an inflated configuration) located along the orienting member according to one embodiment of the present invention.  
         [0028]      FIG. 7A  is a schematic side view of a catheter having an orienting member that includes active elements capable of inducing a curved shape to the orienting member upon activation.  
         [0029]      FIG. 7B  is a section view of a catheter having an orienting member that includes active elements capable of inducing a curved shape to the orienting member upon activation.  
         [0030]      FIG. 7C  is a schematic side view of a catheter having an orienting member that includes active elements that induced a curved shape to the orienting member after activation.  
         [0031]      FIG. 8A  is a magnified side view of a mechanical type active element according to one embodiment of the present invention.  
         [0032]      FIG. 8B  is a magnified section view of a mechanical type active element  61  according to one embodiment of the present invention.  
         [0033]      FIG. 8C  is a magnified side view of a mechanical type active element according to one embodiment of the present invention.  
         [0034]      FIG. 9A  is a side view of a delivery device illustrating passive biasing elements incorporated into the orienting member according to one embodiment of the present invention.  
         [0035]      FIG. 9B  is a section view of a delivery device illustrating passive biasing elements incorporated into the orienting member according to one embodiment of the present invention.  
         [0036]      FIG. 10A  shows a catheter delivery system having a curved shape with a secondary lumen on the outside radius of the orienting member, also referred to as a greater curve bend, according to one embodiment of the present invention.  
         [0037]      FIG. 10B  shows a catheter delivery device having a curved shape with the secondary lumen on the inside radius of the orienting member, which is also sometimes referred to as a lesser curve bend, according to one embodiment of the present invention.  
         [0038]      FIG. 11A  shows a catheter delivery system, with a pre-bent biasing wire, having a curved shape with a secondary lumen on the outside radius of the orienting member, also referred to as a greater curve bend, according to one embodiment of the present invention.  
         [0039]      FIG. 11B  shows a catheter delivery device, with a pre-bent biasing wire, having a curved shape with the secondary lumen on the inside radius of the orienting member, which is also sometimes referred to as a lesser curve bend, according to one embodiment of the present invention.  
         [0040]      FIG. 12A  illustrates a vessel anatomy having a main branch bend and a side branch off the greater curve (convex side) of the main branch bend according to one embodiment of the present invention.  
         [0041]      FIG. 12B  illustrates a vessel anatomy having a main branch bend and a side branch off the lesser curve (concave) of the main branch bend according to one embodiment of the present invention.  
         [0042]      FIG. 13A  shows a guidewire deployed in a main branch vessel having a greater curve anatomy according to one embodiment of the present invention.  
         [0043]      FIG. 13B  shows a guidewire deployed in a main branch vessel having a lesser curve anatomy according to one embodiment of the present invention.  
         [0044]      FIG. 14A  shows a delivery catheter deployed in a main branch vessel having a greater curve anatomy along two guidewires according to one embodiment of the present invention.  
         [0045]      FIG. 14A  shows a delivery catheter deployed in a main branch vessel having a lesser curve anatomy along two guidewires according to one embodiment of the present invention. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0046]     This invention describes a novel method and construction for designing the distal portion of a medical device delivery system. The delivery system can track the medical device towards a target location on a single wire, and pre-orient the payload of the delivery system relative to the target location. This design facilitates rotation of a payload into position for use. To accomplish this rotation, a curved shape is induced on the orienting member of the delivery system prior to advancement of the device to the target location. As an example in this embodiment, the curved shape should be chosen such that the curvature of the device is approximately matched to curvature in the vicinity of the target location. As the device rotates, the curve of the device aligns with the curve of the vessel, orienting the payload into the desired position.  
         [0047]     In one particular embodiment, this invention describes a novel method and construction for designing the distal portion of a medical device delivery system, such as a stent delivery system (SDS). The delivery system can track the medical device towards the bifurcation on a single wire, and pre-orient the side branch features of the delivery system and device towards the side branch ostium. This design facilitates rotation of a bifurcation device into position for deployment. To accomplish this rotation, a curved shape is induced on the orienting member prior to advancement of the device to the bifurcation. As an example in this embodiment, the curved shape should be chosen such that the curvature of the device is approximately matched to curvature in the vicinity of the ostium, with the side branch guidewire exit port facing the ostium of the side branch vessel. As the device rotates, the curve of the device matches the curve of the main branch vessel and the side branch device element will end up facing in the direction of the side branch ostium. This ensures that the device orients fully to the side branch anatomy once both branches are wired and the device is seated at the carina of the bifurcation. The curved shape of the device could also be used to match the curve of the side branch vessel if the main branch vessel does not have pronounced curvature.  
         [0048]      FIGS. 1 and 2  illustrate a delivery system, including catheter  10  of the kind suitable for treating bifurcations in which the payload is a balloon expandable stent. Catheter  10  includes an inflatable balloon and therefore is useful for deploying a balloon expandable stent, although it should be understood that the delivery system described herein could be employed with a self expanding stent, obviating the need for an inflation balloon and lumen to transport inflation fluid, it should be noted that if the payload were a self expanding stent, such as one manufactured of nitinol material, then the device would require a outer restraining sheath positioned over the stent. Catheter  10  generally comprises an elongated catheter shaft  11  having a proximal end  12 , a distal end  13 . At least one guidewire lumen  14  is adapted to receive and pass a guidewire, though a second guidewire lumen  18  is depicted here. An inflation port  20  at the proximal end of catheter shaft  11  has an opening for receiving an inflation fluid from an external source. The inflation port is in fluid communication with the open annular space  16  present within shaft  11 . Guidewire entry port  25  is found at the proximal device end, and can be in communication with guidewire lumen  14  or  18  that are discussed below. An RX guidewire lumen port  19  is located between proximal and distal ends  12  and  13  as shown in  FIG. 1 . RX guidewire lumen port  19  is in communication with the other of the guidewire lumens  14  or  18 .  
         [0049]     In the embodiment of  FIG. 1 , the shaft  11  is a multiple-lumen shaft, typically extruded or otherwise formed with at least one guidewire lumen  14 , and possibly a second guidewire lumen  18  present in annular space  16 . Annular space is sealed on its exterior by wall of shaft  11  and therefore serves as the conduit for transferring the balloon inflation fluid. Here, where the device is intended for the delivery of a stent, at the site of a bifurcation, it is advantageous, though not entirely necessary, to employ a catheter that can receive and pass at least two guidewires  32  and  33 . The catheter shaft is provided with lumens for main branch and side branch guidewires, such lumens designated  14  and  18 , respectively.  
         [0050]     An inflatable balloon  17  is disposed on a distal section of catheter shaft  11 , having a proximal end and a distal end secured and sealed to the shaft  11 . The opening in the balloon at its proximal end is in fluid communication with annular space  16  so that the balloon can receive and retain the inflation fluid as it flows from the external source, through inflation port  20 , through annular space  16 , and into balloon  17 . A stent  30  is mounted over the balloon  17 . See  FIG. 3 . Also shown is a side branch guidewire  32 , indicating that the payload tracks the side branch guidewire and thus payload deployment is to take place adjacent to a side branch ostium of a bifurcated vessel. By no means is this depiction intended to restrict the scope of the present application in any way, as the payload could have been depicted as tracking the main branch guidewire, i.e.,—intended for deployment in the main branch of the bifurcation.  
         [0051]     An orienting member  50  is located at the distal end of the catheter  10 . Orienting member  50  is mounted at the distal end of shaft  11 . In a specific arrangement, the proximal end of shaft  11  is constructed of a material that exhibits sufficiently high torsional flexibility so that the orienting member portion of the catheter is able to undergo the rotation necessary to orient the device. Employing an elastomeric material to construct the shaft in the area proximal to the orienting member  50  is one way to attain this result. In other arrangements, dimensions of shaft  11  can be varied in order to impart torsional flexibility in the region where the orienting member joins to the catheter. For example, the wall thickness of shaft  11  can be reduced in the area proximal to where the shaft  11  joins to the orienting member  50 , or alternatively, the diameter of the shaft  11  in this region can be reduced. In yet another arrangement, the orienting member is butt welded to the end of one of the guidewire lumens  14  or  18 .  
         [0052]     Distal exit ports  27  and  29  for main branch and side branch guide wires, respectively, are located at approximately the mid-portion of the distal payload for the side branch guidewire (not shown) and the catheter tip ( 35 ) for the main branch guidewire.  
         [0053]     As shown in  FIG. 4A , the orienting member  50  is coaxially arranged with the main branch guide wire  33 , that is, with the guidewire arranged coaxially within the orienting member  50 . Orienting member  50  extends within balloon  17  and is co-located therewith for at least a portion of its length with balloon  17  ( FIG. 1 ), with the stent  30  being carried over the balloon and orienting member portion. A portion of the orienting member  50  extends sufficiently distal to the payload in order to orient the device and payload for deployment.  
         [0054]     According to another embodiment of the present invention, as shown in  FIG. 4B , the orienting member  50  is coaxially arranged with the main branch guide wire  33 , that is, with the guidewire arranged coaxially within the orienting member  50 . Balloon  17  is coaxially located with the side branch guide wire  32  with the stent  30  being carried over the balloon. A portion of the orienting member  50  extends sufficiently distal to the payload in order to orient the device and payload for deployment.  
         [0055]      FIGS. 5A and 5B  illustrate side and section views, respectively, of the distal end of the delivery system, particularly catheter  10  having orienting member  50  attached along the distal end  13  according to one embodiment of the present invention. It should be noted that the medical device (stent) has been removed for clarity, and that the device depicted in these figures does not yet have the curved shape induced along the distal end portion.  
         [0056]     As described above, catheter  10  comprises an outer body, catheter shaft  11 , having proximal  12  and distal  13  ends, and an inner body or bodies forming guidewire lumens  14 ,  18 , etc. The distal end may also have a distal tip  35  to assist the delivery system when tracking over a guidewire and/or navigating through the vasculature.  
         [0057]     An expandable member, balloon  17 , is attached along the distal end of catheter  10 , and the secondary guidewire lumen  18  is located along the outer surface of the expandable member  17 .  
         [0058]     A hub may be integrated in the proximal shaft to allow the catheter  11  to be attached to a handle, inflation port, or similar device along the proximal end  12 . In one embodiment of the invention, the catheter  10  is made to track over a guidewire placed through the vasculature to the target location. Any method known in the art for tracking the catheter  10  over a guidewire may be used, including an Over the Wire (OTW) type device or a Rapid Exchange device. Accordingly, the catheter  10  may have an OTW (Over the Wire) port or an Rx (Rapid Exchange) port respectively.  
         [0059]     As earlier described, the purpose of the catheter  10  is to deliver and orient a medical device to the target location in a vessel. A stent has been described as the medical device to be oriented in a particular manner at a vessel bifurcation for the purpose of example. However, one of skill in the art would understand that other medical devices that can be incorporated into the distal end of the delivery catheter can also be delivered and oriented, including but not limited to medical balloons, cameras, sensors, drug delivery devices, and various lumens.  
         [0060]     One key concept of the present invention is the inducement of a curved shape in the orienting member  50  along the distal end of the catheter  10 . The curved shape may be made at any time before or during the delivery process, but is preferably done prior to advancement of the device to the target location. Accordingly, the delivery system may include an element capable of inducing a curved shape along the orienting member  50  to assist in controlling the orientation of the catheter  10  and payload. The elements may be active component elements or passive component elements.  
         [0061]     Active components include components that can be shaped into a curved shape after introduction into the vasculature. In a preferred embodiment, active components can enter the vasculature having a relatively straight longitudinal configuration, such as the device illustrated in  FIG. 5A , and be bent into the desired shape at a subsequent time, preferably once the device is near the desired location. However, this sequence description is not meant to limit the scope of the invention, and one of skill in the art would understand that the active components could be shaped into a curve prior to entering the vasculature.  
         [0062]     There are several methods that can be employed to actively induce the curved shape along the distal end of the catheter  10  and are presented here for the purpose of example. One of skill in the art would understand that other methods might also be employed.  
         [0063]     One method that can be used to induce a curved shape utilizes hydraulics and a pressure chamber that assumes a curved shape when filled. For example a curved or shaped medical balloon may be incorporated into the orienting member  50  or along catheter  10 .  FIGS. 6A and 6B  are perspective views of a catheter  10  having a shaped balloon  60  located along the orienting member  50 , separate from balloon  17 .  
         [0064]     The balloon  60  is shown in the un-inflated configuration in  FIG. 6A , with the catheter  10  and orienting member  50  assuming a relatively straight position. During delivery the balloon  60  remains relatively straight and flexible in an un-inflated, constrained and wrapped configuration. To impart the curved shape along the orienting member  50 , a fluid is introduced into the balloon  60  through the delivery catheter  10 , increasing the balloon&#39;s internal pressure and ultimately filling the balloon  60  until the balloon  60  assumes is curved shape, as shown in  FIG. 6B . The inflated balloon is strong and rigid enough to deflect the orienting member  50  into the desired curved shape. The fluid may be compressible or incompressible, but is preferably a substantially incompressible biologically compatible fluid such as saline.  
         [0065]     In another embodiment of the invention, the orienting member  50  includes at least one element that is capable of changing shape upon the introduction of some type of energy. This energy source may come in the form of mechanical, electrical, chemical, thermal or magnetic energy.  
         [0066]      FIGS. 7A and 7B  are side and section views of catheter  10  having an orienting member  50  that includes active elements  61  capable of inducing a curved shape to the orienting member  50  upon activation.  FIG. 7C  is a side view illustrating the orienting member  50  in a curved configuration after activation of active elements  61 .  
         [0067]     Active elements  61  are typically activated by a clinician or technician manipulating or triggering an operable component associated with the active element. In many cases, the operable component is located along the proximal end of catheter  10 . Accordingly, some embodiments of the delivery catheter  10  utilizing active elements  61  have a communication means between the operable component and the active element  61 . In other embodiments of the invention, the active element  61  itself, or a component part of the active element may traverse through a secondary lumen in the catheter  10  to the proximal end portion  12 . In still other embodiments of the invention, the active element  61  is capable of automatically activating by changes in environmental conditions. In this latter case, it may not be necessary for the active component to have a manually operable component along the proximal end portion  12  of catheter  10 .  
         [0068]     In one embodiment of the invention the active element  61  is a mechanical element or elements that changes the shape of the orienting member  50  through a application of relative motion or force transmitted by a pull wire or similarly configured communication member attached to a proximally located operable component. These elements  61  may include wires, deflectable tubes, deflectable catheters, or deflectable tip guidewires (for example the Cordis Steer-it™ guidewire) and are generally known in the art of deflectable tip catheters and guidewires.  
         [0069]      FIGS. 8A and 8B  are a magnified side and section views of another mechanical type active element  61  according to one embodiment of the present invention. The mechanical active element  61  comprises a semi-compliant element  81  attached along the distal end portion of catheter shaft  11 . A flexible element  82  is fixedly attached to the distal end of the semi-compliant element  81 , and is of sufficient flexibility to bend when put under a compressive loading condition to provide the desired curvature in the orienting member  50 . A pull wire  80  is attached to an anchor  83  located along the distal end of the flexible member  82 , and travels proximally through pull wire lumen  84  and catheter shaft  11  to an operable component located along the proximal end of catheter  10 . The pull wire lumen  84  is off center, which causes the flexible member  82  to deflect in a particular direct. That is, the offset pull wire lumen caused the flexible member  82  to curve such that the inside radius or lesser curve is on the side of the pull wire lumen  84 .  
         [0070]     The active elements  61  are located within or along the orienting member  50 , and remain relatively straight and flexible when introduced into the vasculature and advanced to the desired location.  
         [0071]     When the clinician desires to induce the curved shape he imparts mechanical force or motion to the pull wire  80  at the proximal end of the delivery catheter  10 , which translates this energy into motion along the deflectable distal end portion to the deflectable element  82  associated with orienting member  50 . This deflection bends the orienting member  50  to assume the curved shape.  FIG. 8C  is a magnified side view of the mechanical active element  61  according to one embodiment of the present invention when deflected into a curved shape.  
         [0072]     In another embodiment of the present invention, a deflectable tip guidewire may also be suitable for use in as an active element  61  in conjunction with the orienting member  50 . A similar guidewire concept is disclosed in U.S. Pat. No. 7,128,718 entitled Guidewire With Deflectable Tip, and is incorporated by reference in its entirety herein. The disclosed deflectable guidewire is bi-directional and has a deflectable distal tip that comprises a longitudinal hypotube and a spring coil attached to the distal end of the hypotube. The deflectable guidewire also includes a longitudinally movable deflection member that is attached to the distal end of the spring coil and a tip retaining member that extends from the distal end of the hypotube to the distal end of the spring coil for providing very precise deflection of the distal tip.  
         [0073]      FIG. 8D  is a magnified side section view of a flexible tip guidewire used as an active element  61  according to one embodiment of the present invention. The actively bendable guidewire comprises an elongated hypotube  86 , a helical coil  88  attached to and extending from the distal end of the hypotube  86 . The helical coil  88  is preferably formed from platinum tungsten with the proximal turns being wound such that adjacent turns of the proximal portion are in contact with each other.  
         [0074]     While the preferred embodiment of the present invention includes the helical coil  88 , this element may take the form of any flexible cylindrical member, such as for example a thin metallic tube with or without portions of the tube removed by, for example laser cutting, so as to form a very flexible cylindrical member. An elongated, deflection member  85  extends from the proximal end of the control handle through the hypotube  86  and through the helical coil  88 , and is connected into an attachment member, or rounded bead  87 , which is disposed at the distal tip of the helical coil  88 . In addition, a retaining ribbon  89  is connected to the distal end of the hypotube  86  and is also connected to the rounded bead  87 .  
         [0075]     In operation the distal tip of the active element  61  is normally biased into a downwardly curved position as illustrated in  FIG. 8D , because of the curve of the pre-shaped deflection ribbon  134  and the retaining ribbon  89 . When an operable component along the proximal end of the catheter  10  is moved distally, the deflection member  85  will be moved distally thereby causing the deflection ribbon  134  to move in a distal direction. As the deflection ribbon is moved distally, a force is applied to the top portion of the rounded bead  87 . The retaining ribbon  89  is attached to the lower portion of the bead  87  to thereby maintain the bead at a fixed distance from the distal end of the hypotube  86 . As the deflection ribbon  134  is moved to the right, the tip of the guidewire is caused to deflect downwardly to a maximum position of deflection.  
         [0076]     In another embodiment of the invention, the orienting member  50  includes at least at least one active element  61  that changes shape corresponding to a change in electrical potential or current. Electrically active elements  61  that change shape under these conditions are known in the art, and include piezoelectrics, bimetallic strips with resistive heating elements and MEMS (electro-mechanical actuator) devices. Electrically active elements  61  may also include materials that exhibit shape memory properties under the influence of electric potentials. One such material known in the art is a family of conductive polymers that contract when the electrical potential is increased, and relax or elongate when depolarized. The contraction/relaxation of these elements may be used to locally cause a mechanical element to displace, resulting a bend or curve induced into the orienting member  50 .  
         [0077]     When the clinician desires to induce the curved shape he allows electrical energy to flow to the electrically active element  61 . This may be, for example, by closing a switch at the proximal end  12  of catheter  10 . This change is electrical potential or current causes the electrically active element  61  to change shape or deflect. This deflection bends the orienting member  50 .  
         [0078]     In still another embodiment of the invention, the orienting member  50  has at least one active element  61  that changes shape corresponding to a change in a magnetic field. The magnetic field may be internal to the body or vasculature, or external. One particular type of material for this type of application is a magnetostrictive material. Magnetostriction is the changing of a material&#39;s physical dimensions in response to changing its magnetization. In other words, a magnetostrictive material will convert magnetic energy into kinetic energy and change shape when it is subjected to a magnetic field. One brand name of a magnetostrictive material is Terfenol™ 
         [0079]     When the clinician desires to induce the curved shape he subjects the magnetostrictive active element  61  to a magnetic field. This magnetic field causes the magnetostrictive element  61  to convert the magnetic energy to kinetic energy and change shape. This deflection bends the orienting member  50  to assume the curved shape.  
         [0080]     In other embodiments, the catheter  10 , particularly orienting member  50  has ferrous or ferromagnetic portion or element  61  and responds to an external magnetic field. Accordingly, the orienting member  50  may bend toward the attractive magnetic field, or bend away from a repulsive magnetic field, causing a similar bend in the catheter  10 .  
         [0081]     The orienting member  50  may also be actively bent by forces exerted by a chemically responsive element  61  that changes shape corresponding to a change in local chemistry. This change may be caused by a chemical reaction or change in chemical concentration in the chemically active element  61 . In either case the chemically responsive element  61  may swell or lengthen and change shape in response to the change in local chemistry. One of skill in the art would understand that this shape change or swelling may directly impart a curve in the orienting member  50 . Similarly, the shape change or swelling may indirectly, through local manipulation of a mechanically active element, impart a curve in the orienting member  50 .  
         [0082]     Similarly, forces exerted by a thermally responsive active element  61  may also actively manipulate the orienting member  50 . In these embodiments, the change in local temperature may be a result of placing the device into a warm vessel, or alternatively, changing the local temperature by introducing a hot or cold medium. In one particular embodiment, the thermally active element  61  is in fluid communication to an operable component located along the proximal end portion of catheter  10  through a channel. The clinician may initiate the flow of medium through the catheter channel to the thermally active element  61 , causing the thermally active element to change shape and curve or bend the orienting member  50 .  
         [0083]     In one embodiment, a thermally responsive active element  61  may change shape corresponding to a change in temperature. For example, the material may undergo a change in shape as a result in the increase or decrease in local temperature.  
         [0084]     In another embodiment the thermally responsive active element  61  has components with different coefficients of thermal expansion—for example a bi-metallic strip. When the element is introduced into various thermal environments, the different components respond differently, and expand at different rates. This will cause the thermally responsive active element  61  to change shape or bend. This deflection bends the orienting member  50  to assume the curved shape. In addition, materials having anisotropic thermal expansion properties may be used to impart a curvature along the orienting member  50 . One of skill in the art would understand that this shape change through thermal expansion may directly impart a curve in the orienting member  50 . Similarly, the shape change through thermal expansion may indirectly, through local manipulation of a mechanically active element, impart a curve in the orienting member  50 .  
         [0085]     Thermally responsive active elements  61  may also undergo a phase change, causing the material to exhibit shape memory or super elastic characteristics. One such material is Nitinol.  
         [0086]     Nitinol is utilized in a wide variety of applications, including medical device applications as described above. Nitinol or NiTi alloys are widely utilized in the fabrication or construction of medical devices for a number of reasons, including its biomechanical compatibility, its biocompatibility, its fatigue resistance, its kink resistance, its uniform plastic deformation, its magnetic resonance imaging compatibility, its ability to exert constant and gentle outward pressure, its dynamic interference, its thermal deployment capability, its elastic deployment capability, its hysteresis characteristics, and is moderately radiopaque.  
         [0087]     Nitinol, as described above, exhibits shape memory and/or super-elastic characteristics. Shape memory characteristics may be simplistically described as follows. A metallic structure, for example, a Nitinol tube that is in an Austenitic phase may be cooled to a temperature such that it is in the Martensitic phase. Once in the Martensitic phase, the Nitinol tube may be deformed into a particular configuration or shape by the application of stress. As long as the Nitinol tube is maintained in the Martensitic phase, the Nitinol tube will remain in its deformed shape. If the Nitinol tube is heated to a temperature sufficient to cause the Nitinol tube to reach the Austenitic phase, the Nitinol tube will return to its original or programmed shape. The original shape is programmed to be a particular shape by well-known techniques.  
         [0088]     Super-elastic characteristics may be simplistically described as follows. A metallic structure for example, a Nitinol tube that is in an Austenitic phase may be deformed to a particular shape or configuration by the application of mechanical energy. The application of mechanical energy causes a stress induced Martensitic phase transformation. In other words, the mechanical energy causes the Nitinol tube to transform from the Austenitic phase to the Martensitic phase. By utilizing the appropriate measuring instruments, one can determined that the stress from the mechanical energy causes a temperature drop in the Nitinol tube. Once the mechanical energy or stress is released, the Nitinol tube undergoes another mechanical phase transformation back to the Austenitic phase and thus its original or programmed shape. As described above, the original shape is programmed by well know techniques. The Martensitic and Austenitic phases are common phases in many metals.  
         [0089]     Medical devices constructed from Nitinol are typically utilized in both the Martensitic phase and/or the Austenitic phase. The Martensitic phase is the low temperature phase. A material is in the Martensitic phase is typically very soft and malleable. These properties make it easier to shape or configure the Nitinol into complicated or complex structures. The Austenitic phase is the high temperature phase. A material in the Austenitic phase is generally much stronger than the material in the Martensitic phase. Typically, many medical devices are cooled to the Martensitic phase for manipulation and loading into delivery systems. When the device is deployed at body temperature, they return to the Austenitic phase.  
         [0090]     Other materials that have shape memory characteristics may also be used, for example, some polymers and metallic composition materials.  
         [0091]     The curved shape may also be formed in the distal end of the catheter  10 , i.e. orienting member  50  using a passive component. Passive components are elements that cannot be shaped once introduced into the vasculature but are shapeable into a curved shape prior to introduction of the device into the vasculature. However, the passive components do substantially retain the curved shaped imparted to it even once introduced into the vasculature or body lumen. This may be done during the manufacturing process, or alternatively, by the clinician or a technician just prior to introduction of the delivery device into the vasculature.  
         [0092]     Many of the components incorporated into the distal end of the catheter  10  may be designed as passive components to facilitate inducement of the curved shape. For example, in the case of a stent delivery system, the stent itself may be made or shaped with a curved shape prior to insertion into the vessel. In addition, the catheter inner body, guidewire lumen  14 , including the main branch element, side branch element, or both elements, may be manufactured or subsequently shaped with a curved shape prior to introduction into the vessel.  
         [0093]     In addition to the typical components that make up the delivery system described above, other components may be added to induce or facilitate the curved shape in the orienting member  50  or along the distal end of the catheter  10 . In one embodiment of the invention, a biasing element is added to orienting member  50  to facilitate the curved shape. This element may be, for example, in the form of a stiffening wire, a ribbons or an extrusion. Still one of skill in the art would understand that other biasing element could be used.  
         [0094]      FIGS. 9A and 9B  illustrated side and section views of a delivery device, catheter  10 , having biasing elements  90  incorporated into orienting member  50  along the distal end  13  according to one embodiment of the present invention.  
         [0095]     As can be seen, the passive delivery device has similar components as the delivery device  10  illustrated in  FIGS. 1 through 4 B, including an inner body guidewire lumen  14  for tracking over guidewire  33 , an outer body catheter shaft  11 , an expansion device (balloon)  17 , a distal tip  35 , and a secondary lumen  18  for the secondary or side branch guidewire  32 . A medical device, stent  30 , is also illustrated in these figures. However, the delivery device  10  illustrated in  FIGS. 9A and 9B  also has a pair of biasing wires  90  that start at the balloon  17  proximal seal and travel distally along orienting member  50  to a point just proximal the distal tip  35 . The biasing wires  90  are capable of being bent and taking a set to form a curved shape along the orienting member  50 .  
         [0096]     It should be noted that  FIG. 9A  shows the biasing wires  90  and the catheter  10  delivery system in a relatively straight configuration before the curved shape was induced upon the distal end. As earlier disclosed, the biasing wires  90  may be bent, for example, during manufacture, or by the clinician just prior to insertion into the vessel.  
         [0097]     A catheter delivery device  10  having a curved shape with a radius R along the distal end is illustrated in  FIGS. 10A and 10B .  FIG. 10A  shows the delivery device having a curved shape with the secondary lumen  18  on the outside radius of the orienting member  50 , also referred to as a greater curve bend.  FIG. 10B  shows the delivery device having a curved shape with the secondary lumen  18  on the inside radius of the orienting member  50 , which is also sometimes referred to as a lesser curve bend.  
         [0098]     There are several methods that can be employed to passively induce the curved shape in the orienting member  50  along the distal end of the catheter delivery system  10 , and are presented here for the purpose of example. One of skill in the art would understand that other methods might also be employed.  
         [0099]     As discussed above, the curved shape may be set into the catheter delivery device  10  during the manufacturing process, or alternatively, by the clinician or a technician just prior to introduction of the delivery catheter  10  into the vasculature or body lumen.  
         [0100]     In one embodiment of the invention, the delivery catheter  10  and the components, particularly the orienting member  50 , can be manufactured in a curved shape. Several different curved shapes may be made to allow a clinician to have a set from which to choose a delivery catheter  10  that has a curved shape that most closely resembles the actual vessel anatomy. Alternatively, the orienting member  50  may be appropriately shaped as needed.  
         [0101]     In another embodiment of the invention the typical components comprising the distal end of the delivery catheter  10  are flexible. Auxiliary passive components having a predetermined curved shape, such as pre-bent biasing wires  91 , are incorporated into the distal end and provide the curved shape for the orienting member  50 . Alternatively, the pre-bend biasing wires  91  may be advanced or retracted through the inner body lumen  14  to provide a set shape to the flexible distal end portion of the catheter  10 .  
         [0102]     A catheter delivery device  10 , including a pre-bent biasing wire inducing a curved shape with a radius R along orienting member  50  is illustrated in  FIGS. 11A and 11B .  FIG. 11A  shows the delivery catheter  10  with a curved shape with the secondary lumen  18  on the outside radius (greater curve bend) of the orienting member  50 .  FIG. 11B  shows the delivery device having a curved shape with the secondary lumen  18  on the inside radius (lesser curve bend) of the orienting member  50 . In each case, pre-bent biasing wires  91  are incorporated into the orienting member  50 , to provide the desired curved shape to the distal end portion of catheter  10 .  
         [0103]     In still another embodiment of the invention, one or more of the components comprising the distal end  13  of the delivery catheter  10  are made from materials that can be plastically deformed by the clinician prior to introduction of the catheter  10  into the vessel. This pre-delivery mechanical bend may be by actual manipulation and shaping by the clinician, with or without the use of a bending tool. Still other methods of bending could include specially designed packaging that will induce a bend onto the distal end of the delivery device when removed in a certain way. For example, the packaging may be designed to impart a convex (outside radius) bend for use in greater curve vessel anatomy if the delivery catheter  10  is removed from the packaging in one particular direction, and a concave (inside radius) bend for use in a lesser curve vessel anatomy if the delivery catheter  10  is removed a different direction.  
         [0104]     In addition, the methods described for active bending after introduction into the vasculature may be used to induce a passive curved shape in the delivery catheter  10  or orienting member  50  before it is introduced into the anatomy.  
         [0105]     The curved shape should be chosen such that the curvature of the device near the target payload region, i.e. orienting member  50 , is approximately matched to that of vasculature anatomy. One method to determine the vascular anatomy is to insert the primary delivery guidewire  33  into the vessel and observe the curvature taken by the guidewire  33  relative to curvature of the vessel, or, in the case of bifurcated vessels, the ostium of the side branch vessel.  
         [0106]     By way of example,  FIG. 12A  illustrates a vessel anatomy having a main branch bend  120  and a side branch  121  off the greater curve (convex side) of the main branch bend  120 .  FIG. 13A  shows a guidewire  33  deployed in a similar main branch vessel  120  having a greater curve anatomy, and assists in viewing the vessel anatomy. To access the side branch  121  with a subsequently delivered second guidewire  32 , the clinician would us a delivery catheter  10  with a greater curve side branch bend as shown in  FIG. 10A . The delivery catheter  10  is tracked over the primary guidewire  33  to the bifurcation location, and naturally rotates into position, with the secondary guidewire tube  18  facing the side branch vessel  121 . The secondary guidewire  32  can then be advanced through the secondary guidewire tube  18  into the side branch vessel  121  as illustrated in  FIG. 14A . This ensures that the device orients fully to the side branch anatomy once both branches are wired and the device is seated at the carina of the bifurcation.  
         [0107]     Similarly,  FIG. 12B  illustrates a vessel anatomy having a main branch bend and a side branch off the lesser curve (concave side) of the main branch bend. A guidewire can be inserted into the main branch of the vessel to assist in viewing the vessel anatomy.  FIG. 13B  shows a guidewire  33  deployed in a similar main branch vessel having a lesser curve anatomy. To access the side branch with a subsequently delivered second guidewire  32 , the clinician would us a delivery catheter  10  with a lesser curve side branch bend as shown in  FIG. 10B . The delivery catheter  10  is tracked over the primary guidewire  33  to the bifurcation location, and naturally rotates into position, with the secondary guidewire tube  18  facing the side branch vessel  121 . The secondary guidewire  32  can then be advanced through the secondary guidewire tube  18  into the side branch vessel  121  as illustrated in  FIG. 14B . This ensures that the device orients fully to the side branch anatomy once both branches are wired and the device is seated at the carina of the bifurcation.  
         [0108]     Several factors may be considered when choosing or inducing a curved shape along the distal end of the delivery catheter system  10 , particularly the location and shape of the curved shape, and the orientation of the side branch element to the curved shape.  
         [0109]     Furthermore, is readily appreciable that implantation within the side branch  121  can be similarly achieved, owing to the versatility of the device. For example, as shown in  FIG. 4B , by passing the main branch guide wire  33  through the orienting member  50  (with same positioned exterior to the payload), with the balloon  17  and side branch guidewire  32  within the payload (stent)  30 , the device can be properly oriented by allowing the orienting member  50  to rotate the distal end of the catheter device  10  as the orienting member passes through the bend in the vessel. With this arrangement, the stent can be passed into the ostium of the side branch  121  and then deployed in the side branch  121 .  
         [0110]     It will be understood that this disclosure, in many respects, is only illustrative. Changes may be made in details, particularly in matters of shape, size, material, and arrangement of parts without exceeding the scope of the invention. Accordingly, the scope of the invention is as defined in the language of the appended claims.