Abstract:
A method of deploying a stent in a bifurcation includes introducing two guidewires through the main vessel and using the two guidewires for guiding a dual lumen catheter carrying a stent first to an initial position proximal to the stent deployment position, retracting one wire, and projecting it from the catheter and through a side of the stent a branch guidewire into the second branch vessel, and then moving the catheter to the predetermined deployment position while guided by the main guidewire in the first branch vessel, and the branch guidewire in the second branch vessel. The stent is then expanded, and the catheter is removed with the stent remaining in its deployed position An alternative embodiment includes introducing one wire, advancing the system over the one wire and subsequently introducing the second wire.

Description:
[0001]    This application clams the benefit under U.S.C. 119 of U.S. Provisional Patent Application Serial No. 60/339,802, filed Dec. 17, 2001. This application is a continuation in part of pending U.S. patent application Ser. No. 09/816,690, filed Mar. 22, 2001, which is a continuation in part of pending U.S. patent application Ser. No. 09/533,616, filed Mar. 22, 2000. This application is also a continuation in part of pending U.S. patent application Ser. No. 09/741,761, filed Dec. 18, 2000, which is a continuation in part of abandoned U.S. patent application Ser. No. 09/325,996, filed Jun. 4, 1999, which is a continuation in part of expired U.S. patent application Ser. No. US99/00835, filed Jan. 13, 1999, published as WO99/36002 on Jul. 22, 1999, which claims priority from U.S. patent application Ser. No. 09/007,265, which issued on Apr. 3, 2001 as U.S. Pat. No. 6,210,429, and which is a continuation in part of abandoned U.S. patent application Ser. No. 08/744,002, filed Nov. 4, 1996, all of which are incorporated herein by reference in their entireties. 
     
    
     
       FIELD AND BACKGROUND OF THE INVENTION  
         [0002]    The present invention relates to the delivery of stents. A stent is a type of endoprosthesis device, typically intraluminally placed or implanted within a vein, artery, or other tubular body organ for treating an occlusion, stenosis, aneurysm, collapse, dissection, or weakened, diseased, or abnormally dilated vessel or vessel wall, by expanding the vessel or by reinforcing the vessel wall. In particular, stents are quite commonly implanted into the coronary, pulmonary, neurovascular, peripheral vascular, renal, gastrointestinal and reproductive systems, in order to reinforce individual body organs. The invention described herein is particularly useful for deploying stents in bifurcations, and is therefore described below with respect to this application.  
           [0003]    In vessel bifurcations, a main vessel splits into two branch vessels. Implanting stents in bifurcations is particularly problematic because of the need to precisely locate the stent both longitudinally and radially in the bifurcation. This is especially the case when the stent is designed with a side opening which is to face the ostium of the branching vessel. One technique for precisely locating the stent is by initially introducing two guidewires into the main vessel, one guidewire extending through the bifurcation into one branch vessel, and the other guidewire extending through the bifurcation into the other branch vessel, and then using the two guidewires for guiding the stent, which is mounted on a delivery device, e.g., a balloon angioplasty catheter, to its precise longitudinal position and radial orientation before deploying the stent. One such technique involving the initial placement of two guidewires is described, for example, in U.S. Pat. No. 5,749,825 to Fischell et al.  
           [0004]    However, in such a two-wire technique, due to the tortuosity of the vascular system, the physician must torque the delivery system in order to deliver the guidewires to their correct location. Because of this torquing, the two guidewires frequently tend to cross over one another and/or entangle during their use for guiding the stent delivery device. Such an entanglement or crossover, if it should occur, may result in an inability of the device to be delivered by the physician, requiring the procedure to be started anew.  
           [0005]    There is thus a widely recognized need for, and it would be highly advantageous to have, a method for delivering stents to bifurcations devoid of the above limitations.  
         SUMMARY OF THE INVENTION  
         [0006]    An object of the present invention is to provide a method of deploying a stent in a vessel bifurcation which method substantially reduces or eliminates the possibility of wire entanglement or cross-over when deploying the stent.  
           [0007]    The invention is particularly useful in deploying stents in coronary blood vessel bifurcations, and is therefore described below with respect to such applications. It will be appreciated, however, that the invention could also be used for deploying stents in other vessel bifurcations such as peripheral blood vessels, or vessels related to the renal, gastrointestinal and reproductive systems or any other system in the body wherein a main vessel is split into two (or more) branch vessels.  
           [0008]    According to one aspect of the present invention, there is provided a method of introducing a first and second vessel guidewire into two branches of a vessel, the method including inserting a first guidewire into a fist vessel, inserting a second guidewire into said first vessel, advancing a delivery system through the first vessel over the first guidewire and the second guidewire, the delivery system having a first lumen that slidably engages the first guidewire and a second lumen alongside the first lumen that slidably engages the second guidewire, positioning the delivery system in a region of a bifurcation, retracting the second guidewire proximally until a distal end of the second guidewire is in a region of a bifurcation, and advancing the second guidewire through the second lumen into the second vessel.  
           [0009]    According to a further aspect of the present invention, there is provided a method of deploying a stent in a bifurcation of a main vessel which separates into first and second branch vessels, the stent including a proximal end to be deployed in the main vessel on the proximal side of the bifurcation, and a distal end to be deployed in the first branch vessel on the distal side of the bifurcation. The method includes introducing the distal end of a first guidewire through the main vessel and the bifurcation into the first branch vessel, introducing the distal end of a second guidewire through the main vessel and the bifurcation into the first branch vessel, providing a stent delivery device including a main lumen for receiving the guidewire, a branch lumen, and an expandable stent, inserting the proximal end of the first guidewire into the distal end of the main lumen of the stent delivery device, inserting the proximal end of the second guidewire into the distal end of the main lumen of the stent delivery device, guiding the stent delivery device along the first guidewire through the main vessel and along the second guidewire through the branch vessel to an initial position adjacent to the proximal side of the bifurcation, retracting the second guidewire, advancing the second guidewire into the second branch vessel, advancing the stent delivery device, while tracked by the first guidewire in the first branch vessel and by the second guidewire in the second branch vessel, to the predetermined deployment position with respect to the bifurcation, to bring the distal end of the stent into the first branch vessel, while the proximal end of the stent still remains in the main vessel, radially expanding the stent, and removing the stent delivery device.  
           [0010]    According to another aspect of the present invention, there is provided a method of introducing two guidewires into a first and a second vessel, the method including inserting a first guidewire into the first vessel, advancing a delivery system through the first vessel over the first guidewire, the delivery system having a first lumen that slidably engages the first guidewire and a second lumen alongside the first lumen, positioning the delivery system in a region of a bifurcation, and advancing a second guidewire through the second lumen into the second vessel.  
           [0011]    According to yet another aspect of the present invention, there is provided a method of advancing a delivery system at a bifurcation, the method including advancing a delivery system over a first guidewire, the delivery system having a first lumen for insertion of the first guidewire and a second lumen for insertion of a second guidewire, wherein the first lumen and the second lumen are separated by a barrier and wherein the advancing is done by positioning a first guidewire within the first lumen, and thereafter introducing a second guidewire through the second lumen and into a second vessel.  
           [0012]    According to a further aspect of the present invention, there is provided a method of deploying a stent in a bifurcation of a main vessel which separates into first and second branch vessels, the stent including a proximal end to be deployed in the main vessel on the proximal side of the bifurcation, and a distal end to be deployed in the first branch vessel on the distal side of the bifurcation. The method includes introducing the distal end of a first guidewire through the main vessel and the bifurcation into the first branch vessel, providing a stent delivery device including a main lumen for receiving the guidewire, a branch lumen, and an expandable stent, inserting the proximal end of the first guidewire into the distal end of the main lumen of the stent delivery device, guiding the stent delivery device along the first guidewire through the main vessel to an initial position adjacent to the proximal side of the bifurcation, moving a second guidewire through the branch lumen of the stent delivery device, advancing the second guidewire into the second branch vessel, advancing the stent delivery device, while tracked by the first guidewire in the first branch vessel, and by the second guidewire, in the second branch vessel, to the predetermined deployment position with respect to the bifurcation, to bring the distal end of the stent into the first branch vessel, while the proximal end of the stent still remains in the main vessel, radially expanding the stent, and removing the stent delivery device,  
           [0013]    Either of the first and second guidewire may be pre-loaded in the first or second lumen, respectively. Alternatively, the first or the second guidewire may be introduced after the delivery device is advanced in the vessel.  
           [0014]    According to further embodiments, the vessels are blood vessels, the first vessel is either a main vessel or a branch vessel and the second vessel is either a main vessel or a branch vessel.  
           [0015]    According to further embodiments, the delivery system is a catheter with a stent. The stent has an optional side hole for placing one of the guidewires through so as to enter a branch vessel. The side hole may be the same or different than other openings in the wall of the stent. The stent is either self-expandable, or expandable by an inflatable balloon.  
           [0016]    Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, suitable methods and materials are described below. In case of conflict, the patent specification, including definitions, will control. In addition, the materials, methods, and examples are illustrative only and not intended to be limiting. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0017]    The invention is herein described, by way of example only, with reference to the accompanying drawings. With specific reference now to the drawings in detail, it is stressed that the particulars shown are by way of example and for purposes of illustrative discussion of the preferred embodiments of the present invention only, and are presented in the cause of providing what is believed to be the most useful and readily understood description of the principles and conceptual aspects of the invention. In this regard, no attempt is made to show structural details of the invention in more detail than is necessary for a fundamental understanding of the invention, the description taken with the drawings making apparent to those skilled in the art how the several forms of the invention may be embodied in practice.  
         [0018]    In the drawings:  
         [0019]    FIGS.  1 A- 1 B illustrate a two-wire technique, as, known in the prior art, for deploying a stent in an arterial bifurcation;  
         [0020]    FIGS.  2 A- 2 G are diagrammatical views illustrating the steps of deploying a stent in a bifurcation in accordance with a preferred embodiment of the present invention;  
         [0021]    FIGS.  3 A- 3 F are diagrammatical views illustrating the steps of deploying a stent in a bifurcation in accordance with another preferred embodiment of the present invention;  
         [0022]    [0022]FIG. 4 illustrates a stent deploying device for deploying a stent in a bifurcation in accordance with another embodiment of the method of the present invention;  
         [0023]    [0023]FIG. 5 is an enlarged view of the stein delivery device illustrated in FIGS.  2 - 4 ;  
         [0024]    [0024]FIG. 6 is a cross sectional view of a stent delivery device used for deploying a stent in accordance with another embodiment of the method of the present invention; and  
         [0025]    [0025]FIG. 7 illustrates a delivery device for delivering two wires to a bifurcation, in accordance with an embodiment of the method of the present invention; and 
     
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0026]    The present invention is of a method for deploying a stent at or near a bifurcation. Specifically, the method of the present invention allows insertion of two wires into two branches of a vessel while avoiding wire entanglement.  
         [0027]    For purposes of better understanding the present invention, as illustrated in FIGS.  2 - 5  of the drawings, reference is first made to the two-wire method of deploying a stent in a vessel bifurcation (i.e. the prior art) as illustrated in FIGS. 1A and 1B. In the example illustrated in FIGS. 1A and 1B, the bifurcation, generally designated  2 , involves a main vessel  3 , which splits into a main vessel continuation  4 , and a branch vessel  5 . The point at which the two branches  4 ,  5  intersect is commonly called the “saddle point” of the bifurcation.  
         [0028]    The stent to be deployed is generally designated  8 . It includes a proximal end  8 A to be deployed in the main vessel  3 , and a distal end  8 B to be deployed in the main vessel continuation  4 . For this purpose, it is delivered by a stent delivery device, generally designated  10 , to its precise longitudinal position and radial orientation before it is so deployed. The stent delivery device  10  illustrated in FIG. 1B is a balloon angioplasty catheter, and the stent  8  is outwardly expandable, so that when the stent is precisely positioned within the bifurcation  2 , the inflation of the balloon of the stent delivery device  10  expands the stent to press its proximal end  8   a  firmly against the wall of the main vessel  3 , and its distal end  8   b  firmly against the wall of the main vessel continuation  4 .  
         [0029]    The prior art technique illustrated in FIGS. 1A and 1B for precisely locating the stent  8  before its deployment is a two-wire technique. According to this technique, a main guidewire  11  is initially passed through the main vessel  3 , through the bifurcation  2 , and into the main vessel continuation  4 , and a branch guidewire  12  is also initially passed through the main vessel  3 , the bifurcation  2 , and into the branch  5 , as depicted in FIG. 1A. The main guidewire  11  and the branch guidewire  12 , after being so placed, are then used for tracking the stent delivery device  10  to its proper position before deploying the stent  8 , as depicted in FIG. 1B.  
         [0030]    As briefly described above, a serious problem with the two-wire technique illustrated in FIG. 1 is the risk of entanglement or crossover of the two guidewires  11 ,  12 , during the movement of the stent delivery device  10  along these guidewires toward the bifurcation  2 . If such an entanglement or crossing of the guidewires should occur, this would generally result in the cardiologist having to pull back the wires and possibly the stent delivery device in order to re-commence the procedure. In doing this, the cardiologist may dislodge the stent or dissect or even puncture the vessel.  
         [0031]    Reference is now made to FIGS.  2 A- 2 G, depicting a method of deploying a stent according to a preferred embodiment of the present invention. FIGS.  2 B- 2 F illustrate a stent delivery device, generally designated  20 , to be deployed in a bifurcation corresponding to bifurcation  2  shown in FIG. 1, namely one including a main vessel  3  split into a main vessel continuation  4  and a branch vessel  5 . As shown in FIG. 2A, both a main guidewire  21  and a branch guidewire  22  are initially placed in the main vessel  3 , preferably extending into main vessel continuation  4 . As shown in FIG. 2B, delivery system  20  is then advanced over both guidewires, with main guidewire  21  being positioned through a main lumen of delivery device  20  and with branch guidewire  22  being positioned through a branch lumen of delivery device  20 , the construction of which will be described in further detail hereinbelow. As shown in FIG. 2C, branch guidewire  22  is then retracted until its tip is opposite or proximal to the ostium of the branch vessel  5 . Subsequently, as shown in FIG. 2D, branch guidewire  22  is advanced into the branch vessel  5 . Next as shown in FIG. 2E, delivery device  20  is advanced over both wires until the stent is in its optimal position with respect to the ostium of the bifurcation. The stent is then deployed, as shown in FIG. 2F. Finally, delivery device  20  and guidewires  21  and  22  are removed, leaving only the expanded stent  8  in place.  
         [0032]    In an alternative embodiment, both guidewires  21 ,  22  are initially placed in the branch vessel  5 , and delivery system  20  is advanced over the two wires. In the alternative embodiment just described, main guidewire  21  is retracted and subsequently advanced through main vessel  3  and into main vessel continuation  4 . It is essential that guidewires  21  and  22  are both located in the same vessel, whether that vessel is the main vessel  3 , main vessel continuation  4 , or branch vessel  5 . In this way, crossover and entanglement of the wires is minimized.  
         [0033]    The method described above is particularly useful for rapid exchange systems, such as those disclosed in U.S. Provisional Patent Application Serial No. 60/413,552, filed on Sep. 26, 2002 and incorporated by reference herein in its entirety, and described further hereinbelow, and any other rapid exchange system used in stent delivery. The method may also be used for any other delivery system, including over-the wire systems which are well known in the art, as well as systems such as the ones disclosed in pending U.S. patent application Ser. Nos. 09/455,299, filed Dec. 6, 1999; 091741,761, filed Dec. 18, 2000; and 09/663,111 filed Sep. 15, 2000, all of which are incorporated herein by reference in their entireties and described finer hereinbelow. Furthermore, this method may be useful for a dual stent system, in which a ran stent and a side branch stent, or two portions of one stent, are used in the bifurcation. This type of stent may be useful, for example, for drug delivery into a bifurcated vessel.  
         [0034]    Reference is now made to FIGS.  3 A- 3 F, which illustrate an alternative embodiment of the present invention. FIGS.  3 B- 3 E illustrate a stent delivery device, generally designated  20 , to be deployed in a bifurcation corresponding to bifurcation  2  shown in FIG. 1, namely one including a main vessel  3  split into a main vessel continuation  4  and a branch vessel  5 . In the technique illustrated in FIGS.  3 A- 3 F, a single guidewire is used to track the delivery device  20 . It should be noted that an additional wire may be placed in the blood vessel prior to the procedure described, and that the physician can utilize this additional wire for any one or more of the procedures which precede stent placement, such as, but not limited to, fluoroscope visualization, stentless balloon angioplasty or predilatation, insertion of a visualization catheter, use with additional diagnostic and/or therapeutic devices, etc. However, the additional wire plays no role in the delivery of the device and as such, will generally not be included in the description to follow.  
         [0035]    As shown in FIG. 3A, a main guidewire  21  is initially placed through the main vessel  3 , the bifurcation  2 , and the main vessel continuation  4 . As shown in FIG. 3B, delivery device  20  having a stent  8  thereon is applied to the guidewire  21 , by passing the guidewire  21  through main lumen  12 , and moving the delivery device  20  to its initial position, a preferred embodiment of which is illustrated in FIG. 3B. In this initial position, the delivery device  20  is located proximal to the proximal end of the bifurcation  2 . In alternative embodiments, delivery device  20  may be initially placed directly opposite or distal to the bifurcation  2 , and then adjusted accordingly. If stent  8  is formed with a side opening  30 , the construction of which will be described further hereinbelow, the stent delivery device may be rotated, so as to radially position the stent properly, e.g., with the side opening facing the ostium of the branch vessel. However, it should be noted that automatic alignment of the side opening may take place once the branch guidewire  22  is inserted into the branch vessel  5  and the delivery device  20  is advanced.  
         [0036]    In one embodiment of the invention, the branch guidewire  22  may be pre-loaded in a branch lumen  14  of the delivery device  20 , with the distal end of branch guidewire  22  protruding from a side of the stent, preferably from a designated side hole  30 , so that the branch guidewire  22  is moved with the delivery device  20  to the initial position, a preferred embodiment of which is illustrated in FIG. 3B. In this embodiment, the distal end of branch lumen  14  may also protrude from the side of the delivery device  20  and the stent  8  carried thereby. In the latter case, brunch guidewire  22  might not protrude from the side of the stent, as it can be advanced to protrude therefrom at a later stage.  
         [0037]    In an alternative embodiment the branch guidewire  22  would be inserted into branch lumen  14  of the delivery device  20  only after the delivery device  20  has been moved to its initial position. In both embodiments, the distal end of branch guidewire  22  could protrude through side opening  30  in the stent, or through one of the cellular or spiral spaces in the stent or any other opening, if no side opening is present.  
         [0038]    In either case, when the delivery device  20  has been moved to the vicinity of its initial position, the branch guidewire  22  is manipulated from its proximal end so that its distal end is advanced into the branch vessel  5 , as shown in FIG. 3C.  
         [0039]    The delivery device  20  is den further advanced or Lacked as the case may be, to its final, stent-deployment position, a preferred embodiment of which is shown in FIG. 3D. The preferred stent-deployment position of the sent delivery device  20  is the location where the intersection of tee branch guidewire  22  with the balloon  26  (commonly called the “crotch point”) generally coincides with the saddle point of the main vessel continuation  4  and branch vessel  5 , as described, for example, in U.S. Pat. No. 5,749,825.  
         [0040]    [0040]FIG. 3D illustrates a preferred embodiment of the final stent-deployment position of the delivery device  20 , wherein the delivery device  20  locates the stent  8  both longitudinally and radially with respect to the bifurcation  2 , after it is tacked over the main guidewire  21  in the main vessel continuation  4 .  
         [0041]    When the delivery device  20  has been so positioned, the balloon  26  is inflated to thereby expand the stent  8  to firmly press its proximal end  8 A against the inner surface of the main vessel  3 , and its distal end  8 B against the inner surface of the main vessel continuation  4 , as shown in FIG. 3E. After the stent has been so deployed, balloon  26  is deflated, thereby permitting removal of the delivery device  20 , leaving the stent  8  within the bifurcation  2 , as shown in FIG. 3F.  
         [0042]    It will be appreciated that the movement of the delivery device  20 , and the inflation and deflation of the balloon  26 , cam be effected in accordance with known techniques, e.g., as described in U.S. Pat. No. 5,749,825. In addition, a self-expandable stent  8  may be used, wherein balloon  26  is not included.  
         [0043]    It will also be appreciated that if the bifurcation  2  has already received an additional guidewire then this additional guidewire, which is not utilized in the stent positioning methods described herein, is to be removed prior to inflation of the balloon  26 . If the additional guidewire  66  is not so removed, it will be trapped between the expanded stent  8  and the vessel wall. The main guidewire and/or the branch guidewire will typically be last to be removed from the patient vascular system.  
         [0044]    It should be noted that in this preferred embodiment the branch guidewire  22  is not initially placed into the bifurcation  2  as in the prior art described above with respect to FIG. 1A, but rather is carried by, or received by, the delivery device  20  before or after the delivery device bas been moved, over the main guidewire, to an initial position near the bifurcation, so that it does not become entangled with or cross over the main guidewire  21  during the positioning of the delivery device  20 .  
         [0045]    In an alternative embodiment, shown in FIG. 4, the branch guidewire  22  is used to track the delivery device  20 . As shown in. FIG. 4, branch guidewire  22  is initially placed through the main vessel  3 , the bifurcation  2 , and the branch vessel  5 . For precisely locating the delivery device  20  with respect to both its longitudinal position and its radial orientation, a main guidewire  21  is used. That is, the main guidewire  21  is not initially placed into the bifurcation  2  as in the prior art described above with respect to FIG. 1, but rather is loaded into the delivery device  20  before or after the delivery device  20  is advanced over the branch guidewire  22 , to an initial position, and in this alternative embodiment the main guidewire  21  is then advanced through the delivery device  20 , through the stent  8  into the main vessel continuation  4 . The delivery device  20  is then tracked over the main guidewire  21  in the main vessel continuation  4 , and by the branch guidewire  22  in the branch vessel  5 , to its final longitudinal and radial position before the stent  8  carried thereon is deployed with respect to the main vessel  3  and the main vessel continuation  4 .  
         [0046]    The delivery device  20  may be of a similar construction as that disclosed in pending U.S. patent application Ser. Nos. 09/455,299, filed Dec. 6, 1999; 09/741,761, filed Dec. 18, 2000; and 09/663,111 filed Sep. 15, 2000, all of which are incorporated herein by reference in their entireties. In other embodiments, the delivery device  20  may be of a similar construction as other dual lumen delivery devices, such as the one disclosed in U.S. Pat. No. 5,749,825 to Fischell et al.  
         [0047]    Briefly, as shown in FIG. 5, a delivery device  20  may be a catheter with a catheter body  12  and a side member  14  that is adjacent to catheter body  12 . Side member  14  may be slidably movable with respect to catheter body  12  or may be attached thereto. In one embodiment, catheter body  12  has a balloon  26  around which a stent  8  is crimped. In another embodiment, stent  8  is self-expandable and balloon  26  is not included. In a preferred embodiment, stent  8  has a side hole  30  for alignment with an ostium of a branch vessel. Various types of side hole are described in U.S. Provisional Patent Application No. 60/404,756, filed Aug. 21, 2002, incorporated herein by reference in its entirety. Side hole  30  may be of various shapes and sizes, and may also have a portion designed to partially extend into the branch vessel.  
         [0048]    In an alternative embodiment of the present invention, a rapid exchange delivery system is used, such as the one described in U.S. Provisional Patent Application Serial No. 60/413,552, filed on Sep. 26, 2002 and incorporated by reference herein in its entirety. A system such as the one described is shown in FIG. 6. The system disclosed in the above-referenced patent application and shown in FIG. 6 is a rapid exchange system with a dual lumen catheter, specifically designed for vessel bifurcations.  
         [0049]    As shown in FIG. 6, delivery device  20  has exit ports  23  and  25  for the main guidewire  21  and branch guidewire  22 , respectively, which exit ports are located at a distance of approximately 1 to 150 cm from the distal end of delivery device  20 . In a preferred embodiment, the exit ports  23  and  25  are located at a distance of approximately 10 to 20 cm from the distal end of delivery device  20 . In an exemplary preferred embodiment, the exit ports  23  and  25  are located at a distance of 15 cm from the distal end of delivery device  20 . In this system, a three-way bond is created at exit ports  23  and  25 , maintaining three lumens: exit ports  23  and  25 , and a lumen for fluid infusion for inflation of balloon  26 .  
         [0050]    In alternative embodiments, delivery device  20  is used for delivering guidewires  21  and  22  to a main vessel continuation  4  and a branch vessel  5 , without having a stent placed on the delivery device  20 . An example of such a delivery device includes a catheter with a two-headed balloon or a dual lumen balloon. In this embodiment, delivery device  20  may be of a similar construction as that disclosed in pending U.S. patent application Ser. No. 09/816,690, filed Mar. 22, 2001, and incorporated by reference in its entirety.  
         [0051]    Briefly, delivery device  20  has two lumens  32  and  34  passing therethrough. As can be seen in FIG. 6, lumen  32  has a distal end opening  13  which is preferably disposed at or near the end of the delivery device. Lumen  34  has a distal end opening  15  which is preferably disposed at a location some distance proximal to the distal end of the delivery device  20 . Main branch guidewire  21  (not shown) is receivable through lumen  32  and branch guidewire  22  (not shown) is receivable through lumen  34 .  
         [0052]    While the invention has been described with respect to two preferred embodiments, it will be appreciated that these are set forth merely for purposes of example, and that many other variations, modifications and applications or the invention may be made. It should be readily apparent that either the two-wire method illustrated in FIGS.  2 A- 2 G, or the one wire method illustrated in FIGS.  3 A- 3 F may be used for introducing the wires of any of the delivery devices described herein, or any other delivery device in which two wires are needed.  
         [0053]    Although the invention has been described in conjunction with specific embodiments thereof, it is evident that many alternatives, modifications and variations will be apparent to those skilled in the art. Accordingly, it is intended to embrace all such alternatives, modifications and variations that fall within the spirit and broad scope of the appended claims. All publications, patents and patent applications mentioned in this specification are herein incorporated in their entirety by reference into the specification, to the same extent as if each individual publication, patent or patent application was specifically and individually indicated to be incorporated herein by reference. In addition, citation or identification of any reference in this application shall not be construed as an admission that such reference is available as prior art to the present invention.