Abstract:
The invention is a steerable catheter having a pull wire, a central lumen and a control handle. The central lumen is maintained in a circular shape without obstructions diminishing the useful inter-diameter. The pull wire friction is also reduced by using one wire of larger diameter to create the lumen for the pull wire of smaller diameter, thus reducing the friction on the pull wire and reducing the locking of the catheter body around the pull wire at bends preventing movement of the pull wire. A control handle with a simple operational mechanism that allows direct access to a continuous central lumen from the proximal end of the catheter.

Description:
CROSS-REFERENCE TO RELATED APPLICATION(S)  
       [0001]    Present application is a continuation in part of application Ser. No. 09/833,324. 
     
    
     
       BACKGROUND OF THE INVENTION  
         [0002]    This invention relates to catheters which are used to provide access into the human body. More particularly, the present invention is directed to steerable sheath catheters which are used to provide access into the human vasculature for delivery of additional tools, instruments, medications or fluids.  
           [0003]    Catheters have been commonly used in medical practice to reach locations inside the body otherwise unreachable without surgery. The body of a catheter is long and tubular and contains an inner lumen. A catheter has a distal end or tip which enters the patient as well as a proximal end that has a handle for control by the operator.  
           [0004]    The tip of the catheter is first inserted into a major vein, artery or other body cavity. The catheter is then further inserted and guided to the area of concern. The catheter is often used as a delivery method for other tools, such as balloons for performing angioplasty or a camera for performing endoscopy. As medical knowledge increases, the catheterization procedures have become more complicated and more exacting. The usefulness of catheters is largely limited by the ability to successfully manipulate the position and orientation of the catheter tip into small and tortuous vessels. Therefore the goals for a successful catheter design are to maximize the inner diameter while minimizing the outer diameter and maintaining control and flexibility of the catheter body. The catheter operator should be able to easily steer and maintain the catheter shape during use. Additionally, the operator should be able to easily deliver additional tools, instruments, medications or fluids through the inner lumen or lumens by having direct, unhindered access to the inner lumens at the distal end of the catheter.  
           [0005]    One method of directing a catheter into position is through the use of a guide wire. First the guide wire is fed into position within the patient. Then the catheter is urged over the guide wire. However, it is not uncommon for the position of the catheter tip to become dislodged from the desired location as the guide wire is removed.  
           [0006]    To avoid this problem, other catheters known in the art, are guided into place without the use of guide wires. These catheters have sufficient pushability that the tip of the catheter can be directed from a proximal location without buckling or kinking. Unfortunately, such guide catheters tend to be more difficult to steer into position and the necessary stiffness can limit their placement in areas with sharp curves.  
           [0007]    Catheters with tips preformed into particular shapes specialized for specific applications are known in the art. The pre-shaping of the catheter may aid the placement of the tip in the desired location. However, the pre-shaping of catheters for particular applications requires a hospital to provide a wide array of catheter shapes and sizes for use. Another disadvantage to preformed catheters is that they do not allow the physician to adapt the catheter to account for any peculiarities of a patient&#39;s vascular system. A physician can attempt to reshape a catheter before use, by applying heat. However, such manual reshaping is not only time consuming but can compromise the lumen of the catheter, by causing the circular lumen to ovalize or flatten out as the catheter is bent, or even kink or seal at a bend destroying the catheter&#39;s usefulness.  
           [0008]    Steerable sheath catheters, the present invention being one example, are also directed into position from a proximal location. However, the tips of these catheters are steerable due to the action of one or more pull wires that are embedded along the length of the catheter body. Pre-forming of the catheter is not necessary because the operator can adjust the shape of the catheter or steer the tip as the catheter is directed into the body. Therefore these catheters are capable of use in a wider range of procedures than the specialized preformed catheters.  
           [0009]    A current method in the art used to manufacture steerable sheath catheters is to form the catheter on a mandrel using multiple layers: an inner liner, a layer of wire braid and an outer thermoplastic jacket. The inner liner is pulled over the mandrel and tightened down. The pull wire is laid axially along the inner liner, often within a groove present on the surface of the mandrel. The steel braid is pulled or woven over the inner liner and pull wire. After the steel braid is tightened down, the entire catheter is encased in a thermoplastic outer jacket. The outer jacket is then encased in heat shrink material and heated. The heat causes the thermoplastic jacket layer to flow, which when teamed with the pressure from the heat shrink material causes the thermoplastic outer jacket to flow into the steel braid consolidating the catheter into one unit. Examples include U.S. Pat. No. 5,669,920; U.S. Pat. No. 6,042,578; U.S. Pat. No. 5,527,325.  
           [0010]    The mandrel in this process usually has a longitudinal groove to facilitate the placement of the pull wire during the manufacturing process. The inner liner of the catheter is placed over the mandrel and is pushed into the groove. The pull wire is then laid in the groove on top of the inner liner. The steel braid and outer jacket can then be pulled easily over the mandrel without disturbing the pull wire. However, the use of this process results in the creation of a bulge in the central lumen. This reduces the useable diameter of the central lumen for the insertion of other instruments. In general, it is desirable to maximize the ratio of the inside diameter to the outer diameter of the tubular body of the catheter.  
           [0011]    Another problem in the current art is that by embedding the pull wire through the action of a thermoplastic polymer teamed with a heat shrink material or embedding the wire in the catheter body by spraying the outer jacket material over the wire is that the pull wire creates its own lumen, for example as shown in U.S. Pat. No. 6,030,371. Therefore the pull wire and its lumen are approximately equal in diameter. This creates three related difficulties. First, there is friction created between the walls of the lumen and the pull wire as an operator attempts to control the catheter by moving the pull wire. The friction increases the difficulty in operating the pull wire. Second, as the catheter is deflected (bent) through the movement of the pull wire, the steel braid embedded in the outer wall of the catheter is also pulled and flexed. As the steel braid flexes, the forces created can deform the lumen. This can cause the steel braid to lock down on the pull wire and the pull wire lumen. This greatly increases the friction and can prevent movement of the pull wire as the pull wire lumen is deformed from a circular shape into an ovular shape. The third problem is that as the pull wire is “locked down” in the bent catheter, the pull wire and catheter lose the ability to spring back to the original shape as the force on the pull wire from the operator at the proximal end is removed. Accordingly, there remains a need in the art for a catheter with a pull wire with reduced friction and reduced interference from the steel braid which would allow for easier control by the operator and would allow the catheter to return to its original shape.  
           [0012]    The pull wire of a steerable catheter is generally manipulated by use of a control handle including a steering mechanism. Control handles and steering mechanisms are available in many different designs according to the number of pull wires, type of catheter steering mechanism used, access ports and desired end use for the catheter. It is preferable that any steering mechanism should be able to be actuated without requiring substantial hand movement and the handle should provide for near simultaneous actuation of both proximal and distal steering. The handle must also be able to meet all appropriate environmental and sterility requirements likely to be encountered. The handle should be able to hold the catheter tip in a bent or deflected condition until the operator actively changes deflection.  
           [0013]    In the construction of steerable guide catheters it is additionally beneficial, as previously discussed, to maximize the diameter of the central lumen. Additionally, it is imperative that additional tools and instruments can readily be inserted into the lumen without snagging or jamming in the lumen. In the prior art, the lumens are often not continuous and frequently have a permanent bend as the lumen transitions from the area within the proximal handle portion to the lumen in the catheter body. The discontinuity and indirect route are disadvantages of the current catheter handle and control mechanism designs.  
           [0014]    There are two reasons why the catheter body is not continuous until exiting the handle: first, the pull wire must be accessible in order to be attached to the control mechanism within the handle. When the catheter body is manufactured, excess pull wire is left exposed at the proximal end or the body portion is trimmed away to expose sufficient pull wire. However, for convenience of the user the control mechanism usually appears in the middle of the handle where it can easily be manipulated by the user&#39;s fingers or thumb, not the end of the handle where the end of the catheter body should be to allow access to the lumen. The prior art solution to the problem of needing access to the pull wire within the handle, is to form a joint in the tubing, including the lumens. The end of the catheter body is placed near the connection point for the steering mechanism. For example, see Gould et al., U.S. Pat. No. 4,586,923. A connecting tube is then glued to the catheter body to extend the lumen towards the exit at the proximal end of the handle, while leaving the pull wire free to attach to the control mechanism within the handle. As it is important for the joint to be strong and not leak, one method of joining is to secure the catheter body inside the connecting tube. This style of attachment causes a size change between the tube end exposed to the user at the proximal end of the handle and the actual size of the lumen inside. This may cause the user to insert the wrong size tool which then jams inside the handle. The user may waste several sterile tools before the one that fits is found. As all these products are sterile and cannot be reused, the search for the correct fit is a waste that could be avoided.  
           [0015]    Additionally, the joint, of either an overlapping type described above, or a butted joint, may impede the insertion of instruments. In the overlapped joint, the instruments are likely to hit or be snagged upon the catheter body inside of the connecting tube at the position of the joint. At best, the operator will have to redirect the inserted instrument passed the blockage into the inner lumen, and at worse may damage the instrument being inserted. In a butted joint where the two tubes are glued end-to-end, there is a potential problem if the joint is not made exactly, or if glue leaks inside of the joint that may cause blockage similar to that with the overlapping joint. Also, if the lumen is to be used for the delivery of fluids or medication, there is the potential at any joint for leakage, which may be detrimental by contaminating any samples that are being taken, delivering an imprecise amount of medication, and fluid escaping the lumen and entering the handle body and leaking out into the sterile surgical environment.  
           [0016]    The second problem preventing the use of a continuous, direct catheter body is the type of control mechanism used. Often the bulk or design of the control mechanism limits the size of the lumen, or lumens as shown in U.S. Pat. No. 5,571,086. The design may also force the redirection of the lumen, or lumens to avoid parts of the control mechanism. Both are disadvantages when use of the lumen is desired for the insertion of tools.  
           [0017]    There is a need in the art for a simple steering mechanism. One that is simple to use, easy to construct and low in cost. There is also need for a steering mechanism that does not impede the central lumen by requiring additional joints, bends, or variation in size of the lumen.  
           [0018]    It is preferable that any steering mechanism should operate without requiring substantial hand movement and the handle should provide for near simultaneous actuation of both proximal and distal steering. The handle must also be able to meet all appropriate environmental and sterility requirements likely to be encountered. The handle should be able to hold the tip assembly in a bent or deflected condition until the operator actively changes deflection.  
         BRIEF SUMMARY OF THE INVENTION  
         [0019]    The invention includes a steerable sheath catheter and control handle design utilizing a pull wire control mechanism. A central lumen passes directly through the catheter without size changes, bends or joints that would impair the utility of the lumen. The pull wire friction is also reduced by the improved control mechanism by allowing straight line operation of the pull wire without the necessity of a separate locking mechanism. The control handle and steering mechanism additionally allow direct access to the continuous central lumen. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0020]    [0020]FIG. 1 is a perspective view of the catheter.  
         [0021]    [0021]FIG. 2 is a perspective view of the catheter body.  
         [0022]    [0022]FIG. 3 is a cross-sectional view of the catheter body before lamination by heating.  
         [0023]    [0023]FIG. 4 is a cross-sectional view of the catheter body after lumen-defining wire is removed.  
         [0024]    [0024]FIG. 5 is a cross-sectional view of the catheter body after insertion of pull wire into the lumen.  
         [0025]    [0025]FIG. 6 is a side view of the catheter.  
         [0026]    [0026]FIG. 7 is a top view of the proximal end of a catheter including the first handle embodiment.  
         [0027]    [0027]FIG. 8 is a perspective view of the inner surface of the left handle body.  
         [0028]    [0028]FIG. 9 is a cross-sectional view taken along the Line  9 - 9  in FIG. 6.  
         [0029]    [0029]FIG. 10 is a perspective view of the catheter in the initial position with the left handle body section removed.  
         [0030]    [0030]FIG. 11 is a perspective view of the catheter in the curved position with the left handle body removed.  
         [0031]    [0031]FIG. 12 is a perspective view of a catheter including the second handle embodiment.  
         [0032]    [0032]FIG. 13. is a cross-sectional view through the second handle embodiment. 
     
    
     DETAILED DESCRIPTION  
       [0033]    The present invention provides an improved catheter that maximizes the usable inner diameter, minimizes pull wire friction and allows easy access to the inner lumen or lumens. The inventive control handle design provides for an improved catheter that allows direct and unhindered access into the central lumen while still allowing easy pull wire control of catheter deflection without requiring the controller to maintain the position of the control mechanism manually or the use of additional locking mechanisms. The novel control handle design is also adaptable to virtually any catheter body design. The lack of necessity for an additional locking mechanism, ease of operation and reduced cost are additional benefits of the new design.  
         [0034]    The usable inner diameter of the catheter body is maximized compared to the outer diameter by modifying manufacturing techniques. The pull wire is not laid into a groove in the mandrel. Therefore, there is no predisposition to form a bulge within the inner lumen of the catheter. Also, the shape of the outer jacket material has been modified from a tube with circular cross-section and uniform thickness to a tube with elliptical or ovular cross-section and uneven thickness. The outer jacket material is thicker at the position of the pull wire. When the outer jacket material is heated until it flows, the material will redistribute around the circumference of the catheter body due to the force of the heat shrink material. The result is an approximately circular catheter with the pull wire embedded within the outer jacket, not protruding into the inner lumen nor bulging out of the outer diameter.  
         [0035]    The outer diameter of the catheter is minimized at the tip by a novel treatment method used on the wire braid. The wire braid is formed on a disposable core. An end section of the wire braid is heat tempered and cooled before incorporation into the catheter body. The action of heat tempering the section of wire braid placed at the tip of the catheter releases the stress on the wire and reduces radial forces. Without heat tempering, the wires maintain the stress from being braided, the braid patterns provide radial pressure or outward force at the ends of the braid resulting in a distorted braid pattern. The invention prevents the problem encountered in the prior art of the ends of the wire braid flaring and protruding through the outer jacket of the catheter. In the prior art, the wire braid is contained either through the application of additional material or changing the manufacturing process of the catheter so that the outer jacket material is not heated until fluid. There are problems with both techniques. When additional material is added at the tip of the catheter, an undesirable bulge is formed in that area. If the manufacturing process is changed to deter wire protrusion by incompletely melting the outer jacket material, often the result is incomplete integration and lamination of the catheter, which can result in failure of the catheter.  
         [0036]    One alternative method in the prior art would be to heat treat the entire wire braid. However, there is a loss of radial force capacity and the possibility of increased kinking of the wire braid when the entire length of it is heat tempered. Also, the wire will not expand as desired to into the outer jacket material when the outer jacket material is liquified. The result is a less flexible catheter with possible increased interference between the pull wire and wire braid as well as problems with integrity of the lamination process.  
         [0037]    Another method in the prior art to prevent the wire braid from flaring out of the catheter body, is to place an additional piece of polyester around the end of the wire braid. The polyester has a higher melting point than the outer jacket material. Therefore, when the outer jacket material is liquified to allow it to flow into the wire braid, the wire braid remains contained and does not escape from the catheter. The problem with the addition of this additional polyester material is that an undesirable bulge is created on the distal end of the catheter where this additional material is added. An additional problem of poor bonding due to differences in the materials and their melting points can also occur.  
         [0038]    To minimize pull wire friction, the present invention uses one wire to create a lumen and then removes that wire and replaces it with a smaller diameter pull wire in order to control the catheter. The benefit of having a pull wire with a smaller diameter than the lumen is to allow easier movement of that pull wire through the reduced friction of contact between the lumen and the pull wire. An additional benefit is that as the catheter is bent, there is additional space inside the lumen, so as the wire braid is pulled, thereby placing force onto the lumen, the pull wire will not become as easily locked down by the changed shape of the lumen. If the pull wire is the same size as the lumen as it is in prior art applications, the wire braid can lock down the pull wire and prevent its movement as the lumen is deformed from a circular shape into an ovular shape. This problem may require a catheter to have multiple pull wires just to allow the catheter to move in one plane. If a pull wire in the current art becomes locked down as the catheter is bent, operation of a pull wire on the opposite side is necessary to return the catheter to its original straight configuration. In the current invention, because the lumen is larger than the pull wire, forces placed on the lumen by the wire braid are much less likely to lock down the pull wire and preventing its free movement and control of the catheter. Therefore, the inventive catheter can return to its original straight configuration simply by releasing the force on the pull wire. In summary, the inventive catheter allows a pull wire with free movement without any loss in internal or external space and also has increased flexibility because the braid will not lock up the pull wire.  
         [0039]    The novel control handle design allows for easy one hand operation of the catheter steering mechanism. The steering mechanism does not require a locking mechanism because the position steering mechanism and the operationally attached pull wire are controlled by frictional means. Consequently, the controller of the catheter does not have to maintain the position of the control mechanism manually during use, once the catheter is properly positioned. The pull wire moves only when actuated in either the distal or proximal direction by operator movement of the steering mechanism.  
         [0040]    The steering mechanism is also designed in such a way that allows the body of the catheter, including a central or multiple lumen(s), to pass directly through the handle without interference by the steering mechanism. The central lumen preferably has the same diameter within the handle as in the body of the catheter to provide a continuous and unhindered passage. By allowing the catheter body, and the central lumen inside, to pass unhindered directly and continuously through the handle and steering mechanism to an external port proximal to the controller, the inventive mechanism allows for easy insertion of additional instruments or tools by the operator without risks that the tool will be mismatched in size or will jam on an internal size change, joint seam, or bend in the lumen.  
         [0041]    The inventive mechanism reduces the force needed to actuate the pull wire by allowing the pull wire to move parallel to the catheter body in a straight line without requiring the pull wire to be deflected at a sharp angle to reach the steering mechanism. Movement of the pull wire in a direction approximately in line with the path of the pull wire through the pull wire lumen also reduces the friction of the catheter body on the pull wire. The pull wire is directly affected by the manipulation of the control mechanism of the operator and is therefore sensitive enough to allow tight control of the catheter tip movements.  
         [0042]    The handle design complements the improved method for making the handle body, also disclosed herein, by maintaining the reduction in pull wire friction and allowing the maximized central lumen diameter in ratio to the outer diameter to not be compromised by the steering mechanism.  
         [0043]    The basic structure of a catheter body generally indicated at  26  made in accordance with the present invention is illustrated in FIG. 1. The catheter body  26  extends from a proximal end  11  to a distal end  13 . The proximal end  11  will generally be attached to a handle (not shown), while the distal end  13  contains the catheter tip which is inserted into the body. The overall length of the catheter may be varied as necessary for various applications. Typical catheter lengths will be on the order of 20-60 inches, with a preferred length of 48 inches.  
         [0044]    The catheter body  26  is generally tubular in shape and desirably includes a central lumen  12  as illustrated in FIG. 2. Alternative embodiments include more than one lumen or subdividing a large lumen into two or more separate lumens, such as in balloon angioplasty.  
         [0045]    The basic method of manufacture according to a first embodiment of the present invention will be described below and illustrated in FIG. 3. The catheter components as they are assembled and after completion will be collectively referred to as a catheter body  26 . A ground mandrel  14 , which is preferably approximately 4 feet in length, is the first component of the catheter body  26 . The mandrel  14  has two ends named for reference the distal and the proximal ends. The inner liner  16  is placed on the mandrel  14 . The inner liner  16  is preferably an extruded Teflon® (polytetrafluoroethylene) tubing, which is available commercially. The inner liner  16  is knotted at one end (e.g. the distal end) and is fed on to the mandrel  14 . It is snugged down by pulling and knotted on the other end (e.g. the proximal end) also.  
         [0046]    A lumen defining wire  18 , is placed longitudinally along the inner liner  16 . The lumen defining wire  18 , is composed of stainless steel and is preferably approximately 0.010 inches in diameter. In alternate embodiments the lumen defining wire  18  may be encased inside another Teflon® tube or coated with lubricant before placement.  
         [0047]    A wire braid  20 , which is either purchased separately or braided on site, is formed onto disposable core material in order to achieve the proper diameter. The wire braid  20  is preferably composed of φ0.003 high tensile stainless steel wire. The wire braid  20  is formed in a standard braid pattern with preferably approximately 16 wires at 45-60PPI. Before the wire braid  20  is placed onto the catheter body  26 , one end is heat tempered with a torch or alternate heat source. The wire braid  20  is cooled, removed from the disposable core material and carefully slid over the catheter body  26 . It is necessary that care is taken not to disturb the position of the lumen defining wire  18 , which must remain straight. The end of the wire braid which has been heat treated or annealed terminates somewhat before the distal end  13  of the mandrel  14 . The untreated end of the wire braid  20  is knotted at the proximal end  11  of the mandrel  14 . Therefore, at the distal end  13  of the assembly both the inner liner  16  and the lumen defining wire  18  are exposed.  
         [0048]    An outer jacket  22  is slid over the catheter body  26 . The outer jacket  22  is a tube extruded from Pebax® before application to the catheter body  26 . Pebax® is a thermoplastic elastomer resin by the Atochem Corporation of France. The outer jacket  22  is made of either single or multiple sections of tubing that are butted together over the catheter body  26  leaving the distal end of the wire braid  20  exposed. Different sections of the outer jacket  22  may have different softness/stiffness (tensile) characteristics in order to facilitate particular features in the catheter body. For example, a bending region may have an outer jacket section that has greater softness than a region that will remain straight.  
         [0049]    A tube of heat shrink material  24  is placed over the top of the outer jacket  22 . The heat shrink material  24  is a fluoropolymer or polyolefin material. FIG. 3 displays a cross-section of the catheter body  26  before lamination of the materials by heating.  
         [0050]    Next, the entire catheter body  26  is laminated by heating until the outer jacket  22  liquefies. The heat shrink material  24  has a higher melt temperature than the outer jacket  22  and when it constricts, the heat shrink material retains its tubular shape thereby forcing the liquefied outer jacket  22  into the wire braid and into contact with the lumen defining wire  18  and inner liner  16 . The catheter body  26  is cooled and the outer jacket  22  solidifies. The heat shrink material  24  is scored and cracked open in order to remove it. After removal, the outer jacket  22  becomes the outside layer of the catheter body.  
         [0051]    Next the lumen defining wire  18  is removed from the distal end and removed from the catheter body  26 . A lumen  28  for placement of a pull wire  30  remains in the outer jacket  22  as displayed in FIG. 4. A permanent pull wire  30  is inserted into this lumen  28  from the distal end of the catheter body  26  as displayed in FIG. 5. At the end of the pull wire  30  is attached to a pull ring which is placed around the distal end of the catheter body  26 . The permanent pull wire  30  has a diameter of preferably approximately 0.008 inches. The diameter of the permanent pull wire  30  is smaller than the lumen defining wire  18 . Alternate embodiments include coating the permanent pull wire  30  with Teflon®, marketed by E. I. duPont de Nemours and Company Corporation of Wilmington, Del., or lubricants, such as silicones so that the wire is more easily moved within the lumen.  
         [0052]    After the permanent pull wire  30  and attached pull ring are in place, another section of outer jacket made from Pebax® is placed on the distal end of the catheter body  26 , over the exposed mandrel, permanent pull wire  30 , pull ring and annealed wire braid. This distal end section of Pebax® material is also covered with heat shrink tubing and is heated until the Pebax® material is liquified. When liquified, this distal end section flows to connect with the main section of outer jacket and captures the pull ring of the permanent guide wire. The pull ring is fully secured to the catheter body by the Pebax® polymer when the heating and cooling of the catheter body is complete and the heat shrink tubing is once again removed. The mandrel is removed from the completed catheter body  26  which is ready for installation of a handle on the proximal end  11 .  
         [0053]    An exemplary handle consistent with the first embodiment is generally indicated in FIG. 6. The inventive handle allows the catheter body  26  to pass through the handle  32  without obstruction while allowing easy control of the pull wire  30  (not shown). The first handle embodiment  31  comprises a handle  32  a control lever  36 , which separates vertically into left and right portions. The right portion  34  is shown in FIG. 6. The right and left portions,  34 ,  35  (not visible) sandwich the catheter body  26  between them and are secured together with screws  38  or other suitable fastening means. The handle  32  also may have a shaped grip portion  40  and/or top portion  42  to allow for easier gripping of the handle by the operator.  
         [0054]    The top portion  42  has a opening  44  as illustrated in FIG. 7. Control lever  36  is positioned through opening  44  such that an upper paddle portion  46  is projected above the top portion  42  and connects with additional portions of the control lever  36  inside the handle  32 .  
         [0055]    The right and left portions  34 ,  35  of the handle  32  are approximally mirror images of each other except for alterations to accommodate fasteners, for example, the screw head recesses in one portion. Suitable materials for the handle components include, but are not limited to: polyacetal, Lexan® made by GE Plastics, Rilsan® made by Atochem Corporation, EVA, polypropylene, LDPE, HDPE, and other thermoplastics. The internal structure of the left portion  35  is illustrated in FIG. 8. The right and left portions  34 ,  35  each comprise a channel  52 , a track  54 , a socket  56  and a sweep zone  58 . Channel  52  holds catheter body  26 , which maybe secured into either the right or left portion  34 ,  35  by adhesive means.  
         [0056]    As illustrated in FIG. 9, the control lever  36  has an upper paddle portion  46 , a pin  48 , and a lower fork portion  50 . The ends of pin  48  mate with the sockets  56  of the right and left portions  34 ,  35  of the handle. A curved washer  60  is biased between one end of pin  48  and socket  56  of the left portion  35  of the handle. The pin is operably connected within socket  56  with the curved washer  60  so as to allow rotational movement of the pin, but not lateral movement of control lever  36 . The curved washer  60  may be placed on either end of pin  48  relative to the right or left side of the handle. Preferably, a curved washer  60  may be placed on both ends of pin  48  adjacent to the right and left portions  34 ,  35 .  
         [0057]    The lower fork portion  50  of control lever  36  is divided into two legs  62  which intermesh with slide  64 . Slide  64  has an “H”-like shape, wherein the four side ends  66  of the slide  64  ride in track  54  of the right and left portions  34 ,  35 . Suitable materials for slide  64  include, for example, aluminum and stainless steel. The legs  62  project between the side ends  66  of slide  64 . The pull wire  30  exits the catheter body close to slide  64  and is fastened to slide  64  through a central bore  65 . Exemplary fastening means include a set screw and adhesives.  
         [0058]    The pull wire  30  may be exposed from the continuous catheter body by the following means: a small slit is cut in the outer jacket of the completed catheter body at the location where the pull wire  30  should exit for attachment to the slide. A tool is then used to draw the end of the pull wire  30  out through the slit in the outer jacket allowing for attachment to the slide. The novel method of manufacturing the catheter body of this invention, allows for the pull wire  30  to be visible underneath the outer jacket layer and therefore can readily be accessed by this method.  
         [0059]    The control lever  36  is in the initial position as illustrated in FIG. 10. In the initial position, tension has not been applied to the pull wire  30  therefore, the catheter tip is in a linear conformation. The curved washer  60  biased between pin  48  and socket  56  prevents movement of the control lever  36  when force has not been applied to the control lever  36 .  
         [0060]    In order to cause deflection of the distal end  13  of the catheter body  26 , the upper paddle portion  46  of the control lever  36  is pushed towards the distal end  43  of the catheter. The movement of the upper paddle portion  46  causes rotation about an axis through pin  48  causing the lower fork portion  50  to swing in the direction opposite to the upper paddle portion. Movement of the lower fork portion  50  towards the proximal end  11  of the catheter handle likewise causes the interlocked slide to also move towards the proximal end  11  of the catheter in tracks  54 . The proximal movement of the slide  64  pulls the pull wire  30 , which causes curvature of the distal end  13  of the catheter body  26  as illustrated in FIG. 11.  
         [0061]    The process maybe reversed. If the upper paddle portion  46  of FIG. 11 is pulled toward the proximal end  11  of the handle, the slide will be pushed toward the distal end  13  of the handle, thereby pushing the pull wire  30  into the catheter body  26  causing the distal end  13  of the catheter body  26  to straighten.  
         [0062]    A second handle embodiment generally indicated at  71  in FIG. 12, also allows the catheter body  26  to pass through the handle  32  without obstruction while allowing easy control of the pull wire  30  (not visible). The second handle embodiment  71  moves the pull wire parallel to the catheter body  26  in approximately a straight line. The second handle embodiment  71  is comprised of nose  72 , wheel  82 , which is a portion of displacement member  74 , grip  76 , and cap  78 , which make up handle  32  surrounding catheter body  26  adjacent to proximal end  11 . The catheter is controlled by holding the handle  32  at grip  76  and rotating wheel  82  either clockwise or counterclockwise thereby bending or straightening the catheter body  26  through action of defection mechanism  92  on the pull wire  30  inside the handle  32 .  
         [0063]    The deflection mechanism  92  comprises nose channels  88 , struts  86 , cap channels  90 , shuttle  80  having edge  81 , displacement member  74  including wheel  82  and groove  84 , which are illustrated in FIG. 13. Nose  72  and cap  78  each carry two channels, nose channels  88  and cap channels  90  respectively. The channels  88 ,  90  carry struts  86 , such that one end  87  of the strut is within a nose channel  88  and one end  87  of the strut is within a cap channel  90 . Additionally, the channels are of sufficient length to allow longitudinal movement of strut  86  without ends  87  leaving the channels  88  or  90 . The struts  86  are placed parallel to catheter body  26 , which passes approximately centrally through handle  32 . The struts  86  are attached to shuttle  80 . Catheter body  26  is not attached to shuttle  80 , but passes continuously through shuttle  80  without impairing movement of shuttle  80  parallel to the catheter body  26 .  
         [0064]    The edge  81  of shuttle  80  is operably connected to groove  84  of displacement member  74 . Edge  81  travels within groove  84  such that rotation of wheel  82  causes groove  84  to travel around edge  81  of shuttle  80  thereby displacing shuttle  80  and struts  86  relative to catheter body  26 . Pull wire  30  exits catheter body  26  and is attached to shuttle  80 . Alternatively, pull wire  30  could be attached to struts  86 . When the displacement member  74  is rotated by a wheel  82 , grooves  84  are rotated relative to shuttle  80  causing linear displacement of shuttle  80  with attached pull wire  30  parallel to catheter body  26  either towards the distal tip  13  or proximal end  11  according to rotation direction of wheel  82  and orientation of groups  84 .  
         [0065]    To steer a catheter with the second handle embodiment, an operator holds the handle  32  at grip  76  and rotates wheel  82  counter-clockwise, for example. The counterclockwise movement of wheel  82 , rotates displacement member  74  including groove  84 . The groove  84  travels around edge  81  of shuttle  80 , thereby displacing shuttle  80  towards the proximal end  11 . The displacement of shuttle  80 , likewise displaces the attached pull wire  30  towards the proximal end  11  causing the distal end  13  of the catheter body  26  to curve (not shown). Subsequent rotation of displacement member  74  in the clockwise direction, thereby straightens the catheter body  26  by displacing shuttle  80  towards the distal end  13 , thereby pushing the pull wire  30  into the pull wire lumen of catheter body  26 . The relationship of clockwise and counterclockwise motion to the displacement of shuttle  80  is readily modified by changing the direction and pitch of groove  84  within displacement member  74 . When no rotational force is applied to wheel  82 , frictional forces between groove  84  and shuttle  80 , in addition to other contacting portions of deflection mechanism  92 , prevent the pull wire from moving. Struts  86  prevent the rotation of shuttle  80  relative to the catheter body  26 .  
         [0066]    Both the first handle embodiment  31  and second handle embodiment  71  provide for displacement of the pull wire  30  parallel to the catheter body  26  without altering the approximately straight line path of the pull wire  30  within the handle  32 . Additionally, the catheter body  26  passes through handle  32  without internal size change, joint, seam, bend or other feature changes that would impair the usefulness of the inner lumen or lumens. The inventive control handle embodiments provide for an improved catheter that allows direct and unhindered access into the central lumen while still allowing easy pull wire control of catheter deflection without requiring the controller to maintain the position of the control mechanism manually or requiring additional locking mechanisms.  
         [0067]    Although the present invention has been described with reference to preferred embodiments, workers skilled in the art will recognize that changes may be made in form and detail without departing from the spirit and scope of the invention.