Abstract:
This invention describes a guidewire placement device for facilitating the delivery of multiple guidewires to the branches of a tubular system. The invention also includes a method for placing guidewires in the branches of a tubular system using a device in accordance with the present invention, while mitigating guidewire entanglement. The present invention may be utilized during percutaneous treatment of vascular and non-vascular disease, and in particular to complement the use of balloon angioplasty and the deployment of balloon-expanded or self-expanding stents into a bifurcated vessel system.

Description:
[0001]     This application claims the benefit of U.S. Provisional Application No. 60/793,787, filed Apr. 21, 2006, the entire disclosure of which is incorporated herein by reference. 
     
    
     BACKGROUND OF THE INVENTION  
       [0002]     1. Field of the Invention  
         [0003]     This invention relates to devices for facilitating the delivery of multiple guidewires within a vascular system. More particularly, the present invention is directed to a device having an elongated body with a plurality of guidewire channels configured for placing guidewires in the branches of a vascular system using a device in accordance with the present invention, while mitigating guidewire entanglement.  
         [0004]     2. Description of Related Art  
         [0005]     Percutaneous transluminal coronary angioplasty (PTCA) is a procedure that is well known for the treatment of blockages in the coronary arteries. Blockages may occur from cholesterol precipitation on the coronary wall that may be in any stage from initial deposit through aged lesions. Coronary arteries may also become blocked due to the formation of thrombus. A widely used form of percutaneous coronary angioplasty makes use of a dilatation balloon catheter that is introduced into and advanced through a lumen or body vessel until the distal end thereof is at a desired location in the vessel system. Once in position across a lesion site, the expandable portion of the catheter, or balloon, is inflated to a predetermined size with a fluid at relatively high pressures, to radially compress the atherosclerotic plaque of the lesion against the inside of the artery wall and thereby dilate the lumen of the artery. The balloon is then deflated to a small profile so that the dilatation catheter may be withdrawn from the patient&#39;s vessel system and blood flow resumed through the dilated artery.  
         [0006]     In angioplasty procedures of the kind described above, there may be restenosis of the artery, which either necessitates a subsequent angioplasty procedure, surgical by-pass operation, or some method of repairing or strengthening the area. To reduce restenosis and strengthen the area, a physician can implant an intravascular prosthesis for maintaining vascular patency, such as a stent, inside the artery at the lesion.  
         [0007]     Stents, grafts, stent-grafts, filters, vena cava filters and similar implantable medical devices, collectively referred to hereinafter as stents, are radially expandable endoprostheses which are typically intravascular implants capable of being implanted transluminally and enlarged radially after being introduced percutaneously. Stents may be implanted in a variety of body lumens or vessels such as within the vascular system, urinary tracts, bile ducts, etc. Stents may be used to reinforce body vessels and to prevent restenosis following angioplasty in the vascular system. They may be self-expanding, such as nitinol shape memory stents, mechanically expandable, such as balloon expandable stents, expanded from a collapsed stage to an open stage by means of a balloon or other mechanism and maintain the open stage by being cured or hardened, or hybrid expandable.  
         [0008]     Although PTCA is widely known and used, some PTCA cases remain more challenging than others. For instance, the complexity of the case is increased when the desired location for placement of the stent is also the site of a bifurcation in the vessel system. In these cases, access to both vessel branches is preferably maintained by placing a guidewire in each branch. Typically, each guidewire is placed prior to advancement of the stent or angioplasty device. Since the guidewires may have encountered tortuosity during delivery to their respective body vessels, it is possible that entanglements may have occurred between them. These entanglements can present difficulties for subsequent advancement of a stent or angioplasty device to the treatment site. For example, one guidewire may be twisted over the other multiple times, thereby effectively forming a knot in the guidewires.  
         [0009]     In practice, there are techniques that can help prevent or correct the problems that arise from guidewire entanglement. For example, during advancement of the second guidewire into the appropriate vessel, the operator may take care to not introduce more than a 180-degree twist in the wire. This technique may prevent guidewire entanglement from occurring. Additionally, once the device is advanced, if guidewire entanglement prevents guidewire motion, one of the guidewires may be retracted to relieve the entanglements. The guidewire may then be re-advanced to the appropriate vessel location and the device can then be fully advanced to the desired location. These techniques may be used separately, in combination with each other, or in combination with other operator techniques to mitigate the problem of guidewire entanglement. However, this requires additional attention by the operator, and it complicates the interventional procedure. Therefore, there is still a need for a device and method to assist in guidewire placement and mitigate guidewire entanglement during medical interventional precesures.  
         [0010]     This need is met by the present invention, which is directed toward devices and methods of using the devices to enable placement of one or more guidewires into the branches of a bifurcation while mitigating the problem of guidewire entanglement and knot formation.  
         [0011]     Without limiting the scope of the invention a brief summary of some of the claimed embodiments of the invention is set forth below. Additional details of the summarized embodiments of the invention and/or additional embodiments of the invention may be found in the Detailed Description of the Invention below.  
       SUMMARY OF THE INVENTION  
       [0012]     The purpose and advantages of the present invention will be described and apparent from the description that follows, and through the practice of the invention.  
         [0013]     To achieve these purposes and advantages, and in accordance with the present invention, there exists a guidewire placement device that includes an elongated body having a distal end and proximal end, and at least two guidewire channels. The elongated body has an inner wall thickness to isolate each guidewire channel from another.  
         [0014]     In further accordance with the present invention, the guidewire channels are defined by the inner wall thickness of the elongated body and an outer wall thickness of the elongated body. A discontinuity is formed in the outer wall thickness adjacent each guidewire channel to allow a guidewire to be removably placed in a guidewire channel. The discontinuity has a proximal terminus coincident with the proximal end of the elongated body and a distal terminus along the elongated body. A radiopaque marker is associated with the elongated body thereby permitting visualization of the catheter location within the vessel system.  
         [0015]     In accordance with a further aspect of the invention, each discontinuity can span the entire length of the elongated body.  
         [0016]     In accordance with the present invention, a method can be provided for forming a discontinuity in the outer wall thickness of the elongated body that includes the step of passing a sharpened blade through the outer wall thickness from one terminus to the other.  
         [0017]     In accordance with a further aspect of the invention, a method can be provided for forming a discontinuity in the outer wall thickness of the elongated body that includes supporting the guidewire channel using a mandrel, passing the guidewire channel underneath a laser beam, water jet, or another focused form of energy that will suitably form a discontinuity in the outer wall thickness.  
         [0018]     In accordance with a further aspect of the present invention, the distal end of the guidewire placement device may include an atraumatic tip to facilitate safe and effective tracking of the device through a tortuous anatomy.  
         [0019]     In accordance with another aspect of the present invention, the radiopaque marker can be positioned adjacent to the distal tip of the guidewire placement device to function as a marker during the PTCA procedure.  
         [0020]     In still further accordance with the invention, the radiopaque marker can be comprised of at least two semi-cylindrical components, each component associated with the elongated body without obstructing the wall discontinuity.  
         [0021]     In accordance with a further aspect of the invention, the radiopaque marker can have a variety of constructions, including but not limited to a cylinder, coil, torus, filament, band, and ink.  
         [0022]     In still further accordance with the present invention, a method for associating the radiopaque marker with the elongated body can be provided that includes the steps of applying a cyanoacrylate adhesive to one or both components, placing the components in contact, and optionally, creating a bead of cyanoacrylate adhesive adjacent the edges of the radiopaque marker in order to create a smooth transition.  
         [0023]     In further accordance with the invention, a method can be provided for associating the radiopaque marker with the elongated body using a welding, heat staking, heat bonding, or swaging process.  
         [0024]     In an alternative embodiment of the present invention, the at least one guidewire channel is defined by the inner wall thickness of the elongated body and the inner surface of a guiding catheter that the guidewire placement device is inserted within. In further accordance with this embodiment, the cross section of the elongated body can have a variety of shapes for example, but not limited to an s-curve, cross, and spiral, the outer surface of said cross section defining the inner wall thickness of the elongated body.  
         [0025]     In further accordance with the present invention, a method can be provided for applying a lubricious material to the outer surface of the elongated body and to the guidewire channel in order to improve guidewire trackability.  
         [0026]     In accordance with the present invention, the elongated body may be composed of materials that provide acceptable trackability. Materials that can be provided to meet this need include, but are not limited to, nylon, polyamide, PVC, Pebax, PTFE, FEP, and urethane.  
         [0027]     In still further accordance with the present invention, the elongated body can include a loading channel  200  sized to receive a stiffening mandrel. A stiffening mandrel can be inserted within said lumen in order to impart beneficial structural characteristics to enhance trackability of the guidewire placement device.  
         [0028]     In further accordance with the invention, a method can be provided wherein one or more guidewires is placed within the branches of a vessel system. The method includes the steps of accessing the vessel system with a guiding catheter, tracking the guidewire placement device through the guiding catheter and the vessel system to the desired location, inserting a guidewire into each guidewire channel of the guidewire placement device, tracking the guidewires into the desired vessel system branch, removing each guidewire from the guidewire channels by passing it radially through the discontinuity formed in the outer wall thickness, and maintaining guidewire position while removing the guidewire placement device over the guidewire. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0029]     For a further appreciation of the above and other advantages, reference is made to the following detailed description and to the drawings, in which:  
         [0030]      FIG. 1  is a plan view of an exemplary embodiment of the guidewire placement device in accordance with the present invention;  
         [0031]      FIG. 1A  is a cross sectional view of the exemplary embodiment of the guidewire placement device according to the present invention taken about line A-A of  FIG. 1 ;  
         [0032]      FIGS. 2A through 2D  are perspective views of alternative embodiments of radiopaque marker designs in accordance with the present invention;  
         [0033]      FIG. 3  is a partial-perspective view of a distal end portion of the guidewire placement device in accordance with the present invention illustrating an exemplary embodiment of a radiopaque marker disposed thereon;  
         [0034]      FIG. 4  is a cross sectional view of an alternative embodiment of a guidewire placement device in accordance with the present invention, the alternative embodiment having a loading channel disposed therein;  
         [0035]      FIG. 5  is a plan view of an alternative embodiment of a guidewire placement device in accordance with the present invention;  
         [0036]      FIG. 5A  is a cross sectional view of the alternative embodiment of the guidewire placement device of  FIG. 5  taken about line B-B of  FIG. 5 ;  
         [0037]      FIG. 6  is an end view of the alternative embodiment of the guidewire placement device of  FIG. 5 , wherein the alternative embodiment of the guidewire placement device is shown disposed in a guiding catheter; and  
         [0038]      FIG. 7A through 7B  are end views of other alternative embodiments of guidewire placement devices in accordance with the present invention. 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0039]     While the present invention will be described with reference to a few specific embodiments, the description is illustrative of the invention and is not to be construed as limiting the invention. Various modifications to the present invention can be made to the preferred embodiments by those skilled in the art without departing from the true spirit and scope of the invention as defined by the appended claims. It will be noted here that for a better understanding, like components are designated by like reference numerals throughout the various accompanying figures.  
         [0040]     In accordance with the present invention there is provided a guidewire placement device to facilitate the placement of guidewires during interventional procedures. The device is particularly useful in assisting the placement of guidewires within branches of a tubular system, such as arteries or vessels, such as during the treatement of bifurcated vessels. The guidewire placement device mitigates guidewire entanglement and knotting that can occur when more than one guidewire is disposed within a lumen.  
         [0041]     In accordance with the present invention there is provided a guidewire placement device, wherein the guidewire placement device generally includes an elongated body having a proximal end and a distal end, wherein at least one and preferably two lumens are disposed through the elongated body and extend between the proximal and distal ends of the elongated body. Each of the lumens may include a discontinuity formed in a wall of the lumen, thereby causing the lumens to be in fluid communication with an outer surface of the elongated member.  
         [0042]     Referring now to  FIG. 1 , there is shown an exemplary embodiment of the guidewire placement device  10  in accordance with the present invention. The guidewire placement device  10  includes an elongated body  11  having a proximal end  12  and a distal end  14 . The elongated body  11  is sized to be disposed within a guiding catheter (not shown) and preferably has a generally uniform cross section along the length of the elongated body  11 .  
         [0043]     It is contemplated that the cross sectional profile of the elongated body  11  can vary along the length of the elongated body  11 . For example, the elongated body  11  may taper from the proximal end  12  to the distal end  14 . This can vary the stiffness of the elongated body  11 , which may affect the trackability of the guidewire placement device  10 . In addition, a larger profile of the proximal end  12  can make insertion of guidewires into the guidewire lumens easier as will be described in detail below.  
         [0044]     The elongated body  11  may be constructed of a material that provides sufficient kink resistance and trackability. For example, the elongated body  11  may be constructed of Nylon. Other suitable materials for construction of the elongated body  11  include: polyamide, Pebax, silicone, PVC, polyurethane, urethane, PTFE, polyethylene, or any combination thereof. It is further contemplated that a reinforcement material may be added during construction of the elongated body  11 , where the reinforcement material may be disposed along the entire length of the elongated body or along a portion of the elongated body as desired. Examples of suitable reinforcement materials include wire mesh, wire braiding, nylon braiding or similar reinforcement techniques known to one of ordinary skill in the art.  
         [0045]     In further accordance with the present invention, the elongated body  11  may be constructed as a unitary member from a single material in order to provide uniform material characteristics throughout. Further still, the elongated body  11  may be constructed from multiple materials that are varied along its length to provide a stiffness gradient. The material of the elongated body  11  can be varied to achieve desirable performance characteristics.  
         [0046]     As shown in  FIG. 1 , the distal tip  14  of the guidewire placement device  10  is preferably embodied as an atraumatic tip. The tip  14  is preferably formed having round edges at its distal end to form the atraumatic tip. Alternatively, filleted edges may be used to ensure that the tip is atraumatic to the vessel wall when the device is being tracked through tortuous anatomy. The material at the distal tip may be formed from a low durometer or plasticized to make it atraumatic. Additionally, as shown in  FIG. 1 , the guidewire placement device  10  further includes a radiopaque marker  100  disposed adjacent to the tip  14 . Various embodiments of the marker  100  will be described in greater detail below with regard to additional drawing figures.  
         [0047]     Referring now to  FIG. 1A  there is shown a cross-sectional view of the guidewire placement device  10  in accordance with the present invention taken about line A-A of  FIG. 1 . As shown in  FIG. 1A , the elongated body  11  is generally formed as a solid member including at least two lumens  20  and  21  extending therethrough. The lumens  20 ,  21  define an outer wall thickness  16  and an inner wall thickness  18 . In a further aspect of the present embodiment, the inner wall thickness  18  separates the lumens  20  and  21  from each other.  
         [0048]     Referring again to  FIG. 1A , as shown, the guidewire placement device  10  further includes discontinuities  22  formed in the outer wall thickness  16 . These discontinuities  22  provide communication between the lumens  20 ,  21  and the space that is external to the guidewire placement device  10 . In the present embodiment, each discontinuity  22  is positioned opposite from the other, and located at the point of minimum outer wall thickness  16 . Alternatively, each discontinuity  22  may be positioned symmetrically or asymmetrically relative to the other, and not in a location of minimum outer wall thickness  16 .  
         [0049]     In further accordance with the present invention, each discontinuity  22  may extend along the entire length of the elongated body or terminate at a location adjacent to a proximal end  12  of the elongated body  11 . Each discontinuity  22  may follow a path distally along the elongated body  11 , terminating at the distal end  14  of the elongated body  11 . In doing so, a continuous discontinuity  22  is created, allowing a guidewire to pass from the guidewire channels  20  and  21  through the outer wall thickness  16  over the entire length of the elongated body  11 . The discontinuity is preferably formed having a width less than that of a guidewire, which may be disposed within either of the lumens  20 ,  21 .  
         [0050]     In an alternative embodiment in accordance with the present invention, the discontinuity  22  may terminate at the proximal end  12  of the elongated body  11  and have a distal terminus that is proximal to the distal end  14  of the elongated body  11 .  
         [0051]     The discontinuity  22  may be formed in the outer wall thickness  16 , by passing a cutting apparatus either externally into the lumens  20 ,  21  or drawing the cutting apparatus through the guidewire channels  20  and  21  to form the discontinuity.  
         [0052]     Alternatively, the discontinuity  22  in the outer wall thickness  16 , may be formed by supporting the guidewire channels  20  and  21  with a mandrel, and then passing the outer wall thickness  16  between the mandrel and a laser source, the laser source directing a laser beam through the outer wall thickness  16  and thereby creating the discontinuity  22 . In a further aspect of the alternative embodiment a variety of laser sources may be used, for example but not limited to, Nd-YAG, excimer, nanosecond, femtosecond, and C 02  lasers. The laser may also be replaced by a suitable focused energy source, such as a water jet.  
         [0053]     Referring now to  FIGS. 2A through 2D , there are shown in accordance with the present invention various embodiments for the radiopaque marker  100  of the guidewire placement device  10  in accordance with the present invention and as previously described.  
         [0054]     Referring now to  FIG. 2A , there is shown one embodiment of a radiopaque marker in accordance with the present invention. As shown in  FIG. 2A , marker  100   a  has a cylindrical configuration, which allows it to be placed in association with the entire circumference of the elongated body  11 . It can be appreciated that with this configuration, the discontinuity  22  in the outer wall thickness  16  will be obstructed, and therefore, a guidewire cannot pass from the guidewire channels  20  and  21  to the space that is external to the guidewire placement device  10 . However, the marker can be cut axially to allow the guidewire to pass out of the gas channels.  
         [0055]     Referring now to  FIG. 2B , there is shown a second alternative embodiment of a radiopaque marker  100   b  in accordance with the present invention. As shown in  FIG. 2B , the radiopaque marker  100   b  is embodied as a coiled configuration. In this configuration, the marker can be placed in association with the entire circumference of the elongated body  11 . As described above with regard to the embodiment shown in  FIG. 2B , the radiopaque marker  100   b  will also obstruct the discontinuities  22  in the outer wall thickness  16 . However, the marker can be cut axially to allow the guidewire to pass out of the gas channels.  
         [0056]     Referring now to  FIG. 2C , there is shown a third embodiment of a radiopaque marker in accordance with the present invention. As shown in  FIG. 2C , the radiopaque marker  100   c  is comprised of a first half  102  and a second half  104 , wherein the first and second halves have a radius of curvature substantially equal to that of the elongated member  11 . Each of the halves is preferably affixed to the outer surface of the elongated member  11  at a desired location. When assembled, the halves do not encircle the entire circumference of the elongated shaft  11 , thereby leaving the discontinuities  22  unobstructed.  
         [0057]     Referring now to  FIG. 2D , there is shown a fourth alternative embodiment of the radiopaque marker in accordance with the present invention. As shown in  FIG. 2D , the radiopaque marker  100   d  is formed from at least longitudinal member, and more preferably a plurality of longitudinal members. Each longitudinal member being substantially aligned with a longitudinal axis of the elongated member  11 . The longitudinal members can be associated with the elongated member so as not to obstruct the discontinuity  22  in the outer wall thickness  16  and thereby allowing a guidewire to pass from the guidewire channels  20  and  21  through the discontinuity  22 .  
         [0058]     The radiopaque markers shown in  FIGS. 2A through 2D  and described above are preferably affixed to an outer surface of the elongated shaft with a biocompatible adhesive. This adhesive can be a time or light cured cyanoacrylate that is applied to the inner surface of the radiopaque marker  100  and/or the outer surface of the elongated body  11 . The marker  100  and elongated body  11  can then be placed in contact, allowing the adhesive to cure, and resulting in a bond between the components. In further accordance with the present embodiment, a bead of adhesive can be placed adjacent the edges of the radiopaque marker  100  and the adhesive can then be cured. The cured adhesive bead creates a smooth transition between the surface of the marker  100  and the elongated body  11 , which prevents damage to the vessel when the guidewire placement device  10  is tracked through anatomy.  
         [0059]     Alternatively, the radiopaque marker  100  may be affixed to the elongated shaft using a heat welding process. In this process, the radiopaque marker  100  is placed in contact with the elongated body  11  and heat is applied to the radiopaque marker. Due to the lower melting temperature of the material of which the elongated member is fabricated of, the elongated member would melt and flow into and about the radiopaque marker  100 . The heat can be removed from the components, resulting in a finished assembly. In further accordance with this embodiment, a heat shrink tube may be placed over the assembly prior to heat application. After the heat is applied, the heat shrink tubing will undergo a reduction in diameter and will come in contact with the radiopaque marker  100  and the surface of the elongated body  11 . The material of the elongated body  11  will melt and flow within the heat shrink tubing when the heat is applied. The melted material will flow into and about the radiopaque marker  100 , and will result in a smooth transition at the marker edges, due to the conformance provided by the heat shrink tubing. Mandrels may be placed within the lumens and or the discontinuities so that the lumens and the discontinuities remain patent during this process.  
         [0060]     In still another embodiment of the present invention, there is provided a method for affixing the radiopaque marker  100  to the elongated body  11  using a swaging process. In this embodiment, a marker component such as the one illustrated in  FIG. 2A  may be utilized. Since the marker component has a continuously circumferential material configuration, it is possible to deform the material into a smaller diameter by applying a radial force using a swaging process, for example. Therefore, the radiopaque marker  100  may be placed on the elongated body  11  in the desired location. Next, a radial force may be applied to the radiopaque marker, thereby deforming the marker and placing it in interference contact with the elongated member. The interference contact between the components secures the marker to the elongated member, resulting in a final assembly. Optionally, a mandrel may be placed within one or all of the guidewire channels  20  and  21  of the elongated member during the swaging process.  
         [0061]     It is further contemplated that the radiopaque marker  100  in accordance with the present invention may be embodied in the form of a radiopaque ink. The radiopaque ink can be applied to the elongated body  11  surface using known printing methods such as pad printing. If desired, a protective layer may be disposed over the radiopaque ink, wherein the protective layer may be comprised of a curable adhesive or heat shrink material. The protective layer may also be a film secured over the radiopaque ink by an adhesive or heat welding prcess.  
         [0062]     Referring now to  FIG. 3  there is shown a partial isometric view of the distal end of the guidewire placement device  10  in accordance with the present invention. As shown in  FIG. 3 , a radiopaque marker as shown in  FIG. 2B  is shown disposed adjacent the distal end of the guidewire placement device  10 . As described above, this embodiment of the radiopaque marker includes two components  102  and  104 , each of which are semi-cylindrical in form. As shown in  FIG. 3 , these marker halves can each be placed in association with the elongated body  11  such that the discontinuities in the outer wall thickness  16  of the elongated body  11  are not obstructed. This permits a guidewire to pass from the guidewire channels  20  and  21  through the discontinuity  22  in the outer wall thickness  16  of the elongated body  11 .  
         [0063]     Referring now to  FIG. 4 , there is shown an end view of an alternative embodiment the guidewire placement device in accordance with the present invention. As shown in  FIG. 4 , the elongated body  11 ′ according to the alternative embodiment further includes a loading channel  200 . This loading channel  200  can be used to insert a stiffening mandrel (not shown). The mandrel may be constructed from a material that is stiffer than the material used to construct the elongated body  11 ′. For example, the mandrel may be stainless steel, nitinol, or a glass filled delrin or other biocompatible materials or composites. The stiffer mandrel imparts structural characteristics to the overall assembly that provides better kink resistance and trackability. Although the loading channel  200  in this figure is shown at a location within the inner wall thickness  18 ′ of the elongated body  11 ′, in further embodiments, the loading channel  200  may be placed in a location that is not coaxial with the longitudinal axis defined by the elongated body  11 . It is also possible to use a stiffening mandrel that is softer than the elongated body material. The composite structure will still act to provide an over all increase or stiffness.  
         [0064]     Referring now to  FIG. 5 , there is shown yet another alternative embodiment of a guidewire placement device  50  in accordance with the present invention. According to the embodiment shown in  FIG. 5 , the guidewire placement device  50  comprises an elongated body  51  with a proximal end  52  and a distal end  54 . Referring now to  FIG. 5A  there is shown a cross sectional view of the elongated body  51 , taken along section line B-B of  FIG. 5 . As illustrated by this view, the elongated body  51  includes a loading channel  500  sized to accept a mandrel formed from a stiffer material, as described in a previous embodiment. In addition, a radiopaque material may be inserted within the loading channel  500  both to provide stiffness, and to function as a marker at various points, such as the catheter tip. In the present embodiment, the elongated body  51  has a substantially “S-Curved” profile. The surface of this profile defines the inner wall thickness  58  of the elongated body  51  in accordance with the present invention. Referring now to  FIG. 6 , there is shown the guidewire placement device of  FIG. 5  as disposed within a guiding catheter. As shown in  FIG. 6 , guidewire channels  520  and  521  are formed when the elongated body  51  is placed in association with a guiding catheter  300 . The guidewire channels  520  and  521  are defined by the inner wall thickness  58  of the elongated body  51  and the inner surface of the guiding catheter  300 .  
         [0065]     In further accordance with the present invention, it can be appreciated that the profile of the elongated body in accordance with the various embodiments of the guidewire loading device in accordance with the present invention can be embodied by various geometries without departing from the invention. For example, referring now to  FIGS. 7A through 7B , it is possible to have a cross sectional profile that is substantially a “Cross” geometry as shown in  FIG. 7A . Further still, an elongated body  71  geometry may be used that is substantially a “Spiral” as shown in  FIG. 7B . These elongated member geometries are exemplary, and are not meant to limit the possibility of geometries that may be utilized in accordance with the present invention.  
         [0066]     Moreover, the elongated body need not include a loading channel or stiffening mandrel as described above. For example, and in accordance with an alternative embodiment of the present invention as depicted in  FIG. 7B , the elongated body can be embodied in the form of a spiral, wherein as shown, the spiral configuration forms a first lumen and a second lumen as shown.  
         [0067]     In further accordance with the present invention, the surface of the elongated body may include a coating configured to increase lubricity. In a further aspect of this embodiment, synthetic or natural oil may be applied to the outer surface of the elongated body and/or within the lumens as described herein to reduce friction and/or increase lubricity. In an alternative embodiment, these surfaces may be treated with a hydrophilic coating.  
         [0068]     The guidewire placement device in accordance with the present invention may be utilized to place at least one guidewire into a branch vessel of a vessel system. An example of a branch vessel is a bifurcated coronary vessel. The guidewire placement device of the present invention is preferably utilized in conjunction with a guiding catheter. The guiding catheter having been previously placed within the patient&#39;s vasculature. The guidewire placement device is then disposed within the guiding catheter and advanced to a desired position. Positioning of the guidewire placement device may be verified by viewing of the radiopaque marker disposed adjacent the distal end of the guidewire placement device under fluoroscopy.  
         [0069]     After having placed the guidewire placement device at a desired location, a first guidewire can then be inserted into one of the lumens of the guidewire placement device and advanced into a first coronary bifurcation branch. A second guidewire can then be placed into the second lumen and advanced into a second coronary bifurcation branch. It can be appreciated that since each guidewire is tracked through a separate guidewire channel they are kept separate over the length of the device by the inner wall thickness  18 . Therefore, it is not possible for the guidewires to become entangled, twisted or knotted as may otherwise occur.  
         [0070]     After having placed the guidewires, the guidewires can be removed from the lumens of the guidewire placement device. The guidewires may be removed utilizing different methods. One such method is to allow each guidewire to pass through the discontinuity  22  formed in the outer wall thickness  16  of the elongated body  11  to the space that is external to the guidewire placement device  10 . To initiate removal in this manner, the guidewires may be removed through the discontinuity formed in the proximal end of the guidewire placement device and propagated along the length of the elongated member until each of the guidewires are free of their respective lumens. “Propogation” may be facilitated by passing a secondary device over the guidewires external to the placement device or by passing a surface distally between the guidewires and the outer surface of the guidewire placement device.  
         [0071]     An alternative method of removing the guidewires from their respective lumens is to remove the guidewire placement device from the guiding catheter while retaining the position of each of the guidewires. This may be accomplished by applying an axial force to the guidewire loading device in a proximal direction until the distal end  14  of the elongated body  11  is no longer associated with the guidewires. Optionally, the guidewires are secured proximal to the guiding catheter while applying the axial force, thereby maintaining position of the guidewires within the coronary bifurcation vessels.  
         [0072]     This method results in two guidewires that are placed within the branches of a coronary bifurcated vessel having minimal twists or entanglements between them. Thus, the guidewires can be used to perform an interventional technique such as, but not limited to, Provisional T, Culottes, and Crush techniques. And a “catch all” paragraph to the effect that many embodiments are possible in accordance with the invention, etc.  
         [0073]     While particular embodiments of the present invention have been shown and described, it will be obvious to those skilled in the art that changes and modifications can be made without departing from this invention in its broader aspects. Therefore, the appended claims are to encompass within their scope all such changes and modifications as fall within the true spirit and scope of this invention.