Abstract:
A measuring device for measuring tunnel defects in tissue is disclosed. The measuring device can size the defect to aid future deployment of a tissue distension device. Exemplary tunnel defects are atrial septal defects, patent foramen ovales, left atrial appendages, mitral valve prolapse, and aortic valve defects. Methods for using the same are disclosed.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    This application is a continuation of PCT Application No. PCT/U.S. 06/28239 filed Jul. 19, 2006 which claims priority to U.S. Provisional Application No. 60/700,359, filed Jul. 19, 2005, both of which are incorporated herein in its entirety. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    1. Field of the Invention 
         [0003]    The invention is related to the measuring devices and measurement of anatomical pathologies. 
         [0004]    2. Description of the Related Art 
         [0005]    The ability to accurately measure the dimensions of anatomical structures is of vital importance. In many cases, the anatomical geometry defines the treatment. A small object, small hole, or short length of anatomical pathology can go untreated because it has little to no clinical significance. Larger objects, holes, and longer length of anatomical pathology may lead to adverse clinical outcomes. 
         [0006]    Additionally, many anatomical pathologies are treated with devices, including implantable devices, that are sized to fit the pathology. Knowledge of the specific size of the pathology aids the selection of an appropriately sized treatment device. Using trial and error techniques to determine the proper size of an implantable treatment device undesirably prolongs the surgical procedure, and fitting and removing improperly sized devices often further traumatizes the already-injured anatomical site. 
         [0007]    Existing devices do not easily measure tunnel defects in soft tissue within body structures. Tunnel defects can be found in the heart (e.g., patent foramen ovale (PFO), left atrial appendage, mitral valve prolapse, aortic valve defects). Tunnel defects can be found through out the vascular system (e.g., venous valve deficiency, vascular disease, vulnerable plaque, aneurysms (e.g., neurovascular, abdominal aortic, thoracic aortic, peripheral). Tunnel defects can be found in non vascular systems (e.g., stomach with GERD, prostate, lungs). 
         [0008]    A device for measuring the width of a distended defect in tissue is disclosed. The device has a longitudinal axis. The device can have a first elongated member. The first elongated member can be configured to expand away from the longitudinal axis. The device can have a second elongated member. The first elongated member can be opposite with respect to the longitudinal axis to the second elongated member. The second elongated member can be configured to expand away from the longitudinal axis. The device can have a lumen, for example, in a catheter. The device can have a porous cover on the lumen. 
         [0009]    A method for sizing a tunnel defect. The method can include inserting a measurement tool into the tunnel defect. The method can include distending the tunnel defect into a distended configuration. The method can include measuring the tunnel defect in the distended configuration. Distending can include radially expanding the measurement tool. Measuring can include bending the first measuring wire around a front lip of the tunnel defect. Measuring can include emitting a contrast fluid in the tunnel defect. 
       BRIEF SUMMARY OF THE INVENTION 
       [0010]    Tissue distension devices can be deployed to tunnel defects in tissue. The tissue distension devices can be used to substantially close tunnel defects to treat, for example, patent foramen ovale (PFO), left atrial appendage, mitral valve prolapse, aortic valve defects. Examples of tissue distension devices include those disclosed in U.S. patent application Ser. Nos. 10/847,909, filed May 19, 2004; 11/184,069, filed Jul. 19, 2005; and 11/323,640, filed Jan. 3, 2006., all of which are incorporated by reference herein in their entireties. 
         [0011]    To select a properly fitting tissue distension device, a measuring tool can first be deployed to measure the size of the tunnel defect. The tunnel defect can be measured in a relaxed or distended configuration. The tunnel defect can be distended by the measuring tool before or during measurement. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS  
         [0012]      FIG. 1  illustrates an embodiment of the measurement tool in a first configuration. 
           [0013]      FIGS. 2 and 3  illustrate various embodiments of cross-section A-A of  FIG. 1 . 
           [0014]      FIGS. 4 and 5  illustrate various embodiments of cross-section B-B of  FIG. 1 . 
           [0015]      FIGS. 5 through 11  and  13  through  16  illustrate various embodiments of the measurement tool in a second configuration. 
           [0016]      FIG. 12  is a close-up view of the a portion of the measurement tool of  FIG. 11  including the first measuring wire only, for illustrative purposes, transforming from a radially contracted to a radially expanded configuration. 
           [0017]      FIGS. 17 through 23  illustrate various embodiments of the measuring wire. 
           [0018]      FIG. 24  illustrates a section of tissue having a tunnel defect. 
           [0019]      FIG. 25  illustrates the tunnel defect of  FIG. 24 . 
           [0020]      FIGS. 26 through 28  illustrate an embodiment of a method for deploying an embodiment of the measurement tool. 
           [0021]      FIGS. 29 and 30  illustrate an embodiment of a method for using various embodiments of the measurement tool. 
           [0022]      FIG. 31  illustrates an embodiment of a method for using the measurement tool. 
       
    
    
     DETAILED DESCRIPTION  
       [0023]      FIG. 1  illustrates an anatomical measurement tool, such as a tool for measuring the width in a relaxed and/or distended configuration of a tunnel defect in tissue, in a radially contracted configuration. The measurement tool can have a longitudinal axis. The anatomical measurement tool can have a catheter, a first measuring wire, and a second measuring wire. The measuring wires can be deformable, resilient, or combinations thereof over the length of the measuring wires. 
         [0024]    The catheter can have a catheter porous section. The catheter can be entirely substantially non-porous. The catheter can have a catheter non-porous section. The catheter porous section can partially or completely circumferentially surround the catheter. The catheter porous section can have holes or pores in the catheter outer wall. The pores can have pore diameters from about 1 μm (0.04 mil) to about 1 mm (0.04 in.), more narrowly from about 2 μm (0.08 mil) to about 300 μm (10 mil), for example about 150 μm (6.0 mil). 
         [0025]    The first and second measuring wires can each have at least one wire radially constrained section and at least one wire radially unconstrained section. The measuring wires can transition from the wire constrained sections to the wire radially unconstrained sections at the wire proximal sheath ports. The first and second measuring wires between the wire proximal sheath ports and the wire distal anchor can be the radially unconstrained sections. The measuring wires can be distally fixed to the catheter at a wire distal anchor. The wire distal anchor can be a hinged or otherwise rotatable attachment, for example, to allow the measuring wire to rotate away from the longitudinal axis at the wire distal anchor during use. 
         [0026]    The measurement tool can have a tip extending from a distal end of the catheter. The tip can be blunt or otherwise atraumatic (e.g., made or coated with a softer material than the catheter, made with a soft substantially biocompatible rubber tip). A guide lumen can extend from the tip. The guide lumen can be configured to slidably receive a guidewire. The guide lumen can exit through a dimple in the tip. The tip need not be dimpled at the exit of the guide lumen. 
         [0027]      FIG. 2  illustrates that the catheter can have a catheter outer wall. The catheter outer wall can be porous, or non-porous, or partially porous and partially non-porous. The catheter can have a fluid lumen. The guide lumen can be configured central to the cross-section of the catheter or offset from the center of the cross-section, for example attached to the catheter outer wall. 
         [0028]    The first measuring wire can removably and slidably reside in or removably and slidably attach to a recessed or raised first track in the catheter outer wall. The second measuring wire can removably and slidably reside in or removably and slidably attach to a recessed or raised second track in the catheter outer wall. 
         [0029]    To transform the measurement tool from the radially contracted configuration to the radially expanded configuration, the first and second measuring wires in the wire radially constrained section can be longitudinally translated, as shown by arrows, in a distal direction. The first and second wires, for example, rotatably fixed at the wire distal anchor and not radially constrained between the wire proximal sheath ports and the wire distal anchor, can translate, as shown by arrows, radially outward from the longitudinal axis. 
         [0030]      FIG. 3  illustrates that the first and second measuring wires in the wire radially unconstrained section can be adjacent to, and reside on or attach to, the catheter outer wall. The catheter outer wall can have no tracks for the measuring wires. 
         [0031]      FIG. 4  illustrates that the first and second measuring wires can be slidably attached to and/or encased by first and second sheaths, respectively. The interior of the sheaths can be coated with a low-friction material (e.g., polytetraflouroethylene (PTFE), such as Teflon® by E.I. du Pont de Nemours and Company, Wilmington, Del.). 
         [0032]      FIG. 5  illustrates that the first sheath and/or the second sheath can be inside the catheter (i.e., radially interior to the catheter outer wall). 
         [0033]    The wire distal anchor and wire sheaths can be fixedly attached to the catheter. The wire distal anchor and wire sheaths can be slidably attached to the catheter. 
         [0034]    The catheter and/or tip can have stop. The stop can be longitudinally fixed with respect to the catheter and/or the tip. The stop can be the tip, for example if the diameter of the tip is larger than the diameter of the wire distal anchor. The stop can be configured to interference fit against the wire distal anchor when the wire distal anchor is distally translated beyond a maximum translation point with respect to the catheter and/or tip. 
         [0035]      FIG. 6  illustrates the measurement tool in a radially expanded configuration. The first and second measuring wires in the wire radially unconstrained section can bow, flex, or otherwise be radially distanced with respect to the longitudinal axis from the catheter. The first and second measuring wires can expand in a single plane (i.e., coplanar). 
         [0036]    The measuring wires can be longitudinally translated, as shown by arrows, in the wire radially constrained sections. The first and second measuring wires in the wire radially unconstrained sections can be radially expanded or otherwise translated, as shown by arrows, away from the catheter (e.g., longitudinal axis) into a radially expanded configuration, for example by distally translating the measuring wires in the wire radially constrained sections. The first and second measuring wires in the wire radially unconstrained sections can be radially contracted or otherwise translated toward the catheter (e.g., longitudinal axis) into a radially contracted configuration, for example by proximally translating the measuring wires in the wire radially constrained section. 
         [0037]      FIG. 7  illustrates that the catheter porous section can have a porous section length. The longitudinal distance between the wire distal anchor and the wire proximal sheath ports (i.e., the wire radially unconstrained section) can be an unconstrained wire longitudinal length. The unconstrained wire longitudinal length can be less than, substantially equal to (as shown in  FIGS. 1 and 6 ), or greater than (as shown in  FIG. 7 ) the catheter non-porous section. 
         [0038]      FIG. 8  illustrates that the first and second wires can have substantially discrete angles when the wires are in the radially expanded configurations. Each wire can have a wire first hinge point and a wire second hinge point. The wire hinge points can be biased (e.g., before the measurement tool is configured in the first configuration) to bend when the tension on the measuring wire is decreased. The wire hinge points can have hinges, bends, seams, links, other articulations, or combinations thereof. 
         [0039]    The wire first hinge point can have a wire first hinge angle. The wire second hinge point can have a wire second hinge angle. In a radially expanded configuration, the wire hinge first and second angles can be from about 10° to about 170°, more narrowly from about 30° to about 150°, yet more narrowly from about 45° to about 135°, for example about 125°. 
         [0040]      FIG. 9  illustrates that the measurement tool can have about 12 measuring wires. The measuring wires can be radially expandable in a configuration where the first measuring wire deploys substantially longitudinally adjacent to a third measuring wire. The measuring wires can be radially expandable in a configuration where the second measuring wire deploys substantially longitudinally adjacent to a fourth measuring wire. 
         [0041]    The measuring wires can each have a unique or paired longitudinal position for their wire proximal sheath ports and wire distal anchors. For example, the first and second measuring wires can exit from wire first proximal sheath ports (not shown on  FIG. 9 ) and can be fixed at wire first distal anchors (not shown on  FIG. 9 ). The third and fourth measuring wires can exit from wire second proximal sheath ports (not shown on  FIG. 9 ) and can be fixed at wire second distal anchors (not shown on  FIG. 9 ). The wire first distal anchors can be distal to the wire second distal anchors. The wire first proximal sheath ports can be at a substantially equivalent longitudinal position to the wire second distal anchors. The wire second distal anchors can be distal to the wire second proximal sheath ports. This longitudinal spacing of the wire distal anchors and wire proximal sheath ports can be used for all of the measuring wires. 
         [0042]    The measuring wires on each side of the catheter (e.g., the first, third, fifth, seventh, ninth and eleventh measuring wires or the second, fourth, sixth, eighth, tenth and twelfth measuring wires) can pass through the same or different sheaths. 
         [0043]      FIG. 10  illustrates that the measuring wires can have distal ends that are not attached to the catheter when the measuring wires are in radially expanded configurations. Any or all measuring wire can have a terminal end. When the measurement tool is in a radially expanded configuration, the terminal ends can be unattached to the catheter. When the measurement tool is in a radially expanded configuration, the measuring wires can have a medial turn, bend, hinge, or otherwise angle medially between the terminal ends and the wire proximal ports. A length of the measuring wires can be biased to turn or bend medially when that length of the measuring wire is in a relaxed configuration. The measurement tool can have about eight measuring wires. 
         [0044]      FIG. 11  illustrates that the measuring wires can form a substantially circular or oval loop when the measuring wire is in the radially expanded configuration. The measurement tool can have six measuring wires. 
         [0045]      FIG. 12  illustrates that the loop of wire radially unconstrained section can expand when the measuring wires transform from the radially contracted configuration to the radially expanded configuration. The measuring wires can be longitudinally translated, as shown by arrows, in the wire radially constrained sections. Along the length of the measuring wires near the wire proximal port, the measuring wires can translate along the longitudinal wire-axis, as shown by arrow. The measuring wires in the wire radially unconstrained sections can be radially expanded or otherwise translated, as shown by arrow, away from the catheter (e.g., longitudinal axis) into a radially expanded configuration, for example by distally translating the measuring wires in the wire radially constrained sections. The measuring wires in the wire radially unconstrained sections can be radially contracted or otherwise translated toward the catheter (e.g., longitudinal axis) into a radially contracted configuration, for example by proximally translating the measuring wires in the wire radially constrained section. 
         [0046]      FIG. 13  illustrates that the measuring wires can exit from the respective wire sheaths at the respective wire proximal ports. The measuring wires can all exit the wire proximal ports on the same side of the catheter, or immediately turn to the same side of the catheter after exiting the proximal wire ports. When the measurement tool is in a radially expanded configuration, the measuring wires can have a proximal turn, bend, hinge, or otherwise angle proximally after exiting the proximal wire port. When the measurement tool is in a radially expanded configuration, the measuring wires can have a medial turn, bend, hinge, or otherwise angle toward the longitudinal axis, for example, between the proximal bend and the terminal end. Any length of the measuring wires can be biased to turn or bend when that length of the measuring wire is in a relaxed configuration.  FIG. 14  illustrates that the measuring wire can have a proximal turn, bend, hinge, or otherwise angle proximally. 
         [0047]      FIG. 15  illustrates that the catheter can be removably or fixedly attached to a coupler. The coupler can be removably or fixedly attached to a handle. The coupler can be made from any material disclosed herein including rubber, elastic, or combinations thereof. The coupler can have a substantially cylindrical configuration. The coupler can have threads. The coupler can have slots. The couple can have a joint or hinge. 
         [0048]    The coupler can be flexible. The coupler can substantially bend, for example, permitting the longitudinal axis of the handle to be a substantially non-zero angle (e.g., from about 0° to about 90°) with respect to the longitudinal axis of the catheter. The coupler can permit substantially resistance free rotation between the longitudinal axis of the catheter and the longitudinal axis of the handle. 
         [0049]      FIG. 16  illustrates that the coupler can be removably or fixedly attached to the catheter on the proximal and distal end of the coupler. The coupler can have and/or be proximally adjacent to the wire proximal sheath ports. 
         [0050]      FIG. 17  illustrates that the measuring wire can have a wire body and one or more markers. The wire body can have no markers. The markers can be echogenic,  radiopaque, magnetic, or configured to be otherwise visible by an imaging technique known to one having ordinary skill in the art. The markers can be made from any material disclosed herein including platinum (e.g., pure or as powder mixed in glue). 
         [0051]    The markers can be uniformly and/or non-uniformly distributed along the length of the wire body. The markers can be uniformly and/or non-uniformly distributed along the radius of the wire body. The markers can be separate and discrete from the wire body. The markers can be attached to the wire body. The markers can be incorporated inside the wire body. The marker can have configuration symmetrical about one, two, three, or more axes. The marker can have an omnidirectional configuration. The marker can have a configuration substantially spherical, ovoid, cubic, pyramidal, circular, oval, square, rectangular, triangular, or combinations thereof. The marker&#39;s radius can be smaller than or substantially equal to the wire body&#39;s radius at the location of the marker.  FIG. 18  illustrates that the marker&#39;s radius can be greater than the wire body&#39;s radius at the location of the marker. 
         [0052]      FIG. 19  illustrates that the marker can have a unidirectional configuration. The marker can be configured in the shape of an arrow. All or subsets of the markers on a wire body can be aligned, for example all of the unidirectionally configured markers can be oriented in the same longitudinal or radial direction (e.g., distally, proximally) along the wire body. 
         [0053]      FIG. 20  illustrates that the markers can have alphanumeric characters. The alphanumeric characters can increase in value (e.g., 1, 2, 3, or A, B, C, or I, II, III) incrementally along the length and/or radius of the wire. The markers can include unit values (e.g., mm, in.) 
         [0054]      FIG. 21  illustrates that the markers can be configured as a cylinder (e.g., disc), ring (e.g., toroid, band), partial cylinder, partial ring, or combinations thereof.  FIG. 22  illustrates that the markers can be integrated with the measuring wire.  FIG. 23  illustrates that the markers can be wires or threads. The markers can extend along the length and/or radius of the wire body. 
         [0055]    Any or all elements of the measurement tool and/or other devices or apparatuses described herein can be made from, for example, a single or multiple stainless steel alloys, nickel titanium alloys (e.g., Nitinol), cobalt-chrome alloys (e.g., ELGILOY® from Elgin Specialty Metals, Elgin, Ill.; CONICHROME® from Carpenter Metals Corp., Wyomissing, Pa.), nickel-cobalt alloys (e.g., MP35N® from Magellan Industrial Trading Company, Inc., Westport, Conn.), molybdenum alloys (e.g., molybdenum TZM alloy, for example as disclosed in International Pub. No. WO 03/082363 A2, published Oct. 9, 2003, which is herein incorporated by reference in its entirety), tungsten-rhenium alloys, for example, as disclosed in International Pub. No. WO 03/082363, polymers such as polyethylene teraphathalate (PET), polyester (e.g., DACRON® from E. I. Du Pont de Nemours and Company, Wilmington, Del.), polypropylene, aromatic polyesters, such as liquid crystal polymers (e.g., Vectran, from Kuraray Co., Ltd., Tokyo, Japan), ultra high molecular weight polyethylene (i.e., extended chain, high-modulus or high-performance polyethylene) fiber and/or yarn (e.g., SPECTRA® Fiber and SPECTRA® Guard, from Honeywell International, Inc., Morris Township, N.J., or DYNEEMA® from Royal DSM N.V., Heerlen, the Netherlands), polytetrafluoroethylene (PTFE), expanded PTFE (ePTFE), polyether ketone (PEK), polyether ether ketone (PEEK), poly ether ketone ketone (PEKK) (also poly aryl ether ketone ketone), nylon, polyether-block co-polyamide polymers (e.g., PEBAX® from ATOFINA, Paris, France), aliphatic polyether polyurethanes (e.g., TECOFLEX® from Thermedics Polymer Products, Wilmington, Ma.), polyvinyl chloride (PVC), polyurethane, thermoplastic, fluorinated ethylene propylene (FEP), absorbable or resorbable polymers such as polyglycolic acid (PGA), poly-L-glycolic acid (PLGA), polylactic acid (PLA), poly-L-lactic acid (PLLA), polycaprolactone (PCL), polyethyl acrylate (PEA), polydioxanone (PDS), and pseudo-polyamino tyrosine-based acids, extruded collagen, silicone, zinc, echogenic, radioactive, radiopaque materials, a biomaterial (e.g., cadaver tissue, collagen, allograft, autograft, xenograft, bone cement, morselized bone, osteogenic powder, beads of bone) any of the other materials listed herein or combinations thereof. Examples of radiopaque materials are barium sulfate, zinc oxide, titanium, stainless steel, nickel-titanium alloys, tantalum and gold. 
         [0056]    Any or all elements of the measurement tool and/or other devices or apparatuses described herein, can be, have, and/or be completely or partially coated with agents and/or a matrix a matrix for cell ingrowth or used with a fabric, for example a covering (not shown) that acts as a matrix for cell ingrowth. The matrix and/or fabric can be, for example, polyester (e.g., DACRON® from E. I. Du Pont de Nemours and Company, Wilmington, Del.), polypropylene, PTFE, ePTFE, nylon, extruded collagen, silicone or combinations thereof. 
         [0057]    The measurement tool and/or elements of the measurement tool and/or other devices or apparatuses described herein and/or the fabric can be filled, coated, layered and/or otherwise made with and/or from cements, fillers, glues, and/or an agent delivery matrix known to one having ordinary skill in the art and/or a therapeutic and/or diagnostic agent. Any of these cements and/or fillers and/or glues can be osteogenic and osteoinductive growth factors. 
         [0058]    Examples of such cements and/or fillers includes bone chips, demineralized bone matrix (DBM), calcium sulfate, coralline hydroxyapatite, biocoral, tricalcium phosphate, calcium phosphate, polymethyl methacrylate (PMMA), biodegradable ceramics, bioactive glasses, hyaluronic acid, lactoferrin, bone morphogenic proteins (BMPs) such as recombinant human bone morphogenetic proteins (rhBMPs), other materials described herein, or combinations thereof. 
         [0059]    The agents within these matrices can include any agent disclosed herein or combinations thereof, including radioactive materials; radiopaque materials; cytogenic agents; cytotoxic agents; cytostatic agents; thrombogenic agents, for example polyurethane, cellulose acetate polymer mixed with bismuth trioxide, and ethylene vinyl alcohol; lubricious, hydrophilic materials; phosphor cholene; anti-inflammatory agents, for example non-steroidal anti-inflammatories (NSAIDs) such as cyclooxygenase-1 (COX-1) inhibitors (e.g., acetylsalicylic acid, for example ASPIRIN® from Bayer AG, Leverkusen, Germany; ibuprofen, for example ADVIL® from Wyeth, Collegeville, Pa.; indomethacin; mefenamic acid), COX-2 inhibitors (e.g., VIOXX® from Merck &amp; Co., Inc., Whitehouse Station, N.J.; CELEBREX® from Pharmacia Corp., Peapack, N.J.; COX-1 inhibitors); immunosuppressive agents, for example Sirolimus (RAPAMUNE(, from Wyeth, Collegeville, Pa.), or matrix metalloproteinase (MMP) inhibitors (e.g., tetracycline and tetracycline derivatives) that act early within the pathways of an inflammatory response. Examples of other agents are provided in Walton et al, Inhibition of Prostoglandin E 2  Synthesis in Abdominal Aortic Aneurysms,  Circulation , Jul. 6, 1999, 48-54; Tambiah et al, Provocation of Experimental Aortic Inflammation Mediators and Chlamydia Pneumoniae,  Brit. J. Surgery  88 (7), 935-940; Franklin et al, Uptake of Tetracycline by Aortic Aneurysm Wall and Its Effect on Inflammation and Proteolysis,  Brit. J. Surgery  86 (6), 771-775; Xu et al, Sp1 Increases Expression of Cyclooxygenase-2 in Hypoxic Vascular Endothelium,  J. Biological Chemistry  275 (32) 24583-24589; and Pyo et al, Targeted Gene Disruption of Matrix Metalloproteinase-9 (Gelatinase B) Suppresses Development of Experimental Abdominal Aortic Aneurysms,  J. Clinical Investigation  105 (11), 1641-1649 which are all incorporated by reference in their entireties. 
       METHODS OF USE 
       [0060]      FIG. 24  illustrates a section of tissue that can have a tunnel defect passing through the tissue.  FIG. 25  illustrates that the tunnel defect can have a defect front face and a defect back face (not shown). A defect front lip can be defined by the perimeter of the defect front face. A defect back lip can be defined by the perimeter of the defect back face. The tunnel defect can have a defect height, a defect depth and a defect width. 
         [0061]      FIG. 26  illustrates that a guidewire can be deployed through the tunnel defect. The guidewire can be passed through the guide lumen in the measurement tool. The measurement tool can be in a radialy contracted (as shown) or radially expanded configuration. The measurement tool can be translated, as shown by arrow, along the guidewire. The measurement tool can be translated to the tunnel defect with or without the use of the guidewire. 
         [0062]      FIG. 27  illustrates that the measurement tool can be translated into the tunnel defect. The guidewire can be left in place or removed. The location of the measurement tool can be monitored by dead reckoning, and/or imaging, and/or tracking along the length of the guidewire. The measurement tool can be positioned so that the tunnel defect is located adjacent to the catheter porous section. The measurement tool can be positioned so that the tunnel defect is located substantially between the most distal wire distal anchor and the most proximal wire proximal sheath. 
         [0063]      FIG. 28  illustrates that the measurement tool can be radially expanded. The measuring wires in the wire radially constrained section can be distally longitudinally translated. The measuring wires can translate radially (i.e., away from the longitudinal axis). The measuring wires can radially distend the tunnel defect, for example causing the tunnel defect to widen and shorten. The measuring wires can radially distend the tunnel defect, for example, until the tunnel defect will no longer distend without structurally damaging the tunnel defect. 
         [0064]      FIG. 29  illustrates that the measuring wires can be radially translated beyond the extent that the tunnel defect can be distended without structural damage. The measuring wires can deform around the front and back defect lips. Portions of the measuring wires can configure into wire overdeployment sections proximal and distal to the tunnel defect. The wire overdeployment sections, or markers thereon, can be imaged, for example using x-rays (e.g., radiography, fluoroscopy), ultrasound, or magnetic resonance imaging (MRI). The wire overdeployment sections can illustrate the defect width (i.e., the length between the wire deployment sections) when the defect is in a fully distended configuration. 
         [0065]      FIG. 30  illustrates that the measurement tool can have no catheter-porous section, for example, when the measurement tool is used for the measurement method as shown in  FIG. 29 . The methods of use shown in  FIGS. 29 and 30  can, for example, measure the defect depth and/or the defect height. 
         [0066]      FIG. 31  illustrates that contrast fluid or particles can be deployed into the fluid lumen of the catheter, for example, when tunnel defect is in a fully distended configuration. The contrast fluid can be radiopaque, echogenic, visible contrast (e.g., dyes, inks), any other material disclosed herein, or combinations thereof. The fluid pressure of the contrast fluid or particles can be increased. The contrast fluid or particles can emit, as shown by arrows, through the catheter porous section. The contrast fluid or particles outside of the catheter can configure into a marker cloud. The marker cloud can move into position around the tissue. The marker cloud can illustrate the defect dimensions (i.e., visible with imaging systems known to those having ordinary skill in the art, including x-ray, CAT, MRI, fiber optic camera, ultrasound/sonogram) when the defect is in a fully distended configuration. 
         [0067]    A drug can be deployed from the catheter porous section, for example, similar to the method of deploying the contrast fluid. 
         [0068]    A distension device size can be determined as described, supra. The measurement tool can be radially contracted and removed from the tunnel defect, or the coupler and/or the elements of the measurement tool proximal to the coupler can be detached from the remainder of the measurement tool and removed. If the entire measurement tool is removed from the tunnel defect, a distension device can be selected that has a size that substantially matches (e.g., is equivalent when the distension device is in a substantially or completely radially expanded configuration) the size of the distended tunnel defect. The distension device can be deployed to the tunnel defect, for example along the guidewire. The guidewire can be removed. The distension device can be, for example, a filter, stopper, plug, any distending device described in U.S. patent application Ser. Nos. 10/847,909, filed May 19, 2004; 11/184,069, filed Jul. 19, 2005; and 11/323,640, filed Jan. 3, 2006, all of which are incorporated by reference herein in their entireties, or any combinations thereof. 
         [0069]    Any elements described herein as singular can be pluralized (i.e., anything described as “one” can be more than one). Any species element of a genus element can have the characteristics or elements of any other species element of that genus. The above-described configurations, elements or complete assemblies and methods and their elements for carrying out the invention, and variations of aspects of the invention can be combined and modified with each other in any combination.