referring to the drawings now in detail , and particularly to fig1 there is shown the distal portion of a catheter assembly 10 , also shown in its extended most form in fig4 . the catheter assembly 10 comprises an extruded catheter shaft 12 having a plurality of lumens disposed axially therethrough . the catheter shaft 12 has a first lumen 14 , and a second lumen 16 , both of which are preferably , but not necessarily of cresent shape , as shown in the cross - sectional view of fig2 . the catheter shaft 12 also includes a third lumen 18 , which is preferably of circular cross - section . the catheter shaft 12 has an elongated balloon 20 disposed about its distalmost end , in a known manner . the first lumen 14 extends from an opening , not shown , in a connector 22 , shown in fig4 distally towards a closed end 24 , at the proximal end of the balloon 20 . a stiffening mandrel 26 , as shown in fig1 is disposed within the length of the first lumen 14 . the stiffening mandrel 26 may have a ball welded tip 28 or be otherwise tapered and flexible on its distalmost end , to prevent puncture of the lumen 14 by the mandrel 26 . the stiffening mandrel is made from a metal wire selected from the group consisting of stainless steel or nitinol . the second lumen 16 extends from the connector 22 , through the shaft 12 , parallel to the first lumen 14 , except that the second lumen 16 is in fluid communication with the balloon 20 , as shown in phantom lines 17 , in fig1 . the second lumen 16 provides a conduit for pressurized fluid for inflating and deflating the balloon 20 from an inflation / deflation device , not shown , which would be adaptable to the connector 22 . it is to be noted that the view of fig1 is sectioned to show the first lumen 14 and the third lumen 18 , and not longitudinally bisect the web of material 19 separating the first and second lumens 14 and 16 . the third lumen 18 , of generally circular cross - section , extends from the connector 22 , through the shaft 12 , and through the balloon 20 , opening distally of the balloon 20 , as shown in fig1 and 1a . the third lumen 18 is not in fluid communication with the balloon 20 . an opening or side orifice 30 is disposed through the wall of the catheter shaft 12 , and into the third lumen 18 , as shown in fig1 . the side opening 30 in this preferred embodiment is preferably a slightly oval opening of about 3 mm long and 0 . 5 mm wide , arranged at a sharp angle “ a ” of about 20 to about 60 degrees with respect to the longitudinal axis of the shaft . the side opening 30 includes a valve - like cover flap 32 , integral with the shaft 12 with a distally tapering edge 33 , the flap 32 being about the size to cover the opening 30 , and is resilient so as to allow it flex over the opening 30 , and within the third lumen 18 , obstructing it somewhat , depending upon how the flap 32 is being biased . the side opening 30 is disposed a distance “ x ” of about 15 to about 35 cm . from the proximal end of the inflated balloon 20 , as shown in fig1 and 4 . the third or “ distal ” lumen 18 may thus be utilized in its entire length , from the proximal connector 22 to its distalmost orifice , for receiving a guidewire in an “ over - the - wire ” mode , the flap 32 roughly covering the inside of the opening 30 . the lumen 18 may also be utilized , from the opening 30 to its distal end , in a “ rapid - exchange - wire ” mode with a guidewire extending through the distal end of the third lumen 18 and out the opening 39 once the flap 32 is flexed out of the way . an ro ( radio opaque ) marker band 34 is disposed about the catheter shaft 12 , ( essentially the structure comprising the third lumen 18 ), at the mid - point of the balloon 20 in either the “ over - the - wire ” mode or the “ rapid - exchange ” mode . in one embodiment of the present invention , where the catheter assembly 10 is utilized as aforementioned in the traditional “ over - the - wire ” catheter , a guidewire 50 , normally initially having been inserted into a patient &# 39 ; s vessel , and having its proximal end outside of the patient , has that proximal end inserted through the distal end of the catheter assembly 10 , through the “ distal ” or third lumen 18 , and it extends proximally , out of the proximal guidewire connector 42 , as shown in fig6 . the flap 32 performs basically like a valve , by shutting itself against the opening 30 , thus permitting an unobstructed lumen for passage of the guidewire 40 , or for passage of pressurized fluid injected proximally in the lumen 18 to pass through the lumen 18 , to escape primarily out of the distal end of the catheter shaft 12 through the lumen 18 . in a further embodiment of the present invention , where the catheter assembly 10 may be utililized in the aforementioned “ rapid - exchange ” mode , the guidewire 50 , normally initially inserted into a patient &# 39 ; s vessel , and having its proximal end outside of the patient , has that proximal end inserted through the distal end of the catheter assembly 10 , through the “ distal ” lumen 18 , and extending outwardly proximally , through the side opening 30 as shown in fig1 and 7 . the guidewire 50 in this mode , extends parallel to and external of the shaft 12 , proximal of the side opening 30 . the enlarged view in fig1 a depicts the guidewire 50 shown in phantom lines , and the flap 32 in close fitting overlapping relationship to the guidewire 50 . during the threading of the guidewire through the distal lumen 18 , it is anticipated that the shaft 12 would be bent into a “ u ” shape at the opening 30 , with the opening 30 in the trough of the “ u ”, so as to cause the flap 32 to bend “ away ” from the opening 30 , obstructing the lumen 18 proximally therepast to permit the guidewire 50 to be threaded through the lumen 18 and out the opening 30 . additionally , when the catheter assembly 10 is utilized in this “ rapid - exchange ” mode , a stiffening stylet 52 may be inserted within the “ distal ” or third lumen 18 through the connector 22 , as shown in fig1 a and 2 . the stiffening stylet 52 has a distal end 54 which would extend only up to the side opening 30 , and no further . the stiffening stylet 52 may have several different configurations , such as shown in fig3 a , 3 b or 3 c . the stylet 52 shown in fig3 a , is a straight mandrel 54 , having uniform diameter along its entire length . the stylet 52 shown in fig3 b , is a tapered mandrel 56 , having an initial diameter ( its non - tapered end ) of about 0 . 020 inches , and tapering about 5 cm . or more along its distal length 57 to a diameter of about 0 . 008 inches . the stylet 52 shown in fig3 c is a tapered mandrel 58 , similar to the mandrel 56 shown in fig3 b , but having a ball weld 60 therein , of a diameter of about 0 . 020 inches . each stylet 52 may be made from a stainless steel or nitinol material , in a known manner . it is critical to the present invention that the location of the distalmost end of the stiffening mandrel 26 emplaced within the first lumen 14 , as shown in fig1 be juxtaposed distal to the location of the side hole 30 in the distal lumen 18 of the shaft 12 . fig5 shows a trifurcated connector 59 mounted on the proximal end of a catheter shaft 12 having a locking hub 61 which would be arranged to adjustably lock at stiffening stylet 26 within the first lumen 14 if desired . a further locking hub 63 may be arranged off of the connector 59 to adjustably seize a stiffening mandrel 52 in the third lumen 18 for longitudinal adjustment thereof , at the physicians option , while the catheter is being utilized in the “ rapid - exchange ” mode . fig8 shows a further adaptation of the catheter assembly 10 , wherein a plurality of orificii 66 is disposed through the wall of the catheter sheath 12 to provide fluid communication with the distal lumen 18 from the outside of the catheter shaft 12 at a location proximal of the balloon 20 , and distal of the side hole 30 . the orificii 66 are about 0 . 025 inches in diameter , and function as openings for passive perfusion . a further similar plurality of orificii 68 is disposed through the wall of the sheath 12 and distal of the balloon 20 , to provide fluid communication with the distal lumen 18 , to function as openings for passive perfusion with respect to that lumen 18 . a further embodiment of the side hole 30 is shown in fig9 wherein a portion of a catheter shaft 74 has a “ distal ” lumen 76 extending therethrough , in a manner similar to the aforementioned catheter shaft 12 . a slit 78 is cut diagonally through the outer wall of the catheter shaft 74 , making a flap 80 , which when flexibly lifted away from the lumen 76 provides a “ d ” shaped opening , through which a guidewire 82 may be passed . fig1 shows the flap 80 in its “ at rest ” configuration , with the “ d ” shaped opening closed , to provide a full passage lumen 76 thereadjacent . a yet another embodiment of the side hole 30 is shown in fig1 , wherein a portion of a catheter shaft 84 has a “ distal ” lumen 86 extending therethrough . a slot 88 about 2 cm . long and 0 . 05 cm wide is diposed longitudinally through the outer wall of the catheter shaft 84 , to make a flexibly openable orifice which a guidewire 90 may be passed . fig1 shows the slot 38 in a plan view , in its “ at rest ” configuration . thus what has been shown is a novel stiffened catheter assembly 10 capable of being utilized by a physician as an “ over - the - wire ” catheter with adjustable stiffness means therewith , or optionally as a “ rapid - exchange - wire ” catheter apparatus , also including the capability of being able to control or vary the stiffness of the catheter shaft by selective insertion and / or controlled withdrawal of a stiffening stylet adaptably arranged within the guidewire lumen , the “ rapid - exchange - wire ” mode being facilitated by a side opening having valve - like obstructable flap across its inner side to minimize fluid exchange when that lumen accepts the catheter to be utilized in its full length “ over - the - wire ” mode . in its use as either a “ rapid - exchange - wire ” or an “ over - the - wire ” mode , the portion of the “ distal ” lumen enclosing the guidewire may have a plurality of orificii through the wall of the catheter shaft just proximal and just distal of the elongated inflated balloon , to permit perfusion of body fluid across the then expanded balloon in the body vessel .
a stiffenable balloon catheter assembly capable of being converted from an “ over - the - wire ” mode with respect to a guidewire extending therethrough to a “ rapid - exchange ” mode with respect to a guidewire extending therethrough , and vice versa . the catheter has a plurality of lumens , one lumen however , having a side opening with an obstructable galp , the orientation of which , determines the utilization “ mode ” of the catheter assembly . stiffening stylets may be adjustably locked into the lumens , depending upon the “ mode ”, to control the stiffness of the catheter assembly during its utilization within a patient .