This invention generally relates to medical devices, and more particularly to devices for delivering an implantable prosthesis to a target anatomy.
Prosthetic devices may be placed in vessels and ducts for a number of medical procedures. Typically, placement of the prosthetic devices into the vessels and ducts functions to maintain an open passage through the vessel or duct. For example, where a bilary or pancreatic duct becomes occluded, it is often desirable to facilitate drainage through the duct by the placement of a tubular prosthesis within the occluded area. In some procedures, stents have been used to maintain an open passage. Flexibility of the stent is important to avoid irritation of the placement site with a rigid stent. For example, patients may develop pancreatitis and morphological changes or strictures due to irritation at the implant site by a stent that is too stiff.
Placement of a stent within a patient can be problematic due to the patient anatomy and stent flexibility. For example, placement of the stent in the biliary tree can be difficult, since a deployment system must make a severe turn from the duodenum through the opening of the common bile duct. The geometry of cancerous biliary or pancreatic ducts is also very tortuous. In addition, the narrow passageways of the biliary and pancreatic ductal system or the urinary system restrict the diameter of the delivery system that may be used for delivering a stent within the narrow passageways. Similarly, small diameter flexible stents suitable for biliary and pancreatic ducts or the urinary system may be problematic to deliver due to the size of the stent and the flexibility of the stent. For example, buckling or kinking of the stent during delivery to the target site may occur in stents that are flexible and soft enough such that these stents may be longitudinally compressible during delivery.
In some delivery systems, the stent is delivered to the implantation site using a catheter. For example, the biliary or pancreatic stent may be mounted on a guiding catheter that is fed over a wire guide into the biliary tree. To deploy the stent from over the guiding catheter, a pushing catheter is used to contact a proximal end of the stent and urge the stent forward over the guiding catheter until deployment occurs and the stent is released at the implantation site. Stents may also be delivered by placing a stent directly over a wire guide and pushing the stent with a pushing catheter. Typically, stents with smaller French sizes (generally about 7 FR and smaller, limited by the diameter of the wire guide) are delivered by direct placement of the stent on the wire guide. When the stent is relatively stiff, the stent may be delivered to a site without buckling. However, these types of deliverable stents do not address the problem of irritation within the duct due to the presence of the stiff stent. When a soft stent that may be longitudinally compressible during delivery is deployed using a pushing catheter to push on the end of the stent as the stent advances over the guiding catheter, the stent may buckle or accordion during delivery. Buckling of the stent may make delivery to the implantation site difficult or impossible if the stent cannot advance past the stricture into position. In addition, buckling of the stent may interfere with proper positioning of the stent or irritate the passageway of the biliary tree or urinary system as the stent is being delivered. If the stent buckles during delivery, the buckling may cause inadvertent displacement of the stent relative to the pushing catheter and affect proper placement of the stent in the stricture. In addition, with some materials, kinking of the stent may damage the stent and render the stent unusable.
What is needed is a stent introducer system that enables deployment of a longitudinally compressible stent to the delivery site without buckling the stent during delivery.
Accordingly, it is an object of the present invention to provide a stent delivery system and method having features that resolve or improve on one or more of the above-described drawbacks.
The foregoing object is obtained by providing a stent delivery system having an outer sheath having a proximal portion, a distal portion and a first lumen extending at least partially through the sheath. The system further includes an inner shaft slidably received within the first lumen and extending at least partially through the sheath. A tubular stent is slidably positionable within the first lumen and at least a portion of the stent operably contacts a pushing surface on the inner shaft. The inner shaft and the stent are slidable relative to the outer sheath and the outer sheath provides sufficient rigidity to the stent for delivery of the stent to a delivery site.
In another aspect, a method of delivering a pancreatic stent using a delivery system of the present invention. The method includes providing a stent delivery system, advancing the delivery system to a delivery site, deploying the stent into the delivery site by sliding the shaft and the stent relative to the sheath, the sheath providing sufficient rigidity to the stent for delivery of the stent to the delivery site and withdrawing the shaft and the sheath.
The invention is described with reference to the drawings in which like elements are referred to by like numerals. The relationship and functioning of the various elements of this invention are better understood by the following detailed description. However, the embodiments of this invention are not limited to the embodiments illustrated in the drawings. It should be understood that the drawings are not to scale, and in certain instances details have been omitted which are not necessary for an understanding of the present invention, such as conventional fabrication and assembly.
As used in the specification, the terms proximal and distal should be understood as being in the terms of a physician using the deployment system. Hence the term “distal” means the portion of the deployment system which is farthest from the physician and the term “proximal” means the portion of the deployment system which is nearest to the physician.
The stent 42 is slidably received in a distal end portion 52 of the lumen 44 of the outer sheath 38 and is disposed distally of the shaft 40. The stent 42 may be any kind of tubular, non-expandable stent known in the art that is suitable for placement in a passageway of a patient. By way of non-limiting example, the stent 42 may be a pancreatic, biliary or urological stent. The stent 42 may be longitudinally compressible during delivery due to the geometry of the stent 42 and the materials forming the stent, such that the stent 42 is not consistently adequately independently pushable absent the outer sheath 38. The outer sheath 38 provides protection from deformation of the stent 42 during delivery of the stent 42 to the delivery site. The sheath 38 provides sufficient rigidity to the stent 42 to allow the stent 42 to be pushable. The sheath 38 may be configured to prevent frictional engagement of the stent 42 with the tissue as the stent is navigated through the bodily passageways and to avoid inwardly directed lateral pressure The sheath 38 may, but is not required to provide compression for the stent 42, for example when the stent 42 includes retention members (discussed below).
The inner shaft 40 may further include one or more lumens 62, 64 defined through a portion of the shaft 40.
As shown in
In some embodiments, a shaft proximal end 72 includes a luer-lock fitting 74 for releasably fixing the wire guide 70 relative to shaft 40 as shown in
In an alternate embodiment shown in
The outer sheath 38 may be made from a material that allows the sheath to be sufficiently flexible yet having adequate columnar strength to navigate the patient's ductal system. In some embodiments, the outer sheath is made primarily of a substantially clear polymer such as polytetrafluorothylene (PTFE). Additional possible materials include, but are not limited to the following, polyethylene ether ketone (PEEK), fluorinated ethylene propylene (FEP), perfluoroalkoxy polymer resin (PFA), polyamide, polyurethane, high density or low density polyethylene, and nylon including multi-layer or single layer structures and may also include reinforcement wires, braid wires, coils, coil springs and or filaments. In some embodiments, the outer sheath 38 is formed from a lubricious material such as PTFE and the like for easy slidability of the inner shaft 40 and the stent 42 within the outer shaft 38. An inner surface 39 of the outer sheath 38 may also be treated with materials to make the inner surface 39 more lubricious. The outer sheath 38 may also be coated or impregnated with other compounds and materials to achieve the desired properties. Exemplary coatings or additives include, but are not limited to, parylene, glass fillers, silicone hydrogel polymers and hydrophilic coatings. In some embodiments, the thickness of the outer sheath wall may range from about 0.005-0.030 inch.
The size of the outer sheath 38 will depend on the size of the inner shaft 40 and the stent 42. In some embodiments, the sheath 38 will be sized to tightly slidably receive the shaft 40 and the stent 42. For example, the sheath 38 may have an outer diameter 96 that is about 1-3 French (Fr) greater than the stent 42 outer diameter. The shaft 40 may have an outer diameter 98 that is just slightly larger than the stent 42 outer diameter. The relationship between the sheath outer diameter 96 and the shaft 40 outer diameter 98 is shown in
The shaft 40 may be made from a material that allows the shaft to be sufficiently flexible yet have adequate columnar strength and be slidable within the sheath 38. Possible materials include, but are not limited to PTFE, PEEK, polyethylene, nylon, polyimide, and polyurethane. The shaft 40 may be sized and shaped such that the outer diameter of the shaft is dimensioned to take up most of the inner diameter of the sheath 38. The outer diameter of the distal end 46 of the shaft 40 generally depends on the type of the stent 42 to be delivered and the inner diameter of the outer sheath 38. The shaft 40 may also be coated or formed from materials having a lubricious surface, such as PTFE, nylon, FEP, PEEK, polyethylene and the like.
The wire guide 70 may be any type of wire guide known in the art suitable for entering tortuous passageways in the body. The wire guide 70 should be sized and shaped to fit and extend at least partially through the lumen 64 in the shaft 40. In some embodiments, the wire guide 70 may be about 0.018 to about 0.035 inch in diameter (coated or uncoated) and about 205 cm in length for a device that allows exchange at the distal end portion of the shaft and up to about 1000 cm in length. In some embodiments, the wire guide 70 may be about 480 cm or about 660 cm in length. Other diameters and lengths may be used as these sizes are presented only for illustrative purposes.
As discussed above, the stent 42 may be any stent suitable for deployment into a bodily passageway. In some embodiments, the stent may have an outer diameter of about 3-5 Fr, although larger stents may be used, for example, about 5-7 Fr, about 7-9 Fr and the like. If smaller stents become available, i.e. smaller than 3 Fr, the apparatus 10 would be suitable for delivering the smaller stents without buckling during delivery. Similarly, any soft stent may be delivered using the apparatus 10 described herein where the stent is not placed over a guiding catheter or a pushing catheter for delivery. The stent may be made from materials so that the stent is soft enough to eliminate or reduce irritation at the implantation site that occurs with a rigid stent, thus reducing the risk of pancreatitis or other ductal changes in the biliary and urological ducts. These soft stents tend to buckle without the outer sheath of the present invention overlying the stent for delivering the stent to the implant site. Suitable materials for the stent for use with the delivery system of the present invention include, but are not limited to the following, SOF-FLEX®, a type of polyether urethane, silicone, block polymers, urethane, polyethylene, PTFE and combinations thereof.
By way of non-limiting example, the stent may be provided for facilitating the drainage of fluids within an obstructed duct. As shown in
The tubular drainage stent 142 may also include a retention members 154, 156 at one or more end portions 144, 146 such as flaps, pigtail loops, etc. The number, size and orientation of the retention numbers that may optionally be included may be modified to accommodate the migration-preventing requirements of the particular stent to be implanted. The retention members may be included near one end portion 144 or 146 or both end portions 144, 146 of the tubular stent 142. In some embodiments, the retention members may be formed by slicing small longitudinal sections 158 in the stent 142 and orienting the sliced sections 158 radially. The sliced sections forming the retention members 154, 156 shown in
As shown in
As shown in
Suitably shaped tubular stents known in the art include, but are not limited to, a ST-2 SOEHENDRA TANNENBAUM® stent, a COTTON-LEUNG® stent, a COTTON-HUIBREGTSE® stent, a GEENEN® Pancreatic Stent, a JOHLIN® Pancreatic Wedge Stent, or a ZIMMON® Pancreatic (available from Cook Endoscopy, Inc., Winston-Salem, N.C.). Other tubular stents known in the art are also suitably shaped for delivery using the stent introducer apparatus of the present invention. The stent of the present invention may be similarly shaped, but is also formed from a material and is of a size that the stent is longitudinally compressible and may not be independently pushable absent the outer sheath of the delivery system. For example, the stent of the present invention may be formed from a material such as polyether urethane having a lower gurley stiffness, lower durometer and lower modulus than a stent formed from a material such as polyethylene. In some embodiments, the stent for use with the delivery system of the present invention may have a resistance to bending less than about 1,300,000 mgs/in2. Typically, polyethylene stents known in the art are stiffer and have a higher resistance to bending that is greater than about 1,300,000 mgs/in2 and may be less than about 2,3321,000 mgs/in2.
The stent for delivery using the apparatus 10 may be made from any suitable material that is biocompatible and flexible enough to be longitudinally compressible for positioning in a bodily passage to allow fluid flow therethrough. The stent may be made from plastic materials known in the art. The stent materials may be substantially non-biodegradable or biodegradable.
Radiopaque markers may be provided on the distal portion 52 of the sheath 38, the distal end 46 of the shaft 40 and/or the stent 42. Alternatively, portions of the stent introducer apparatus 10 may be made from materials that are radiopaque themselves. Exemplary radiopaque bands 55, 255 are shown on the sheath 38 and the sent 242 in
In operation, the stent introducer apparatus 10 may be used to place the stent in the bodily lumen.
As shown in
As shown in
The above Figures and disclosure are intended to be illustrative and not exhaustive. This description will suggest many variations and alternatives to one of ordinary skill in the art. All such variations and alternatives are intended to be encompassed within the scope of the attached claims. Those familiar with the art may recognize other equivalents to the specific embodiments described herein which equivalents are also intended to be encompassed by the attached claims. For example, the invention has been described in the context of the biliary system for illustrative purposes only. Application of the principles of the invention to any other bifurcated lumens or vessels within the body of a patient, including areas within the digestive tract such as the pancreatic system, as well as areas outside the digestive tract such as other vascular systems, by way of non-limiting examples, are within the ordinary skill in the art and are intended to be encompassed within the scope of the attached claims.
This application claims the benefit of U.S. Provisional Application No. 60/955,940, filed Aug. 15, 2007, which is incorporated by reference herein in its entirety.
Number | Date | Country | |
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60955940 | Aug 2007 | US |