This invention is a medical device and a method of using it. The device is a foldable stent-graft which may be percutaneously delivered with (or on) an endovascular catheter or via surgical techniques or using other suitable techniques and then expanded. The stent-graft uses a kink-resistant stent structure and an interior graft which is attached to the stent in such a way that the graft does not kink and yet the stent is able to conform to curves in the blood vessel lumen.
The expandable stent structure preferably has a helically deployed torsional member with an undulating shape which is wound to form the generally cylindrical shape deployed as the stent. The helical winding desirably is aligned to allow the undulations in adjacent turns of the helix to be in phase. The adjacent undulating shapes may be held in that phased relationship using a flexible linkage, typically made of a polymeric material. The stent may also be of a ring configuration. The stent may be flared to promote smooth blood flow and to assure that the stent will remain in its chosen position.
The graft component cooperating with the stent is tubular and mounted on the interior of the stent. Although it may be made of any of a variety of materials, it preferably is an expanded polyfluorocarbon. The graft component may be attached to the stent in a variety of ways but desirably is bound to the flexible linkage which holds the stent windings in phase (or to the stent structure itself) at a number of sliding attachment points. This manner of attachment allows the stent to slide locally with respect to the graft structure or, in the case of the helically wound stent structure, allows the adjacent undulating shapes in adjacent helical turns to slide longitudinally with respect to each other as the stent is bent and still support the shape of the graft.
The stent-graft may be used to reinforce vascular irregularities, to provide a smooth nonthrombogenic interior vascular surface for diseased areas in blood vessels, or to increase blood flow past a diseased area of a vessel by mechanically improving the interior surface of the vessel. The inventive stent-graft is especially suitable for use within smaller vessels between 2 mm and 6 mm in diameter but is equally suitable for significantly larger vessels. The inventive stent-graft may be self-expandable; it is kink-resistant, easily bent along its longitudinal axis, and does not change its length during that expansion.
Included in the invention are methods for coupling the stent structure to the graft to optimize the flexibility and the kink resistance of the resulting stent-graft.
Treatment or isolation of vascular aneurysms or of vessel walls which have been thinned or thickened by disease has traditionally been done via surgical bypassing with vascular grafts. Shortcomings of this procedure include the morbidity and mortality associated with surgery, long recovery times after surgery, and the high incidence of repeat intervention needed due to limitations of the graft or of the procedure. Vessels thickened by disease are currently sometimes treated less invasively with intraluminal stents that mechanically hold these vessels open either subsequent to or as an adjunct to a balloon angioplasty procedure. Shortcomings of current stents include the use of highly thrombogenic materials (stainless steels, tantalum, ELGILOY) which are exposed to blood, the general failure of these materials to attract and support functional endothelium, the irregular stent/vessel surface that causes unnatural blood flow patterns, and the mismatch of compliance and flexibility between the vessel and the stent.
Important to this invention is the use of less invasive intraluminal delivery and, in a preferred aspect, placement of a nonthrombogenic blood-carrying conduit having a smooth inner lumen.
The most desired variations of this invention involve a stent-graft which is self-expanding, which does not shorten upon delivery, which has excellent longitudinal flexibility, which has high radial compliance to the vessel lumen, and exposes the blood to a smooth, nonthrombogenic surface capable of supporting endothelium growth.
The inventive device may be delivered in a reduced diameter and expanded to maintain the patency of any conduit or lumen in the body. An area in which the inventive stent-graft is particularly beneficial is in the scaffolding of atherosclerotic lesions in the cardiovascular system to establish vessel patency, prevention of thrombosis, and the further prevention of restenosis after angioplasty. In contrast to many of the stents discussed below having metallic struts intruding into the blood flow in the vessel lumen which generate turbulence and create blood stasis points initiating thrombus formation, the smooth, continuous surface provided by the preferred tubular inner conduit of our invention provides a hemodynamically superior surface for blood flow.
Mechanically, the linked helical stent structure used in the stent-graft provides a good combination of radial strength and flexibility. The structure is also radially resilient. It can be completely crushed or flattened and yet spring open again once the obstructive loading is removed. This ability is important for use in exposed portions of the body around the peripheral vasculature or around joints. The stent-graft can sustain a crushing traumatic blow or compression from the bending of a joint and still return to the open configuration once the load is removed.
With regard to delivery, the self-expansion mechanism eliminates the need for a balloon catheter and the associated balloon rupture problems often associated with that delivery procedure. In addition, the absence of the bulk of the balloon allows a smaller delivery profile to be achieved. Unlike some other self-expanding stent designs, this stent-graft maintains a constant length throughout the expansion process. Thus, the stent-graft does not have some of the positioning problems associated with other many self-expanding stents. In treating longer lesions, our self-expanding design eliminates the need for special long balloons or repositioning of the balloon between inflations in order to expand the entire length of the stent.
The impermeability of the preferred stent-graft makes it suitable for shunting and thereby hydraulically isolating aneurysms. The expansile properties derived from the stent structure provide a secure anchor to the vessel wall.
Stents
The stents currently described in the open literature include a wide variety of different shapes.
Wallsten, U.S. Pat. No. 4,655,771, suggests a vascular prosthesis for transluminal implantation which is made up of a flexible tubular body having a diameter that is varied by adjusting the axial separation of the two ends of the body relative to each other. In general, the body appears to be a woven device produced of various plastics or stainless steel.
U.S. Pat. No. 4,760,849, to Kroph, shows the use of a ladder-shaped coil spring which additionally may be used as a filter in certain situations.
Porter, U.S. Pat. No. 5,064,435, suggests a stent made up of two or more tubular stent segments which may be deployed together so to produce a single axial length by a provision of overlapping areas. This concept is to permit the use of segments of known length, which, when deployed, may be used together in overlapping fashion additively to provide a stent of significant length.
Quan-Gett, U.S. Pat. No. 5,151,105, discloses an implantable, collapsible tubular sleeve apparently of an outer band and an inner spring used to maintain the sleeve in a deployed condition.
Wall, U.S. Pat. No. 5,192,307, suggests a stent having a number of holes therein and which is expandable using an angioplasty balloon so to allow ratchet devices or ledges to hold the stent in an open position once it is deployed.
Perhaps of more relevance are the patents using wire as the stent material.
Gianturco, in U.S. Pat. Nos. 4,580,568 and 5,035,706, describes stents formed of stainless steel wire arranged in a closed zigzag pattern. The stents are compressible to a reduced diameter for insertion into and removal from a body passageway. The stents appear to be introduced into the selected sites by discharge of the collapsed zigzag wire configuration from the tip of a catheter.
U.S. Pat. Nos. 4,830,003 and 5,104,404, to Wolff et al., shows a stent of a zigzag wire configuration very similar in overall impression to the Gianturco device. However, the stent is said to be self-expanding and therefore does not need the angioplasty balloon for its expansion.
Hillstead, U.S. Pat. No. 4,856,516, suggests a stent for reinforcing vessel walls made from a single elongated wire. The stent produced is cylindrical and is made up of a series of rings which are, in turn, linked together by half-hitch junctions produced from the single elongated wire.
Wiktor, U.S. Pat. Nos. 4,649,992, 4,886,062, 4,969,458, and 5,133,732, shows wire stent designs using variously a zigzag design or, in the case of Wiktor '458, a helix which winds back upon itself. Wiktor '062 suggests use of a wire component made of a low-memory metal such as copper, titanium or gold. These stents are to be implanted using a balloon and expanded radially for plastic deformation of the metal.
Wiktor '458 is similarly made of low-memory alloy and is to be plastically deformed upon its expansion on an angioplasty balloon.
Wiktor '732 teaches the use of a longitudinal wire welded to each turn of the helically wound zig-zag wire which is said to prevent the longitudinal expansion of the stent during deployment. A further variation of the described stent includes a hook in each turn of the helix which loops over a turn in an adjacent turn.
WO93/13825, to Maeda et al, shows a self-expanding stent similar to the Gianturco, Wolff, and Wiktor designs, formed of stainless steel wire, which is built into an elongated zig-zag pattern, and helically wound about a central axis to form a tubular shape interconnected with a filament. The bends of the helix each have small loops or “eyes” at their apexes which are interconnected with a filament. Because of the teaching to connect the eyes of the apexes, the stent appears to be a design that axially expands during compression and may tear attached grafts because of the relative change in position of the arms of the zig-zag during compression of the stent.
MacGregor, U.S. Pat. No. 5,015,253, shows a tubular non-woven stent made up of a pair of helical members which appear to be wound using opposite “handedness”. The stent helices desirably are joined or secured at the various points where they cross.
Pinchuk, in U.S. Pat. Nos. 5,019,090, 5,092,877, and 5,163,958, suggests a spring stent which appears to circumferentially and helically wind about as it is finally deployed except, perhaps, at the very end link of the stent. The Pinchuk '958 patent further suggests the use of a pyrolytic carbon layer on the surface of the stent to present a porous surface of improved antithrombogenic properties.
U.S. Pat. No. 5,123,917, to Lee, suggests an expandable vascular graft having a flexible cylindrical inner tubing and a number of “scaffold members” which are expandable, ring-like, and provide circumferential rigidity to the graft. The scaffold members are deployed by deforming them beyond their plastic limit using, e.g., an angioplasty balloon.
Tower, in U.S. Pat. Nos. 5,161,547 and 5,217,483, shows a stent formed from a zig-zag wire wound around a mandrel in a cylindrical fashion. It is said to be made from “a soft platinum wire which has been fully annealed to remove as much spring memory as possible.” A longitudinal wire is welded along the helically wound sections much in the same way as was the device of Wiktor.
There are a variety of disclosures in which super-elastic alloys such as nitinol are used in stents. See, U.S. Pat. Nos. 4,503,569, to Dotter; 4,512,338, to Balko et al.; 4,990,155, to Wilkoff; 5,037,427, to Harada, et al.; 5,147,370, to MacNamara et al.; 5,211,658, to Clouse; and 5,221,261, to Termin et al. None of these references suggest a device having discrete, individual, energy-storing torsional members as are required by this invention.
Jervis, in U.S. Pat. Nos. 4,665,906 and 5,067,957, describes the use of shape memory alloys having stress-induced martensite properties in medical devices which are implantable or, at least, introduced into the human body.
Stent-Grafts
A variety of stent-graft designs are shown in the following literature.
Perhaps the most widely known such device is shown in Ersek, U.S. Pat. No. 3,657,744. Ersek shows a system for deploying expandable, plastically deformable stents of metal mesh having an attached graft through the use of an expansion tool.
Palmaz describes a variety of expandable intraluminal vascular grafts in a sequence of patents: U.S. Pat. Nos. 4,733,665; 4,739,762; 4,776,337; and 5,102,417. The Palmaz '665 patent suggests grafts (which also function as stents) that are expanded using angioplasty balloons. The grafts are variously a wire mesh tube or of a plurality of thin bars fixedly secured to each other. The devices are installed, e.g., using an angioplasty balloon and consequently are not seen to be self-expanding.
The Palmaz '762 and '337 patents appear to suggest the use of thin-walled, biologically inert materials on the outer periphery of the earlier-described stents.
Finally, the Palmaz '417 patent describes the use of multiple stent sections each flexibly connected to its neighbor.
Rhodes, U.S. Pat. No. 5,122,154, shows an expandable stent-graft made to be expanded using a balloon catheter. The stent is a sequence of ring-like members formed of links spaced apart along the graft. The graft is a sleeve of a material such as expanded a polyfluorocarbon, e.g., GORETEX or IMPRAGRAFT.
Schatz, U.S. Pat. No. 5,195,984, shows an expandable intraluminal stent and graft related in concept to the Palmaz patents discussed above. Schatz discusses, in addition, the use of flexibly-connecting vascular grafts which contain several of the Palmaz stent rings to allow flexibility of the overall structure in following curving body lumen.
Cragg, “Percutaneous Femoropopliteal Graft Placement”, Radiology, vol. 187, no. 3, pp. 643-648 (1993), shows a stent-graft of a self-expanding, nitinol, zig-zag, helically wound stent having a section of polytetrafluoroethylene tubing sewed to the interior of the stent.
Cragg (European Patent Application 0,556,850) discloses an intraluminal stent made up of a continuous helix of zig-zag wire and having loops at each apex of the zig-zags. Those loops on the adjacent apexes are individually tied together to form diamond-shaped openings among the wires. The stent may be made of a metal such as nitinol (col. 3, lines 15-25 and col. 4, lines 42+) and may be associated with a “polytetrafluoroethylene (PTFE), dacron, or any other suitable biocompatible material”. Those biocompatible materials may be inside the stent (col. 3, lines 52+) or outside the stent (col. 4, lines 6+). There is no suggestion that the zig-zag wire helix be re-aligned to be “in phase” rather than tied in an apex-to-apex alignment. The alignment of the wire and the way in which it is tied mandates that it expand in length as it is expanded from its compressed form.
Grafts
As was noted above, the use of grafts in alleviating a variety of vascular conditions is well known. Included in such known grafting designs and procedures are the following.
Medell, U.S. Pat. No. 3,479,670, discloses a tubular prothesis adapted to be placed permanently in the human body. It is made of framework or support of a synthetic fiber such as DACRON or TEFLON. The tube is said to be made more resistant to collapse by fusing a helix of a polypropylene monofilament to its exterior. The reinforced fabric tube is then coated with a layer of collagen or gelatin to render the tubing (to be used as an esophageal graft) impermeable to bacteria or fluids.
Sparks, in U.S. Pat. Nos. 3,514,791, 3,625,198, 3,710,777, 3,866,247, and 3,866,609, teach procedures for the production of various graft structures using dies of suitable shape and a cloth reinforcing material within the die. The die and reinforcement are used to grow a graft structure using a patient's own tissues. The die is implanted within the human body for a period of time to allow the graft to be produced. The graft is in harvested and implanted in another site in the patient's body by a second surgical procedure.
Braun, in U.S. Pat. No. 3,562,820, shows a biological prosthesis manufactured by applying onto a support of a biological tissue (such as serosa taken from cattle intestine) a collagen fiber paste. The procedure is repeated using multiple layers of biological tissue and collagen fiber paste until a multi-layer structure of the desired wall thicknesses is produced. The prosthesis is then dried and removed prior to use.
Dardik et al, U.S. Pat. No. 3,974,526, shows a procedure for producing tubular prostheses for use in vascular reconstructive surgeries. The prosthesis is made from the umbilical cord of a newly born infant. It is washed with a solution of 1 percent hydrogen peroxide and rinsed with Ringer's lactate solution. It is then immersed in a hyaluronidase solution to dissolve the hyaluronic acid coating found in the umbilical cord. The vessels are then separated from the cord and their natural interior valving removed by use of a tapered mandrel. The vessels are then tanned with glutaraldehyde. A polyester mesh support is applied to the graft for added support and strength.
Whalen, U.S. Pat. No. 4,130,904, shows a prosthetic blood conduit having two concentrically associated tubes with a helical spring between them. Curved sections in the tube walls help prevent kinking of the tube.
Ketharanathan, U.S. Pat. No. 4,319,363, shows a procedure for producing a vascular prosthesis suitable for use as a surgical graft. The prosthesis is produced by implanting a rod or tube in a living host and allowing collagenous tissue to grow on the rod or tube in the form of coherent tubular wall. The collagenous implant is removed from the rod or tube and tanned in glutaraldehyde. The prosthesis is then ready for use.
Bell, U.S. Pat. No. 4,546,500, teaches a method for making a vessel prosthesis by incorporating a contractile agent such as smooth muscle cells or platelets into a collagen lattice and contracting the lattice around a inner core. After the structure has set, additional layers are applied in a similar fashion. A plastic mesh sleeve is desirably sandwiched between the layers or imbedded within the structure to provide some measure of elasticity.
Hoffman Jr. et al, U.S. Pat. No. 4,842,575, shows a collagen impregnated synthetic vascular graft. It is made of a synthetic graft substrate and a cross-linked collagen fibril. It is formed by depositing a aqueous slurry of collagen fibrils into the lumen of the graft and massaging the slurry into the pore structure of the substrate to assure intimate admixture in the interior. Repeated applications and massaging and drying is said further to reduce the porosity of the graft.
Alonoso, U.S. Pat. No. 5,037,377, is similar in overall content to the Hoffman Jr. et al patent discussed above except that, in addition to collagen fibers, soluble collagen is introduced into the fabric. A suitable cross-linking agent such as glutaraldehyde is used to bond adjacent collagen fibers to each other.
Slepian et al, U.S. Pat. No. 5,213,580, teaches a process described as “paving” or “stabilizing by sealing the interior surface of a body vessel or organ” by applying a biodegradable polymer such as a polycaprolactone. The polymer is made into a tubular substrate, placed in position, and patched into place.
Finally, there are known vascular grafts using collagenous tissue with reinforcing structure. For instance, Pinchuk, in U.S. Pat. Nos. 4,629,458 and 4,798,606, suggests the use of collagen with some other type of fibrous structure supporting the collagen as a biograft. Similarly, Sinofsky et al., U.S. Pat. No. 5,100,429, suggests a partially-cured, collagen-based material used to form a graft within a blood vessel.
Kreamer, U.S. Pat. No. 4,740,207, suggests a intraluminal graft made of a semi-rigid resilient tube, open along a seam extending from one end to the other, which is expanded within the vessel and which resulting larger diameter is maintained by use of a ledge at the longitudinal seam for catching the opposite side of the seam on the expanded graft.
The use of expanded polyfluorocarbons in vascular devices is shown in British patent Nos. 1,506,432, and 1,567,122, which patents show in particular blood vessel linings of the material.
None of the cited references suggest a stent-graft similar to that described herein.
This invention is a foldable stent-graft which may be percutaneously delivered through or over a catheter, typically an endovascular catheter, or using surgical techniques or other appropriate methodologies.
The incorporated expandable stent structure utilizes torsional regions which allow it to be folded to a very small diameter prior to deployment. Preferably, the torsional members have an undulating shape which may be helically wound to form the stent's cylindrical shape. The undulating shape may be aligned to allow the undulations in adjacent turns of the helix to be in phase. Adjacent undulating shapes may be held in the phased relationship using a flexible linkage, often made of a polymeric material. In the helically wound variation of the invention, the undulating torsional members do not have any means at (or near) the apex of the undulating shapes which would tend to constrict the movement of the flexible linkage during compression or bending of the stent. The stent is preferably made of a highly flexible, superelastic alloy such as nitinol, but may be of any suitable elastic material such as various of the medically accepted stainless steels. The stent structure may also be of a series of rings incorporating the torsional members which rings may be axially linked.
The graft component used to complement the stent is typically tubular, placed within the stent, and may be made of a polymeric material which may be attached variously to the filament used to maintain the shape of the stent structure, when such filament is used, or to the stent structure itself. Preferably, the graft component is a biocompatible, expanded polyfluoroethylene polymer. The attachment between the graft component and the stent, e.g., by bonding the graft component to the flexible linkage or by using eyelets or other discrete or continuous linking sites, is carefully crafted to allow the stent torsional members to slide longitudinally with respect to each other and to the graft component and so maintain the interior shape of graft. This is to say that the graft component is supported at a variety of sites located along its outer surface. Bending the stent-graft combination distributes the flexing movement of the graft over a long region because of the distributed support of the stent. The tendency of the graft component to kink in a single site is minimized and the resultant flexing is observed to take place in a collection of smaller non-kinking bends located among the tie points to the stent or the stent's filament.
The stent-graft may be used to reinforce vascular irregularities and provide a smooth interior vascular surface, particularly within smaller vessels.
As was noted above, this invention is an expandable stent-graft and a method of using it. The stent-graft is a combination of several components: first, a thin-walled tube forming the graft component which graft component is generally coaxial to and within the stent and, second, the expandable stent structure. The graft material may optionally contain a fibrous reinforcement material. The expandable stent structure is a cylindrical body produced either of a helically placed (wound or otherwise preformed) torsion member having an undulating or serpentine shape or a series of axially situated rings comprising those torsion members. When the undulating torsion member is formed into the cylinder, the undulations may be aligned so that they are “in phase” with each other. The helically wound undulations are desirably linked, typically with a flexible linkage of a suitable polymeric or metallic material, to maintain the phased relationship of the undulations during compression and deployment and during bending of the stent. These stent configurations are exceptionally kink-resistant and flexible, particularly when flexed along the longitudinal axis of the stent.
Central to the invention is the distributed attachment of the stent component to the graft component via, e.g., the bonding of the graft to the filament which may used to maintain the stent in its tubular shape or via bonding to other loops, eyelets, or fasteners associated with or adhering to the stent component.
The stent-graft may be delivered percutaneously, typically through the vasculature, after having been folded to a reduced diameter. Once reaching the intended delivery site, it is expanded to form lining on the vessel wall.
Stent Component
Our stent is constructed of a reasonably high strength material, i.e., one which is resistant to plastic deformation when stressed. The structure is typically from one of three sources:
A percutaneously delivered stent-graft must expand from a reduced diameter, necessary for delivery, to a larger deployed diameter. The diameters of these devices obviously vary with the size of the body lumen into which they are placed. For instance, the stents of this invention may range in size (for neurological applications) from 2.0 mm in diameter to 30 mm in diameter (for placement in the aorta). A range of about 2.0 mm to 6.5 mm (perhaps to 10.0 mm) is believed to be desirable. Typically, expansion ratios of 2:1 or more are required. These stents are capable of expansion ratios of up to 5:1 for larger diameter stents. Typical expansion ratios for use with the stents-grafts of the invention typically are in the range of about 2:1 to about 4:1 although the invention is not so limited. The thickness of the stent materials obviously varies with the size (or diameter) of the stent and the ultimate required yield strength of the folded stent. These values are further dependent upon the selected materials of construction. Wire used in these variations are typically of stronger alloys, e.g., nitinol and stronger spring stainless steels, and have diameters of about 0.002 inches to 0.005 inches. For the larger stents, the appropriate diameter for the stent wire may be somewhat larger, e.g., 0.005 to 0.020 inches. For flat stock metallic stents, thicknesses of about 0.002 inches to 0.005 inches is usually sufficient. For the larger stents, the appropriate thickness for the stent flat stock may be somewhat thicker, e.g., 0.005 to 0.020 inches.
The stent-graft is fabricated in the expanded configuration. In order to reduce its diameter for delivery the stent-graft would be folded along its length, similar to the way in which a PCTA balloon would be folded. It is desirable, when using super-elastic alloys which are also have temperature-memory characteristics, to reduce the diameter of the stent at a temperature below the transition-temperature of the alloys. Often the phase of the alloy at the lower temperature is somewhat more workable and easily formed. The temperature of deployment is desirably above the transition temperature to allow use of the super-elastic properties of the alloy.
As a generic explanation of the mechanical theory of a stent suitable for use in this invention, reference is made to
Generically speaking, the stents of this invention use undulating torsion members which are “open” or “unconfined” at their apex or end member (104). By “open” or “unconfined” we mean that the apex or end member (104) does not have any means in that apex which would tend to inhibit the movement of the flexible linkage (discussed below) down between the arms or torsion lengths (106) of the torsion pair (102).
The configurations shown in
As ultimately deployed, a section of the torsion member found on one of
The scope of materials for the filament (124), graft component (134), and loops (136) will be discussed in detail below.
The stent support structure may also be made by forming a desired structural pattern out of a flat sheet. The sheet may then be rolled to form a tube.
The stent shown in
As ultimately deployed, a roll of the sheet found in
It should be clear that a variety of materials variously metallic, super elastic alloys, and preferably nitinol, are suitable for use in these stents. Primary requirements of the materials are that they be suitably springy even when fashioned into very thin sheets or small diameter wires. Various stainless steels which have been physically, chemically, and otherwise treated to produce high springiness are suitable as are other metal alloys such as cobalt chrome alloys (e.g., ELGILOY), platinum/tungsten alloys, and especially the nickel-titanium alloys generically known as “nitinol”.
Nitinol is especially preferred because of its “super-elastic” or “pseudo-elastic” shape recovery properties, i.e., the ability to withstand a significant amount of bending and flexing and yet return to its original form without deformation. These metals are characterized by their ability to be transformed from an austenitic crystal structure to a stress-induced martensitic structure at certain temperatures, and to return elastically to the austenitic shape when the stress is released. These alternating crystalline structures provide the alloy with its super-elastic properties. These alloys are well known but are described in U.S. Pat. Nos. 3,174,851, 3,351,463, and 3,753,700. Typically, nitinol will be nominally 50.6% (±0.2%) Ni with the remainder Ti. Commercially available nitinol materials usually will be sequentially mixed, cast, formed, and separately cold-worked to 30-40%, annealed, and stretched. Nominal ultimate yield strength values for commercial nitinol are in the range of 30 psi and for Young's modulus are about 700 Kbar.
The '700 patent describes an alloy containing a higher iron content and consequently has a higher modulus than the Ni—Ti alloys.
Nitinol is further suitable because it has a relatively high strength to volume ratio. This allows the torsion members to be shorter than for less elastic metals. The flexibility of the stent-graft is largely dictated by the length of the torsion member components in the stent structural component. The shorter the pitch of the device, the more flexible the stent-graft structure can be made. Materials other than nitinol are suitable. Spring tempered stainless steels and cobalt-chromium alloys such as ELGILOY are also suitable as are a wide variety of other known “super-elastic” alloys.
Although nitinol is preferred in this service because of its physical properties and its significant history in implantable medical devices, we also consider it also to be useful in a stent because of its overall suitability with magnetic resonance imaging (MRI) technology. Many other alloys, particularly those based on iron, are an anathema to the practice of MRI causing exceptionally poor images in the region of the alloy implant. Nitinol does not cause such problems.
Other materials suitable as the stent include certain polymeric materials, particularly engineering plastics such as thermotropic liquid crystal polymers (“LCP's”). These polymers are high molecular weight materials which can exist in a so-called “liquid crystalline state” where the material has some of the properties of a liquid (in that it can flow) but retains the long range molecular order of a crystal. The term “thermotropic” refers to the class of LCP's which are formed by temperature adjustment. LCP's may be prepared from monomers such as p,p′-dihydroxy-polynuclear-aromatics or dicarboxy-polynuclear-aromatics. The LCP's are easily formed and retain the necessary interpolymer attraction at room temperature to act as high strength plastic artifacts as are needed as a foldable stent. They are particularly suitable when augmented or filled with fibers such as those of the metals or alloys discussed below. It is to be noted that the fibers need not be linear but may have some preforming such as corrugations which add to the physical torsion enhancing abilities of the composite.
The flexible linkage between adjacent turns of the helix (124 in
As will be discussed below, the material chosen for the linkage or the loops is preferably of a material which can be bonded to the graft liner in a distributed sequence of points along the outside surface of the graft liner. By bonding the liner to the linkage or the loops in such fashion, the flexibility and resistance to kinking of the stent is maintained in the resulting stent-graft. To state the central concept of the invention in another way, the graft component is to be distributively attached to the stent structure at a number of sites. The attachments should allow some movement between the graft component and the stent at the attachment points. This may be accomplished by causing adherence of the graft independently to at least some of the linkage, to the loops, or to one or the other. Other structural attachments may be used to meet the functional requirements recited here.
Tubular Component Materials
The tubular component or graft member of the stent-graft may be made up of any material which is suitable for use as a graft in the chosen body lumen. Many graft materials are known, particularly known are those used as vascular graft materials. For instance, natural materials such as collagen may be introduced onto the inner surface of the stent and fastened into place. Desirable collagen-based materials include those described in U.S. Pat. No. 5,162,430, to Rhee et al, and WO 94/01483 (PCT/US93/06292), the entirety of which are incorporated by reference. Synthetic polymers such as polyethylene, polypropylene, polyurethane, polyglycolic acid, polyesters, polyamides, their mixtures, blends, copolymers, mixtures, blends and copolymers are suitable; preferred of this class are polyesters such as polyethylene terephthalate including DACRON and MYLAR and polyaramids such as KEVLAR, polyfluorocarbons such as polytetrafluoroethylene with and without copolymerized hexafluoropropylene (TEFLON or GORETEX), and porous or nonporous polyurethanes. Especially preferred in this invention are the expanded fluorocarbon polymers (especially PTFE) materials described in British. Pat. Nos. 1,355,373, 1,506,432, or 1,506,432 or in U.S. Pat. Nos. 3,953,566, 4,187,390, or 5,276,276, the entirety of which are incorporated by reference.
Included in the class of preferred expanded fluoropolymers are polytetrafluoroethylene (PTFE), fluorinated ethylene propylene (FEP), copolymers of tetrafluoroethylene (TFE) and per fluoro(propyl vinyl ether) (PFA), homopolymers of polychlorotrifluoroethylene (PCTFE), and its copolymers with TFE, ethylene-chlorotrifluoroethylene (ECTFE), copolymers of ethylene-tetrafluoroethylene (ETFE), polyvinylidene fluoride (PVDF), and polyvinyfluoride (PVF). Especially preferred, because of its widespread use in vascular prostheses, is expanded PTFE.
In addition, one or more radio-opaque metallic fibers, such as gold, platinum, platinum-tungsten, palladium, platinum-iridium, rhodium, tantalum, or alloys or composites of these metals like may be incorporated into the device, particularly, into the graft, to allow fluoroscopic visualization of the device.
The tubular component may also be reinforced using a network of small diameter fibers. The fibers may be random, braided, knitted, or woven. The fibers may be imbedded in the tubular component, may be placed in a separate layer coaxial with the tubular component, or may be used in a combination of the two.
Production of the Stent-Graft
The preferred method of constructing the stent-graft is to first construct the stent incorporating a filamentary linkage of the type discussed above and then to place the tubular component inside the stent. The tubular component is then expanded using a mandrel or the like and heated to allow the materials of the filamentary linkage and the tubular graft component to merge and self-bind.
Loops may be molded into or glued onto the graft component and later attached to the stent or linkage or the loops may be independently introduced and tied onto the stent structure.
Deployment of the Invention
When a stent-graft having torsion members is folded, crushed, or otherwise collapsed, mechanical energy is stored in torsion in those torsion members. In this loaded state, the torsion members have a torque exerted about them and consequently have a tendency to untwist. Collectively, the torque exerted by the torsion members as folded down to a reduced diameter must be restrained from springing open. The stent typically has at least one torsion member per fold to take advantage of the invention. The stent-graft is folded along its longitudinal axis and restrained from springing open. The stent-graft is then deployed by removing the restraining mechanism, thus allowing the torsion members to spring open against the vessel wall.
The attending physician will choose a stent or stent-graft having an appropriate diameter. However, inventive devices of this type are typically selected having an expanded diameter of up to about 10% greater than the diameter of the lumen to be the site of the stent deployment.
The stent-graft may be tracked through the vasculature to the intended deployment site and then unfolded against the vessel lumen. The graft tube component of the stent-graft is flexible and easy to fold. Folding or otherwise collapsing the stent structure allows it to return to a circular, open configuration.
Other methods of deployment are suitable for use with this device and are described in U.S. patent application Ser. Nos. 07/927,165 and 07/965,973, the entirety of which are incorporated by reference.
Many alterations and modifications may be made by those of ordinary skill in the art without departing from the spirit and scope of the invention. The illustrated embodiments have been shown only for purposes of clarity and examples, and should not be taken as limiting the invention as defined by the following claims, which include all equivalents, whether now or later devised.
This is a continuation application under 37 C.F.R. §1.53(b) of U.S. application Ser. No. 08/903,210, filed Jul. 21, 1997, now U.S. Pat. No. 6,517,570, issued on Feb. 11, 2003, which is a continuation of U.S. application Ser. No. 08/740,030 filed Oct. 23, 1996 (abandoned), which is a continuation application of U.S. patent application Ser. No. 08/299,190 filed Aug. 31, 1994 (abandoned).
Number | Name | Date | Kind |
---|---|---|---|
2638093 | Kulick | May 1953 | A |
3029819 | Starks | Apr 1962 | A |
3096560 | Liebig | Jul 1963 | A |
3142067 | Liebig | Jul 1964 | A |
3152618 | Rothermal et al. | Oct 1964 | A |
3174851 | Buehur et al. | Mar 1965 | A |
3351463 | Rozner et al. | Nov 1967 | A |
3479670 | Medell | Nov 1969 | A |
3514791 | Sparks | Jun 1970 | A |
3562820 | Braun | Feb 1971 | A |
3625198 | Sparks | Dec 1971 | A |
3657744 | Ersek | Apr 1972 | A |
3710777 | Sparks | Jan 1973 | A |
3753700 | Harrison et al. | Aug 1973 | A |
3774596 | Cook | Nov 1973 | A |
3805301 | Liebig | Apr 1974 | A |
3866247 | Sparks | Feb 1975 | A |
3866609 | Sparks | Feb 1975 | A |
3868956 | Alfidi et al. | Mar 1975 | A |
3927422 | Sawyer | Dec 1975 | A |
3938524 | Sparks et al. | Feb 1976 | A |
3949073 | Daniels et al. | Apr 1976 | A |
3953566 | Gore | Apr 1976 | A |
3974526 | Dardik et al. | Aug 1976 | A |
3993045 | Ion | Nov 1976 | A |
4011861 | Enger | Mar 1977 | A |
4047252 | Liebig et al. | Sep 1977 | A |
4112177 | Salditt et al. | Sep 1978 | A |
4118806 | Porier et al. | Oct 1978 | A |
4130904 | Whalen | Dec 1978 | A |
4140126 | Choudhury | Feb 1979 | A |
4164045 | Bokros et al. | Aug 1979 | A |
4187390 | Gore | Feb 1980 | A |
4300244 | Bokros | Nov 1981 | A |
4306318 | Mano et al. | Dec 1981 | A |
4319363 | Ketharanathan | Mar 1982 | A |
4355426 | MacGregor | Oct 1982 | A |
4411655 | Schreck | Oct 1983 | A |
4424208 | Wallace et al. | Jan 1984 | A |
4425908 | Simon | Jan 1984 | A |
4488911 | Luck et al. | Dec 1984 | A |
4494531 | Gianturco | Jan 1985 | A |
4502159 | Woodroof et al. | Mar 1985 | A |
4503569 | Dotter | Mar 1985 | A |
4512338 | Balko et al. | Apr 1985 | A |
4517687 | Liebig et al. | May 1985 | A |
4530113 | Matterson | Jul 1985 | A |
4546500 | Bell | Oct 1985 | A |
4553545 | Maass et al. | Nov 1985 | A |
4557764 | Chu | Dec 1985 | A |
4562596 | Kornberg | Jan 1986 | A |
4580568 | Gianturco | Apr 1986 | A |
4582640 | Smestad et al. | Apr 1986 | A |
4592754 | Gupte et al. | Jun 1986 | A |
4604762 | Robinson | Aug 1986 | A |
4617932 | Kornberg | Oct 1986 | A |
4629458 | Pinchuk | Dec 1986 | A |
4641653 | Rockey | Feb 1987 | A |
4642117 | Nguyen et al. | Feb 1987 | A |
4647416 | Seiler, Jr. et al. | Mar 1987 | A |
4649922 | Wiktor | Mar 1987 | A |
4655771 | Wallsten | Apr 1987 | A |
4665906 | Jervis | May 1987 | A |
4689399 | Chu | Aug 1987 | A |
4728328 | Hughes et al. | Mar 1988 | A |
4733665 | Palmaz | Mar 1988 | A |
4738666 | Fuqua | Apr 1988 | A |
4739762 | Palmaz | Apr 1988 | A |
4740207 | Kreamer | Apr 1988 | A |
4760849 | Kropf | Aug 1988 | A |
4776337 | Palmaz | Oct 1988 | A |
4787899 | Lazarus | Nov 1988 | A |
4790313 | Borrelly | Dec 1988 | A |
4795458 | Regan | Jan 1989 | A |
4798606 | Pinchuk | Jan 1989 | A |
4800882 | Gianturco | Jan 1989 | A |
4816028 | Kapadia et al. | Mar 1989 | A |
4816339 | Tu et al. | Mar 1989 | A |
4820298 | Leveen et al. | Apr 1989 | A |
4830003 | Wolff et al. | May 1989 | A |
4842575 | Hoffman, Jr. et al. | Jun 1989 | A |
4856516 | Hillstead | Aug 1989 | A |
4877025 | Hanson | Oct 1989 | A |
4878906 | Lindemann et al. | Nov 1989 | A |
4886062 | Wiktor | Dec 1989 | A |
4886500 | Lazarus | Dec 1989 | A |
4892539 | Koch | Jan 1990 | A |
4913141 | Hillstead | Apr 1990 | A |
4921479 | Grayzel | May 1990 | A |
4941870 | Okada et al. | Jul 1990 | A |
4948860 | Solomon et al. | Aug 1990 | A |
4950227 | Savin et al. | Aug 1990 | A |
4955899 | Della Corna et al. | Sep 1990 | A |
4957504 | Chardack | Sep 1990 | A |
4957508 | Kaneko et al. | Sep 1990 | A |
4969458 | Wiktor | Nov 1990 | A |
4990151 | Wallsten | Feb 1991 | A |
4990155 | Wilkoff | Feb 1991 | A |
4994071 | MacGregor | Feb 1991 | A |
5007926 | Derbyshire | Apr 1991 | A |
5015253 | MacGregor | May 1991 | A |
5019085 | Hillstead | May 1991 | A |
5019090 | Pinchuk | May 1991 | A |
5035706 | Giantureo et al. | Jul 1991 | A |
5037377 | Alonso | Aug 1991 | A |
5037392 | Hillstead | Aug 1991 | A |
5037427 | Harada et al. | Aug 1991 | A |
5041126 | Gianturco | Aug 1991 | A |
5042161 | Hodge | Aug 1991 | A |
5064435 | Porter | Nov 1991 | A |
5066298 | Hess | Nov 1991 | A |
5067957 | Jervis | Nov 1991 | A |
5078726 | Kreamer | Jan 1992 | A |
5092877 | Pinchuk | Mar 1992 | A |
5100429 | Sinofsky et al. | Mar 1992 | A |
5102417 | Palmaz | Apr 1992 | A |
5104404 | Wolff | Apr 1992 | A |
5108424 | Hoffman, Jr. et al. | Apr 1992 | A |
5122154 | Rhodes | Jun 1992 | A |
5123917 | Lee | Jun 1992 | A |
5127919 | Ibrahim et al. | Jul 1992 | A |
5133732 | Wiktor | Jul 1992 | A |
5139480 | Hickle et al. | Aug 1992 | A |
5147370 | McNamara et al. | Sep 1992 | A |
5151105 | Kwan-Gett | Sep 1992 | A |
5156619 | Ehrenfeld | Oct 1992 | A |
5161547 | Tower | Nov 1992 | A |
5162430 | Rhee et al. | Nov 1992 | A |
5163958 | Pinchuk | Nov 1992 | A |
5171262 | MacGregor | Dec 1992 | A |
5178630 | Schmitt | Jan 1993 | A |
5192289 | Jessen | Mar 1993 | A |
5192307 | Wall | Mar 1993 | A |
5195984 | Schatz | Mar 1993 | A |
5197977 | Hoffman, Jr. et al. | Mar 1993 | A |
5197978 | Hess | Mar 1993 | A |
5201757 | Heyn et al. | Apr 1993 | A |
5209735 | Lazarus | May 1993 | A |
5211658 | Clouse | May 1993 | A |
5213580 | Slepian et al. | May 1993 | A |
5217483 | Tower | Jun 1993 | A |
5221261 | Termin et al. | Jun 1993 | A |
5226913 | Pinchuk | Jul 1993 | A |
5232446 | Arney | Aug 1993 | A |
5236447 | Kubo et al. | Aug 1993 | A |
5242451 | Harada et al. | Sep 1993 | A |
5246452 | Sinnott | Sep 1993 | A |
5258042 | Mehta | Nov 1993 | A |
5264276 | McGregor et al. | Nov 1993 | A |
5271410 | Wolzinger et al. | Dec 1993 | A |
4733665 | Palmaz | Jan 1994 | B1 |
5275622 | Lazarus | Jan 1994 | A |
5276276 | Gunn | Jan 1994 | A |
5282823 | Schwartz et al. | Feb 1994 | A |
5282824 | Gianturco | Feb 1994 | A |
5282846 | Schmitt | Feb 1994 | A |
5282847 | Trescony et al. | Feb 1994 | A |
5282848 | Schmitt | Feb 1994 | A |
5290305 | Inoue | Mar 1994 | A |
5306261 | Alliger et al. | Apr 1994 | A |
5306294 | Wnston et al. | Apr 1994 | A |
5314472 | Fontaine | May 1994 | A |
5324304 | Rasmussen | Jun 1994 | A |
5324323 | Bui | Jun 1994 | A |
5330528 | Lazim | Jul 1994 | A |
5336254 | Brennen et al. | Aug 1994 | A |
5342348 | Kaplan | Aug 1994 | A |
5342387 | Summers | Aug 1994 | A |
5344426 | Lau et al. | Sep 1994 | A |
5348537 | Wiesner et al. | Sep 1994 | A |
5354308 | Simon et al. | Oct 1994 | A |
5354309 | Schnepp-Pesch et al. | Oct 1994 | A |
5356423 | Tihon et al. | Oct 1994 | A |
5360443 | Barone et al. | Nov 1994 | A |
5366472 | Hillstead | Nov 1994 | A |
5366473 | Winston et al. | Nov 1994 | A |
5366504 | Andersen et al. | Nov 1994 | A |
5370683 | Fontaine | Dec 1994 | A |
5370691 | Samson | Dec 1994 | A |
5372600 | Beyar | Dec 1994 | A |
5382261 | Palmaz | Jan 1995 | A |
5383928 | Scott et al. | Jan 1995 | A |
5385580 | Schmitt | Jan 1995 | A |
5387235 | Chuter | Feb 1995 | A |
5389106 | Tower | Feb 1995 | A |
5405377 | Cragg | Apr 1995 | A |
5405378 | Strecker | Apr 1995 | A |
5413598 | Moreland | May 1995 | A |
5421955 | Lau et al. | Jun 1995 | A |
5423849 | Eugelson et al. | Jun 1995 | A |
5425710 | Kahir et al. | Jun 1995 | A |
5425739 | Jessen | Jun 1995 | A |
5443500 | Sigwart | Aug 1995 | A |
5449373 | Pinchasik et al. | Sep 1995 | A |
5453084 | Moses | Sep 1995 | A |
5456713 | Chuter | Oct 1995 | A |
5456721 | Legrand | Oct 1995 | A |
5458605 | Klemm | Oct 1995 | A |
5458615 | Klemm et al. | Oct 1995 | A |
5464449 | Ryan et al. | Nov 1995 | A |
5476506 | Lunn | Dec 1995 | A |
5480423 | Ravenscroft et al. | Jan 1996 | A |
5484444 | Braunschweiler | Jan 1996 | A |
5484449 | Amundson et al. | Jan 1996 | A |
5487858 | Schmitt | Jan 1996 | A |
5489295 | Piplani et al. | Feb 1996 | A |
5496364 | Schmitt | Mar 1996 | A |
5496365 | Sgro | Mar 1996 | A |
5499994 | Tihon et al. | Mar 1996 | A |
5507767 | Maeda et al. | Apr 1996 | A |
5507769 | Marin et al. | Apr 1996 | A |
5507771 | Gianturco | Apr 1996 | A |
5509902 | Raulerson | Apr 1996 | A |
5509931 | Schmitt | Apr 1996 | A |
5514154 | Lau et al. | May 1996 | A |
5522822 | Phelps et al. | Jun 1996 | A |
5522880 | Barone et al. | Jun 1996 | A |
5522881 | Lentz | Jun 1996 | A |
5522961 | Leonhardt | Jun 1996 | A |
5540701 | Sharkey et al. | Jul 1996 | A |
5540712 | Kleshinski et al. | Jul 1996 | A |
5545210 | Hess et al. | Aug 1996 | A |
5545211 | An et al. | Aug 1996 | A |
5549635 | Solar | Aug 1996 | A |
5549663 | Cottone, Jr. | Aug 1996 | A |
5554180 | Turk | Sep 1996 | A |
5554181 | Das | Sep 1996 | A |
5554182 | Dinh et al. | Sep 1996 | A |
5556413 | Lam | Sep 1996 | A |
5562724 | Vorwerk et al. | Oct 1996 | A |
5562726 | Chuter | Oct 1996 | A |
5562727 | Turk et al. | Oct 1996 | A |
5571166 | Dinh et al. | Nov 1996 | A |
5571169 | Plaia et al. | Nov 1996 | A |
5571172 | Chin | Nov 1996 | A |
5571173 | Parodi | Nov 1996 | A |
5571176 | Taheri | Nov 1996 | A |
5575815 | Slepian et al. | Nov 1996 | A |
5575817 | Martin | Nov 1996 | A |
5578071 | Parodi | Nov 1996 | A |
5591198 | Boyle et al. | Jan 1997 | A |
5591228 | Edoga | Jan 1997 | A |
5591229 | Parodi | Jan 1997 | A |
5599305 | Hermann et al. | Feb 1997 | A |
5607444 | Lam | Mar 1997 | A |
5607445 | Summers | Mar 1997 | A |
5609625 | Piplani et al. | Mar 1997 | A |
5609627 | Goicoechea et al. | Mar 1997 | A |
5620763 | House et al. | Apr 1997 | A |
5622188 | Plaia et al. | Apr 1997 | A |
5626561 | Butler et al. | May 1997 | A |
5628783 | Quiachon et al. | May 1997 | A |
5628784 | Strecker | May 1997 | A |
5628788 | Pinchuk | May 1997 | A |
5630840 | Mayer | May 1997 | A |
5632763 | Glastra | May 1997 | A |
5632772 | Alcime et al. | May 1997 | A |
5637113 | Tartaglia et al. | Jun 1997 | A |
5639278 | Dereume et al. | Jun 1997 | A |
5643208 | Parodi | Jul 1997 | A |
5647380 | Campbell et al. | Jul 1997 | A |
5649978 | Samson | Jul 1997 | A |
5653743 | Martin | Aug 1997 | A |
5653748 | Strecker | Aug 1997 | A |
5662614 | Edoga | Sep 1997 | A |
5662675 | Polanskyj Stockert et al. | Sep 1997 | A |
5662701 | Plaia et al. | Sep 1997 | A |
5666117 | Rhodes | Sep 1997 | A |
5667523 | Bynon et al. | Sep 1997 | A |
5669924 | Shaknovich | Sep 1997 | A |
5669930 | Igarashi | Sep 1997 | A |
5674276 | Andersen et al. | Oct 1997 | A |
5676671 | Inoue | Oct 1997 | A |
5676696 | Marcade | Oct 1997 | A |
5676697 | McDonald | Oct 1997 | A |
5681346 | Orth et al. | Oct 1997 | A |
5683449 | Marcade | Nov 1997 | A |
5683450 | Goicoechea et al. | Nov 1997 | A |
5683451 | Lenker et al. | Nov 1997 | A |
5683452 | Barone et al. | Nov 1997 | A |
5693084 | Chuter | Dec 1997 | A |
5693085 | Buirge et al. | Dec 1997 | A |
5693086 | Goicoechea et al. | Dec 1997 | A |
5693087 | Parodi | Dec 1997 | A |
5693088 | Lazarus | Dec 1997 | A |
5695517 | Marin et al. | Dec 1997 | A |
5697970 | Schmitt et al. | Dec 1997 | A |
5700285 | Myers et al. | Dec 1997 | A |
5700286 | Tartaglia | Dec 1997 | A |
5709657 | Zimmon | Jan 1998 | A |
5713917 | Leonhardt et al. | Feb 1998 | A |
5716365 | Goicoechea et al. | Feb 1998 | A |
5718724 | Goicoechea et al. | Feb 1998 | A |
5718973 | Lewis et al. | Feb 1998 | A |
5720776 | Chuter et al. | Feb 1998 | A |
5723003 | Winston et al. | Mar 1998 | A |
5723004 | Dereume et al. | Mar 1998 | A |
5728131 | Frantzen et al. | Mar 1998 | A |
5728150 | McDonald et al. | Mar 1998 | A |
5730698 | Fischell et al. | Mar 1998 | A |
5732572 | Litton | Mar 1998 | A |
5735892 | Myers et al. | Apr 1998 | A |
5741274 | Lenker et al. | Apr 1998 | A |
5741325 | Chaikof et al. | Apr 1998 | A |
5749825 | Fischell et al. | May 1998 | A |
5749880 | Banas et al. | May 1998 | A |
5749921 | Lenker et al. | May 1998 | A |
5755769 | Richard et al. | May 1998 | A |
5769882 | Fogarty et al. | Jun 1998 | A |
5779732 | Amundson | Jul 1998 | A |
5800521 | Orth | Sep 1998 | A |
5800522 | Campbell et al. | Sep 1998 | A |
5800524 | Borghi | Sep 1998 | A |
5810870 | Myers et al. | Sep 1998 | A |
5824041 | Lenker et al. | Oct 1998 | A |
5840190 | Scholander et al. | Nov 1998 | A |
5843069 | Butler et al. | Dec 1998 | A |
5843166 | Lentz et al. | Dec 1998 | A |
5843171 | Campbell et al. | Dec 1998 | A |
5865723 | Love | Feb 1999 | A |
5868704 | Campbell et al. | Feb 1999 | A |
5873906 | Lau et al. | Feb 1999 | A |
5876432 | Lau et al. | Mar 1999 | A |
5888243 | Silvestrini | Mar 1999 | A |
5919225 | Lau et al. | Jul 1999 | A |
5925061 | Ogi et al. | Jul 1999 | A |
5925075 | Myers et al. | Jul 1999 | A |
5935161 | Robinson et al. | Aug 1999 | A |
5961546 | Robinson et al. | Oct 1999 | A |
5972441 | Campbell et al. | Oct 1999 | A |
5976650 | Campbell et al. | Nov 1999 | A |
5993489 | Lewis et al. | Nov 1999 | A |
6001123 | Lau | Dec 1999 | A |
6015429 | Lau et al. | Jan 2000 | A |
6015431 | Thornton et al. | Jan 2000 | A |
6017362 | Lau | Jan 2000 | A |
6019787 | Richard et al. | Feb 2000 | A |
6019788 | Butters et al. | Feb 2000 | A |
6025044 | Campbell et al. | Feb 2000 | A |
6027779 | Campbell et al. | Feb 2000 | A |
6027811 | Campbell et al. | Feb 2000 | A |
6042605 | Martin et al. | Mar 2000 | A |
6048484 | House et al. | Apr 2000 | A |
6086604 | Fischell et al. | Jul 2000 | A |
6098630 | Papazoglou | Aug 2000 | A |
6120477 | Campbell et al. | Sep 2000 | A |
6139572 | Campbell et al. | Oct 2000 | A |
6159565 | Campbell et al. | Dec 2000 | A |
6165210 | Lau et al. | Dec 2000 | A |
6193745 | Fogarty et al. | Feb 2001 | B1 |
6203568 | Lombardi et al. | Mar 2001 | B1 |
6331188 | Lau et al. | Dec 2001 | B1 |
6336937 | Vonesh et al. | Jan 2002 | B1 |
6357104 | Myers | Mar 2002 | B1 |
6361637 | Martin et al. | Mar 2002 | B2 |
6517570 | Lau et al. | Feb 2003 | B1 |
6517571 | Brauker et al. | Feb 2003 | B1 |
6613072 | Lau et al. | Sep 2003 | B2 |
6673102 | Vonesh et al. | Jan 2004 | B1 |
6692521 | Pinchasik | Feb 2004 | B2 |
20020004676 | Wallace et al. | Jan 2002 | A1 |
20020029077 | Leopold et al. | Mar 2002 | A1 |
20020099436 | Thornton et al. | Jul 2002 | A1 |
20020156523 | Lau et al. | Oct 2002 | A1 |
20020165603 | Thornton et al. | Nov 2002 | A1 |
20030055484 | Lau et al. | Mar 2003 | A1 |
20030130721 | Martin et al. | Jul 2003 | A1 |
20030208260 | Lau et al. | Nov 2003 | A1 |
Number | Date | Country |
---|---|---|
B-4248589 | Apr 1990 | AU |
B-3474293 | Jan 1993 | AU |
2026604 | Apr 1991 | CA |
2079417 | Apr 1993 | CA |
37 24 514 | Feb 1989 | DE |
39 18736 | Dec 1990 | DE |
41 37 857 | May 1992 | DE |
196 17 823 | Nov 1997 | DE |
357003 | Mar 1990 | EP |
0 382 014 | Aug 1990 | EP |
0 408 245 | Jan 1991 | EP |
0 418 677 | Mar 1991 | EP |
0 423 916 | Apr 1991 | EP |
0 435 518 | Jul 1991 | EP |
0312852 | Aug 1991 | EP |
0472731 | Aug 1991 | EP |
0 464 755 | Jan 1992 | EP |
0 472 731 | Apr 1992 | EP |
0 540 290 | May 1993 | EP |
0 551 179 | Jul 1993 | EP |
0 556 850 | Aug 1993 | EP |
0 565 251 | Oct 1993 | EP |
0 667 131 | Jan 1995 | EP |
0705577 | Apr 1995 | EP |
0 689 806 | May 1995 | EP |
0 686 379 | Dec 1995 | EP |
0 696 447 | Feb 1996 | EP |
0 701 800 | Mar 1996 | EP |
0696447 | Mar 1996 | EP |
0 705 577 | Apr 1996 | EP |
0 716 834 | Jun 1996 | EP |
0 747 020 | Dec 1996 | EP |
2 678 508 | Aug 1993 | FR |
1 506 432 | Apr 1978 | GB |
1 567 122 | May 1980 | GB |
1 355 373 | Jun 1994 | GB |
49-3634 | Jan 1974 | JP |
49083634 | Aug 1974 | JP |
02-174859 | Jul 1990 | JP |
5212121 | Aug 1993 | JP |
06-007454 | Jan 1994 | JP |
6503734 | Apr 1994 | JP |
06-181993 | Jul 1994 | JP |
7-500272 | Jan 1995 | JP |
7500272 | Jan 1995 | JP |
07-024688 | Mar 1995 | JP |
7185011 | Jul 1995 | JP |
08-52165 | Feb 1996 | JP |
8173548 | Jul 1996 | JP |
8224247 | Sep 1996 | JP |
8224297 | Sep 1996 | JP |
8-509899 | Oct 1996 | JP |
1000180 | Oct 1996 | NL |
1635980 | Dec 1988 | SU |
WO 8806026 | Aug 1988 | WO |
WO 9004982 | May 1990 | WO |
WO 9203107 | Mar 1992 | WO |
WO 9204097 | Mar 1992 | WO |
WO 9206734 | Apr 1992 | WO |
WO 9209246 | Jun 1992 | WO |
WO 9313825 | Jul 1993 | WO |
WO 9313825 | Jul 1993 | WO |
WO 9317636 | Sep 1993 | WO |
WO 9319803 | Oct 1993 | WO |
WO 9319804 | Oct 1993 | WO |
WO 9322984 | Nov 1993 | WO |
WO 9322986 | Nov 1993 | WO |
WO 9322989 | Nov 1993 | WO |
WO 9400179 | Jan 1994 | WO |
WO 9401483 | Jan 1994 | WO |
WO 9404097 | Mar 1994 | WO |
WO 9412136 | Jun 1994 | WO |
WO 9415549 | Jul 1994 | WO |
WO 9501466 | Feb 1995 | WO |
WO 9505131 | Feb 1995 | WO |
WO 9505132 | Feb 1995 | WO |
WO 9509586 | Apr 1995 | WO |
WO 9521592 | Aug 1995 | WO |
WO 9526695 | Oct 1995 | WO |
WO 9610967 | Apr 1996 | WO |
WO 9618360 | Jun 1996 | WO |
WO 9618361 | Jun 1996 | WO |
WO 9621404 | Jul 1996 | WO |
WO 9624306 | Aug 1996 | WO |
WO 9635577 | Nov 1996 | WO |
WO 9721402 | Jun 1997 | WO |
WO 9721403 | Jun 1997 | WO |
WO 9721641 | Jun 1997 | WO |
WO 9830173 | Jul 1998 | WO |
Entry |
---|
Stedman's Medical Dictionary, (c) 1976, The William and Wilkins Company, 23rd Edition, pp. 694-695. |
Dictionary.com at http://dictionary.reference.com/search?q=implantable&r=66. |
Abstract of European patent EP-0357003 published Mar. 7, 1990. |
Abstract of Japanese patent JP-7500272T published Jan. 12, 1995. |
Blum et al.; “Dacron Endografts for Infrarenal Abdominal Aortic Aneurysms: 2 Year Follow-Up”; Fifth international and Interdisciplinary Symposium on Endoluminal Stents and Grafts (Oct. 10-13, 1996) Washington, D.C., 2 pages total. |
U.S. Appl. No. 09/510,937, filed Feb. 22, 2000, Goffena et al. |
U.S. Appl. No. 10/163,568, filed Jun. 7, 2002, Lau et al. |
U.S. Appl. No. 10/434,122, filed May 9, 2003, Lau et al. |
U.S. Appl. No. 10/236,968, filed Sep. 9, 2002, Martin et al. |
U.S. Appl. No. 09/985,498, filed Nov. 5, 2001, Leopold et al. |
U.S. Appl. No. 09/985,500, filed Nov. 5, 2001, Thornton et al. |
U.S. Appl. No. 10/184,989, filed Jul. 1, 2002, Thornton et al. |
Blum, U. et al.; “Dacron Endografts for Infrarenal Abdominal Aortic Aneurysms: 2 Year Follow-Up”; Cardiovascular and Interventional Radiology. Springer, vol. 20, No. 1; Jan./Feb. 1997. |
Chuter et al.; “Bifurcated stent-grafts for AAA: 3 year follow-up”; Abstracts from the Seventh International Course on Peripheral Vascular Intervention; J. Endovas. Surg. (1996) 3:453. |
Chuter et al.; “Bifurcated stent-grafts for AAA: 3 year follow-up”; Fifth International and Interdisciplinary Symposium on Endoluminal Stents and Grafts (Oct. 10-13, 1996) Washington, D.C., 2 pages total. |
Cragg et al., “Nitinol Intravascular Stent; Results of Preclinical Evaluation”, Radiology 189(3): 775-778 (1993). |
Cragg, “Percutaneous Femoropopliteal Graft Placement” Radiology 187(3): 643-648 (1993). |
Cragg, et al.; “Percutaneous Femoropopliteal Graft Placement” Journal of Vascular and Interventional Radiolbgy 4(4): 455-462 (1993). |
Dereume, JP et al.; “Endoluminal Treatment of Abdominal Aortic Aneurysm with the Corvita Endovascular Graft, Results of a Single-Center, Prospective Feasibility Study of 90 Patients”; Abstracts from the Seventh International Course on Peripheral Vascular Intervention J. Endovasc. Surg. (1996) 3:460-461. |
Hagen et al., “Self-Expandable Macroporous Nitinol Stents for Transfemoral Exclusion of Aortic Aneurysm in Dogs” Cardiovascular Intervention Radiology 16:339-342 (1993). |
Katzen et al., “Initial experience performing combined surgical/interventional procedures in the interventional suite” Abstracts from the Seventh International Course on Peripheral Vascular Intervention J. Endovasc. Surg. (1996) 3:467. |
Moore et al., “Transfemoral endovascular repair of abdominal aortic aneurysm: Result of the North American EVT phase 1 trial” J. Vasc. Surg. (1996) 23:543-552. |
Parodi et al., “long-term follow-up of AAA endoluminal repair” Abstracts from the Seventh International Course on Peripheral Vascular Intervention. J. Endovasc. Surg. (1996) 3:335. |
Product Brochure for Cook-ZTM Stents, Gianturco-Rosch Biliary Design, CookR, A Cook Groups Company, P.O. Box 489, Bloomington, IN, 47402, U.S.A., 4 pages total, (1989). |
Product Brochure for PalmazTM Balloon-Expandable Stent, Johnson & Johnson Interventional Systems, 40 Technology Drive, P.O. Box 4917, Warren, NJ, 07059, 2 pages total, (1990). |
White et al., “Endoleak following endoluminal repair of AAA: Diagnosis, significance, and amanagement” Abstracts from the Seventh International Course on Peripheral Vascular Intervention J. Endovasc. Surg. (1996) 3:339-340. |
Wilson et al.; “A self expanding bifurcated endovascular graft for Abdominal Aortic Aneurysm Repair. An Initial Study in a Canine Model” ASAIO Journal 42(5): 386-393 (1996). |
World Medical News, World Medical manufacturing Corporation, 13794 NW 4th Street, Bldgs. 210 & 211, Sunrise, Florida, 33325 U.S.A., vol. 5, Issue 3 (Jul. 1996) 3 pages total. |
U.S. Appl. No. 08/871,427 & pending claims as of Apr. 16, 2001, filed Jun. 9, 1997, Lau, et al. |
U.S. Appl. No. 09/207,944 & response dated Aug. 21, 2000, filed Dec. 9, 1998, Vonesh et al. |
U.S. Appl. No. 09/235,214, filed Jan. 22, 1999, Brauker et al. |
U.S. Appl. No. 09/235,458 & response dated Sep. 28, 2000, filed Jan. 22, 1999, Vonesh et al. |
U.S. Appl. No. 09/306,522, filed May 6, 1999, Myers. |
U.S. Appl. No. 09/376,931 & pending claims as of Apr. 16, 2001, filed Aug. 13, 1999, Martin, et al. |
U.S. Appl. No. 09/408,866 & response dated Jan. 10, 2001, filed Sep. 30, 1999, Brenton et al. |
U.S. Appl. No. 09/488,229, filed Jan. 20, 2000, Cully et al. |
U.S. Appl. No. 09/489,604, filed Jan. 20, 2000, Vonesh et al. |
U.S. Appl. No. 09/510,937 & response dated Oct. 5, 2000, filed Feb. 22, 2000, Goffena et al. |
Laborde et al., “Intraluminal Bypass of Abdominal Aortic Aneurysm: Feasibility Study”; Radiology 1992, 184:185-190, Jul. 1992. |
MinTec™ Minimally Invasive Technologies Product Brochure for the Craggstent and Cragg EndoPro System 1, 4 pages total, Sep. 1993. |
Number | Date | Country | |
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20030055484 A1 | Mar 2003 | US |
Number | Date | Country | |
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Parent | 08903210 | Jul 1997 | US |
Child | 10265361 | US | |
Parent | 08740030 | Oct 1996 | US |
Child | 08903210 | US | |
Parent | 08299190 | Aug 1994 | US |
Child | 08740030 | US |