Aneurysms typically involve a bulging or deformation of a region of a blood vessel. This bulging can occur for a number of reasons, including weakening of the vessel wall and high pulsatile blood flow against a region of the vessel. Over time, the cavity can increase in size as blood continues to flow into it, increasing the risk of rupture or hemorrhagic stroke.
Aneurysms that expand on most or all sides of a vessel typically are known as fusiform aneurysms and represent about 3-13% of all intracranial aneurysms. Often, these fusiform aneurysms are found in the middle cerebral artery (MCA), the internal carotid artery (ICA), and the anterior cerebral artery (ACA). An example fusiform aneurysm 10 can be seen in
Due to their size and bulging on multiple sides along a vessel wall, fusiform aneurysm treatment can be challenging. Conventional treatment techniques include the use of a flow-diversion stent to divert flow away from the bulging side regions and to form an endothelial layer along the aneurysm neck over time. Since these aneurysms can be relatively large, the flow diversion stent may not always be long enough to effectively extend across the entire treatment region with enough overlap or radial force to stay in place.
Stent assisted coiling can also be used, whereby a stent is placed across the vessel while coils are separately introduced into the various sections of the fusiform aneurysm. However, this technique also presents challenges since the coils are introduced into multiple sides of the bulging vessel section.
What is needed is a fusiform aneurysm treatment that better addresses the shortcomings of the current treatment techniques.
This specification is generally directed to stents that are configured to better deploy and remain implanted across a fusiform aneurysm. Specifically, these stents include one or more anchoring members that radially expand within a fusiform aneurysm. In some instances, the anchoring members radially expand to a diameter that is larger than that of regions of vessels that are adjacent to the fusiform aneurysm.
In some embodiments, the anchoring mechanism may comprise an outer stent layer that radially expands to a bulbous shape. The largest expanded diameter of the bulbous shape may be larger than the diameter of regions of vessel that are adjacent to fusiform aneurysm, thereby preventing the stent from migrating out of the fusiform aneurysm. The outer stent layer may be disposed over a tubular flow diverting layer that creates a tubular passage through the fusiform aneurysm similar in size to the regions of vessel adjacent to the fusiform aneurysm.
In some embodiments, the anchoring mechanism may be a plurality of radially expandable structures, such as loops, arms, longitudinal wires, and/or hydrogel rings. These structures can be fixed on the outside of a generally cylindrical tubular braided stent with one or two layers. The radially expandable structures can be located at or near the proximal and distal ends, as well as any locations in between.
These and other aspects, features and advantages of which embodiments of the invention are capable of will be apparent and elucidated from the following description of embodiments of the present invention, reference being made to the accompanying drawings, in which:
Specific embodiments of the invention will now be described with reference to the accompanying drawings. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the invention to those skilled in the art. The terminology used in the detailed description of the embodiments illustrated in the accompanying drawings is not intended to be limiting of the invention. In the drawings, like numbers refer to like elements.
As previously discussed, a fusiform aneurysm 10 refers to an aneurysm that expands on most or all sides of a vessel relative to the diameters of upstream and downstream vessel regions 12, as seen in
This specification includes embodiments of stents that are configured to better deploy and remain implanted across a fusiform aneurysm 10. Deployment and retention can be improved in several different ways, including the use of one or more radially expandable structures such as an outer anchoring layer that conforms to the fusiform aneurysm, or a relatively long stent with loops, arms, longitudinal wires, or hydrogel rings at each end that better engages the interior of the aneurysm 10 and prevent the stent from migrating. In some embodiments, stents may include only one type of radially expandable structures or may alternately include two or more types of radially expandable structures.
The stent 100 may generally have a radially compressed configuration that allows delivery via a delivery catheter, as well as a radially expanded configuration seen in
In one example, the outer anchoring layer 102 and the inner layer 104 may be both composed of a woven or braided wire mesh. In other words, one or more wires are braided together to form both the outer anchoring layer 102 and the inner layer 104. The entire device may be woven from the same wires and/or wires of the same diameter. Alternately, the outer anchoring layer 102 and the inner layer 104 may be woven from different diameter wires (i.e., the wires of the outer anchoring layer 102 may be larger in diameter than those of the inner layer 104). Additionally, each layer 102, 104 may have several different diameter wires that make up each layer.
At least some of the wires of the stent 100 may preferably be composed of a shape memory material, such as Nitinol or similar alloy that allows an expanded secondary shape to be imparted to it.
In one specific example, the wire of the outer anchoring layer 102 has a diameter within an inclusive range of about 0.001 inch and 0.10 inch in diameter, and more particularly within an inclusive range of about 0.0018 inch and about 0.0050 inch. The inner layer 104 may be composed of wires having a diameter within an inclusive range of about 0.0005 inch and about 0.0018 inch.
The porosity of the outer anchoring layer 102 may be generally more porous (i.e., have larger sized pores) than the inner layer 104. This may allow the outer anchoring layer 102 to better exert anchoring force while allowing the inner layer to better divert or block blood flow through its walls. In one example, the outer anchoring layer 102 may have a porosity within an inclusive range of about 75% to 95%, and more preferably an inclusive range between about 80% to 88%. The inner layer 104 may have a porosity within an inclusive range of about 45 to 70%.
The stent 100 can be created in several different ways, one of which is shown in
Once the initial tubular structure is created, it can be placed over a mandrel 20, as seen in
Depending on how the stent 100 is deployed, the stent 100 can then be heat set to the desired shape of the mandrel 20 or can be both heat set and its free ends connected at its proximal end at areas 108. More specifically, the stent 100 may be compressed within a delivery catheter in the shape shown in
In the first instance, it may be desirable that either before or after heat setting that the bottom edges of the tubular structure be connected to each other via connecting members. These connecting members can be wire (e.g., woven circumferentially through both layers), coils, welded areas, or similar connection mechanisms. Additionally, any of these connecting mechanisms may include or be composed of radiopaque material.
In the second instance, both ends of the initial tubular structure are not connected together, but the heat set shape resembles that of
In either instance, the stent 100 forms a tubular shape with the inner layer 104 that is similar to the two adjacent vessel regions 12 and further creates a separate, enclosed bulbous anchoring portion from the outer anchoring layer 102.
While not shown in the figures, the proximal and/or distal ends of the stent 100 may include anchoring members. These anchoring members may take the form of a plurality of radially expandable loops, a plurality of wire coils on regions of the wire at each end, barbs, spikes, or similar engagement mechanisms. In one specific example, the anchoring members may include a plurality of wire loops that have coils on the wire of one or more of the loops.
One or more areas of the stent 100 may also include a hydrogel coating. For example, the inner layer 104 may include a hydrogel coating that gradually expands in size once deployed within a patient.
While the stent 100 at least partially relies on the bulbous shape of its outer anchoring layer 102, alternate stent embodiments may use other anchoring features to help retain the stent within the fusiform aneurysm 10. One such example is that the stent can include a plurality of radially extending structures that expand from an outer circumference of the stent in one or more areas. These radially extending structures preferably expand to a diameter larger than that of the diameter of the adjacent vessels 12 so as to help prevent the stent from migrating out of the fusiform aneurysm 10.
The radially extending features can have a variety of different forms. For example, these features may be a plurality of radially extending wire loops, wire triangular shapes, wire arms, wire hooks, longitudinally curved wires, or hydrogel rings that radially expand when exposed to blood.
The radially extending features are preferably located so that they expand within or close to the fusiform aneurysm. In this respect, the features can be located along the length of the stent at the very proximal and distal ends of the stent, offset towards a middle of the stent from each end (e.g., by 5%, 10%, 15%, 20% or more of the total stent length), near a middle of the stent, or any combination of these locations.
The radially extending features may expand to a radial size that is larger than the radius of the stent body. The exact size may vary based on the size of the stent and the size of the fusiform aneurysm 10. However, the radially extending features may expand to a diameter relative to the stent body that is 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, or amounts in between these values.
One specific embodiment of a stent 120 that includes a plurality of radially extending features is illustrated in
The stent 120 may be composed of an outer anchoring layer 122 and an inner flow diverting layer 124 that is located within an inner passage of the outer anchoring layer 122. The two layers 122, 124 can be attached to each other by braiding one or more connecting wires between the two layers 122, 124, by using one or more connecting members (e.g., a wire loop, coil, or band), or by welding.
The two individual layers 122, 124 can be separately seen in
Since it may be desirable to expand the plurality of loops 126 within the fusiform aneurysm 10, it may also be desirable that the inner flow diverting layer 124 extends proximally and distally beyond the ends of the outer anchoring layer 122, as best seen in the magnified view of
The loops 126 can be composed of wire. This wire can be either separately attached to the braided tubular body of the outer anchoring layer 122 or can be formed during the braiding process with the wire that also forms the braided tubular body of the outer anchoring layer 122. If separately attached, a ring forming a plurality of loops 126 can be formed and then attached via welding, wire loops, wire coils, or similar attachment mechanisms.
The loops 126 may all be about the same size or may alternate between larger and smaller loops. The loops 126 may be heat set to radially expand or flare outwards from the main tubular body of the outer anchoring layer 122. This can be achieved by expanding outward at an angle relative to a longitudinal axis of the body of the stent 120 within an inclusive range of 5 degrees to 90 degrees towards a middle of the stent 120. The loops may each form a relatively flat plane or can be configured to gently curve or arc outwards away from the body of the stent 120.
The size of the loops 126 may vary, depending on the heat set angle that the loops 126 expand away from the stent 120 and the desired circumferential size the loops are to expand to. Again, the expanded circumferential size of the loops 126 may expand to a diameter relative to that of the stent body that is 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40% larger, or amounts in between these values.
The loops 126 are depicted as having a sharp, triangular shape. However, other shapes are possible, such as a rounded or circular shape. While described as loops, the loops 126 might alternately be a circular wire that repeat wave shapes that are fixed to the stent.
In the present example stent 120, the loops 126 are connected at a very distal end or edge and proximal end or edge of the outer anchoring layer 122. Since the inner flow diverting layer 124 further extends proximally and distally, the stent loops 126 are positioned somewhat away from the ends of the stent 120 as a whole, allowing the loops 126 to expand within the fusiform aneurysm 10 and allowing the inner flow diverting layer 124 to engage the smaller diameter adjacent vessels 12, as seen in
Alternately, only a single stent layer may be used. For example,
In the present example stent 140, the loops 126 are positioned at both the very proximal and distal ends of the flow diverting layer 122, as best seen in
Any of the stents 120, 140, and 150 may additionally have loops 126 located near the middle of the stent. Optionally these middle-positioned loops 126 may have a larger diameter than those closer to the proximal and distal ends of the stent.
In another example, any of the stents 120, 140, and 150 may have multiple circumferential rings of loops 126. For example, the stents may have 2, 3, 4, 5, 6, 7, 8, 9, 10, or more. These rings of loops 126 may be positioned at equal longitudinal positions from each other or may be positioned at different distances. The rings of loops 126 may also increase or decrease in their expanded radial diameter relative to adjacent rings of loops 126. For example, the rings of loops may increase in diameter towards the middle of the stent or may alternate between larger and smaller diameter rings of loops 126.
Again, while loops 126 are specifically shown, other radially expandable structures may alternately be used in its place. For example, a plurality of wire arms 162 may bend radially outward from the stent 160, as seen in
In another example seen in
In another example seen in
Any of the radially expandable structures may be configured such that they expand at an angle between 5 degrees to 90 degrees towards a middle of the stent and relative to a longitudinal axis of a stent. In other words, their radial position/size increases towards a middle of the stent. In some instances where the radially expandable structures are positioned away from the very distal and proximal ends, it may be desirable to configure the radially expandable structures to expand in an opposite angle, namely, between 5 degrees to 90 degrees away from a middle of the stent and relative to a longitudinal axis of a stent.
Alternately, a combination of loops 126, arms 162, wires 182, and/or hydrogel rings 172 may be used at various longitudinal positions along the stent.
The loops 126 have been previously described and depicted as having a rounded or triangular/pointed shape. However, more complicated loop shapes are also possible. For example,
Specifically, each loop has a wider portion 192A that extends from and is fixed near an edge of the anchoring layer 122. This wider portion 192A extends at an angle both towards a middle of the anchoring layer 122 and radially outward from the anchoring layer 122. A narrower portion 192B that forms a loop end or tip may be folded back relative to the wider portion 192A so that it extends back towards the edge of the anchoring layer 122 and further radially outward from the anchoring layer 122.
Another way to describe this feature is that each of the loops 192 form a peak angled towards a middle of the stent 190, followed by a peak angled away from the middle of the stent 190, followed by a peak angled towards the middle of the stent 190. Further, the middle peak may be radially further away from the stent 190 than the two side peaks.
The fold or inflection point between the widest portion 192A and narrower portion 192B can be at almost any position along the length of the loop 192. For example, the inflection point may occur at 20%, 30%, 40%, 50%, 60%, 70%, or 80% of the length of the loop 192, as well as location in between these values. All of the loops 192 are depicted as being the same size and have inflection points between the portions 192A, 192B at the same relative location. However, these loops 192 may have different sizes, such as alternating between larger and smaller loops. Additionally or alternately, the loops 192 may have different inflection point locations, such as alternating between different inflection points (e.g., between a location at 60% and 40% of loop length).
Relative to the longitudinal axis of the stent 190, the wider portion 192A and narrow portion 192B can form a variety of different angles. For example, the wider portion 192A may form an angle of 10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees, as well as angles in between these values. In another example, the narrower portion 1928 may form an angle of 90, 100, 110, 120, 130, 140, 150, 160, 170, or 180, as well as angles in between these values. Again, these angles are both relative to the longitudinal axis of the stent 190.
These loops 192 with two different bend angles can also be used on a single layer stent 194, which is similar to the previously described stent 140. In this example, the stent 194 includes both loops 192 and the smaller loops 124A that form a rounded or triangular loop shape away from the body of the stent 140. The loops 124A can be positioned and fixed to the flow diverting layer 124 so that each loop 124A partially overlaps two adjacent loops 192. These loops 124A can fixed above the loops 192 (i.e., on the side opposite the stent body as seen in
Any of the previously described stents can generally be deployed by deploying a distal end of the stent within or near a first adjacent portion of a vessel 12, deploying a middle section of stent along an interior of a fusiform aneurysm 10, and finally deploying a proximal end of the stent within or near a second adjacent portion of a vessel 12. This method may also include expanding anchoring elements such as an outer anchoring layer or radially expandable structure.
The previously described stent 100 may additionally include the radially expandable structures. These may by positioned, for example, near the proximal and distal ends of the stent 100 so that they do not interfere with expansion of the outer anchoring layer 102.
The stents of this specification may have a variety of different sizes and diameters, depending on their location of use. Generally, all of the stents in this specification may have an example length within an inclusive range of 12 mm to 35 mm (e.g., 12 mm, 14 mm, 16 mm, 18 mm, 20 mm, 22 mm, 24 mm, 26 mm, 28 mm, 30 mm, 32 mm, and 34 mm. Generally, the dual layer stents of this specification (e.g., stent 120 and 190) have an inner lumen diameter of the flow diverting layer 124 within an inclusive range of 2.5 mm to 5 mm (e.g., 2.5 mm, 3 mm, 3.5 mm, 4 mm, 4.5 mm, and 5 mm). Generally, the dual layer stents of this specification (e.g., stent 120 and 190) have an inner lumen diameter of the anchoring layer 122 within an inclusive range of 2.8 mm to 5.5 mm (e.g., 2.8 mm, 3 mm, 3.5 mm, 4 mm, 4.5 mm, 5 mm, and 5.5 mm). Generally, the single layer stents of this specification (e.g., stent 140 and 194) have an inner lumen diameter of the flow diverting layer 124 within an inclusive range of 2.5 mm to 5.5 mm (e.g., 2.5 mm, 3 mm, 3.5 mm, 4 mm, 4.5 mm, 5 mm, and 5.5 mm).
While different elements or features of a stent are shown in each embodiment, it is specifically contemplated that any of these features described herein can be mixed, matched, and otherwise combined with each other.
Although the invention has been described in terms of particular embodiments and applications, one of ordinary skill in the art, in light of this teaching, can generate additional embodiments and modifications without departing from the spirit of or exceeding the scope of the claimed invention. Accordingly, it is to be understood that the drawings and descriptions herein are proffered by way of example to facilitate comprehension of the invention and should not be construed to limit the scope thereof.
This application claims benefit of and priority to U.S. Provisional Application Ser. No. 63/115,486 filed Nov. 18, 2020 entitled Fusiform Aneurysm Treatment, which is hereby incorporated herein by reference in its entirety.
Number | Date | Country | |
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63115486 | Nov 2020 | US |