The invention relates to devices and methods for blocking emboli in an aorta from entering arteries.
Emboli form, for example, as a result of the presence of particulate matter in the bloodstream. Vascular emboli are a major single causative agent for multiple human pathologies. It is a leading cause of disability and death.
Since emboli are typically particulate in nature, various devices, e.g., types of filters, have been proposed in an attempt to remove or divert such particles from the bloodstream. These devices may be inserted into a blood vessel prior to or during a procedure or at another time. Such devices may be inserted by way of a catheter that may be threaded through a vein or artery and into, for example, an aorta or other vessel where the device may be released from the catheter and, for example, deployed. The device may filter, deflect, or block emboli or other objects from entering into a blood supply that feeds the brain.
The devices known in the art, generally lack a suitable anchoring system, as the pulsating blood flow, aortic elasticity, and movement may all cause a device inserted into a major blood vessel to become dislodged. Furthermore, such devices may feature rigid structures that may create turbulent blood flow at certain locations such as the aortic arch, leading to decreased cerebral flow and possible activation of the closing mechanism. Additionally, the manufacture of such devices and/or structures is a complicated process because these device require multiple components to form their required elements, rather than having the ability to form the required elements from a single component.
Therefore, there is a need for a more effective and more easily manufactured device and method for protecting against particulate such as emboli.
In one aspect, the invention features an intra-vascular device for deflecting emboli including an interlaced portion, (e.g., a filter), and at least one or two (or more) loop portions, (e.g., a portion where one or two (or more) interlaced filaments and/or internal inserts exits and re-enters the interlaced portion). This filter may include a plurality of filaments interlaced together including an edge. These loops can be further configured, e.g., twisted, so as to form an extern at member and can include structural filaments. In some cases, all, a portion, or a subset of the exited interlaced filaments and/or internal inserts, (e.g., one wire, at least two wires) may not re-enter the interlaced portion thereby maintaining axial strength in the device.
In the devices of the invention, the internal insert can be capable of providing structural support and further be capable of providing functionality, e.g., serving as a duct for a catheter. These internal inserts may be made from a material with a shape-memory effect, e.g., Nitinol, and may be substantially more rigid than any other portion of the device. The internal inserts and/or structural filaments may be positioned at the edge of the interlaced portion so as to provide a relatively stiff edge and include NiTi, Platinum, and/or Tantalum. These internal inserts can also be positioned away, e.g., 1 mm, 2 mm, 3 mm, 4 mm, 5 mm, 10 mm, 20 mm, 30 mm, 40 mm, 50 mm, 60 mm, 70 mm, or 80 mm, from the edge of the interlaced portion. This positioning can provide a relatively flexible edge that can be capable of functioning as a gasket.
In the devices of the invention, the loops may be twisted, e.g., external members, and/or the loops may be formed and/or positioned at the edge of the interlaced portion. The loops may also be formed less than 80 mm, e.g., 1 mm, 2 mm, 3 mm, 4 mm, 5 mm, 10 mm, 20 mm, 30 mm, 40 mm, 50 mm, 60 min, 70 mm, or 80 mm, away from the edge of the interlaced portion, in some embodiments forming an external skeleton and a relatively flexible edge, e.g., an edge capable of functioning as a gasket. The loops may also be formed at the edge of the interlaced portion, but positioned and affixed at less than 80 mm, e.g., 1 mm, 2 mm, 3 mm, 4 mm, 5 mm, 10 mm, 20 mm, 30 mm, 40 mm, 50 mm, 60 mm, 70 mm, or 80 mm, away from the edge of the interlaced portion. These external members, e.g., loops, may be capable of providing structural support to the device. These loops may be formed by interlaced filaments, structural filaments, and/or internal inserts, and can be substantially more rigid than any other portion of the device. Any of these loops can be optionally attached by an adhesive component, a connecting structure, and/or soldered connection. Thus, the loops can be integrated with the remainder of the device. In other aspects of the invention, the loops may extend downward and/or upward from the horizontal plane of the device. In another aspect, a loop may be formed by at least two interlaced filaments, structural filaments, and/or internal inserts, and these interlaced filaments, structural filaments, and/or internal inserts may or may not re-enter the interlaced portion. In some embodiments, the device may also be a three-dimensional convex structure.
Any of the devices of the invention may taper at one or both ends. If the filaments are interlaced to form a filter, the openings within the filter can be big enough to let blood pass, but small enough to block emboli. In some embodiments, the devices may serve as a coronary stent, peripheral stent, a heart valve, and/or be combined with a synthetic graft.
In another aspect, the invention features methods of preventing passage of a particle from the aorta into the left subclavian, left common carotid, and/or brachiocephalic arteries by deploying into an aorta any of the above-described devices such that the device prevents a particle from passing to the left subclavian, left common carotid, and/or brachiocephalic arteries. In other aspects, the device features one or more loops (as described above) extending downward from the horizontal plane of the deployed device such that one or more of the loops contacts, e.g., a medial surface of the ascending aorta, one or more of the loops extending upwards from the deployed device such to contact a medial surface of a subclavian artery, and/or the interlaced portion contacting the ascending, descending aorta, or both.
As used herein, the term “interlaced” refers to any filament segments that are braided, woven, knitted, or twisted together.
As used herein, the term “relatively flexible” refers to any portion that is more flexible relative to the internal portions of the device.
As used herein, the term “relatively stiff” refers to any portion that is more stiff relative to the internal portion of the device.
As used herein, the term “provide functionality” refers to a property that provides additional utility (e.g., connection loop, internal duct, or creates a seal with contacted tissue) beyond the mere structural properties of the filament.
As used herein, the term “provide structural support” refers to the property contributing to the shape, stiffness, and stability of the device.
As used herein, the term “structural filament” refers to a filament that is stiffer and/or thicker than the remaining filaments.
As used herein, the term “blood” refers to all or any of the following: red cells (erythrocytes), white cells (leukocytes), platelets (thrombocytes), and plasma.
As used herein, the term “filaments” refers to any elongated structure (e.g., cords, fibers, yarns, wires, cables, and threads) fabricated from any non-degradable material (e.g., polycarbonate, polytetrafluorothylene (PTFE), expanded polytetrafluorothylene (ePTFE), polyvinylidene fluoride, (PVDF), polypropylene, porous urethane, Nitinol, fluoropolymers (Teflon®), cobalt chromium alloys (CoCr), and para-aramid (Kevlar®), or textile (e.g., nylon, polyester (Dacron®), or silk).
As used herein, the term “internal insert” refers to one or more additional filaments inserted into an interlaced portion. Portions and/or filaments of these one or more additional filaments may be interlaced with each other, they may be hollow, they may provide structural support, and may facilitate insertion, deployment, and retrieval of the device.
As used herein, the term “delivery cable” refers to any delivery system used in interventional cardiology to introduce foreign bodies to a treatment site (e.g., catheters, guidewires, tubes, and wires).
As used herein, the term “internal skeleton” refers to a structural element within the perimeter of the filter that provides structural support to the interior of the device.
The invention herein described, by way of example only, with reference to the accompanying drawings, wherein:
In general, the invention features methods of constructing devices (e.g., intravascular devices) out of woven or braided filaments. The devices, in addition to containing surfaces constructed from woven or braided filaments, also contains structural and/or functional elements constructed out of filaments that are integrated into the woven or braided surfaces (i.e., internal inserts). These internal insert filaments can be themselves woven or braided into the surfaces or can be inserted into the weave or braid.
The devices of the invention feature an interlaced portion, including, e.g., interlaced filaments and internal inserts. This interlaced portion provides structure to the device and may serve as a filter. The devices of the invention can also feature external members that may be sections of the interlaced filaments, or internal inserts exiting from the interlaced portion. These interlaced filaments or internal inserts may or may not re-enter the interlaced portion. The use of the same interlaced filaments or internal inserts for both the internal portion and external members may permit the modification of the devices properties, e.g., modify stiffness, strength, or shape, without the use of external connective methods, e.g., adhesive, solder, or external connecting structures between the internal interlaced portion and the external members. These external members can provide additional structural support for the device and can facilitate the creation of a seal between the filter of the device and a blood vessel wall. Alternatively, the interlaced portion itself may create a seal against the blood vessel wall and exhibit a relatively flexible edge that may act as a gasket.
The device of the invention may include an interlaced portion and internal inserts that exit the interlaced portion to form a loop, e.g., an external member, and optionally re-enter the interlaced portion. The interlace portion may filter and/or deflect emboli or other large objects from entering protected secondary vessels, while the external member may facilitate device placement within the primary vessel. The device can also serve as coronary stent, peripheral stent, synthetic graft, heart valve, gastrointestinal stent, laryngeal stent, ureteral stent, tracheal implant, or transdermal implant. The device can also be an intravascular device for preventing particles from passing from a primary blood vessel (e.g., the aorta) to one or more secondary blood vessels (e.g., the left subclavian, left common carotid, and brachiocephalic artery). In general, the device may further be compatible with common delivery methods used in interventional cardiology (e.g., TAVI procedures). The device may be integrated into a delivery system. In other embodiments the device may be detachable from the delivery system. Upon deployment, the device may be positioned so as to contact the orifice of one or more secondary blood vessels in the primary blood vessel, e.g., in the aortic arch. In still other embodiments, the filaments may be arranged so that the edge of the device is relatively flexible and may serve as a gasket for improved device performance within a primary vessel.
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In some embodiments, the upper member may be inserted into, e.g., a left subclavian artery where a curve of the bend may be held against a left inner wall of the left subclavian artery, and a second portion may engage a counter wall.
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In some embodiments, it is desirable to incorporate radiopaque elements into the intra-vascular device. Such radiopaque elements can be affixed to, or incorporated into the intra-vascular device (e.g., affixed to the internal inserts or interwoven filaments). The radiopaque element can be a bead or clamp (e.g., as depicted in
In some embodiments, interlaced portion (1) may include an additional fine wire netting or mesh, e.g., as depicted in
In some embodiments, one or more filaments or internal inserts may include a lumen, such as, for example, a hollow wire, which may hold, for example, a medicament that may be released into an artery or area where the device is implanted.
In some embodiments, device (11) may assume a substantially elliptical or elongated shape. Other shapes may be used. Because the aortic anatomy can vary between individuals, embodiments of the intra-vascular device of the invention are shaped to adapt to a variety of aortic anatomies. The size of the device (11) may be pre-sized and pre-formed to accommodate various patient groups (e.g., children and adults) or particular aortic anatomy. The device may vary in length from 10 mm to 120 mm (e.g., 25 mm, 45 mm, 60 mm, 75 mm, 90 mm, or 105 mm) and width from 5 mm to 70 mm (e.g., 10 mm, 20 mm, 30 mm, 40 mm, 50 mm, or 60 mm).
In certain embodiments, the stiffness of the intra-vascular device will be determined by the stiffness of interwoven filaments, internal inserts, and/or structural filaments. For example, the device can be stiffened by the inclusion of heavier gauge wire or by the inclusion of stiffer internal inserts. Furthermore, multiple wires of a certain gauge can be wound together to increase the stiffness of the device (e.g., the device can include 2, 3, 4, 5, or more filaments to increase the stiffness of the intra-vascular device).
Reference is made to
In other embodiments, the device (11), catheter, or delivery cable may end in a loop and may be threaded through a latch. When so threaded, a wire or catheter fitted with a looped end may be clicked into a hook and may securely push the device into place or pull the device out of position from a blood vessel (e.g., the aorta).
In some embodiments, the hook may end in a ball-tip so that strands from the device (11) do not fray or scratch the vessel wall or the inner tube of a catheter.
In other embodiments, a clasp at an end of the device may be pressed into or onto a clasp at, for example, an end of a catheter or delivery cable, and the two clasps may be joined by such pressing. In some embodiments, the device may be rotated clockwise or counter-clockwise respectively.
In an installed position, the intra-vascular device may be inserted into a first blood vessel. In some embodiments, the first blood vessel may be or include an aorta, though the device may be inserted into other vessels. The interlaced portion (1) of the device may be positioned so that an opening of a second blood vessel is covered by the filter, so that, for example, large particles are filtered, blocked, or deflected from entering, for example, the left subclavian, left common carotid, or brachiocephalic artery, or any combination thereof (e.g., the left subclavian, left common carotid, and brachiocephalic artery; the left subclavian and left common carotid artery; left common carotid and brachiocephalic artery; and the left common carotid and brachiocephalic artery). The space under interlaced portion (1) may allow unfiltered blood to pass by the branch artery of the aorta. The space in the aorta that is left below the filter means that not all blood passing through the aorta is subject to the filtering or deflecting process of interlaced portion (1). In an installed position, the device remains substantially flat (e.g., does not exceed a radius of curvature of 80 mm).
Reference is made to
In still other embodiments, device (11) may be adapted for use with other embolism protection devices (e.g., those described U.S. application Ser. Nos. 13/300,936, and 13/205,255; in U.S. Publication Nos. 2008-0255603 and 2011-0106137; and in U.S. Pat. Nos. 8,062,324 and 7,232,453), each of which is hereby incorporated by reference in its entirety.
All publications and patents cited in this specification are incorporated herein by reference as if each individual publication or patent were specifically and individually indicated to be incorporated by reference. Although the foregoing invention has been described in some detail by way of illustration and example for purposes of clarity of understanding, it will be readily apparent to those of ordinary skill in the art in light of the teachings of this invention that certain changes and modifications may be made thereto without departing from the spirit or scope of the appended claims.
This application claims benefit of U.S. Provisional Application No. 61/714,401 filed Oct. 16, 2012, which is hereby incorporated by reference in its entirety.
Filing Document | Filing Date | Country | Kind |
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PCT/IL2013/050826 | 10/14/2013 | WO | 00 |
Number | Date | Country | |
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61714401 | Oct 2012 | US |