Patent Grant
10675012
The present disclosure relates to joint assemblies that may be used with medical devices, including implantable devices that can be used to occlude apertures, conduits, or structures within a patient.
Cardiac features such as septal defects and atrial appendages often contribute to cardiac blood flow disturbance, which is associated with a number of cardiac-related pathologies. For example, complications caused by blood flow disturbance within the left atrial appendage (LAA) and associated with atrial fibrillation can be a contributor to embolic stroke. The LAA is a muscular pouch extending from the anterolateral wall of the left atrium of the heart and serves as a reservoir for the left atrium. During a normal cardiac cycle, the LAA contracts with the left atrium to pump blood from the LAA, and generally prevents blood from stagnating within the LAA. However, during cardiac cycles characterized by arrhythmias (e.g., atrial fibrillation), the LAA often fails to sufficiently contract, which can allow blood to stagnate within the LAA. Stagnant blood within the LAA is susceptible to coagulating and forming a thrombus, which can dislodge from the LAA and ultimately result in an embolic stroke or other thromboembolic complication.
In some instances, thrombus formation in the LAA of arrhythmic patients can be minimized by occluding the LAA. Some LAA occlusion devices that are placed within the LAA or across the ostium of the LAA (the opening between the left atrium and the LAA) terminate at an elongate eyelet at each end of the device. The elongate eyelet of the device that faces the left atrium after implantation can often protrude from the device into the left atrial chamber, which can disturb blood flow within the left atrial chamber and can lead to thrombus formation and accumulation near the eyelet. Furthermore, a protruding eyelet may present a blood-material interface that is different than that which exists along other atrial-facing regions of the occluder device. Thrombus formation may increase the risk of stroke, and serious injury or death can result if the thrombus becomes dislodged and enters the circulatory system.
In some aspects, a device for occluding an aperture within a body of a patient includes a frame comprising a plurality of elongate members, and a hub component comprising a plurality of attachment members. A first end of each elongate member of the plurality of elongate members is fixedly attached to an attachment member of the plurality of attachment members at an attachment region. The frame and the hub component together form at least one occlusive element. Each attachment member of the plurality of attachment members is configured to pivot with respect to the hub component, such that each attachment region is movable with respect to the hub component.
In some implementations, each attachment region may be movable with multiple degrees of freedom with respect to the hub component. Each attachment region may be movable with one degree of freedom with respect to the hub component. The hub component may include a plurality of sockets, each attachment member of the plurality of attachment members may include a generally spherical member and each of the generally spherical members may be received by a socket of the plurality of sockets to form a ball-and-socket arrangement. Each socket of the plurality of sockets may include one or more positional stops adapted to maintain a position of the received generally spherical member. A tension on the generally spherical member may increase as the generally spherical member pivots within the socket. Each elongate member of the plurality of elongate members may be formed from a single wire. The occlusive element may include a substantially planar face. The hub component may be a first hub component disposed at a proximal end of the device, and the device may include a second hub component disposed at a distal end of the device. The frame of the device may include a covering that covers at least a portion of the frame, and the covering may cover at least a portion of the hub. The covering may include a membrane. The membrane may include a fluoropolymer including PTFE such as ePTFE, and may include a copolymer. The plurality of attachment members may be substantially equally spaced about the hub component. The hub component may be disposed substantially at a center of the occlusive element. Each elongate member of the plurality of elongate members may move, at the respective attachment region, independently of other elongate members of the plurality of elongate members. The plurality of elongate members may have an elastic property and a preformed shape, and the frame may collapse to assume a delivery configuration and may expand to the preformed shape to assume a deployed configuration. At least one elongate member of the plurality of elongate members may move parallel to a center axis of the hub component. The hub component may define an aperture that passes through the hub component along a center axis of the hub component. The hub component may include a plurality of sockets, and each attachment member of the plurality of attachment members may be coupled to a socket via one or more pins. The attachment members may comprise receptacles for connection of the elongate member to the hub. The attachment member may be integral with the first end of the elongate member. The occlusive element may include a substantially convex face. The occlusive element may include a substantially concave face. The device may include at least one fixation member that extends from at least one of the elongate members.
In some aspects, a method of occluding an aperture within a body of a patient includes delivering a device to the aperture and deploying the device such that device forms an occlusive element. The device is configured to occlude the aperture. The occlusive element includes a portion of a frame including a plurality of elongate members, and a hub component including a plurality of attachment members. A first end of each elongate member of the plurality of elongate members is fixedly attached to a receptacle of the plurality of attachment members at an attachment region. Each attachment member of the plurality of attachment members is configured to pivot with respect to the hub component, such that each attachment region is movable with respect to the hub component.
In some implementations, the method may include loading the device on a catheter and passing the device and the catheter through a delivery sheath. The frame may collapse as the device is passed through the delivery sheath. Deploying the device may include advancing the device through the delivery sheath, such that at least a portion of the device exits the delivery sheath distal of the delivery sheath. The frame may expand as the device exits the delivery sheath. Deploying the device may include pulling the delivery sheath away from the aperture while maintaining a position of the device. The plurality of attachment members may be locked into respective positions as the device is deployed. The aperture may be located within a vessel, and deploying the device may substantially close the vessel. The aperture may be located within a heart.
The details of one or more embodiments are set forth in the accompanying drawings and the description below. Other features, objects, and advantages will be apparent from the description and drawings, and from the claims.
Like reference symbols in the various drawings indicate like elements.
This document provides joint assemblies for use with medical devices, including but not limited to implantable medical devices that can be used to occlude apertures, holes, defects, appendages, conduits, cavities, vessels, organs, or structures within a patient. In some embodiments, the joint assemblies provided herein include receptacles to couple a plurality of elongate frame members to a hub component. Each receptacle of the plurality of elongate frame members is configured to pivot with respect to the hub component, such that each elongate frame member attachment region is movable with respect to the hub component.
As shown in
In other examples, the hub 102 may be recessed in the distal direction from a plane formed by the portions of the elongate members 111. For example, the portions of the elongate members 111 may be oriented proximally in comparison to the hub 102, such that the portions of the elongate members 111 and the hub 102 form a plane with a concave or recessed area in which the hub 102 is disposed. In some examples, the portions of the elongate members 111 may be oriented distally in comparison to the hub 102, such that the portions of the elongate members 111 and the hub 102 form a plane with a convex area in which the hub 102 is disposed.
In some implementations, the occlusion device 100 may assume two or more configurations. In some embodiments, each of the two or more configurations is distinct from the others of the two or more configurations. For example, the occlusion device 100 may assume a delivery configuration when the occlusion device 100 is delivered over or through a catheter to a delivery site (refer to
In various embodiments, the occlusion member 115 may be shaped appropriately to occlude an aperture. In certain instances, the plurality of elongate members 111 each form a curvature tapering the frame 110 to a distal end portion 108 of the frame to reduce a diameter of the frame 110 ending the curvature at the distal end portion 108. In some examples, the occlusion member 115 may be shaped to partially occlude an aperture. The occlusion member 115 may have, from a frontal view of the proximal portion 104 of the device 100, a shape of a circle, an oval, a square, a rectangle, a triangle, a diamond, a semi-circle, a crescent, or any other appropriate shape to occlude a particular opening or aperture. In some embodiments, the hub 102 may be positioned generally centrally with respect to a proximal face 113 of the occlusion member 115. For example, if the proximal face 113 of the occlusion member 115 is shaped as a circle, the hub 102 may be positioned generally near a center of the circle. Similarly, if the proximal face of the occlusion member 115 is shaped as a square, the hub 102 may be positioned generally near a center of the square, or near the center of an oval or rectangle for devices with occlusion members 115 having these shapes. In some embodiments, the hub 102 may be positioned non-centrally with respect to a proximal face 113 of the occlusion member 115. For example, if the proximal face 113 of the occlusion member 115 is shaped as a semi-circle, the hub 102 may be positioned generally near a midpoint of a straight (e.g., diameter-defining) edge of the semi-circle.
As assembled (see
In some embodiments, the interior region of each socket 140 includes a generally semi-spherical pocket 144. The generally semi-spherical pockets 144 are formed when the first and second hub base members 114, 116 are engaged. Each socket 140 further includes two semi-cylindrical channels 142 extending from opposite sides of each semi-spherical pocket 144. When assembled with receptacles 150 as will be described below, each of the semi-spherical pockets 144 constrains in at least a first dimension a generally spherical member 152 of a receptacle 150. The channels 142 and the pockets 144 may have radii of about 0.35 mm to about 0.65 mm and about 0.12 mm to about 0.51 mm, respectively. In some embodiments, a hub may include fewer than six sockets (e.g., two, three, four, five), or more than six sockets (e.g., seven, eight, nine, ten, twelve, or more).
In this example, each receptacle 150 includes a generally spherical member 152 attached to a neck region 154 that is further attached to a tubular member 156 that is sized to receive and surround a respective end portion of an elongate member 111. For simplicity, only a single receptacle 150 and a single elongate member 111 is shown in
The elongate members 111 may be attached to the receptacles 150 in various manners. For example, an end of each elongate member 111 may be placed within a tubular member 156 of a receptacle 150 and laser welded therein (e.g., with a circumferential, 360 degree laser weld). Other examples of ways the elongate members 111 may be attached to the tubular members 156 of the receptacles 150 can include a mechanical crimp of the tubular member 156 around the elongate member 111 (e.g., a micro-swedge joint), an adhesive connection, an RF weld, or an ultrasonic bond, or combinations of the techniques. In various implementations, the ends of the elongate members may be inserted about 0.60 mm to about 2.0 mm into the tubular members 156. In some examples, the elongate members 111 are inserted into the elongate tubular members 156 of the receptacles 150 to a depth that is about three times the diameter of the elongate members 111.
As described above, a first end of an elongate member 111 can be fixedly attached to a receptacle 150 at an attachment region. The receptacle 150 is configured to pivot with respect to the hub 102, such that the attachment region is movable with respect to the hub 102. The elongate members 111 are securely joined with tubular members 156 such that collective positions of the receptacles 150 affect the overall shape of the frame 110. Termination of the elongate members 111 within the receptacles 150 allows the proximal end 104 of the occlusion device 100 to form the substantially planar face 113 when all of the receptacles 150 extend substantially parallel to the proximal surface 126 of the hub base member 116.
The spherical members 152 can be sized to be received into the semi-spherical pockets 144 of the sockets 140 while allowing clearance between the spherical members 152 and the socket openings 146 such that the spherical members 152 can pivot within the sockets 140. The spherical members 152 may be permitted to pivot within the sockets 140 with one degree of freedom (as indicated by a first arrow 153). In some embodiments, a clearance region between outer surfaces of the spherical members 152 and inner surfaces of the semi-spherical pockets 144 may allow the spherical members 152 to minimally pivot with a second degree of freedom (as indicated by a second arrow 155). Each receptacle 150 (and the attached end of the associated elongate member 111) may generally pivot independently of the other receptacles 150 (and elongate members 111). The side walls 134, 136 of the hub 119 may generally constrain movement of the receptacle 150 in the direction indicated by the first arrow 153. In some embodiments, the clearance between the spherical members 152 and the semi-spherical pockets 144 is such that stresses exerted on the spherical members 152 may increase as the receptacles 150 pivot within the sockets 140. As the spherical members 152 pivot within the semi-spherical pockets 144, the spherical members 152 may receive varying tensile and compressive forces that depend on the shapes that the elongate members 111 take at the delivery site. As the occlusion device 100 is collapsed and moved through a catheter sheath (as will be discussed in more detail below), the spherical members 152 may experience more tensile forces than compressive forces within the semi-spherical pockets 144. In some implementations, the first hub base member 114 and the second hub base member 116 may be press fit onto the spherical members 152 of the receptacles 150. In some implementations, the spherical members 152 may be snap fitted into the sockets 140 of the hub 102 or the hub assembly 119. The spherical members 152 may have a diameter of about 0.35 mm to about 0.65 mm in some implementations.
In some embodiments, spherical members may be formed directly on ends of the elongate members 111 using a precision laser weld technique (e.g., using an Nd:YAG laser). Such embodiments can eliminate a need for the receptacles 150 and allow the elongate members 111 to be engaged directly with the sockets 140 of the hub 119. For example, the spherical member at the end of the elongate member 111 may be press-fit or snap fitted into the semi-spherical pocket 144 of the hub 119. In some examples, spherical members may alternatively be fixedly and directly attached to ends of the elongate members 111 instead of being integrally formed with the elongate members 111. For any of the examples discussed herein that describe receptacles 150 and a spherical member 152 of the receptacle, the receptacle 150 may generally be omitted, and a spherical member formed or attached at the end of an elongate member 111 may replace the spherical member 152.
In some implementations, the semi-spherical pocket 144 described above can be replaced by two semi-spherical pockets that are disposed on opposing walls of a socket.
Referring again to
In some embodiments, the elongate members 111 can include wires, such as spring wires, shape memory alloy wires, or super-elastic alloy wires. The elongate members 111 may be nitinol wires. In some embodiments, the diameter or thickness of the elongate members 111 may be about 0.20 mm to 0.40 mm, but in other embodiments elongate members 111 having smaller or larger diameters may be used. In some embodiments, each of the elongate members 111 has the same diameter. In some embodiments, one or more portions of the elongate members 111 may be tapered. The elongate members 111 may have a round cross-sectional shape or may have a cross-sectional shape that is not round, such as a rectangle or other polygon. Examples of other cross-sectional shapes that the elongate members 111 may have include a square, oval, rectangle, triangle, D-shape, trapezoid, or irregular cross-sectional shape formed by a braided construct. In some embodiments, an occlusion device may include flat elongate members 111. In some examples, the elongate members 111 may be formed using a centerless grind technique, such that the diameter of the elongate members 111 varies along the length of the elongate members 111.
In some embodiments, one or more projections (not shown) extend from a surface of the spherical members 152 and are sized to engage one or more detents positioned across a surface of the socket 140. In some examples, the detents on the sockets 140 and the projections extending from the spherical members 152 can allow the receptacles to be encouraged, biased, held, or locked in a particular position, such that the elongate members 111 can maintain a particular position to provide a desired shape to the frame 110. In some embodiments, each socket 140 includes one or more detents (not shown) sized to engage protrusions extending from receptacles positioned within the sockets 140.
In some embodiments, either or both of the one or more semi-spherical pockets 144 and the one or more semi-cylindrical channels 142 may include protruding lip features (not shown) that extend to opposing edges of the socket openings 146 and serve to constrain the neck regions 154 of the receptacles 150 as the receptacles 150 pivot within the sockets 140. In some embodiments, the sockets 140 may not include detents, but may instead include one or more alternative motion-limiting features, such as slots or openings sized to engage the protrusions extending from the receptacles.
Referring again to receptacle 150, neck region 154, which extends between spherical member 152 and tubular member 156, can be sized to allow the receptacle 150 to pivot within the socket 140. In some implementations, neck region 154 has a diameter that is less than the width of the socket opening 146. For example, neck region 154 may have a diameter of about 0.127 mm to about 0.25 mm less than that of the diameter of the spherical members 152. In some embodiments, the tubular member 156 may have an inner diameter of about 0.02 mm to about 0.05 mm larger than that of the thickness (e.g., diameter) of the elongate member 111, a wall thickness of about 0.07 mm to about 0.15 mm, and a length of about 1.0 mm to about 2.6 mm.
Referring now to
In some embodiments, the fixation members 158 may be compliant, non-compliant, or partially compliant and partially non-compliant. In some embodiments, a portion or the entire surface of the fixation members 158 may be coated with one or more biocompatible materials including a fluoropolymer (e.g., PTFE), a polyester, a silicone, a urethane, or another suitable biocompatible material. In some embodiments, coated portions of the fixation members 158 may provide a substrate that promotes tissue ingrowth around the fixation members 158. In some embodiments, the coated portions of the fixation members 158 substantially prevent tangling of fixation members 158 amongst each other. In some embodiments, the covered portions of the fixation members 158 minimize friction between the fixation members 158 and a surrounding catheter wall, thereby aiding deployment of the occlusion device 100 at a delivery site or retrieval of the occlusion device 100 from the delivery site following implantation. In some examples, the covered portion of the fixation members 158 may limit the extent to which the fixation members 158 can penetrate a tissue. In some embodiments, the covered portions of the fixation members 158 may be impregnated with or coated with one or more drug substances that are released in situ to promote wound healing or reduce tissue inflammation. In some embodiments, the drug substance may be a corticosteroid, a human growth factor, an anti-mitotic agent, an antithrombotic agent, an anti-inflammatory agent, an analgesic, an anti-infective agent, or dexamethasone sodium phosphate. In some embodiments, the covered portions of the fixation members 158 may provide texture that aids in securing the occlusion device 100 to the surrounding tissue.
In some embodiments, fixation members do not pierce tissue at the delivery site but instead secure the frame 110 to the delivery site using, for example, friction or pressure. In some embodiments the fixation members terminate with an atraumatic ending (e.g. a ball or a plate). In some embodiments, the surface of the atraumatic ending is textured to further increase the friction between the fixation member and the tissue at the delivery site.
The fixation members 158 may be attached to the elongate members 111 of the frame 110 in a variety of manners. For example, a fixation member 158 may be welded to an elongate member 111, as by laser welding or RF welding, or bonded to the elongate member 111 by an adhesive bond, an ultrasonic bond, or other bonding method. In some examples, combinations of the foregoing fixation member 158 attachment techniques may be used on a device.
Referring again to
Still referring to
The various components (e.g., the hub 102 or 119, the receptacle 150, the elongate members 111, and the covering 112) of the occlusion device 100 can be formed of one or more of a variety of biocompatible materials. In some embodiments, either or both of the hub 102 or 119 and the receptacles 150 may be injection molded from one or more materials including stainless steel, titanium, polyetheretherketone (PEEK), polyethermide (PEI), polycarbonate, polyamide, polytetrafluoroethylene (PTFE), NiTi, L605 (Cobalt Chromium), MP35N, or any other appropriate material. In some examples, the hub base members 114, 116 can be assembled with a press-fitting, a snap-fitting, an adhesive substance, or a weld (e.g., a laser weld) between the central hole 118 within the first hub base member 114 and the projection 120 extending from the second hub base member 116.
In some embodiments, the receptacles 150 may be formed of one or more materials including without limitation nitinol (NiTi), stainless steel, L605 alloy, MP35N alloy, and titanium. The elongate members 111 may generally be formed of one or more of any biocompatible materials that are sufficiently strong, conformable, and fatigue resistant. In some embodiments, the elongate members 111 may be formed as wires. In some embodiments, the elongate members 111 may be formed of NiTi, which has super-elastic properties that makes it a particularly good material from which to form such elongate members 111. For example, elongate members formed from NiTi can be heat set into a prescribed shape (e.g., in a manner such that the elongate members 111 provide the frame 110 with the shape shown in
In some examples, the eyelet 106 and frame 110 of the occlusion device 100 may be wound first, and the receptacles 150 and hub 102 or 119 attached thereafter. In some examples, the receptacles 150 may be attached to respective ends of the elongate members 111, the receptacles 150 may be attached to the hub 102 or 119, and then the elongate members 111 may be wound to form the frame 110 and the eyelet 106. In some examples, the receptacles 150 may be received by the hub assembly 102 or 119 prior to attaching the elongate members 111 to the receptacles 150, while in other examples the elongate members 111 may first be attached to the receptacles 150, and then the receptacles 150 may be received by the hub assembly 102 or 119.
In examples where spherical members are formed directly on the proximal ends of the elongate members 111, or attached thereto, the receptacles 150 may not be included with occlusion device 100, and the proximal ends of the elongate members 111 may be received directly within the sockets 140 of the hub 102 or 119. In some implementations, the eyelet 106 and the frame 110 may be wound first, and then the spherical members formed (or attached) at the proximal end of the elongate members 111 may be press-fit or snap-fitted into the sockets 140 of the hub 102 or 119. In some implementations, the spherical members formed (or attached) at the proximal end of the elongate members 111 may be press-fit or snap-fitted into the sockets 140 of the hub 102 or 119, and thereafter the frame 110 and eyelet 106 may be wound.
Some embodiments may comprise a covering 112. The covering 112, in some embodiments may be formed of a fluoropolymer (e.g., expanded PTFE (ePTFE) or PTFE). In some embodiments, the covering 112 may be formed of a polyester, a silicone, a urethane, or another biocompatible polymer, or combinations thereof. In certain embodiments, the covering 112 may be formed of a copolymer. In some examples, a first portion of the covering 112 may be formed of a first material and a second portion of the covering 112 may be formed of a second material. For example, the portion of the covering 112 that covers the occlusion member 115 may be formed of a first material, and the portion of the covering 112 that covers the support member 117 may be formed of a second material.
Referring to
Coupled with the delivery catheter 170, the occlusion device 100 may then be forced through the delivery sheath 168 until the occlusion device 100 is positioned completely within the delivery sheath 168. As the occlusion device 100 is forced through the delivery sheath 168, the elongate members 111 of the frame 110 may collapse within the delivery sheath 168. For some implementations that include fixation members 158, the fixation members 158 may collapse against the elongate members 111 of the frame 110.
The configuration of device 100 shown in
The occlusion device 100 and the catheter 170 may be advanced through the sheath 168 to the delivery site in a manner as would be known to one of ordinary skill in the art. At the delivery site, the occlusion device 100 may be deployed by pushing the delivery catheter 170 out of the delivery sheath 168 until the occlusion device 100 is positioned distal of the delivery sheath 168. As the occlusion device 100 moves distally out the delivery sheath 168, and as the frame 110 of the device 100 is liberated from the restrictive force imparted by the inner surface of the delivery sheath 168, the receptacles 150 (or an end portion of the elongate member 111 for embodiments that do not include receptacles 150) may pivot within the sockets 140 of the hub 102 to allow the frame 110 to expand to its prescribed shape. For implementations that include a detent feature, the receptacles 150 may pivot within the sockets 140 until the protrusions extending from the spherical members 152 of the receptacles 150 become substantially engaged with particular detents positioned along the semi-spherical pockets 144 of the sockets 140, thereby limiting further movement of the receptacles 150 within the sockets 140. For example, the detents may be engaged as the frame 110 conforms to its final shape at the delivery site. In some examples, the detents may be engaged in response to operator movement of a portion of the system that pushes the pivot hub into the almost fully formed frame shape. The forces generated by the engagement may be felt by the operator or may be observed using fluoroscopy or transesophageal echocardiography (TEE) imaging. In some examples where the sockets 140 do not include detents but instead include alternative motion-limiting features (e.g., a channel or slot), a cam-over effect or over-centering action may be utilized to limit a reverse movement or reverse pivot movement of the receptacles 150 or elongate member. In some embodiments, the cam-over effect or over-centering action may make the use of alternative motion-limiting features optional.
Referring to
Alternatively, the occlusion device 100 may be deployed by retracting the delivery sheath 168 while maintaining the position of the occlusion device 100 near the ostium 172 of the LAA 174. In some examples, the occlusion device 100 may be deployed by performing a combination of pushing the delivery catheter 170 out of the delivery sheath 168 and retracting the delivery sheath 168 while maintaining the position of the occlusion device 100. In some examples where the delivery catheter includes an inner through-catheter component, the delivery catheter may be attached to the occlusion device 100, to one or both of the proximal and distal eyelets, or to a hub. In some embodiments, one or more of the catheter components imparts an independent axial pistoning movement. In some embodiments, one or more catheter components impart an axial pistoning movement and one or more other catheter components serve an alignment function. In some embodiments, the delivery catheter is attached to the occlusion device 100 only at the proximal end of the occlusion device 100.
Still referring to
After the occlusion device 100 has been deployed within the LAA 174 at a desired position, the occlusion device 100 may be released from the delivery catheter 170, and the catheter delivery system 166 may be removed in an endovascular fashion, as is known to one of skill in the art. The occlusion device 100 may then be operable to substantially occlude the LAA 174.
In some examples, the occlusion device 100 can be repositioned within the LAA 174 (or other delivery site), or may be retrieved from the LAA 174 (or other delivery site) following implantation. For example, a retrieval cord can be included with a catheter delivery system. In some examples, the delivery catheter 170 can be used to reposition the occlusion device 100 while the occlusion device 100 is partially deployed by applying a gentle traction to the delivery catheter 170 until the occlusion device 100 collapses back within the sheath 168, or is positioned appropriately at the delivery site. In some examples, the retrieval cord can be coupled with the hub 102 and used to remove the deployed occlusion device 100 from the LAA 174 after the occlusion device 100 has been released from the delivery catheter 170 by pulling the entire occlusion device 100 out of the LAA 174 and back into the delivery sheath 168. In some examples, a retrieval cord can be engaged with a keyed hub. In other examples, the retrieval cord can be engaged with a threaded hub.
In some examples, the occlusion device 100 may alternatively be delivered to the LAA over a guidewire using rapid exchange or other methods of guidewire delivery known to those of ordinary skill in the art (see, for example, U.S. Pat. Nos. 5,040,548, 5,061,273, and 6,165,197 to Yock and U.S. Pat. No. 4,762,129 to Bonzel).
While the occlusion device 100 has been described as having the hub 102 positioned at the proximal end 104 of the occlusion device 100 and the eyelet 106 positioned at the distal end 108 of the occlusion device 100, in some embodiments, an occlusion device may have two hubs 102, one positioned at the proximal end 104 and the other at the distal end 108, and may omit the eyelet. In some examples, replacing the eyelet 106 at the distal end 108 of the occlusion device 100 with another hub 102 may provide a less traumatic interface between the distal end 108 of the occlusion device 100 and a wall of the LAA during initial deployment of the occlusion device 100 and following positioning of the occlusion device 100 within the LAA. Furthermore, providing a hub 102 at the distal end 108 of the occlusion device 100 may improve the conformability of the frame 110 to the cavity of the LAA. In some examples, implantable medical devices may include one, two, three, or more hub devices.
While the occlusion device 100 has been described as including the hub 102 formed of two hub base members 114, 116, in some embodiments, an occlusion device can alternatively include a hub that is formed of a single component.
Within each socket 140 is located a generally semi-spherical pocket (not shown in
In some implementations, an occlusion device can include a hub assembly that guides the pivotal motion of elongate members. For example, a hub may include, for each elongate member, a slot that guides the pivotal motion of the elongate member.
The support member 323 (see
In some implementations, one or more of the slots 340, through which elongate members 311 extend, includes an edge 350 that may limit a proximal rotation of a portion of the elongate member 311 that passes through the slot 340. The slots 340 may have a width that allows passage of the elongate members 311 but that does not allow passage of the spherical members 352, and may thus limit constrain radial movement of the spherical members 352. The spherical members 352 may be retained within pocket regions 344. Referring particularly to
The occlusion device 300 may generally include an occlusion member (e.g., an occlusion member similar to the occlusion member 115) and a support member (e.g., a support member similar to the support member 117). The elongate members 311 can extend from the slots 340 to form a substantially planar occluder face, can extend slightly proximal to the hub 302 to form a concave occluder face, or can extend slightly distal to the hub 302 to form a convex occluder face. In some embodiments, the slots 340 have a width of about 0.25 mm to about 0.31 mm and a length of about 0.75 mm to about 2.6 mm.
While in the depicted embodiments the portions of the elongate members 311 in proximity to the spherical members 352 is generally straight, in some embodiments, the elongate member 311 may include a bend in a portion of the elongate member proximate the spherical member 352. The bend may adjust an angle at which the elongate member 311 extends from the proximal end 304 of the occlusion device 300. In some embodiments, the elongate members 311 may be bent to an angle of about 10° to about 45° (e.g., 30°).
In some embodiments, the slots 340 may include an angle that biases the elongate members 111 in a desired direction relative to the tubular member 334 of the hub 302. In some embodiments, the spherical members 352 may have a diameter of up to two times that of the elongate members 311. The elongate members 311 may terminate at a distal end of the occlusion device 300 at an eyelet (e.g., the eyelet 106) or at another hub (e.g., the hub 102, 119, 202, or 302).
As shown in
In some embodiments, the detents 360 are positioned to maintain, once engaged, the spherical members 352 in a particular rotational position. In some embodiments, the detents are positioned to maintain, once engaged, the spherical members 352 in a particular longitudinal position. In some examples, the detents may allow the spherical members 352 to be maintained at about a 90° angle relative to the central axis 341 of the hub 302 when a frame 310 of the occlusion device 300 has assumed its deployed configuration (e.g., to form a substantially planar occluder face). In some examples, the detents 360 may allow the spherical members 352 to be maintained at an angle slightly greater than about 90° to achieve an inverted shape (e.g., to form a concave occluder face) for camming over the center. In some examples, the detents 360 may allow the spherical members 352 and the elongate members 311 to be generally collapsed along the slots 340 when the frame 310 is substantially collapsed (e.g., when the occlusion device 300 is in a delivery configuration). In some embodiments, a hub may include fewer than six slots 340 or more than six slots 340.
The various components of the occlusion device 300 may generally be formed of the same or similar materials as those discussed above with reference to the occlusion devices 100, 200. In some examples, the end cap 316 may be formed of one or more materials including stainless steel, L605, MP35N, PEEK, PTFE, or any other suitably hard, biocompatible plastic, for example. The various components of the occlusion device 300 may be assembled in a similar manner or in substantially the same manner as those of the occlusion devices 100, 200, with the exception of the hub 302. In some examples, the slots 340 may be laser cut into the tubular member 334 of the hub 302. A portion of the elongate members 311 adjacent the spherical members 352 may then be inserted within the respective slots 340 of the tubular member 334, and the lip 317 of the end cap 316 and the support member 323 may be snap-fitted into the lumen 321 of the hub 302.
In some embodiments, an occlusion device may include a hub that allows elongate members to collapse substantially flush with an outer surface of the hub. For example,
Referring now to
In some embodiments, an occlusion device may include a hub that allows elongate members to move with more than one degree of freedom (e.g., a first degree of freedom allowing a pivotal motion and a second degree of freedom allowing a translational motion). For example,
Referring to
In some embodiments, an occlusion device may include a hub that allows elongate members to move with more than one degree of pivotal motion. For example,
In the depicted example, the opposing edges 650 of each slot 640 taper outward substantially equal distances from a central axis 655 of each slot 640, and allow for an increased degree of lateral movement of the elongate members 311 within the slots 640 as a distance from the edge 350 of the slot 640 increases. In this manner, in some examples a frame 310 of the occlusion device 600 may allow the occlusion device 600 to more easily collapse to a delivery configuration or to more easily conform to a geometry of the LAA.
The various components of the occlusion device 600 may generally be formed of the same or similar materials as those discussed above with reference to the occlusion devices 100, 200, 300, 400, and 500. The various components of the occlusion device 600 may be assembled in a substantially similar manner or in substantially the same manner as that of the occlusion devices 300, 400, and 500.
In some embodiments, an occlusion device may include a hub that has slots within a tubular member that has one edge that tapers with respect to a central axis of the slot and an opposing edge that may not taper with respect to the central axis of the slot (e.g., an opposing edge that is generally parallel to the central axis of the slot). In some examples, some or all slots positioned around the tubular member may have the same edge orientations. Such a slot configuration may allow positions of elongate members (e.g., the elongate members 311) to be biased towards one rotational direction (e.g., for embodiments of an occlusion device where the elongate members are right-handedly or left-handedly helically wound around an eyelet (e.g., the eyelet 106)). In some embodiments, slots having different edge orientations may be alternately positioned around the tubular member. Such a slot configuration may allow the elongate members to be alternately biased towards different rotational directions (e.g., for embodiments of an occlusion device where some elongate members are right-handedly helically wound around an eyelet (e.g., the eyelet 106)) and some elongate members are left-handedly helically wound around the eyelet.
In some embodiments, an occlusion device includes a hub having bucket-shaped receptacles attached to elongate members, where the bucket-shaped receptacles can pivot via attached pins that are also attached to the hub. For example, as shown in
With reference to
While several of the hubs discussed herein have been described as including sockets or pockets that extend at an angle of about 90° from sidewalls of the hub (or from a plane tangential to a portion of the sidewalls near an elongate member entry point of the hub), in some embodiments, an occlusion device may include a hub that has sockets or pockets extending from sidewalls of the hub at an angle other than about 90° with respect to a horizontal reference axis of the sidewall. Without limitation, angles that sockets or pockets may extend from the sidewalls of a hub with respect to the horizontal reference axis of the sidewall can include about 80°, about 70°, about 60°, about 50°, about 40°, about 30°, about 20°, or about 10°. Accordingly, spherical members (e.g., the spherical members 152 of the receptacles 150 or the spherical members 352) may be positioned within the sockets or pockets at an angle that can allow elongate members (e.g., the elongate members 111, 311) of a frame to be arranged in a helically wound frame construct. In some examples, such a configuration of the sockets and the spherical members may be provided in an occlusion device that includes more than one hub on one end of the occlusion device. Some implementations of an occlusion device can include two or more hubs on one end of the occlusion device, where a first hub terminates elongate members that are wound in a first direction (e.g., in a leftward or counterclockwise direction), and a second hub terminates elongate members that are wound in a second direction (e.g., in a rightward or clockwise direction). Such a hub arrangement may provide for an equal number of first-direction-wound and second-direction-wound elongate members, for example.
Similarly, sockets or pockets can extend at various angles from sidewalls of the hub (or from a plane tangential to a portion of the sidewalls near the elongate member entry point to the hub), with respect to a vertical reference axis of the sidewall. Without limitation, angles that sockets or pockets may extend from the sidewalls of a hub with respect to the vertical reference axis of the sidewall can include about 80°, about 70°, about 60°, about 50°, about 40°, about 30°, about 20°, or about 10°. Such angles may be varied, for example, to provide devices or portions of devices with particular shapes formed by the elongate members. In some implementations, an entry angle of about 45° with respect to a vertical reference axis may provide an occlusion member 115 (see
While several of the hubs discussed herein have been described as allowing the spherical members or elongate members to pivot with respect to the sockets and the slots, or to translate longitudinally (with respect to a central longitudinal hub axis), in some embodiments, an occlusion device may include a hub that has sockets or slots that allow spherical members or elongate members to translate radially from a central axis of the hub within the sockets or slots. For example, the spherical member or elongate member may move toward or away from a central longitudinal axis of the hub, according to some implementations. In some implementations, such movement may be substantially perpendicular to the central longitudinal axis of the hub, and in some implementations a channel or socket may be configured to permit movement at other angles (e.g., about 120°, about 110°, about 100°, about 80°, about 70°, about 60°, or other appropriate angle). In some embodiments, such sockets or slots may have a width that varies in a direction that is radial to the central axis, such that the sockets or slot may bias spherical members to a preferred radial position. Such embodiments of an occlusion device may provide a frame of an occlusion device with an additional degree of conformability.
While some of the hubs discussed herein have been described as allowing the elongate members to pivot freely with one degree of freedom (as indicated, for example, by the arrow 153 in
In another example, an occlusion device may include a hub that has a semi-spherical pocket extending from a sidewall of the hub (e.g., a donut-shaped hub) and respective elongate members (e.g., the elongate members 311) that have spherical members (e.g., spherical members similar to the spherical members 352) on ends of the elongate members such that the spherical members may be tethered to the semi-spherical pockets. In some examples, the spherical members may be tethered to the semi-spherical pockets with a tethering member such as a suture, another string-like member, or other flexible elongate member. In some embodiments, the tethering members may extend through the hub or be wrapped around the spherical members. Such a configuration of the spherical members being tethered to the hub may allow the elongate members to pivot in all directions (i.e., with three degrees of freedom) from the semi-spherical pockets.
While the occlusion devices 100, 200, 300, 400, 500, 600, 700, 800 have been described with respect to an LAA, in some embodiments, the occlusion devices 100, 200, 300, 400, 500, 600, 700, 800 can be used to occlude or seal other apertures within a body of a patient, such as a right atrial appendage, a fistula, a patent ductus arteriousus, a septal defect, a paravalvular leak, an arteriovenous malformation, or a body vessel.
The examples discussed herein have focused on occlusion devices, but it is contemplated that the hub assemblies described herein may also be used with other types of medical devices including both implantable devices and accessories. Examples of implantable devices and accessories include, without limitation, occlusion and closure devices, filters (e.g. inferior vena cava filter or an embolic protection filter), catheter based grabbers or retrieval devices, temporary filtration devices, and vessel sizers.
For additional examples of delivery system devices, systems, and techniques that can be used to deliver, deploy, reposition, and retrieve the devices discussed herein, see the provisional application titled “Implantable Medical Device Deployment System,” having inventors Steven J. Masters and Thomas R. McDaniel, filed on 16 Nov. 2012, assigned U.S. Ser. No. 61/727,328 and non-provisional patent application titled “Implantable Medical Device Deployment System,” having inventors Steven J. Masters and Thomas R. McDaniel, filed on 15 Mar. 2013, the disclosures of which are considered part of and are specifically incorporated by reference in their entirety (including the figures) for all purposes in the present disclosure.
For additional examples of medical devices that can use the hub features described herein, see the provisional patent application titled “Space Filling Devices,” having inventors Coby C. Larsen, Brandon A. Lurie, Steven J. Masters, Thomas R. McDaniel, and Stanislaw L. Zukowski, filed on 16 Nov. 2012, assigned U.S. Ser. No. 61/727,458 and the provisional patent application titled “Space Filling Devices,” having inventors Coby C. Larsen, Brandon A. Lurie, Steven J. Masters, Thomas R. McDaniel, and Stanislaw L. Zukowski, filed on 15 Mar. 2013, the disclosures of which are considered part of and are specifically incorporated by reference in their entirety (including the figures) for all purposes in the present disclosure.
Several characteristics and advantages have been set forth in the preceding description, including various alternatives together with details of the structure and function of the devices and/or methods. The disclosure is intended as illustrative only and as such is not intended to be exhaustive. It will be evident to those skilled in the art that various modifications may be made, especially in matters of structure, materials, elements, components, shapes, sizes, and arrangements of parts including combinations within the principles described herein, to the full extent indicated by the broad, general meaning of the terms in which the appended claims are expressed. To the extent that these various modifications depart from the spirit and scope of the appended claims, they are intended to be encompassed therein. All references, publications, and patents referred to herein, including the figures and drawings included therewith, are incorporated by reference in their entirety.
This application claims priority to U.S. Provisional Application No. 61/727,328, filed Nov. 16, 2012. The disclosure of the prior application is considered part of and is incorporated by reference in the disclosure of this application.
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