The present invention relates to medical devices and methods for treating an anatomical space (e.g., vessels) of the body. More specifically, the invention relates to methods, apparatuses, and systems that include an implantable medical device prosthesis that allows for accurate deployment in the anatomical space.
Disease of the vasculature is increasingly common. Treatment of the vasculature may be difficult because of the tortuous nature and complexity of the vasculature. Aortic dissections, for example, commonly begin at or near the aortic valve root and continue to the ascending aorta and the aortic arch. Medical devices implanted at a diseased state may be used for treatment of aortic dissections, aneurysms, and other diseases of the vasculature or other luminal systems of the body, such as the biliary tract, gastrointestinal tract, or respiratory system, for example.
It remains desirable to provide medical devices, systems and methods for repairing disease along the aorta and also for repairing disease along the aorta and the branches extending and luminal spaces therefrom.
In one example (“Example 1”), a medical device delivery system includes a catheter shaft; at least one loop attached to the catheter shaft; a medical device having an interior and an exterior; at least one opening through the medical device configured to allow the loop to extend from the interior to the exterior of the medical device; and a release line exterior to the medical device held in place by passing through the loop.
In another example (“Example 2”), further to the system of Example 1, the at least one loop is flexible and includes at least two flexible loops aligned relative to a longitudinal axis of the medical device.
In another example (“Example 3”), further to the system of any one of Examples 1-2, the at least one flexible loop includes a fiber coupled to the catheter shaft.
In another example (“Example 4”), further to the system of Example 3, the fiber is at least one of wrapped, glued, and bonded to the catheter shaft to form the at least one flexible loop.
In another example (“Example 5”), further to the system of any one of Examples 1-4, the medical device is configured to collapse to a delivery configuration and the at least one flexible loop is configured to collapse toward the catheter shaft in response to the medical device being collapse to the delivery configuration.
In another example (“Example 6”), further to the system of Example 5, the system also includes at least one sheath configured to releasably hold the medical device in the delivery configuration.
In another example (“Example 7”), further to the system of any one of Examples 1-6, the medical device comprises a stent and graft combination and the at least one opening is formed through the graft, and the at least one flexible loop comprises a graft material.
In another example (“Example 8”), further to the system of any one of Examples 1-7, the at least one flexible loop is configured to maintain at least a portion of the release line in contact with an exterior surface of the medical device.
In another example (“Example 9”), further to the system of any one of Examples 1-8, the at least one flexible loop is configured to form a lumen for the release line.
In another example (“Example 10”), further to the system of any one of Examples 1-9, the release line terminates in an olive at one end of the catheter shaft.
In another example (“Example 11”), further to the system of Example 10, the release line is configured to release from the olive in response to tension and withdraw through the at least one flexible loop.
In another example (“Example 12”), further to the system of any one of Examples 1-11, the release line and the at least one loop are configured to maintain the medical device coupled to the catheter shaft during orientation of the medical device.
In one example (“Example 13”), a method of manufacturing a delivery system for a medical device includes coupling at least one flexible loop to a catheter shaft; arranging the at least one flexible loop through an opening in the medical device; and arranging a release line through the at least one flexible loop to releasably couple the medical device to the catheter shaft.
In another Example (“Example 14”), further to the method of Example 13, coupling the at least one flexible loop to the catheter shaft includes at least one of wrapping, gluing, and bonding a fiber to the catheter shaft to form the at least one flexible loop.
In another example (“Example 15”), further to the method of any one of Examples 13-14, the method also includes collapsing the medical device against the catheter shaft to a delivery configuration and collapsing the at least one flexile loop toward the catheter shaft in response to the medical device being collapse to the delivery configuration.
In another example (“Example 16”) a medical device delivery system includes a catheter shaft; a medical device having an interior and an exterior; a flexible lumen attached to the catheter shaft and extending through at least one opening through the medical device, the flexible lumen being configured to collapse in response to reduction in diameter of the medical device; and a release line arranged through the flexible lumen and configured to releasably couple the medical device to the catheter shaft.
In another example (“Example 17”), further to the system of Example 16, the flexible lumen includes a first flexible loop and a second flexible loop arranged at opposite ends of the medical device.
In another example (“Example 18”), further to the system of Example 17, the release line is configured to withdrawn through the first flexible loop and the second flexible loop in response to tension, and the first flexible loop and the second flexible loop maintain coupled to the catheter shaft.
In another example (“Example 19”), further to the system of Example 18, the catheter shaft is configured to withdraw the first flexible loop and the second flexible loop after delivery of the medical device.
In another example (“Example 20”), further to the system of Example 16, the at least one flexible loop includes a fiber coupled to the catheter shaft and the fiber is at least one of wrapped, glued, and bonded to the catheter shaft to form the at least one flexible loop.
The accompanying drawings are included to provide a further understanding of the disclosure and are incorporated in and constitute a part of this specification, illustrate embodiments, and together with the description serve to explain the principles of the disclosure.
Persons skilled in the art will readily appreciate that various aspects of the present disclosure can be realized by any number of methods and apparatus configured to perform the intended functions. It should also be noted that the accompanying drawing figures referred to herein are not necessarily drawn to scale, but may be exaggerated to illustrate various aspects of the present disclosure, and in that regard, the drawing figures should not be construed as limiting.
Various aspects of the present disclosure are directed toward apparatuses, systems, and methods that include an implantable medical device that may be used in treatment of the vasculature or other luminal and non-luminal systems of the body. In some examples, the implantable medical device is delivered to the vasculature using a delivery system, such as a transcatheter delivery system. In terms of configurations for the implantable medical device, a variety of configurations are contemplated, and the implantable medical devices described herein may be substantially cylindrical, include a bifurcation, or have any of a variety of features. Further, the implantable medical devices may be configured to conform to the vasculature into which the implantable medical device is implanted, and have a profile that facilitates delivery of the implantable medical device using a minimally invasive procedure (e.g., via transcatheter techniques), and able to withstand forces and other stresses that occur once implanted in the vasculature.
The medical device may be collapsed to a delivery configuration for delivery and expanded at the target location. In certain instances, the medical device may be partially expanded (e.g., for steering or orienting) or remain otherwise coupled to the catheter shaft during deployment. To maintain coupling of the medical device to the catheter, the delivery system may include a release line coupled to the medical device and the catheter.
As compared to delivery systems without a structural aspect to releasably couple a medical device to a catheter shaft, the release line, in certain instances, can increase an overall delivery profile of the system due in part to a catheter lumen for the release line. To facilitate delivery of the medical device with a release line (or other similar device-to-catheter coupling), the systems discussed herein include a flexible loop or lumen through which the release line is arranged. As discussed in further detail below, the flexible loop or lumen facilitate delivery of the medical devices discussed herein.
In various embodiments, the medical device 106 can include a radially collapsed configuration suitable for delivery to the treatment area of the vasculature of a patient. The medical device 106 can be constrained toward a radially collapsed configuration and releasably mounted onto a delivery device such as catheter shaft 102. The diameter of the medical device 106 in the collapsed configuration is small enough for the medical device 106 to be delivered through the vasculature to a target treatment location or area. In various embodiments, the diameter of the collapsed configuration is small enough to minimize the crossing profile of the delivery system 100 and reduce or prevent tissue damage to the patient. In the collapsed configuration, the medical device 106 can be guided by a catheter shaft 102 through the vasculature.
The medical device 106 can comprise a radially expanded configuration suitable for implanting the medical device 106 in the treatment area of a patient's vasculature. In the expanded configuration, the diameter of the medical device 106 can be approximately the same as the vessel or other body lumen in which the medical device 106 is to be placed. In other embodiments, the diameter of the medical device 106 in the expanded configuration can be slightly larger than the vessel to be treated to provide a friction or interference fit within the vessel.
In various embodiments, medical device 106 can comprise a self-expandable device, such as a self-expandable stent graft. Such devices dilate from a radially collapsed configuration to a radially expanded configuration when unrestrained. In other embodiments, medical device 106 can comprise a device that is expanded with the assistance of a secondary device applying an expansion force on the medical device 106, such as, for example, a balloon. In yet other embodiments, delivery system 100 can comprise a plurality of medical devices 106. The use of the delivery system 100 with any number of medical devices 106 is within the scope of the present disclosure. The medical devices 106 discussed herein may include, for example, stents, grafts, stent grafts, heart valves, and other similar devices. Thus, medical device 106 can include one or more stent components with one or more graft members disposed over and/or under the stent, which can dilate from a delivery diameter, through a range of larger intermediary diameters, and toward a maximal, pre-determined functional diameter. In certain instances, the medical device 106 includes one or more stent components made of nitinol and a graft member made of ePTFE. However, and as discussed below, any suitable combination of stent component(s) and graft member(s) is within the scope of the present disclosure.
In certain instances, the delivery system 100 may include a sleeve or multiple sleeves (and other constrain mechanisms) to constrain the medical device 106 in a collapsed configuration for endoluminal delivery of the medical device 106 to a treatment portion of the vasculature or other body lumen of a patient. For the purposes of the disclosure, the term “constrain” may mean (i) to limit the expansion, either through self-expansion or assisted by a device, of the diameter of a medical device 106 or (ii) to cover or surround but not otherwise restrain a medical device 106 (e.g., for storage or biocompatibility reasons and/or to provide protection to the medical device 106 and/or the vasculature). The delivery system 100, for example, comprises a sleeve 104 (or pull-back sheath or other similar constraining structure) which surrounds and constrains medical device 106 toward a reduced diameter or collapsed configuration as shown in further detail with reference to
In other embodiments, the medical device 106 is constrained by a plurality of sleeves (e.g., similar to the sleeve 104) which circumferentially surround the medical device 106, which allow the medical device 106 to be deployed and held at intermediate configurations larger than the collapsed configuration and smaller than the deployed configuration. The plurality of sleeves can comprise at least two sleeves (e.g., each similar to sleeve 104) which circumferentially surround each other.
The sheet of material(s) used to form the sleeve(s) can comprise a series of openings, such that the openings extend from one edge of the sheet to the other. In such configurations, a coupling member 224 can be woven or stitched through the series of openings in the sheet of material(s), securing each of the two edges together and forming a tube. For example, in
In various embodiments, disengaging a single coupling member which closes a single sleeve from the sleeve allows the expandable device to be expanded toward a larger diameter or outer peripheral dimension. For example, with reference to
In such embodiments, the medical device 106 can be expanded from the collapsed configuration toward the intermediate configuration once the implant has been delivered near the treatment area of the vasculature of a patient. The intermediate configuration may, among other things, assist in properly orienting and locating the medical device 106 within the treatment area of the vasculature. In various embodiments, a medical device 106 can be concentrically surrounded by two sleeves having different diameters. In such configurations, a primary sleeve constrains the medical device 106 toward the collapsed configuration. Once the collapsed configuration sleeve is opened, a secondary sleeve constrains the medical device 106 toward the intermediate configuration similarly configured and arranged as the sleeve 104 (e.g., the secondary sleeve may also be held together released by a coupling member).
As noted above, the medical device 106 may be oriented at the treatment area of the vasculature. To orient the medical device 106, the delivery system 100 includes a steering line 220. Tension can be applied to the steering line 220 to displace the steering line 220 and bend the medical device 106. Bending the medical device 106 may, among other things, assist in travelling through curved or tortuous regions of vasculature. Bending the medical device 106 may also allow the medical device 106 to conform to curvatures in the vasculature, or other body lumens of a patient.
In certain instances, the delivery system 100 may include a handle 108 (as shown in
The release line 326 may be arranged external to the medical device 106 (as shown), may be internal to the medical device 106, or may be routed through the medical device 106 such that portions of the release line 326 are external to the medical device 106 and other portions of the release line 326 are internal to the medical device 106. Another end of the release line 326, similar to the coupling member 224 and steering line 220 discussed above, may be coupled to a handle 108 (not shown) of the delivery system 100. At the handle 108, tension may be applied to the release line 326 by a user to remove the release line 326 from the patient and uncouple the medical device 106 from the delivery system 100.
In various embodiments, the release line 326 can be formed from metallic, polymeric or natural materials and can comprise conventional medical grade materials such as nylon, polyacrylamide, polycarbonate, polyethylene, polyformaldehyde, polymethylmethacrylate, polypropylene, polytetrafluoroethylene, polytrifluorochlorethylene, polyvinylchloride, polyurethane, elastomeric organosilicon polymers; metals such as stainless steels, cobalt-chromium alloys and nitinol. Elongated members or lock wires can also be formed from high strength polymer fibers such as ultra high molecular weight polyethylene fibers (e.g., Spectra®, Dyneema Purity®, etc.) or aramid fibers (e.g., Technora®, etc.).
In certain instances and as shown in
The medical device 106 may be collapsed to a delivery configuration for delivery and expanded at the target location. In certain instances, the medical device 106 may be partially expanded (e.g., for steering or orienting) or remain otherwise coupled to the catheter shaft during deployment. To maintain coupling of the medical device 106 to the catheter shaft 102, the delivery system may include a release line 326 (as shown in
As compared to delivery systems without a structural aspect (e.g., a release wire, lock wire, or other similar structure) to releasably couple the medical device 106 to the catheter shaft 102, the release line 326, in certain instances, can increase an overall delivery profile of the system 100 due in part to the requirement for a catheter lumen to maintain the release line. To facilitate delivery of the medical device 106 with a release line (or other similar device-to-catheter coupling), a flexible loop 530 may serve as a pathway for the release line 326. In certain instances, the delivery systems discussed herein may include multiple flexible loops 530. In certain instances, the flexible loop 530 (or flexible loops 530) may form a flexible lumen through which the release line 326 is arranged.
In certain instances, the flexible loop 530 (flexible loops 530) may be attached to the catheter shaft 102 (as shown in
In certain instances, the flexible loop 530 includes a fiber 634 coupled to the catheter shaft 102. The fiber 634 may be wrapped, glued, bonded, sewn, tacked, interlocked or otherwise coupled to the catheter shaft 102 to form the flexible loop 530. The medical device 106 (as discussed above but not shown) discussed herein may be a stent and graft combination, or any configuration described in association with the medical device 106. The flexible loop 530 may be formed of the same or a similar material as the graft material of the medical device. In addition, the opening through which the flexible loop 530 is arranged may be arranged through the graft portion of the medical device 106.
To manufacture a delivery system that includes the flexible loop 530 or more than one flexible loop 530, the flexible loop 530 is coupled to the catheter shaft 102 (e.g., wrapping, gluing, bonding, sewing, tacking, interlocking, or otherwise coupling the fiber 634 to the catheter shaft 102 to form the flexible loop 530). After the flexible loop 530 is formed, the flexible loop 530 is arranged through an opening (e.g., as shown in
As shown in
In certain instances, the flexible loop 530 (or loops 530) is configured to maintain at least a portion of the release line 326 in contact with an exterior surface of the medical device 106. Thus, the flexible loop 530 is configured to form a lumen for the release line 326 in certain instances. The flexible loop 530 (or flexible loops 530 as shown in
In certain instances and as shown in
The flexible loop(s) 530, in certain instances, facilitate a minimal delivery profile of the system 100 due in part to removing the need for a lumen for the catheter lumen for the release line 326 (which can add to overall delivery size). In certain instances, the flexible loop 530 (or flexible loops 530) may form a flexible lumen through which the release line 326 is arranged, and which may collapse along with the medical device 106.
After orienting and deployment of the medical device 106, the release line 326 is configured to withdrawn through the flexible loop(s) 530 in response to tension. The flexible loop(s) 530 are fixedly coupled to the catheter shaft 106. The catheter shaft 102 may be removed from the vasculature after deployment of the medical device 106 and leave the medical device 106 at the target treatment location. The catheter shaft 102 may be withdrawn to remove the system 100 from the vasculature. By withdrawing the catheter shaft 102, the flexible loop(s) 530 are also removed due to the flexible loop(s) 530 being fixedly attached to the catheter shaft 102. The flexible loop(s) facilitate use of the release line 326 without increasing the size of the delivery system 100, which may facilitate use of the system 100 through reach into smaller vasculature as compared to prior systems.
Potential materials for graft members of the medical devices discussed herein include, for example, expanded polytetrafluoroethylene (ePTFE), polyester, polyurethane, fluoropolymers, such as perflouorelastomers and the like, polytetrafluoroethylene, silicones, urethanes, ultra-high molecular weight polyethylene, aramid fibers, and combinations thereof. Other embodiments for a graft member material can include high strength polymer fibers such as ultra-high molecular weight polyethylene fibers (e.g., Spectra®, Dyneema Purity®, etc.) or aramid fibers (e.g., Technora®, etc.). The graft member may include a bioactive agent. In one embodiment, an ePTFE graft includes a carbon component along a blood contacting surface thereof. Any graft member which can be delivered by a catheter is in accordance with the present disclosure.
In addition, stent components of the medical devices discussed herein can have various configurations such as, for example, rings, cut tubes, wound wires (or ribbons) or flat patterned sheets rolled into a tubular form. Stent components can be formed from metallic, polymeric or natural materials and can comprise conventional medical grade materials such as nylon, polyacrylamide, polycarbonate, polyethylene, polyformaldehyde, polymethylmethacrylate, polypropylene, polytetrafluoroethylene, polytrifluorochlorethylene, polyvinylchloride, polyurethane, elastomeric organosilicon polymers; metals such as stainless steels, cobalt-chromium alloys and nitinol and biologically derived materials such as bovine arteries/veins, pericardium and collagen. Stent components can also comprise bioresorbable materials such as poly(amino acids), poly(anhydrides), poly(caprolactones), poly(lactic/glycolic acid) polymers, poly(hydroxybutyrates) and poly(orthoesters). Any expandable stent component configuration which can be delivered by a catheter is in accordance with the present disclosure.
The invention of this application has been described above both generically and with regard to specific embodiments. It will be apparent to those skilled in the art that various modifications and variations can be made in the embodiments without departing from the scope of the disclosure. Thus, it is intended that the embodiments cover the modifications and variations of this invention provided they come within the scope of the appended claims and their equivalents.
This application is a national phase application of PCT Application No. PCT/US2018/050773, internationally filed on Sep. 12, 2018, which is herein incorporated by reference in its entirety for all purposes.
Filing Document | Filing Date | Country | Kind |
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PCT/US2018/050773 | 9/12/2018 | WO | 00 |