The present invention relates to medical devices for removal of an obstruction, such as a clot or thrombus from vessel, typically a vessel that supplies blood to regions of the brain or a clot located in any other vessel, such as a pulmonary emboli.
The use of stent type structures to restore blood flow within the cerebral vasculature, where a clot, thrombus, or other obstruction blocks blood flow causing an ischemic stroke are increasing in frequency. When an individual suffers from an ischemic stroke, regions of the brain do not receive oxygenated blood from the heart and lungs. The lack of blood flow also prevents the removal of carbon dioxide and cellular waste from the affected brain tissue. Blockages that interfere with the supply of blood eventually result in permanent brain damage since the disruption of blood flow can cause irreversible brain cell death. Therefore, a patient suffering from an ischemic stroke must have the obstruction removed as soon as possible in order for recovery from the stroke.
The use of stent retrievers to remove the obstruction can increase positive outcomes for patients suffering an ischemic stroke. Typically, a physician advances the stent or retrieval structure into the cerebral region of the vasculature. When the retrieval device is located in the vessel of interest, the physician deploys a device for retrieval of the obstruction causing the blockage. Typically, the physician deploys the device directly into the obstruction, but the device can be deployed proximal or distal to the obstruction.
The removal of obstruction presents its own risks since the procedure can produce debris caused by disturbance or breaking of obstruction. The debris can often migrate to smaller vessels where navigation of a retrieval device is difficult if not impossible. In some cases, it is difficult or impossible to know if any debris migrates from the obstruction.
Use of a retrieval device often requires the physician to expand or position the clot retrieval device within the obstruction and then navigate the device and enmeshed obstruction to a guide catheter for removal from the body. Handling of the obstruction in this manner can also cause debris to break from the obstruction and cause blood flow blockage in smaller vessels.
In view of the above, there remains a need for an improved device that reduces the risk of debris from migrating during a surgical procedure intended to restore blood flow within a patient experiencing ischemic stroke.
Recently, stents and stent type devices have been discussed for use in restoring control to individuals that suffer from various neuromuscular disorders where control of limbs is severely impaired. In many of these patients, however, the portion of the brain responsible for movement remains intact, and it is disease and trauma to the spinal cord, nerves and muscles that limit mobility, function and independence. For these people, the ability to restore lost control at even a rudimentary level could lead to a greatly improved quality of life.
For example, commonly assigned U.S. patent application Ser. Nos. 15/957,574 and 16/164,482 disclose stent based devices that can record and stimulate cortical tissue when placed in the vasculature of the brain. Such devices use blood vessels as a conduit to the brain and provide for improved intravascular electrodes, telemetry circuitry and implantation positions that are capable of more efficiently transmitting and receiving electrical energy between vessels and external circuitry, while minimizing the occlusion of blood flow. While such devices are demonstrating promise in improving BCI for control of external devices. The stent-based devices can offer therapeutic advantages to meet a number of surgical needs.
It is known that all biological cells and surfaces of the human body carry an electrical charge. The magnitude of this charge is determined not only by the characteristics of the cells and particles themselves, but also by the liquid or solid in which they are immersed. Particles within blood carry a negative charged. It is also known that an incision into a vessel will result in a positive voltage at the incision site. Experiments have shown that if the incision site remains negatively using an electrical current, coagulation of blood takes longer at the site. If the incision site is provided with a positive voltage, clotting at the site accelerates. In a laboratory setting two oppositely charged electrodes that are immersed in blood form a clot at the positive electrode only. If the procedure is carried out correctly, the blood surrounding the negative electrode will have highly effective anticoagulant properties.
Therefore, there remains a need to control an electrical charge at the site of an occlusion within the brain can assist in controlling debris and/or thrombosis during the removal of the stent as well as produce areas within the vessel that provide anticoagulant properties.
According to the present invention, there is provided a medical device for use in a clot/obstruction removal procedure intended to treat ischemic stroke, where the device can produce various electrical effects at and/or near the site of the occlusion.
In one variation, the present invention includes methods for restoring blood flow in a blood vessel occluded by an obstruction at an occlusion site in the blood vessel. For example, such a method can include advancing a microcatheter into the blood vessel, the microcatheter containing an expandable stent structure; deploying the expandable stent structure within the blood vessel such that a portion of the expandable stent structure embeds into the obstruction; applying energy to the expandable stent structure to cause a first electrical effect along a first portion of the expandable stent structure and a second electrical effect along a second portion of the expandable stent structure, within the blood vessel, where the first electrical effect varies from the second electrical effect and where at least the first electrical effect or the second electrical alters an attraction of the obstruction to the expandable stent structure; manipulating the expandable stent structure to dislodge at least a portion of the obstruction from the occlusion site; and withdrawing the expandable stent structure and at least the portion of the obstruction from the vessel allowing blood flow to resume within the blood vessel.
In one variation of the method, where the first electrical effect comprises a positive charge to the first portion of the expandable stent structure. Alternatively, the first electrical effect can comprise a negative charge to the first portion of the expandable stent structure.
In another variation, the method can further include obtaining an impedance measurement using the second portion of the expandable stent structure while the first electrical effect comprises either a negative charge or a positive charge to the first portion of the expandable stent structure.
A variation of the method includes applying energy to the expandable stent structure comprises negatively charging at least a portion of the expandable stent structure.
Variations of the method can include the expandable stent structures that comprise a frame structure forming a plurality of struts, where the frame structure is moveable between a reduce profile and an expanded profile in which a diameter of the frame structure increases; where at least one of the plurality of struts forming the frame structure comprises an electrically conductive material on a support material, the electrically conductive material extending along at least a portion of the strut and being covered with a non-conductive material.
In another variation of the method, the expandable stent structure comprises; at least one electrode formed by an opening in the non-conductive material on the portion of the strut.
Variations of the method can also include using at least a portion of the non-conductive material to create a capacitive effect between at least a portion of the electrically conductive material and the blood vessel.
In variations of the method, the obstruction comprises a blood clot, debris from a blood clot caused during the procedure, plaque, cholesterol, thrombus, a naturally occurring foreign body, a non-naturally occurring foreign body or a combination thereof.
The first electrical effect and/or the second electrical effect can cause altering of movement of a debris from the obstruction. Such altered movement of the debris can comprise electrical attraction between the debris and a portion of the expandable stent structure.
A variation of the method includes applying energy to the expandable stent structure to cause the first electrical effect within the blood vessel comprises cycling energy at various parameters.
In an additional variation of the method, applying energy to the expandable stent structure causes the first electrical effect of increasing coagulation of blood at a portion of the expandable stent structure which causes debris flowing in the blood to adhere to the expandable stent structure.
Preferred embodiments of the present invention are hereafter described, by way of non-limiting example only, with reference to the accompanying drawing.
The system described herein includes a medical device that is designed for placement within a vessel 202 of an animal or human 110 to engage a clot or obstruction 204 within the vessel 202 to restore blood flow 206 within the vessel 202. The obstruction can comprise a blood clot, debris from a blood clot caused during the procedure, plaque, cholesterol, thrombus, a naturally occurring foreign body, a non-naturally occurring foreign body or a combination thereof. While the present disclosure discusses removal of a clot from a cerebral vasculature, the methods and devices described herein are useful in removal of an obstruction from any vessel within the body, including but not limited to: pulmonary embolism; clots in the legs, arms, etc.; venous and arterial clots.
As shown in
In any case, the ability to enmesh the stent 100 within the obstruction 204 as well as deliver energy to the stent allows for the power supply 150 to produce an electrical effect within the blood vessel. As noted below, the electrical effect is generally any effect that assists with removal of the obstruction 204 and/or causes debris or other thrombi to become adhered to the stent through electromagnetic attraction to the powered stent 100. The power supply 150 can comprise a disposable power supply or can be a controller that is reusable with various stent/catheter systems. Alternatively, the power supply can comprise a system that inductively or otherwise wirelessly delivers energy to the stent 100.
Ultimately, the stent 100 is manipulated to dislodge at least a portion of the obstruction from the occlusion site and then the stent 100 and captured obstruction are withdrawn from the vessel allowing blood flow to resume within the blood vessel.
In one variation, energy is applied to the entire stent structure 130 to produce a charge, where the charge produces a positive electrical effect within the vessel. For instance, it is believed that positively charging at least a portion of the expandable stent structure/electrodes can prevent accelerate coagulation and clotting of blood and electromagnetic attraction of debris or other thrombi to the stent 100. Such an effect reduces the likelihood that debris caused by dislocation and/or movement of the clot 204 will migrate further downstream in the vasculature. Alternatively, negatively charging at least a portion of the expandable stent structure can prevent clotting and electromagnetic attraction of debris or other thrombi to the stent 100.
As shown, the stent 100 can comprises an expandable stent structure. Such an expandable structure can be self-expanding or activated to expand. The stent 100 can further comprises a frame structure forming a plurality of struts, where the frame structure is moveable between a reduce profile and an expanded profile in which a diameter of the frame structure increases as it engages the obstruction 204.
As discussed below, at least one of the plurality of struts forming the frame structure comprises an electrically conductive material on a support material, the electrically conductive material extending along at least a portion of the strut and being covered with a non-conductive material.
In another variations, the ability to provide different regions of charge along a stent also allows one or more regions to be used for impedance measurements as an indication of clot adhesion to the stent device. Some regions can be used to attract portions of the clot or debris, while others could probe the environment for impedance changes.
Variations of the stent 100 can include formation of at least one electrode formed by an opening in the non-conductive material on the portion of the strut. In any case, variations of the system are intended to produce an electrical effect that causes an altering of movement of a debris from the obstruction. Such movement can aid in removal of the debris or cause the debris to attach to the stent 100.
The application of energy to the stent 100 can occur prior to deployment of the stent 100 In other variations, applying energy to the expandable stent structure 100 can comprise cycling energy at various parameters before, during, and/or after expansion of the stent 100 into the obstruction.
In yet another variation, applying energy to the expandable stent structure cause the electrical effect of increasing coagulation of blood at a portion of the expandable stent structure which causes debris flowing in the blood to adhere to the expandable stent structure.
1. Medical Device
As shown in
Electrode lead wires 141 can be electrically connected to at least one electrode and will be wound around the stent strut lattice 108 such that mechanical compression and extension is not interfered with. Electrode wires 141 may be wound around the stent shaft 121, thread through a stylet shaft or may form part of the stent shaft directly. Lead wires 141 will form connections with electrode contacts 151 on the opposite end of the stent shaft to the stent, whereby electrical contact a connector block mechanism 12 enables the connection path with external equipment 16, which included but is not limited to computers, wheelchairs, exoskeletons, robotic prosthesis, cameras, vehicles and other electrical stimulation, diagnostic and measurement hardware and software.
The term electrode 131 is used in this specification to refer to any electrical conductor used to make contact with media in and/or around a blood vessel 103.
A detailed description of the operation of each of these components is set out below.
The Stent
The stent 101 includes a plurality of struts 108 coupled together with strut cross links 109.
In the arrangement shown in
Alternatively, the device 100 includes a stent with any suitable number of electrodes 131 arranged in any suitable configuration. For example, the electrodes can be configured as follows: the sinusoidal arrangement of electrodes 131 shown in
Electrodes
As particularly shown in
As shown, the electrodes 131 are located on or at the stent cross links 109. Locating the electrodes in these positions allows for changes in shape of the stent 101 (i.e expanding and collapsing) without significantly affecting the integrity of the electrodes. Alternatively, may also be located in between the stent strut crosslinks (not depicted).
To enhance contact and functionality of the device 100, electrodes 131 include the attachment of additional material (shape memory alloy or other conducting material) through soldering, welding, chemical deposition and other attachment methods to the stent 101 including but not limited to: directly on or between the stent struts 108; to lead wires 14 passing from the electrodes 131 to wireless telemetry links or circuitry; and directly to an olive 112 placed on the distal aspect of the device 100 to or stent shafts.
To further enhance the device 100 performance, there may be one or more electrodes 131 per wire strand 141 and there may be one or more strands 141 utilized per device 100. These strands 141 may be grouped to form a bundle 144, which may be woven in alternate sinusoidal paths around the stent struts 108 in the manner shown in
Alternatively, the electrodes 131 are made from electrically conductive material and attached to one or more stents, which form the device 100 and allow for multiple positions. In this embodiment, the electrodes 131 are made from common electrically active materials such as platinum, platinum-iridium, nickel-cobalt alloys, or gold, and may be attached by soldering, welding, chemical deposition and other attachment methods to one or more lead wires 141, which may be directly attached to the shape memory shaft(s). The electrodes 131 are preferably one or more exposed sections on the insulated lead wire 141 and the electrode lead wires may be wrapped around one or more shape memory backbones. There may be one or more electrodes and lead wires wrapped around a single shape memory backbone, and, where multiple shape memory backbones are used in the one device, the backbones may have different initial insertion and secondary deposition positions. Thus, they may be used for targeting multiple vessels simultaneously.
Contacts
As particularly shown in
The contacts 151 are platinum rings or rings of other conductive, biocompatible materials. The contacts can be made from or contain magnetic materials (ie, Neodinium).
The contacts 151 are preferably: (a) between 500 um and 2 mm in diameter; (b) between 500 um and 5 mm in length; and (c) between 10 um and 100 um in thickness.
The contacts 151 are shaped as discs, tubes, parabaloids or other shapes similar to those used for the electrodes 131.
The contacts are placed over non-conducting sleeve (including but not limited to a silicone tube, heat shrink, polymer coating) to assist with electrical insulation of other lead wires and electrode and stent wire, and to assist in retaining shape tubular shape whilst allowing some flexibility.
Preferably, the contacts 151 have a contact to contact separation of between 100 um and 10 mm.
The contacts 151 are formed through wire wrapping of the wires 141.
Preferably, at least one contact 151 is a dummy connector (including but not limited to a metal ring, magnetic ring, plastic tube). A dummy connector in this instance is a connector that is not in electrical contact with an electrode, instead, the purpose is to enable a connection or securing point (ie, through a screw terminal) to the device in a desired location and such that the contacts (connected to electrodes) are not damaged.
The contacts 151 are separated by a non-conductive sleeve (including but not limited to a silicone tube, heat shrink, polymer coating) to reduce electrical noise and prevent contact between superficial lead wires 141.
The electrical connection of the electrodes 131 to leads extending through the device can be accomplished by the construction of one or more connection pads (similar in construction to the electrodes described below) where the size of the pads ensures sufficient contact with the wire/lead, the type of pads ensures robustness and reduces track fatigue when crimped and attached. The section containing the pads can be compressed into a tube at, for example, distal section 146 to enable insertion of a cable 121.
In certain variations, the connection pads should be able to feed through the catheter. Furthermore, the connection pads 132 can include one or more holes or openings that enable visual confirmation that the pads are aligned with contacts on the lead. These holes/openings also enables direct/laser welding or adhesion of the contact leads (inside tube 121) and the contact pads (on the inside of the tube spanning through the hole to the outside)
In one example, a coaxial-octofilar cable (i.e. an inner cable with 8 wires positioned inside an outer cable having 8 wires) is used to enhance fatigue resistance and to ensure that wires can fit within constraints (i.e., can be inserted through a sufficiently small catheter, and can have an internal stylet as required).
Placement of the electrodes in a specific pattern (e.g., a corkscrew configuration or a configuration of three linear (or corkscrew oriented) lines that are oriented 120 degrees from each other) can ensure a deployed electrode orientation that directs electrodes towards the brain. Once implanted, orientation is not possible surgically (i.e., the device will be implanted and will be difficult if not impossible to rotate). Therefore, variations of the device will be desirable to have an electrode pattern that will face towards the desired regions of the brain upon delivery.
Electrode sizing should be of a sufficient size to ensure high quality recordings and give large enough charge injection limits (the amount of current that can be passed through the electrodes during stimulation without damaging the electrodes which in turn may damage tissue). The size should also be sufficient to allow delivery via a catheter system.
As discussed above, embedding the electrode and conductive path presents advantages in the mechanical performance of the device. Furthermore, embedding of electrodes provides the ability to increase the number of electrodes mounted on the structure give that the conductive paths (30-50 μm×200-500 nm) can be smaller than traditional electrode wires (50-100 μm).
Manufacture of thin-film stents can be performed by depositing Nitinol or other superelastic and shape memory materials (or other materials for deposition of electrodes and contacts (including but not limited to gold, platinum, iridium oxide) through magnetron sputtering in a specific pattern (56) using a sacrificial layer (58) as a preliminary support structure. Removal of the support structure (54) enables the thin film to be further structured using UV-lithography and structures can be designed with thicknesses corresponding with radial force required to secure the electrodes against a vessel wall.
Electrical insulation of electrodes is achieved by RF sputtering and deposition of a non-conductive layer (52) (eg, SiO) onto the thin-film structure (54). Electrodes and electrode tracks (50) are sputter deposited onto the non-conductive layer (using conductive and biomedically acceptable materials including gold, Pt, Ti, NiTi, PtIr), with an additional non-conductive layer deposited over the conductive track for further electrical isolation and insulation. As shown, conducting path 50 is left exposed to form the electrode 138 (similarly, a contact pad area can remain exposed). Finally, the sacrificial layer 56 and substrate are removed leaving the expandable stent structure 101 as shown in
In certain variations where the base structure 54 comprises superelastic and shape-memory materials (i.e. Nitinol), the expandable stent structure 101 can be annealed in a high vacuum chamber to avoid oxidation during the annealing process. During heat treatment, the amorphous Nitinol structure 54 crystallizes to obtain superelasticity and can be simultaneously shape set into a cylindrical or other shape as desired. The structure 101 can then be heat treated.
In the variation shown in
The tracks can remain uninsulated and be used to attract debris across the length of the stent and over the entire circumference of the stent. In another variation, a single track could be used, or multiple tracks can be used (to increase the relative negativity or area).
Again, the tracks disclosed above can be made in any number of configurations, including having them recessed into the scaffold or as fins to increase the volume of debris that can be attracted without increasing the volume and difficulty of debris removal. (i.e., when the stent/catheter is removed, a large amount of debris will impact the stent compression and may make removal difficult. Having set or predetermined areas where the debris is attracted will improve efficiency of getting the debris without impacting the ability to remove the device). Again, the images shown in
Many modifications will be apparent to those skilled in the art without departing from the scope of the present invention.
The reference to any prior art in this specification is not, and should not be taken as, an acknowledgment or any form of suggestion that the prior art forms part of the common general knowledge in Australia
In this specification and the claims that follow, unless stated otherwise, the word “comprise” and its variations, such as “comprises” and “comprising”, imply the inclusion of a stated integer, step, or group of integers or steps, but not the exclusion of any other integer or step or group of integers or steps.
References in this specification to any prior publication, information derived from any said prior publication, or any known matter are not and should not be taken as an acknowledgement, admission or suggestion that said prior publication, or any information derived from this prior publication or known matter forms part of the common general knowledge in the field of endeavour to which the specification relates.
This application claims the benefit of U.S. Provisional Application No. 62/932,935 filed on Nov. 8, 2019, the entire contents of which are incorporated by reference.
Number | Date | Country | |
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62932935 | Nov 2019 | US |