Typically, stents are tubular devices that are delivered into a patient's vascular system via a catheter or similar delivery device. Stents can be used to treat a variety of different conditions, including stenosis and aneurysms. When used to treat stenosis (narrowing of a vessel), the stent is used to press against thrombus and open a vessel to allow normal blood flow. When used to treat aneurysms, low-porosity stents can be used to limit blood flow to a vessel (so-called flow-diversion stents) to promote clotting of the aneurysm and reduce the risk of aneurysm rupture. Alternatively, the stent can be used as a scaffold to keep other embolic material (such as embolic coils) within the aneurysm.
When a stent is deployed in a generally linear portion of a vessel, stent delivery is typically straightforward. For example, a distal end of a delivery catheter is advance near a desired delivery location and the outer sheath is withdrawn, allowing the stent to expand within the vessel. Even in these linear vessel situations though, stent delivery can still be challenging due to variables such as the size of the stent, size of the delivery catheter, and size of the vessel. Often, when the stent must be deployed at or near a tortuous or heavily curved portion of a vessel, a self-expanding stent may have difficulty properly deploying. For example,
The present invention is directed to a method, apparatus, and kit for assisting the expansion of a self-expanding stent, especially within highly curved or tortuous blood vessels.
One embodiment is directed to a stent delivery device comprising an elongated pusher having a self-expanding mesh portion at its distal end. The mesh portion preferably includes one or more mesh bulbs connected to each other by a reduced-diameter region. Optionally, different areas of the mesh portion, such as a middle region of the bulbs, can have a more densely braided portion have a higher pic-per-inch.
In one embodiment, the mesh portion is disposed on a core wire that extends from a distal end of the pusher. The mesh portion can slide longitudinally on the core wire, a proximal end can be fixed to the core wire or pusher, or a distal end can be fixed to the core wire.
The mesh portion can contain one bulb portion or can contain a plurality of bulb portions (e.g., between 2 and 10 or more). Further the bulb portions can have a variety of different shapes, such as spherical, spheroid, elongated cylindrical, conical, or diamond shape.
In one embodiment the core wire can terminate at the distal end of the pusher or partway within the first bulb portion. By not extending all the way through the mesh portion, the assistance device may be more flexible to accommodate a higher degree of vessel curvature.
In one embodiment, structural wire members extend between bulbs and over the reduced diameter region. These structural wire members help capture clots or other debris dislodged during a stent delivery procedure.
In one embodiment, a distal protection device is included at the distal end of the device. The distal protection device can include a relatively larger expandable mesh bulb containing a filter or similar structure to catch any material dislodged during stent deployment. The distal protection device can be braided integrally with the mesh portion or can be a separate structure connected near a distal end of the core wire.
The present invention is also directed to a method of deploying a stent, comprising exposing a distal portion of a stent within a curved region of a vasculature, expanding the mesh portion of a stent assistance device within the stent so as to apply radial expansion force to an interior of the stent, fully deploying the stent, and then withdrawing the stent assistance device.
The present invention is also directed to a kit comprising a catheter, a pusher within the catheter, a self-expanding mesh portion attached to a distal end of the pusher, and a stent disposed over the mesh portion.
These and other aspects, features and advantages of which embodiments of the invention are capable of will be apparent and elucidated from the following description of embodiments of the present invention, reference being made to the accompanying drawings, in which:
Specific embodiments of the invention will now be described with reference to the accompanying drawings. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the invention to those skilled in the art. The terminology used in the detailed description of the embodiments illustrated in the accompanying drawings is not intended to be limiting of the invention. In the drawings, like numbers refer to like elements.
The present invention is generally directed to devices that can be expanded within an interior passage of a self-expanding stent 12 during deployment to provide additional expansion force that helps the stent 12 radially expand and to maintain that radially expanded state. This added expansion force can be particularly helpful in highly tortuous vessels 10 that tend to force the stent 12 to form collapsed portions 12A, as shown and discussed with regard to
Please note for
In one embodiment, the core wire spans a lumen of pusher body 112 where only a distal section of core wire 104 is exposed. In another embodiment, core wire 104 is attached to a distal end of pusher body 112. The core wire 104 includes a fixed radiopaque marker band 107. In one example, the stent 12 can include a number of proximally placed flared ends or loops with enlarged marker coil regions and one or more of the flared end or loops sit within marker bands 109 and 107—at location 104A—to hold the stent during delivery. The enlarged marker coil region maintains the stent flare/loop pinned between marker bands 107 and 109. Marker bands 107, 109 may be sized about 0.0135 inches in diameter while core wire 104 is about 0.003 inches in diameter. The stent adopts a first, collapsed configuration when sheathed within a delivery catheter 14—best shown in
The stent assistance device 100 further includes a mesh portion 102 which sits along core wire 104. The purpose of this mesh portion is to provide additional, outward radial force on the stent 12 to help the stent 12 expand and to maintain that expanded shape during the procedure. The mesh portion 102 is formed from a plurality of wires and is heat set into an expansile shape such that the mesh portion self-expands upon being freed from the overlying delivery catheter 14.
Preferably, the mesh portion 102 is braided and heat-set to form one or more bulbs 102A (e.g., 2 bulbs as shown in
The mesh portion 102 can be woven in a variety of different configurations. For example, 12, 16, 24, 36, or 48 wires can be woven together in a 1×1, 1×2, or other wire configurations.
The porosity or size of the openings of the mesh portion 102 in its expanded configuration can vary over the length of the mesh portion 102. In the embodiment shown in
Other embodiments may have other parts of the mesh portion 102 strengthened in this manner, such as the ends of the bulbs 102A or the reduced diameter regions 102B. In one embodiment, the wires of the mesh portion 102 are comprised of nitinol and have a diameter of the range of about 0.001 to 0.0015 inches. Radiopaque (e.g. tantalum) wires may also be included in the mesh to augment visualization as well as to provide regions of increasing stiffness in the braid to further enhance the contact force against the overlying stent 12. Drawn-filled tubing with a nitinol jacket and tantalum core, or vice-versa, may also be used.
The mesh portion 102 can be created in a number of different ways. For instance, a mandrel with bulbed regions shaped similar to bulbs 102A and reduced diameter regions shaped similar to region 102B can be used to create the mesh portion shape. Either the wires can be woven on the mandrel and then heat set to impart the shapes, or a pre-woven mesh cylinder can be placed over the mandrel and heat set.
Alternatively, a mandrel with a consistent cylindrical diameter can be used, where the mesh portion is first woven over said mandrel. The mesh portion 102 is then be taken off of the mandrel and ties or marker bands are selectively applied at locations to create the reduced diameter regions 102B. A subsequent heat treatment is then be applied to impart the shape shown in, for instance,
In one embodiment, core wire 104 maintains a fixed position relative to the other components of the pusher body 112. Crimp point 108 is fixed to core wire 104 while crimp point 106 slides or floats longitudinally over said core wire 104. Since braided mesh structures tend to foreshorten in length as they radially expand, the longitudinally slideable crimp point 106 allows the distal end of the mesh portion 102 to move proximally as it is exposed from the catheter 14 and begins to radially expand.
If a stent 12 is far oversized compared to the vessel, there is high radial force against the vessel wall which could cause the stent 12 to get stuck. This could also result in the mesh portion 102 becoming stuck, since it might also be oversized relative to the vessel and therefore may become stuck in the vessel or to the stent wires. To avoid scenarios where the mesh portion 102 becomes stuck in an expanded shape, the core wire can include a fixed marker band 110 between the two crimp points 106, 108 where fixed marker band 110 acts as a backstop to make sure crimp point 106 cannot foreshorten too far proximally.
Alternative embodiments are also possible, including configurations where either one of crimp point 106, 108 is fixed/slidable, or scenarios where crimp points 106, 108 are both fixed or both slidable. To enable a slidable crimp point, the crimp point inner diameter would have to be at least slightly larger than the core wire diameter. In one example the core wire would be about 0.003 inches in diameter while any sliding crimp point would have an inner diameter of about 0.005-0.006 inches. To create a fixed crimp point, in one example, a crimping tool, adhesive, or welding can be used to mechanically affix the crimp point to core wire 104.
Core wire 104 can be comprised of a nitinol wire. As seen best in
In operation, as seen in
Catheters often include a radiopaque marker band which is located 3 centimeters from their distal tip so that the user can line up a marker band located somewhere along the delivery pusher determine the location of the proximal end of a stent is. In this respect, the physician can judge when the stent is fully deployed or almost fully deployed based on the pusher's longitudinal position.
In some embodiments, the core wire 104 is freely movable relative to the body of the pusher body 112. This movable core wire 104 can allow a physician to manually control the expansion and/or contraction of the mesh portion 102, depending on the configuration of the crimp points 106 and 108.
For example,
Proximal crimp point 108 is fixed either to pusher body 112 or to core wire 104. If proximal crimp point 108 is fixed to core wire 104 (rather than fixed to pusher body 112), said proximal crimp point 108 is placed relatively close to the pusher body 112 such that when the core wire is retracted the crimp point will immediately abut pusher body 112, preventing any further proximal movement of mesh portion 102. Distal crimp point 106 is longitudinally movable over core wire 104. The core wire 104 includes another fixed distal marker band 122 which is distal of mesh crimp point 106, where said fixed distal marker band 122 is fixed to the core wire. When the user/physician retracts core wire 104, distal marker band 122 will contact crimp point 106 and since crimp point 106 can slide, this causes crimp point 106 to move proximally inwards which would increase the radial profile of mesh portion 102A as mesh portion 102 longitudinally contracts due to the push force supplied by distal marker 122. In this way, the user may selectively augment the radial expansion force applied to the stent by being able to independently control the diameter of mesh bulb 102A. Marker band 110, like in the embodiment of
Another alternative embodiment is similar to the device 120 of
In one example, the core wire adopts a first, retracted configuration where all or a portion of mesh portion 102 is housed within pusher body 112. The user then delivers the stent 12, and if there are tracking issues where the stent 12 is stuck at a tortuous bend where a portion of the stent won't open, the user may then push the core wire distally so that the mesh portion 102 is exposed and the mesh bulb sections 102A contact the stent 12 to push it open. This is primarily enabled by the ability of proximal crimp point 108 to slide in this embodiment, since this will allow the mesh portion 102 to longitudinally expand and thus radially contract.
Alternatively, this functionality is also possible if proximal crimp point 108 is fixed to core wire 104 but distal crimp point 106 is slidable relative to core wire 104. In this arrangement, when core wire 104 is retracted within pusher body 112, the proximal crimp point 108 will enter pusher body 112 and then as more of the mesh portion 102 is retracted within pusher body 112, the mesh portion 102 will longitudinally expand pushing the slidable distal crimp 106 distally which in turn facilitates the continued radial contraction/longitudinal expansion of mesh portion 102. In contrast, if both crimp points 106, 108 were fixed, mesh portion 102 would have a relatively fixed shape and it would be difficult to get a radially compressed/longitudinally expanded shape to fit within pusher body 112.
In addition to various numbers of bulbs 102A, the bulbs 102A can have a variety of different shapes (e.g., either all bulbs have the same shape or a mixture of shapes are present).
Previous embodiments discussed a core wire 104 which spanned the entirety of mesh portion 102, where the mesh portion sat directly over core wire 104. Alternative embodiments can utilize core wire 104 that terminates at a location proximal of the distal end of the mesh portion 102. This earlier termination point can provide the mesh portion a degree of independence to conform to the tortuous conditions of the vasculature to further aid in promoting full stent expansion.
For example,
Optionally, the distal end of the mesh portion 102 may include a distal tip 114 connected to it, similar to previously described embodiments, in order to provide a guiding surface under the stent 12 as well as to provide a soft vessel contact surface to aid in placing the stent 12 without providing vessel trauma. As best seen in
Often, once a stent is deployed within a patient, thrombi can dislodge and move downstream, leading to further complications downstream in the vasculature. The following discussion are directed to embodiments that help collect or trap thrombi dislodged during a stent deployment procedure.
In one embodiment (shown in
Alternately, as seen in the device 166 in
The embodiments disclosed herein have utilized a common delivery pusher body 112 used to deliver a stent 12 and a mesh portion 102. Other embodiments can utilize a stent 12 which is connected to a first, elongated delivery pusher that has a passage therethrough. A second pusher body 112 for the stent assistance device can be positioned within the first pusher, allowing the user to move the stent and stent assistance devices separately and independently.
It should be understood that the present invention is also directed to a kit comprising an introducer tube, a pusher body 112 disposed within the introducer tube, any of the stent assistance embodiments described in this specification attached to the pusher body 112, and a stent located near a distal end of the introducer tube and over a mesh portion 102 of the pusher body 112. In use, the physician can connect the introducer tube to the proximal hub of a catheter 14 and then advance the pusher (including the mesh portion 102) and the stent 12 into the catheter 14.
While the present invention has been described in terms of separate components, such as a pusher body 112, a core wire 104, and a mesh portion 102, it should be understood that one or more of these components may also be considered a pusher, a stent assistance system, or a stent assistance device.
Although the invention has been described in terms of particular embodiments and applications, one of ordinary skill in the art, in light of this teaching, can generate additional embodiments and modifications without departing from the spirit of or exceeding the scope of the claimed invention. Accordingly, it is to be understood that the drawings and descriptions herein are proffered by way of example to facilitate comprehension of the invention and should not be construed to limit the scope thereof.
This application is a continuation of and claims priority to U.S. patent application Ser. No. 15/725,142 filed Oct. 4, 2017 entitled Method And Apparatus For Stent Delivery, which claims benefit of and priority to U.S. Provisional Application Ser. No. 62/404,102 filed Oct. 4, 2016 entitled Methods For Delivering and Using a Stent, both of which are hereby incorporated herein by reference in their entireties.
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Number | Date | Country | |
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Child | 16910400 | US |