The present disclosure relates generally to systems and methods for delivering multi-component devices. More specifically, the disclosure relates to systems and methods for delivering endovascular devices that include individual components to a target site.
A variety of branched, anatomical passages may benefit from treatment in the form of an implanted, endoluminal device. One such passage is a vascular passage, such as an artery, with an aneurysm. Aortic disease and trauma such as aneurysms and dissections present a significant risk to a patient. That risk is increased based on the patient's condition. Such conditions or factors can include the patient's age and preexisting and/or related conditions such as cardiopulmonary bypass, cardiac arrest, circulatory arrest. These and other factors may limit the patient's ability to withstand and recover from surgery to repair the aortic disease. This same issue exists in other diseased and damaged tissues in the patients.
With respect to aneurysms, in order to prevent rupturing of an aneurysm, a stent graft may be introduced into a blood vessel percutaneously and deployed to span the aneurysmal sac. Stent grafts include a graft fabric secured to a cylindrical scaffolding or framework of one or more stents. The stent(s) provide rigidity and structure to hold the graft open in a tubular configuration as well as the outward radial force needed to create a seal between the graft and a healthy portion of the vessel wall and provide migration resistance. Blood flowing through the vessel can be channeled through the luminal surface of the stent graft to reduce, if not eliminate, the stress on the vessel wall at the location of the aneurysmal sac. Stent grafts may reduce the risk of rupture of the blood vessel wall at the aneurysmal site and allow blood to flow through the vessel without interruption.
Various endovascular repair procedures such as the exclusion of an aneurysm require a stent graft to be implanted adjacent to a vascular bifurcation. Often the aneurysm extends into the bifurcation requiring the stent graft to be placed into the bifurcation. A bifurcated stent graft is therefore required in these cases. Modular stent grafts, having a separate main body and branch component are often preferred in these procedures due to the ease and accuracy of deployment. See U.S. Patent Application No. 2008/0114446 to Hartley et al. for an example of a modular stent graft having separate main body and branch stent components. In the Hartley et al. publication the main body stent has a fenestration in the side wall that is tailored to engage and secure the side branch stent.
An endoprosthesis including a main body is provided with side branch portals for providing fluidic access to side branches of a main lumen when the main body of the endoprosthesis is deployed in the main lumen. A method of deployment of the endoprosthesis is also provided
According to one example (“Example 1”), a method of deploying includes a multibranch stent graft at a target site having a main lumen and a first branch lumen is provided, the method including advancing a main guidewire to a target site; advancing a catheter including a main body of a multibranch stent graft along the main guidewire toward the main lumen of the target site, the main body having a first portion and a second portion, the main body defining a first portal operable to provide fluidic access from the main body to a first side branch extending from the target site when the main body is deployed at the target site, the first portal being pre-cannulated with a first secondary guidewire prior to advancing the main body along the main guidewire; partially deploying the first portion of the main body in the main lumen of the target site; advancing a first sheath along the first guide member through the first portal; advancing a first articulatable wire or guide catheter through the first sheath; positioning the first articulatable wire or guide catheter into a first branch lumen of the target site; partially deploying the second portion of the main body in the main lumen of the target site; fully deploying the first portion and the second portion of the main body; advancing a first side branch body along the first articulatable wire or guide catheter into the first branch lumen of the target site; and deploying the first side branch body in the first branch lumen of the target site.
According to another example (“Example 2”), further to Example 1, the method includes deploying an embolic filter in the first branch lumen of the target site.
According to another example (“Example 3”), further to Example 2, the method includes aspirating a filter sheath of the embolic filter.
According to another example (“Example 4”), further to Example 3, the method includes removing the embolic filter after the first side branch body has been deployed.
According to another example (“Example 5”), further to any of the preceding Examples, wherein the first guide member includes a first end that is looped around a cap of the catheter.
According to another example (“Example 6”), further to any of the preceding Examples, wherein the main body further defines a second portal and a third portal operable to provide fluidic access from the main body to a second side branch and a third side branch extending from the target site when the main body is deployed at the target site, the second portal being pre-cannulated with a second guide member and the third portal being pre-cannulated with a third guide member prior to advancing the main body along the main guidewire.
According to another example (“Example 7”), further to Example 6 further includes advancing a second sheath along the second guide member through the second portal; advancing a second articulatable wire or guide catheter through the second sheath; positioning the second articulatable wire or guide catheter into a second branch lumen of the target site; advancing a third sheath along the third guide member through the third portal; advancing a third articulatable wire or guide catheter through the third sheath; and positioning the third articulatable wire or guide catheter into a third branch lumen of the target site.
According to another example (“Example 8”), further to Example 7, the method includes advancing a second side branch body along the second articulatable wire or guide catheter into the second branch lumen of the target site; deploying the second side branch body in the second branch lumen of the target site; advancing a third side branch body along the third articulatable wire or guide catheter into the third branch lumen of the target site; and deploying the third side branch body in the third branch lumen of the target site.
According to another example (“Example 9”), further to Example 8, the method further includes removing the main guidewire, the first, second, and third guide members, and the first, second, and third sheaths.
According to another example (“Example 10”), further to Example 9, wherein the catheter is removed prior to advancing the first, second, and third sheaths.
According to another example (“Example 11”), an endoprosthesis delivery system includes an elongate member having a first end and a second end; an end cap coupled to the first end of the elongate member; an endoprosthesis including a main body defining a main lumen and at least one side branch portal and at least one second body defining a secondary lumen; and at least one guide member extending through the at least one side branch portal and coupled to the end cap.
According to another example (“Example 12”), further to Example 11, the endoprosthesis delivery system further includes a constraining member constraining the main body of the endoprosthesis to the elongate member.
According to another example (“Example 13”), further to Example 12, the endoprosthesis delivery system, wherein the constraining member is operable to constrain the main body at a constrained configuration and at a partially deployed configuration, the main body having a first diameter at the constrained configuration, a second diameter at the partially deployed configuration that is greater than the first diameter, and a third diameter at a deployed configuration that is greater than the first diameter and the second diameter.
According to another example (“Example 14”), further to Example 13, the endoprosthesis delivery system, wherein the constraining member includes a first portion and a second portion, wherein the first portion and the second portion are operable to independently constrain corresponding first and second portions of the main body at the constrained configuration and the partially deployed configuration.
According to another example (“Example 15”), further to any one of Examples 11-14, the endoprosthesis delivery system further includes a sheath operable to be advanced along the at least one guide member.
According to another example (“Example 16”), further to Example 15, the endoprosthesis delivery system further includes an articulatable wire or guide catheter operable to be advanced through the sheath.
According to another example (“Example 17”), further to Example 16, the endoprosthesis delivery system further includes at least one secondary branch operable to be advanced along the articulatable wire or guide catheter and to be deployed at least partially within the at least one side branch portal.
According to another example (“Example 18”), further to Example 17, the endoprosthesis delivery system further includes a removeable filter operable to be deployed downstream from a target site of the endoprosthesis.
According to another example (“Example 19”), further to Example 18, the endoprosthesis delivery system wherein the removeable filter includes a central lumen through which the articulatable or guide catheter wire is operable to extend.
According to another example (“Example 20”), further to any one of Examples 11-19, the endoprosthesis delivery system, wherein the end cap is curved.
According to another example (“Example 21”), further to the endoprosthesis delivery system of any one of Examples 11-20, wherein the endoprosthesis delivery system is curved from the end cap through the main body.
According to another example (“Example 22”), an endoprosthesis delivery system includes an elongate member having a first end and a second end; an endoprosthesis positioned longitudinally between the first end and second end of the elongate member, the endoprosthesis including a main body defining a main lumen and a side branch portal; a guide member extending through the side branch portal; and a guide member retainer removably coupled to the elongate member at a coupling position, the guide member being coupled to the guide member retainer at a position between the side branch portal and the coupling position of the guide member retainer.
According to another example (“Example 23”), further to the endoprosthesis delivery system of Example 22, wherein the main body defines a plurality of side branch portals.
According to another example (“Example 24”), further to the endoprosthesis delivery system of either Example 22 or Example 23, further includes a plurality of guide members.
According to another example (“Example 25”), further to the endoprosthesis delivery system of any one of Examples 22-24, wherein the guide member retainer extends through loops formed at an end of each of the guide members.
According to another example (“Example 26”), further to Example the endoprosthesis delivery system of any one of Examples 22-25, wherein the guide member retainer is operable to be selectively decoupled from the first coupling position.
According to another example (“Example 27”), further to the endoprosthesis delivery system of any one of Examples 22-26, wherein the elongate member includes a lock wire retainer positioned at the first end of the elongate member.
According to another example (“Example 28”), further to the endoprosthesis delivery system of Example 27, wherein the guide member retainer is releasably coupled to the lock wire retainer.
According to another example (“Example 29”), further to the endoprosthesis delivery system of any one of Examples 22-28, further including a side branch body, wherein each guide member includes a first end, wherein each first end of the guide members is retained by the guide member retainer between the coupling position and the side branch portal when the side branch body is advanced along the guide member.
According to another example (“Example 30”), further to the endoprosthesis delivery system of any one of Examples 22-29, wherein each guide member is operable to be removed from a corresponding side branch portal when the guide member retainer is released.
According to another example (“Example 31”), further to the endoprosthesis delivery system of any one of Examples 22-30, further including a plurality of guide member retainers, wherein each guide member retainer is coupled to a corresponding guide member.
According to another example (“Example 32”), further to the endoprosthesis delivery system of Example 29, wherein each guide member retainer is operable to be individually and selectively released from engagement at the first coupling position such that each guide member is operable to be individually removed from a corresponding side branch portal.
According to another example (“Example 33”), further to the endoprosthesis delivery system of Example 22, wherein the elongate member includes a cap positioned at the first end of the elongate member, wherein the guide member retainer is coupled to the cap at the coupling position.
According to another example (“Example 34”), further to the endoprosthesis delivery system of any one of Examples 22-33, the guide member retainer is coupled to the elongate member at the first end of the elongate member.
The foregoing Examples are just that, and should not be read to limit or otherwise narrow the scope of any of the inventive concepts otherwise provided by the instant disclosure. While multiple examples are disclosed, still other embodiments will become apparent to those skilled in the art from the following detailed description, which shows and describes illustrative examples. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature rather than restrictive in nature.
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.
This disclosure is not meant to be read in a restrictive manner. For example, the terminology used in the application should be read broadly in the context of the meaning those in the field would attribute such terminology.
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. Stated differently, other methods and apparatus can be incorporated herein 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.
Certain relative terminology is used to indicate the relative position of components and features. For example, words such as “top”, “bottom”, “upper,” “lower,” “left,” “right,” “horizontal,” “vertical,” “upward,” and “downward” are used in a relational sense (e.g., how components or features are positioned relative to one another) and not in an absolute sense unless context dictates otherwise. Similarly, throughout this disclosure, where a process or method is shown or described, the method may be performed in any order or simultaneously, unless it is clear from the context that the method depends on certain actions being performed first.
With respect to terminology of inexactitude, the terms “about” and “approximately” may be used, in certain instances, to refer to a measurement that includes the stated measurement and that also includes any measurements that are reasonably close to the stated measurement. Measurements that are reasonably close to the stated measurement deviate from the stated measurement by a reasonably small amount as understood and readily ascertained by individuals having ordinary skill in the relevant arts. Such deviations may be attributable to measurement error, differences in measurement and/or manufacturing equipment calibration, human error in reading and/or setting measurements, minor adjustments made to optimize performance and/or structural parameters in view of differences in measurements associated with other components, particular implementation scenarios, imprecise adjustment and/or manipulation of objects by a person or machine, and/or the like, for example.
As used herein, “couple” means join, connect, attach, adhere, affix, or bond, whether directly or indirectly, and whether permanently or temporarily.
As used herein, the term “elastomer” refers to a polymer or a mixture of polymers that has the ability to be stretched to at least 1.3 times its original length and to retract rapidly to approximately its original length when released. The term “elastomeric material” refers to a polymer or a mixture of polymers that displays stretch and recovery properties similar to an elastomer, although not necessarily to the same degree of stretch and/or recovery. The term “non-elastomeric material” refers to a polymer or a mixture of polymers that displays stretch and recovery properties not similar to either an elastomer or elastomeric material, that is, considered not an elastomer or elastomeric material as is generally known.
The term “film” as used herein generically refers to one or more of the membrane, composite material, or laminate.
The term “biocompatible material” as used herein generically refers to any material with biocompatible characteristics including synthetic materials, such as, but not limited to, a biocompatible polymer, or a biological material, such as, but not limited to, bovine pericardium. Biocompatible material may comprise a first film and a second film as described herein for various embodiments.
For reference, the terms “circumference” and “diameter” are not meant to require a circular cross-section (although are inclusive of a circular cross-section), and are instead to be understood broadly to reference an outer surface or dimension and the dimension between opposing sides of the outer surface, respectively.
Although the embodiments herein may be described in connection with various principles and beliefs, the described embodiments should not be bound by theory. For example, embodiments are described herein in connection with vascular stent grafts, and more specifically branched stent grafts. However, embodiments within the scope of this disclosure can be applied toward any endoprostheses of similar structure and/or function. Furthermore, embodiments within the scope of this disclosure can be applied in non-vascular applications.
Persons skilled in the art will readily appreciate that various aspects of the present disclosure can be realized by any number of methods and apparatuses 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.
Devices, systems, and methods of endoluminally delivering a branchable expandable implant in accordance with various embodiments are disclosed herein for treating disease of human vasculature. Although the description below and figures are illustrated in the context of treating the aorta 20, including the ascending aorta 21, aortic arch 22, and descending aorta 23, and branches therefrom, including the brachiocephalic artery 24, the left common carotid artery 25, and the left subclavian artery 26, it should be appreciated that the present disclosure can be applied to treatment of other portions of the vasculature or, including, for example, any disease where a larger vessel and one or more branch vessels are to be treated.
Referring to
Although various configurations of the implantable device 10 are contemplated with respect to the delivery systems and methods described herein, several discrete examples of an implantable device 10 are provided in detail in order to provide reference for the various components and steps of the delivery system and method of delivery and deployment. For example,
In some embodiments, the main body 100 is formed of a stent structure 120 and a graft member 130. The stent structure 120 is operable to maintain patency of the main body 100 and/or the main vessel (e.g., the aorta 20) when the main body 100 is deployed. The stent structure 120 can be formed of various materials, including, but not limited to, metals, metal alloys, polymers, and any combination thereof to provide elastic or plastic properties (e.g., self-expanding or balloon-expandable stents). The graft member 130 is coupled to the stent structure 120 and forms the fluid impermeable or semi-permeable layer through which fluids may flow (e.g., blood).
The main body 100 further includes at least one side branch portal 110. The side branch portal 110 is operable to provide fluidic access between the main lumen 102 and a branch vessel. The side branch portal 110 forms or is positioned in an opening 112 through the wall 104 along the outer profile of the main body 100. In certain instances, the side branch portal 110 extends through the wall 104 of the main body 100 longitudinally between the first end 106 and the second end 108 of the main body 100. Thus, fluid may flow through the first opening 107 and through the side branch portal 110. Some embodiments include a plurality of side branch portals 110. For example,
Referring still to
In some embodiments, the side branch portal 110 is positioned between the first end 106 and the second end 108 of the main body 100 and does not extend beyond or increase the outer profile of the main body 100 (see
Each side branch portal 110 may be include a first end 118 and a second end 122 defining a first opening 119 and a second opening 121, respectively. Fluids travel through the side branch portal from the first end 118 to the second end 122 (or vice versa) defining a side branch fluid flow direction. The side branch portal 110 is positioned such that the first opening 119 is positioned within or oriented toward the main lumen 102 of the main body 100 and the second opening 121 is positioned exterior to or oriented away from the main body 100 (e.g., the first opening 119 is the interior opening and the second opening 121 is the exterior opening of the side branch portal 110 relative to the wall 104 and main lumen 102 of the main body 100). For example,
In some embodiments, the side branch portal 110 is oriented such that the side branch fluid flow direction is opposite to the main body fluid flow direction (e.g., retrograde to the main body fluid flow direction). It is understood that opposite or retrograde in these embodiments is not limited to 180 degrees of difference, but generally encompasses a change in the direction of the fluid flowing that is greater than 90 degrees. It is also understood that the direction of the fluid flow is with respect to the specific location along the longitudinal length of the main body 100 as the main body may conform to a curved anatomy. For example, in embodiments where the side branch fluid flow direction is opposite or retrograde to the main body fluid flow includes those embodiments in which the side branch portal 110 second opening 121 is longitudinally closer to the main body 100 first end 106 relative to the side branch portal 110 first opening 119. By orienting the side branch portal 110 in the retrograde orientation, a surgeon may be able to perform the intervention and any subsequent interventions from a more advantageous access site (e.g., femoral access site to reduce trauma to carotid arteries, subclavian, or other arteries or decrease surgical presence in more anatomically crowded portions of a patient such as around the neck or thorax when operating in the aortic arch). This orientation may be advantageous in some presentations where access may difficult, obstructed, or dangerous from certain access sites.
In other embodiments, the side branch portal 110 is oriented such that the side branch fluid flow direction is generally oriented with the main body fluid flow direction (e.g., antegrade to the main body fluid flow direction). In embodiments where the side branch fluid flow direction is antegrade to the main body fluid flow includes those embodiments in which the side branch portal 110 first opening 119 is longitudinally closer to the main body 100 first end 106 relative to the side branch portal 110 second opening 121. Antegrade orientations may be advantageous in some embodiments to maintain more traditional fluid flow, especially in tissues or anatomies that may have unique geometries that would limit the use of a retrograde orientation. In embodiments implementing a plurality of side branch portals 110, the side branch portal may all have an antegrade orientation, may all have a retrograde orientation, or may include one or more branch portals with an antegrade orientation and one or more portals having a retrograde orientation.
The second opening 121 of the side branch portal 110 can be positioned at various longitudinal positions between the first end 106 and the second end 108 of the main body 100. For example, the second opening 121 of the side branch portal 110 may be positioned generally at the midpoint between the first and second ends 106, 108 of the main body 100. In other embodiments, the second opening 121 of the side branch portal 110 may be positioned closer to the first end 106 relative the second end 108 or, alternatively, closer to the second end 108 relative to the first end 106 of the main body 100. In those embodiments including a plurality of side branch portals 110, each second opening 121 may be aligned longitudinally along the length of the main body 100 (see
The side branch portals 110 may be incorporated into the main body 100 in variety of ways. For example, the side branch portals 110 may be wrapped between layers of film in the graft member 130. It is noted that in those embodiments in which a plurality of side branch portals 110 are implements, a plug (not shown) may be inserted into any one or multiple side branch portals 110 if one or more of the side branch portals are not needed in a particular application. For example, a device 10 may include three side branch portals 110, but only two are needed fora patient (e.g., in the aortic arch with a bypass), one of the side branch portals 110 may be closed (e.g., via a plug).
In some embodiments, the stent structure 120 extends around an outer periphery of the side branch portals 110. In embodiments implementing a side branch stent structure 114 that may implement materials that are more discreet or provide less holding or expansion force than the main body stent structure 120, the stent structure 120 may extend around the side branch portals 110 to limit collapsing of the side branch portals 110 (and side branch stent structures 114 when included) during delivery, deployment, and used of the device 10. However, in some embodiments, the stent structure 120 does not extend around the side branch portals 110.
Referring now to
Referring again to
It is understood that the portal access feature 150 does not have to begin at the second opening 121 of the side branch portal 110. For example, in some embodiments, the portal access feature 150 extends beneath the side branch portals 110. The side branch portals may be positioned between the portal access feature 150 and an outer layer of the graft member 130. In these embodiments, the portal access feature 150 extends from the side branch portal 110 toward the first end 106 of the main body 100.
With further reference to
In other embodiments, the stent structure 120 can extend across the portal access feature 150. For example, in an embodiment in which the stent structure 120 extends across the portal access feature 150, the stent structure can be formed and/or shape set to accommodate and/or form the profile of the portal access feature 150. The portion of the stent structure 120 defined over the portal access feature 150 may be continuous with the remainder of the stent structure 120. For example, in main bodies 100 implementing a stent structure 120 that is helically disposed or wrapped about the main body 100, the stent structure 120 may substantially continue the helical path at the portal access feature 150. In some embodiments, the apices 170a of the stent structure 120 at the portal access feature 150 may be shorter than the apices 170b around the remainder of the main body 100 (see
In some embodiments, the portal access feature 150 may include a portal access stent (not shown) that is independent from the stent structure 120 as previously discussed. The independent stent member can is coupled to the graft member 130 at the portal access feature 150. The independent stent member can incorporate any number of configurations, including patterns operable to conform to the peripheral profile of the portal access feature 150.
The portal access feature 150 may further include a reinforcing material. The reinforcing material is operable to provide increased strength to the portal access feature 150. The reinforcing material can resist tear, puncture, and other damage that can be incurred by the portal access feature 150 as the device 10 is being deployed. For example, cannulation and/or delivery and deployment of the branch body 200 may result in contacting the portal access feature, the reinforcing material being sufficiently sturdy to withstand tears or wear that could result in damage to the device 10. In some embodiments, the reinforcing material is applied to the portal access feature, is incorporated into the graft member 130 at the portal access feature, or a combination thereof. Various materials may be implemented for the reinforcement material, including but not limited to dense ePTFE layers or multilayers.
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In some embodiments, the guide members 1400a, 1400b, 1400c may implement a coupling system for coupling the guide members 1400 to the to the guide member retainer 1980 proximate the second end 1204 of the elongate member 1200, the coupling system including a feature, for example a spherical tip, that is received by a corresponding member of the guide member retainer 1980. For example, the guide member retainer 1980 may receive the spherical tip of the guide members 1400 through an aperture or through a loop, where the diameter of the spherical tip of the guide members 1400 is greater than the diameter of the aperture or loop of the guide member retainer 1980. Other examples of embodiments for matingly engaging or coupling the guide members 1400a, 1400b, 1400c at an end of the delivery system 1000 proximate the second end 1204 of the elongate member 1200 can be achieved by a variety of coupling arrangements, including press fitting, threads, ball and detent, articulating clips or jaws, hook and loop, and magnetic arrangements. Any number of methods and structures may be implemented for fastening the guide members 1400a, 1400b, 1400c proximate the second end 1204 of the elongate member 1200, and the disclosed embodiments are not to be limiting to the scope of the disclosure. In some embodiments, a plurality of guide member retainers 1980 may be implemented, each guide member retainer 1980 being operable to retain a corresponding guide member 1400. Thus, each guide member 1400 may be independently retained and released from engagement proximate the first end 1202 of the elongate member 1200. When the guide members 1400 are released, the guide members can be removed from the corresponding side branch portal 110.
In some embodiments, the guide members 1400 may be coupled directly to the lock wire retainer 1902. The guide member retainer 1980 and the guide members 1400 (either directly or indirectly from the lock wire retainer 1902) may be selectively released from the lock wire retainer 1902. Each of the guide members 1400 may be selectively retained either collectively or individually.
Now referring to
In various embodiments, each steering line may further include an end loop. For example, each steering line 1850 comprises an end loop. The lock wire 1900 may pass through each end loop, securing each steering line 1850 to delivery system 1000. Any method of securing the steering line or lines 1850 to delivery system 1000 is within the scope of the invention.
In various embodiments, lock wires can be formed from metallic, polymeric or materials and can include 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 various embodiments, a catheter assembly used to deliver an expandable implant comprises a catheter shaft, an expandable implant, one or more sleeves, one or more steering lines, and a lock wire. In such configurations, the expandable implant is capable of bending, through tension applied to the one or more steering lines and corresponding displacement, to conform to curvature in the vasculature of a patient. Tension can be applied to the steering lines 1850, causing expandable implant implantable device 10 to bend in a desired manner. For example, implantable device 10 can bend in a direction aligned with the location of the steering lines 1850. Once the implantable device 10 has been sufficiently bent, consistent tension is applied to steering lines 1850 to maintain the degree of bending. In other examples, the device 10 is configured to remain curved following tensioning of the steering lines 1850 absent a straightening force.
In various embodiments, tension can be applied to the steering lines 1850 by pulling the lines from the outside of the body of the patient. In other embodiments, the steering lines 1850 can be connected to one or more dials or other mechanisms for applying the tension at the trailing end of the elongate member 1200. In this configuration, the dial can be used to apply a desired tension, as well as maintain the correct amount of tension once a desired angle of bending of implantable device 10 has been achieved. Various embodiments may also comprise an indicator, scale, gradient, or the like which demonstrates the amount of tension or displacement of the steering line, and/or the amount of bending in implantable device. In various embodiments, the catheter assembly can comprise one more additional markings (e.g., on a handle) that allow a user to determine the orientation of the steering line with respect to the vasculature.
After a sufficient degree of bending has been achieved in the implantable device 10, the implant can be rotated for final positioning in the treatment area of the vasculature. In various exemplary embodiments, the lock wire 1900 is engaged with the steering lines 1850 such that torsional rotation of the catheter shaft causes the implantable device 10 to rotate within the vasculature. However, any configuration of the delivery system 1000 which allows for rotation of implantable device 10 is within the scope of the present disclosure.
After the implantable device 10 is in position and expanded within the vasculature, the lock wire 1900 can be disengaged from delivery system 1000. In various embodiments, the lock wire 1900 is disengaged by applying sufficient tension to the lock wire 1900 from outside of the body of the patient. After the lock wire 1900 is disengaged, the steering lines 1850 can be released from coupling with the elongate member 1200 and can be removed from implantable device 10 and delivery system 1000.
With further reference to
Referring now to
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In some embodiments, the sheath 1600 includes a lumen through which an articulatable secondary guide member or catheter 1700 can be inserted (e.g., the same lumen through which the guide members 1400 are passed). Various secondary articulatable member or catheter 1700 may be implemented, including, but not limited to, steerable catheters and guidewires. For example, articulatable secondary member or catheter 1700 can be steered using at least one tether or tension member (not shown) coupled to a distal end of the articulatable guidewire 1700 (the articulatable guide member or catheter 1700 may be an integral unit, or may be a composite of various components for providing the articulating function, e.g., a guide catheter and a guidewire). The articulatable guide member or catheter 1700 may be steered by applying tension to the tether or tension member. Various degrees of motion can be achieved using multiple tethers and/or tension members. Other embodiments may include robotic or motor-driven guidewires. Various embodiments of an articulatable guidewire may be implemented in the delivery system 1000 and method. The articulatable secondary guide member or catheter 1700 is advanced to the treatment site via the sheath 1600. For example, as illustrated in
Referring now to
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In some embodiments, the tubular member 520 includes a first graft member 541 defining the primary lumen 526 and a second graft member 542 coupled to the first graft member 541 to form the column 528 defining the secondary lumen 530 between the first graft member 541 and the second graft member 542. For example, the first graft member 541 includes graft material formed in the shape of a tube to define the primary lumen 526. The second graft member 542 optionally includes graft material that is coupled to the first graft member 541 (e.g., via boding, adhesive, or by otherwise being coupled together) to form the secondary lumen 530. The graft materials of the first and second graft members 541, 542 may be the same material or different materials as desired. Though some materials may provide certain advantages over others, a variety of suitable graft materials may be implemented, and generally any suitable graft material may be implemented including those materials discussed herein.
In some embodiments the secondary lumen 530 extends at least partially along a longitudinal length of the main body 512. The secondary lumen 530 of the column 528 opens into the primary lumen 526 at the proximal opening of the secondary lumen 530. In some embodiments, the column 528 extends to the second end 524 of the tubular member 520 such that the column opening 534 is positioned at or coplanar with the second opening 525 of the tubular member 520. In other embodiments, the column 528 extends toward the second end 524 of the tubular member 520 such that the column opening 534 is longitudinally spaced from the second opening 525 of the tubular member 520. In embodiments including a plurality of columns 528, the column openings 534 may be positioned at the same longitudinal length across, or in different terms, at the same longitudinal position along, the tubular member 520 or they may be staggered at two or more longitudinally-spaced positions along the length of the tubular member 520.
In some embodiments, the column 528, and consequently the secondary lumen 530 are collapsible. For example, the column 528 may be unsupported by a stent member, although supported, collapsible embodiments are also contemplated. Lack of a support, or a suitably configured support, may allow the column 528 to be collapsed (radially collapsed) to seal the aperture 532 and limit the leaking or other passing of fluids (e.g., blood) through the aperture 532. In some embodiments, the pressure (e.g., hydrostatic pressure, fluid pressure gradients, and/or pressure exerted by fluids in motion) that is exerted by the fluid collapses the column 528 such that the column coapts or seals against the tubular member 520 to limit flow through the secondary lumen 530 and consequently the aperture 532.
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As illustrated in
Referring to
In some embodiments, the main body 512 may include a plurality of columns 528. For instance, the main body 512 may include two columns 528 that are circumferentially spaced from each other in order to deploy two side branches 514 into the side branch lumens of the patient's anatomy. Furthermore, the main body 512 may include a plurality of columns 528 that are associated with each side branch lumen of the patient's anatomy. For example, if the main body 512 is to be deployed in the abdominal aorta and the side branches 514 are to be deployed into the renal arteries, each patient may have a various positions circumferentially at which the renal arteries enter the aorta.
By having a plurality of columns 528 through which each side branch 514 may be deployed, the surgeon may select the appropriate columns 528 that best conform to the patient's native anatomy without applying torsion to the vessels when the implantable device 10 is deployed. Thus, in one example, the main body 512 may include three columns 528 on one circumferential side of the tubular member 520 and three more columns 528 on an opposite circumferential side of the tubular member 520. Each column 528 is circumferentially spaced from the adjacent column 528 about the circumference of the tubular member 520. It is contemplated that any number of columns 528 and the spacing of the columns 528 may be implemented, including one, two, three, four, five, six, seven, eight, or more columns 528 which may be spaced equally or variably about the circumference of the tubular member 520. It is further contemplated that the specific spacing may be determined by surveying the average circumferential spacing of side branches for a particular implementation in a sample population of patients to determine the spacing of the columns 528. Circumferential spacing of the column 528 allows for clocking of the main body 512 within the patient's anatomy with increased positions for appropriately positioning the side branches 514 into the side branch vessels. As used herein, the term “clocking” refers to the ability to position features at a desired location about a circumference of an object. This ability to clock the one or more columns 528 can be further advantageous for use with visualization, for example when the procedure is being performed via fluoroscopy. This simplifies placement by providing several entry points when dealing with the two-dimensional planes shown by visualization techniques and for parallax associated with such visualization. In some embodiments, the columns 528 may be irregularly spaced about the circumference of the main body 512 (e.g., non-uniform spacing between the columns 528). In some embodiments not shown, the column 528 extends longitudinally and at angle greater than zero relative to the main body 512 longitudinal axis. For example, the secondary lumen 530 extends along a secondary lumen axis that extends longitudinally at an angle greater than zero relative to an axis of the primary lumen 526 (e.g., helically about the main body 512).
Referring again to
In some embodiments, the tubular member 520 may include a scallop 552 at the first end 522. The scallop 552 is a facilitates placement of the tubular member 520 in a lumen including a side branch lumen that does not need a prosthetic side branch deployed. For example, when the implantable device 10 is positioned in the abdominal aorta and the superior mesenteric artery does not need a side branch 514 deployed therein, the scallop 552 may be positioned over the entrance into the superior mesenteric artery without blocking or restricting blood perfusion therethrough. The scallop 552 may include various shapes including straight edge profiles, curved profiles, and combinations thereof.
Referring now to
Although the method was disclosed with reference to the aorta 20, the systems and method described herein could be implemented on various lumens where branching occurs.
Catheters, introducer sheaths, hubs, handles and other components usable in medical device delivery systems and methods disclosed herein can be constructed using any suitable medical grade material or combination of materials using any suitable manufacturing process or tooling. Suitable medical grade materials can include, for example, nylon, polyacrylamide, polycarbonate, polyethylene, polyformaldehyde, polymethylmethacrylate, polypropylene, polytetrafluoroethylene, expanded polytetrafluoroethylene, polytrifluorochlorethylene, polyvinylchloride, polyurethane, elastomeric organosilicon polymers, Pebax® polyether block amide, and metals such as stainless steels and nitinol. Catheters can also include a reinforcing member, such as a layer of metal braid.
A biocompatible material for the graft components, discussed herein, may be used. In certain instances, the graft may include a fluoropolymer, such as a polytetrafluoroethylene (PTFE) polymer or an expanded polytetrafluoroethylene (ePTFE) polymer. In some instances, the graft may be formed of, such as, but not limited to, a polyester, a silicone, a urethane, a polyethylene terephthalate, or another biocompatible polymer, or combinations thereof. In some instances, bioresorbable or bioabsorbable materials may be used, for example a bioresorbable or bioabsorbable polymer. In some instances, the graft can include Dacron, polyolefins, carboxy methylcellulose fabrics, polyurethanes, or other woven, non-woven, or film elastomers.
It is understood that any of the components of the systems can also include radiopaque markers to facilitate viewing on an x-ray fluoroscope during an implantation procedure. Any number, shape and location of radiopaque markers can be utilized as needed.
Delivery systems and methods disclosed herein are particularly suited for endoluminal delivery of branchable expandable implants for treating branched vasculature. Expandable implants can include, for example, stents, grafts, and stent grafts. Further, expandable implants 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 configuration, through a range of larger intermediary configurations, and toward a deployed configuration engaged with vessel walls at a treatment site. However, and as discussed below, any suitable combination and configuration of stent component(s) and graft member(s) is within the scope of the present disclosure. For example, stent components 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).
Moreover, potential materials for graft members include, for example, expanded polytetrafluoroethylene (ePTFE), polyester, polyurethane, fluoropolymers, such as perfluoroelastomers 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, nitinol (NiTi) may be used as the material of the frame or stent (and any of the frames discussed herein), but other materials such as, but not limited to, stainless steel, L605 steel, polymers, MP35N steel, polymeric materials, Pyhnox, Elgiloy, or any other appropriate biocompatible material, and combinations thereof, can be used as the material of the frame. The super-elastic properties and softness of NiTi may enhance the conformability of the stent. In addition, NiTi can be shape-set into a desired shape. That is, NiTi can be shape-set so that the frame tends to self-expand into a desired shape when the frame is unconstrained, such as when the frame is deployed out from a delivery system. Other materials may also be used as appropriate, including but not limited to NiTiCo.
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.
Any of a variety of bio-active agents may be implemented with any of the foregoing. For example, any one or more of (including portions thereof) the implantable device 10 and the delivery system 1000 may comprise a bio-active agent. Bio-active agents can be coated onto one or more of the foregoing features for controlled release of the agents. Such bio-active agents can include, but are not limited to, thrombogenic agents such as, but not limited to, heparin. Bio-active agents can also include, but are not limited to agents such as anti-proliferative/antimitotic agents including natural products such as vinca alkaloids (e.g., vinblastine, vincristine, and vinorelbine), paclitaxel, epidipodophyllotoxins (e.g., etoposide and teniposide), antibiotics (e.g., dactinomycin (actinomycin D), daunorubicin, doxorubicin, and idarubicin), anthracyclines, mitoxantrone, bleomycins, plicamycin (mithramycin) and mitomycin, enzymes (e.g., L-asparaginase which systemically metabolizes L-asparagine and deprives cells which do not have the capacity to synthesize their own asparagine); antiplatelet agents such as G(GP) IIb/IIIa inhibitors and vitronectin receptor antagonists; anti-proliferative/antimitotic alkylating agents such as nitrogen mustards (e.g., mechlorethamine, cyclophosphamide and analogs, melphalan, chlorambucil), ethylenimines and methylmelamines (e.g., hexamethylmelamine and thiotepa), alkyl sulfonates-busulfan, nitrosoureas (e.g., carmustine (BCNU) and analogs, streptozocin), trazenes-dacarbazinine (DTIC); anti-proliferative/antimitotic antimetabolites such as folic acid analogs (e.g., methotrexate), pyrimidine analogs (e.g., fluorouracil, floxuridine, and cytarabine), purine analogs and related inhibitors (e.g., mercaptopurine, thioguanine, pentostatin and 2-chlorodeoxyadenosine {cladribine}); platinum coordination complexes (e.g., cisplatin and carboplatin), procarbazine, hydroxyurea, mitotane, aminoglutethimide; hormones (e.g., estrogen); anti-coagulants (e.g., heparin, synthetic heparin salts and other inhibitors of thrombin); anti-platelet agents (e.g., aspirin, clopidogrel, prasugrel, and ticagrelor); vasodilators (e.g., heparin, aspirin); fibrinolytic agents (e.g., plasminogen activator, streptokinase, and urokinase), aspirin, dipyridamole, ticlopidine, clopidogrel, abciximab; antimigratory agents; antisecretory agents (e.g., breveldin); anti-inflammatory agents, such as adrenocortical steroids (e.g., cortisol, cortisone, fludrocortisone, prednisone, prednisolone, 6α-methylprednisolone, triamcinolone, betamethasone, and dexamethasone), non-steroidal agents (e.g., salicylic acid derivatives, such as aspirin); para-aminophenol derivatives (e.g., acetaminophen); indole and indene acetic acids (e.g., indomethacin, sulindac, and etodalac), heteroaryl acetic acids (e.g., tolmetin, diclofenac, and ketorolac), arylpropionic acids (e.g., ibuprofen and derivatives), anthranilic acids (e.g., mefenamic acid and meclofenamic acid), enolic acids (e.g., piroxicam, tenoxicam, phenylbutazone, and oxyphenthatrazone), nabumetone, gold compounds (e.g., auranofin, aurothioglucose, and gold sodium thiomalate); immunosuppressives (e.g., cyclosporine, tacrolimus (FK-506), sirolimus (rapamycin), azathioprine, and mycophenolate mofetil); angiogenic agents (e.g., vascular endothelial growth factor (VEGF)), fibroblast growth factor (FGF); angiotensin receptor blockers; nitric oxide donors; anti-sense oligonucleotides and combinations thereof; cell cycle inhibitors, mTOR inhibitors, growth factor receptor signal transduction kinase inhibitors; retinoids; cyclin/CDK inhibitors; HMG co-enzyme reductase inhibitors (statins); and protease inhibitors. Delivery systems and methods in accordance with various embodiments disclosed herein can utilize removable guidewires to preserve branch portals for guidewire cannulation therethrough subsequent to compacting the expandable implant toward a delivery configuration for endoluminal delivery to the treatment site. Removable guidewire tube can comprise the same materials listed above for the catheter materials.
Numerous characteristics and advantages of the present invention have been set forth in the preceding description, including preferred and alternate embodiments together with details of the structure and function of the invention. 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, shape, size and arrangement of parts within the principals of the invention, 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 do not depart from the spirit and scope of the appended claims, they are intended to be encompassed therein. In addition to being directed to the embodiments described above and claimed below, the present invention is further directed to embodiments having different combinations of the features described above and claimed below.
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/US2022/017333, internationally filed on Feb. 22, 2022, which claims the benefit of Provisional Application No. 63/152,144, filed Feb. 22, 2021, which are incorporated herein by reference in their entireties for all purposes.
Filing Document | Filing Date | Country | Kind |
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PCT/US2022/017333 | 2/22/2022 | WO |
Number | Date | Country | |
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63152144 | Feb 2021 | US |