Patent Grant
11690628
The present disclosure generally relates to a system and method for delivering and deploying a medical device within a vessel, more particularly, it relates to a system and method for delivering and deploying an endoluminal therapeutic device within the vasculature of a patient to embolize and occlude aneurysms, particularly, cerebral aneurysms.
Walls of the vasculature, particularly arterial walls, may develop areas of pathological dilatation called aneurysms. As is well known, aneurysms have thin, weak walls that are prone to rupturing. Aneurysms can be the result of the vessel wall being weakened by disease, injury or a congenital abnormality. Aneurysms could be found in different parts of the body with the most common being abdominal aortic aneurysms and brain or cerebral aneurysms in the neurovasculature. When the weakened wall of an aneurysm ruptures, it can result in death, especially if it is a cerebral aneurysm that ruptures.
Aneurysms are generally treated by excluding the weakened part of the vessel from the arterial circulation. For treating a cerebral aneurysm, such reinforcement is done in many ways including: (i) surgical clipping, where a metal clip is secured around the base of the aneurysm; (ii) packing the aneurysm with small, flexible wire coils (micro-coils); (iii) using embolic materials to “fill” or “pack” an aneurysm; (iv) using detachable balloons or coils to occlude the parent vessel that supplies the aneurysm; and (v) intravascular stenting.
In conventional methods of introducing a compressed stent into a vessel and positioning it within in an area of stenosis or an aneurysm, a guiding catheter having a distal tip is percutaneously introduced into the vascular system of a patient. The guiding catheter is advanced within the vessel until its distal tip is proximate the stenosis or aneurysm. A guidewire positioned within an inner lumen of a second, inner catheter and the inner catheter are advanced through the distal end of the guiding catheter. The guidewire is then advanced out of the distal end of the guiding catheter into the vessel until the distal portion of the guidewire carrying the compressed stent is positioned at the point of the lesion within the vessel. Once the compressed stent is located at the lesion, the stent may be released and expanded so that it supports the vessel.
Additional features and advantages of the subject technology will be set forth in the description below, and in part will be apparent from the description, or may be learned by practice of the subject technology. The advantages of the subject technology will be realized and attained by the structure particularly pointed out in the written description and embodiments hereof as well as the appended drawings.
Systems and procedures for treating aneurysms can include an intrasaccular device having one or more expandable components that can be inserted into an aneurysm to facilitate a thrombotic, healing effect. The components can have a specific characteristics, including porosity, composition, material, shape, size, interconnectedness, inter-engagement, coating, etc. These characteristics can be selected in order to achieve a desired treatment or placement of the intrasaccular device.
The intrasaccular device can comprise a single component having two or more sections that have an average porosity that is different from each other. In some embodiments, the intrasaccular device can comprise multiple components that each have an average porosity. In either embodiment, the intrasaccular device can be arranged within an aneurysm according to a desired porosity profile. The intrasaccular device can be repositioned as necessary within the aneurysm during expansion.
The intrasaccular device can optionally comprise one or more components having a desired shape, which can allow a clinician to implant an intrasaccular device tailored to the aneurysm. A plurality of individual, independent components can operate collectively to form a composite unit having one or more desired characteristics. Such components can have an interlocking structure, which can include a framing component, according to some embodiments.
The intrasaccular device, when used with a framing component, can enable expandable components to be securely retained within an aneurysm. A framing component can comprise a foam or braided structure. Further, one or more expandable components can be inserted into a cavity of or formed by the framing component.
Additionally, the intrasaccular device can also be configured to provide a plurality of interconnected expandable components, extending in linear, planar, or three-dimensional arrays or matrices. These arrays or matrices can be deployed in whole or in part into a target aneurysm, allowing a clinician to select portions of the array or matrix for implantation.
The subject technology is illustrated, for example, according to various aspects described below. Various examples of aspects of the subject technology are described as numbered embodiments (1, 2, 3, etc.) for convenience. These are provided as examples and do not limit the subject technology. It is noted that any of the dependent embodiments may be combined in any combination with each other or one or more other independent embodiments, to form an independent embodiment. The other embodiments can be presented in a similar manner. The following is a non-limiting summary of some embodiments presented herein:
A device for treatment of an aneurysm, comprising a foam component having first and second sections, the first section having an average porosity different from an average porosity of the second section, the component being expandable from a compressed configuration to an expanded configuration when released into an aneurysm from a catheter.
The device of Embodiment 1, wherein the component is self-expanding to assume the expanded configuration thereof.
The device of Embodiment 1, wherein the component is adapted to expand upon exposure to a thermal agent.
The device of Embodiment 1, wherein the component is adapted to expand upon exposure to a chemical agent.
The device of Embodiment 1, wherein the first section comprises a first material and the second section comprises a second material different from the first material, the first and second sections being coupled to each other.
The device of Embodiment 5, wherein the first section is coupled to the second section by chemical bonding, by thermal bonding, or by mechanical crimping.
The device of Embodiment 1, wherein the component further comprises a third section coupled to the second section, the third section having an average porosity different from the porosity of the second section.
The device of Embodiment 7, wherein the third material is different from the first material.
The device of Embodiment 7, wherein the second section is coupled to the third section using an adhesive.
The device of Embodiment 7, wherein the second section comprises a second material and the third section comprises a third material different from the second material.
The device of Embodiment 7, wherein the third section porosity is different from the first section porosity.
The device of Embodiment 11, wherein the first section comprises an average porosity of between about 1 μm and about 150 μm, and the third section comprises an average porosity of between 150 μm and about 300 μm.
The device of Embodiment 1, further comprising a transition zone between the first and second sections, the transition zone having an average porosity intermediate the porosities of the first and second sections.
The device of Embodiment 13, wherein the transition zone porosity varies spatially from about that of the first section to about that of the second section.
The device of Embodiment 13, wherein the porosity in the first and second sections each spatially varies progressively from an end of the first section to an opposite end of the second section.
The device of Embodiment 13, wherein the transition zone porosity decreases from the porosity of the first section to the porosity of the second section.
The device of Embodiment 1, wherein in the expanded configuration, the component comprises a substantially spherical shape that is divided crosswise into the first and second sections.
The device of Embodiment 17, wherein the first and second sections correspond to first and second hemispheres of the substantially spherical shape.
The device of Embodiment 17, further comprising a third section coupled to the second section, the first, second, and third sections collectively forming the substantially spherical shape.
The device of Embodiment 1, wherein the component further comprises a bioactive coating.
The device of Embodiment 20, wherein the bioactive coating comprises a thrombogenic drug.
The device of Embodiment 1, wherein the component further comprises an expansion-limiting coating configured to control an expansion rate of the component.
The device of Embodiment 1, wherein the first section comprises an average porosity of between about 1 μm and about 100 μm, and the second section comprises an average porosity of between about 100 μm and about 200 μm.
The device of Embodiment 1, wherein a shape of the component is selected from the group consisting of cylinders, hemispheres, polyhedrons, prolate spheroids, oblate spheroids, plates, bowls, hollow structures, clover shapes, non-spherical surface of revolution, and combinations thereof.
The device of Embodiment 24, further comprising a second foam component having a shape selected from the group consisting of spheres, cylinders, hemispheres, polyhedrons, prolate spheroids, oblate spheroids, plates, bowls, hollow structures, clover shapes, non-spherical surface of revolution, and combinations thereof.
The device of Embodiment 25, wherein the foam component and the second foam component are different sizes from each other.
The device of Embodiment 25, wherein the foam component and the second foam component are different shapes from each other.
The device of Embodiment 25, wherein the foam component and the second foam component have mating structures configured to abut each other in a complementary configuration and restrict at least degrees of freedom of motion of each of the foam component and the second foam component.
The device of Embodiment 25, further comprising a plurality of additional foam components having substantially spherical shapes.
A system for treatment of an aneurysm, comprising a plurality of foam components being expandable from a compressed configuration to an expanded configuration when released into an aneurysm from a catheter, each of the plurality of components having an average porosity that is different from an average porosity of another of the plurality of components, the plurality of components being positionable within the aneurysm to form a composite foam component having a composite porosity configured to provide a therapeutic effect.
The system of Embodiment 30, wherein each of a first group of the plurality of components comprises a first average porosity, and each of a second group of the plurality of components comprises a second average porosity different from the first average porosity.
The system of Embodiment 31, wherein the first average porosity is between about 1 μm and about 100 μm, and the second average porosity is between about 100 μm and about 200 μm.
The system of Embodiment 30, wherein a shape of at least one of the plurality of components is substantially spherical.
The system of Embodiment 30, wherein a shape of at least one of the plurality of components is selected from the group consisting of spheres, cylinders, hemispheres, polyhedrons, prolate spheroids, oblate spheroids, plates, bowls, hollow structures, clover shapes, non-spherical surface of revolution, and combinations thereof.
The system of Embodiment 30, wherein each of the plurality of components is interconnected to another of the plurality of components via a filament.
The system of Embodiment 35, wherein each of the plurality of components is interconnected to at least two others of the plurality of components.
The system of Embodiment 30, wherein the plurality of components is self-expanding to assume the expanded configuration thereof.
The system of Embodiment 30, wherein the plurality of components is adapted to expand upon exposure to a thermal agent.
The system of Embodiment 30, wherein the plurality of components is adapted to expand upon exposure to a chemical agent.
The system of Embodiment 30, wherein at least one of the plurality of components comprises a bioactive coating.
The system of Embodiment 30, wherein at least one of the plurality of components comprises a thrombogenic drug.
The system of Embodiment 30, wherein at least one of the plurality of components comprises an expansion-limiting coating configured to control an expansion rate of the component.
The system of Embodiment 30, wherein each of the plurality of components is different sizes from another of the plurality.
The system of Embodiment 30, wherein each of the plurality of components is different shapes from another of the plurality.
The system of Embodiment 30, wherein a first of the plurality of components and a second of the plurality of components have mating structures configured to abut each other in a complementary configuration and restrict at least degrees of freedom of motion of each of the first and second of the plurality of components.
A device for treatment of an aneurysm, comprising a foam component having a region of variable average porosity and a radiopaque marker, the marker being visible under imaging and positionable relative to the region so as to facilitate identification and orientation of the component when implanted into the aneurysm from a catheter, the component being expandable from a compressed configuration to an expanded configuration when released into the aneurysm.
The device of Embodiment 46, wherein the region comprises a first section and a second section having an average porosity different from an average porosity of the first material.
The device of Embodiment 47, wherein the region further comprises a third section adjacent to the second section, the third section having an average porosity different from the porosity of the second section.
The device of Embodiment 48, wherein the second section is coupled to the third section by chemical bonding, by thermal bonding, or by mechanical crimping.
The device of Embodiment 48, wherein the third section porosity is different from the first section porosity.
The device of Embodiment 46, wherein the region comprises a first material and a second material different from the first material, the first and second materials being coupled to each other.
The device of Embodiment 51, wherein the region further comprises a third material different from the first material.
The device of Embodiment 46, wherein the marker comprises a material blended into the component such that the component is visible under imaging.
The device of Embodiment 53, wherein the marker comprises bismuth or tantalum blended with a foam material to form the component.
The device of Embodiment 46, wherein the marker is coupled to an exterior of the component.
The device of Embodiment 55, wherein the marker comprises a coating or a material that is bonded or mechanically coupled to the component.
The device of Embodiment 46, wherein a shape of the component is selected from the group consisting of cylinders, hemispheres, polyhedrons, prolate spheroids, oblate spheroids, plates, bowls, hollow structures, clover shapes, non-spherical surface of revolution, and combinations thereof.
The device of Embodiment 57, further comprising a second foam component having a shape selected from the group consisting of spheres, cylinders, hemispheres, polyhedrons, prolate spheroids, oblate spheroids, plates, bowls, hollow structures, clover shapes, non-spherical surface of revolution, and combinations thereof.
The device of Embodiment 58, wherein the foam component and the second foam component are different sizes from each other.
The device of Embodiment 58, wherein the foam component and the second foam component are different shapes from each other.
The device of Embodiment 58, wherein the foam component and the second foam component have mating structures configured to abut each other in a complementary configuration and restrict at least degrees of freedom of motion of each of the foam component and the second foam component.
The device of Embodiment 58, further comprising a plurality of additional foam components having substantially spherical shapes.
A method for treatment of an aneurysm, comprising: advancing a foam component through a catheter lumen, the component comprising a first section having a different average porosity than an average porosity of a second section; releasing the component into the aneurysm; allowing the component to expand from a compressed configuration to an expanded configuration within the aneurysm; and positioning the component within the aneurysm such that the first section is positioned away from the aneurysm neck and the second section is positioned adjacent to a neck of the aneurysm.
The method of Embodiment 63, wherein the positioning comprises rotating the component.
The method of Embodiment 63, wherein the positioning comprises maintaining a position of the component relative to the aneurysm neck during expansion to the expanded configuration.
The method of Embodiment 63, wherein the aneurysm is disposed adjacent at bifurcation of a parent vessel into two efferent vessels, and wherein the positioning further comprises positioning the second section adjacent to the bifurcation and permitting flow through the bifurcation and into at least one of the first or second efferent vessels.
The method of Embodiment 66, wherein the first section comprises an average porosity of between about 1 μm and about 150 μm.
The method of Embodiment 66, wherein the second section comprises an average porosity of between about 100 μm and about 200 μm.
The method of Embodiment 63, wherein the component further comprises a third section disposed between the first and second sections, the third section having an average porosity different than the porosity of the second section, wherein the positioning comprises positioning the component such that the first section is positioned at a fundus of the aneurysm and the third section is positioned between the fundus and the aneurysm neck.
The method of Embodiment 63, wherein the positioning comprises aligning a radiopaque marker relative to the aneurysm to position the second section adjacent to the aneurysm neck.
The method of Embodiment 70, wherein the aligning comprises aligning the marker with a fundus of the aneurysm.
The method of Embodiment 63, further comprising injecting a liquid embolic material into the aneurysm after positioning the component.
The method of Embodiment 63, further comprising implanting a support structure into the aneurysm before releasing the component into the aneurysm, and wherein the releasing comprises releasing the component through a wall of the support structure into the aneurysm.
The method of Embodiment 73, wherein the support structure comprises a substantially enclosed interior cavity, and the releasing further comprises releasing the component into the interior cavity.
A system for treatment of an aneurysm, comprising: a first foam component being expandable from a compressed configuration to an expanded configuration when released into the aneurysm, the first component having a first shape when in the expanded configuration; and a second foam component, separate from and freely movable relative to the first component, being expandable from a compressed configuration to an expanded configuration when released into the aneurysm, the second component having a second shape when in the expanded configuration; wherein at least one of the first and second shapes is selected from the group consisting of cylinders, hemispheres, polyhedrons, prolate spheroids, oblate spheroids, plates, bowls, hollow structures, clover shapes, non-spherical surface of revolution, and combinations thereof.
The system of Embodiment 75, wherein the first and second shapes are different from each other.
The system of Embodiment 75, wherein the first and second components are different sizes from each other.
The system of Embodiment 75, further comprising a third foam component, the third component having a third shape different from the first shape.
The system of Embodiment 78, wherein the third shape is substantially spherical.
The system of Embodiment 78, wherein the first, second, and third components are different sizes from each other.
The system of Embodiment 78, wherein the first, second, and third components have different shapes from each other.
The system of Embodiment 75, further comprising third, fourth, and fifth foam components, each of the third, fourth, and fifth components having shapes different from those of the first and second shapes.
The system of Embodiment 75, further comprising third, fourth, and fifth foam components, each of the third, fourth, and fifth components having sizes different from those of the first and second components.
The system of Embodiment 75, wherein the first and second components have first and second mating structures configured to abut each other in a complementary configuration.
The system of Embodiment 84, wherein the mating structures can operate to restrict at least two degrees of freedom of motion of the other component.
The system of Embodiment 84, wherein in the complementary configuration, the first component restricts at least two degrees of freedom of motion of the second component.
The system of Embodiment 84, wherein in the complementary configuration, the first component restricts at least three degrees of freedom of motion of the second component.
The system of Embodiment 87, wherein the first component restricts four, five, or six degrees of freedom of motion of the second component.
The system of Embodiment 84, wherein in the complementary configuration, the first and second components are interconnected to form a composite structure.
The system of Embodiment 84, wherein in the complementary configuration, the first and second components are interconnected to form a composite structure, and wherein the first and second components have different average porosities from each other.
The system of Embodiment 84, further comprising a third foam component having a third mating structure configured to abut at least the first mating structure, wherein in the complementary configuration, the first component restricts at least two degrees of freedom of motion of the third component.
The system of Embodiment 91, wherein the first component restricts four, five, or six degrees of freedom of motion of the third component.
The system of Embodiment 75, wherein the first and second components have different average porosities from each other.
The system of Embodiment 75, wherein the first component comprises a first coating and the second component is substantially free of the first coating.
The system of Embodiment 75, wherein the component further comprises a bioactive coating.
The system of Embodiment 95, wherein the bioactive coating comprises a thrombogenic drug.
The system of Embodiment 75, wherein the component further comprises an expansion-limiting coating configured to control an expansion rate of the component.
A system for treatment of an aneurysm, comprising a plurality of separate and independently expandable components each being expandable from a compressed configuration to an expanded configuration when released into the aneurysm, each of the components having shapes different from each other, wherein the shapes are selected from the group consisting of cylinders, hemispheres, polyhedrons, prolate spheroids, oblate spheroids, plates, bowls, hollow structures, clover shapes, non-spherical surface of revolution, and combinations thereof.
The system of Embodiment 98, wherein the components are different sizes from each other.
The system of Embodiment 98, further comprising at least one additional component that is substantially spherical.
The system of Embodiment 98, further comprising a plurality of additional components that are substantially spherical.
The system of Embodiment 101, wherein the plurality of additional components are different sizes from each other.
The system of Embodiment 98, wherein at least two of the components have mating structures configured to abut each other in a complementary configuration for restricting freedom of motion of the components.
The system of Embodiment 103, wherein the components each have mating structures configured to abut each other in a complementary configuration.
The system of Embodiment 104, wherein in the complementary configuration, the components are interconnected to form a composite structure.
The system of Embodiment 103, wherein in the complementary configuration, the components are interconnected to form a composite structure, and wherein the components have different porosities from each other.
A method for treatment of an aneurysm, comprising: positioning a distal opening of a catheter adjacent to an aneurysm; and releasing a plurality of separate and independently foam components into the aneurysm; wherein shapes of the plurality of components are selected from the group consisting of cylinders, hemispheres, polyhedrons, prolate spheroids, oblate spheroids, plates, bowls, hollow structures, clover shapes, non-spherical surface of revolution, and combinations thereof.
The method of Embodiment 107, wherein the releasing comprises releasing the plurality of components based on a shape of the aneurysm.
The method of Embodiment 108, further comprising selecting the plurality of components based on the shape of the aneurysm.
The method of Embodiment 107, wherein the releasing comprises interconnecting at least two components to create a composite structure.
The method of Embodiment 107, wherein the releasing comprises releasing the plurality of components into the aneurysm to fill the aneurysm such that as a composite, the plurality of components provides a lower porosity adjacent to a neck of the aneurysm relative to a fundus of the aneurysm.
The method of Embodiment 107, further comprising imaging the aneurysm.
The method of Embodiment 112, wherein the imaging comprises determining a shape of the aneurysm to select the plurality of components.
The method of Embodiment 112, further comprising repositioning a first of the plurality of components within the aneurysm after the first component has been released into the aneurysm.
The method of Embodiment 114, wherein the repositioning comprises repositioning the first component such that the plurality of components, as a composite, is arranged within the aneurysm to provide a lower porosity adjacent to a neck of the aneurysm relative to a fundus of the aneurysm.
The method of Embodiment 107, further comprising, prior to releasing the plurality of components into the aneurysm, implanting a framing device into the aneurysm.
The method of Embodiment 116, wherein the releasing comprises releasing the plurality of components into a cavity of the framing device.
A method for treatment of an aneurysm, comprising: positioning a distal opening of a catheter adjacent to the aneurysm; and advancing a framing device into the aneurysm, the framing device having an interior cavity and an exterior surface for contacting a wall of the aneurysm; and while at least a portion of the device exterior surface is in contact with the aneurysm wall, releasing at least one expandable component into the device cavity; wherein the framing device comprises at least one of a foam or a braided structure.
The method of Embodiment 118, wherein the aneurysm is a saccular aneurysm and before releasing the at least one expandable component, the device is expanded such that the exterior surface contacts an inner surface of the aneurysm having a cross-sectional profile greater than a passing profile of a neck of the aneurysm.
The method of Embodiment 118, wherein the releasing comprises causing the device to expand into contact with the aneurysm wall.
The method of Embodiment 118, wherein the device comprises a substantially closed three-dimensional expanded shape.
The method of Embodiment 118, wherein the component comprises at least one of a foam, a coil, or a braided structure.
The method of Embodiment 121, wherein the three-dimensional shape is selected from the group consisting of spheres, cylinders, hemispheres, polyhedrons, prolate spheroids, oblate spheroids, non-spherical surface of revolution, and combinations thereof.
The method of Embodiment 118, wherein the device comprises for quadrants, and the releasing comprises causing at least a portion of each quadrant to contact the aneurysm wall.
The method of Embodiment 124, wherein the device comprises a substantially spherical expanded shape.
The method of Embodiment 118, wherein the device comprises an opening to the device cavity, and the releasing comprises injecting the at least one expandable component into the device cavity through the device aperture.
The method of Embodiment 126, wherein the device comprises a braided material and the opening is an opening formed between filaments of the braided material.
The method of Embodiment 126, wherein the framing device has a closed end and an open end opposite the closed end, the open end forming the opening, and wherein the releasing advancing comprises aligning the opening with a neck of the aneurysm.
The method of Embodiment 128, wherein the open end comprises a plurality of filament ends extending into the device cavity and forming the opening, the plurality of filament ends collectively forming a tubular portion extending into the device cavity, wherein the releasing comprises permitting the at least one expandable component to expand within the device cavity such that the tubular portion is deflected into contact with an inner wall of the device, thereby closing the opening.
The method of Embodiment 118, wherein the releasing comprises releasing a plurality of expandable components into the aneurysm such that as a composite, the plurality of expandable components provides a lower average porosity adjacent to a neck of the aneurysm relative to an average porosity at a fundus of the aneurysm.
The method of Embodiment 118, wherein the at least one expandable component comprises a shape selected from the group consisting of cylinders, hemispheres, polyhedrons, prolate spheroids, oblate spheroids, plates, bowls, hollow structures, clover shapes, non-spherical surface of revolution, and combinations thereof.
The method of Embodiment 118, wherein the releasing comprises releasing at least one coil into the device cavity.
The method of Embodiment 118, wherein the releasing comprises releasing at least one expandable component into the device cavity.
The method of Embodiment 133, wherein the at least one expandable component comprises an expandable composite comprising first and second portions having different porosities from each other.
A method for treatment of an aneurysm, comprising: implanting a stent into a lumen of a parent vessel from which an aneurysm arises such that the stent extends across at least a portion of the aneurysm; and releasing at least one expandable component into an inner volume of the aneurysm between a wall of the aneurysm and an outer surface of the stent; wherein the expandable component comprises at least one of a foam or a braided structure.
The method of Embodiment 135, wherein the aneurysm comprises a fusiform aneurysm.
The method of Embodiment 135, wherein the aneurysm comprises a wide-neck aneurysm.
The method of Embodiment 135, wherein the portion comprises a neck.
The method of Embodiment 135, wherein the at least one expandable component comprises a plurality of expandable components, and the releasing comprises releasing the plurality based on relative sizes of the expandable components.
The method of Embodiment 139, further comprising selecting the at least one expandable component based on the shape of the inner volume.
The method of Embodiment 140, wherein the at least one expandable component comprises a shape selected from the group consisting of cylinders, hemispheres, polyhedrons, prolate spheroids, oblate spheroids, plates, bowls, hollow structures, clover shapes, non-spherical surface of revolution, and combinations thereof.
The method of Embodiment 135, wherein the at least one expandable component comprises a first portion having an average porosity greater than that of a second portion thereof, and the releasing comprises positioning the at least one expandable component such that the first portion abuts an outer surface of the stent device and the second portion extends along an inner wall of the aneurysm.
The method of Embodiment 135, wherein the releasing comprises releasing a plurality of expandable components into the inner volume.
The method of Embodiment 135, wherein the aneurysm inner volume extends around a circumference of the stent device, and the releasing comprises depositing a plurality of expandable components into the inner volume around the circumference of the stent device.
The method of Embodiment 144, wherein at least one of the plurality of expandable components comprises a flat or cylindrically shaped surface, and the releasing comprises positioning the at least one of the plurality of expandable components such that the flat or cylindrically shaped surface substantially conforms to an outer surface of the stent device.
A system for treatment of an aneurysm, comprising: an intrasaccular device comprising first and second expandable components adapted to transition from a compressed configuration to an expanded configuration when deployed into the aneurysm, the first and second components being interconnected by a non-helical coupling such that the first and second components can be advanced as an interconnected unit, into the aneurysm; wherein the first component comprises at least one of a shape or an average porosity different from a shape or an average porosity of the second component.
The system of Embodiment 146, wherein the first component shape is selected from the group consisting of cylinders, hemispheres, polyhedrons, prolate spheroids, oblate spheroids, plates, bowls, hollow structures, clover shapes, non-spherical surface of revolution, and combinations thereof.
The system of Embodiment 146, wherein the second component comprises a substantially spherical shape.
The system of Embodiment 146, wherein at least one of the first or second components comprises a foam or a braided structure.
The system of Embodiment 146, wherein at least one of the first or second components comprises a coil.
The system of Embodiment 146, wherein the first component comprises an average porosity of between about 1 μm and about 100 μm and the second component comprises an average porosity of between about 100 μm and about 200 μm.
The system of Embodiment 146, further comprising a third component interconnected with the second component such that the first, second, and third components are interconnected in series.
The system of Embodiment 146, wherein the coupling interconnecting the first and second components comprises a filament.
The system of Embodiment 146, wherein the coupling has a preset shape such that in an expanded position, the first and second components are spaced relative to each other at a preset orientation.
The system of Embodiment 146, further comprising an introducer sheath configured to receive the device therein such that the device can be loaded into the guide catheter for delivery to the aneurysm.
A system for treatment of an aneurysm, comprising: an intrasaccular device comprising at least three expandable components adapted to transition from a compressed configuration to an expanded configuration when deployed into the aneurysm, each of the at least three components being interconnected to at least two of the at least three components such that at least three expandable components can be advanced as an interconnected unit, into the aneurysm.
The system of Embodiment 156, wherein the at least three expandable components comprises at least four expandable components.
The system of Embodiment 157, wherein at least two of the at least four expandable components is interconnected with at least three of the at least four expandable components such that the device comprises a multi-planar shape.
The system of Embodiment 156, wherein the at least three components are interconnected by filaments.
The system of Embodiment 156, wherein at least three components are interconnected by filaments having preset shapes such that in an expanded position, the at least three components are spaced relative to each other at a preset orientation.
The system of Embodiment 156, wherein the device comprises at least one central expandable component positioned such that, when the device is in an expanded configuration, the central expandable component is centrally interconnected with a plurality of the expandable components.
The system of Embodiment 161, wherein the at least one central expandable component has an expanded size greater than an expanded size of each remaining one of the plurality of components.
The system of Embodiment 161, wherein the at least one central expandable component has an average porosity greater than an average porosity of each remaining one of the plurality of the components.
The system of Embodiment 158, wherein the multi-planar shape comprises a polyhedron.
The system of Embodiment 164, wherein the multi-planar shape comprises a pyramid.
The system of Embodiment 164, wherein the multi-planar shape comprises a prism.
The system of Embodiment 156, wherein a first component of the at least three components comprises a shape or an average porosity different than that of a second component of the at least three components.
The system of Embodiment 156, wherein the first component shape is selected from the group consisting of cylinders, hemispheres, polyhedrons, prolate spheroids, oblate spheroids, plates, bowls, hollow structures, clover shapes, non-spherical surface of revolution, and combinations thereof.
The system of Embodiment 156, wherein the second component comprises a substantially spherical shape.
The system of Embodiment 156, wherein the first component comprises an average porosity of between about 1 μm and about 100 μm, and the second component comprises an average porosity of between about 100 μm and about 200 μm.
The system of Embodiment 156, further comprising an introducer sheath configured to receive the device therein such that the device can be loaded into the guide catheter for delivery to the aneurysm.
A method for treatment of an aneurysm, comprising: advancing an intrasaccular device toward the aneurysm through a lumen of a catheter, the device comprising a plurality of expandable components each adapted to transition from a compressed configuration to an expanded configuration when deployed into the aneurysm from the catheter, each of the plurality of components being interconnected by a coupling.
The method of Embodiment 172, further comprising: advancing the device into the aneurysm such that a first component is disposed within the aneurysm and a second component, interconnected with the first component by the coupling, is disposed within the catheter lumen; severing the coupling between the first and second components to release the first component into the aneurysm; retaining the second component within the lumen; and withdrawing the catheter.
The method of Embodiment 172, further comprising advancing a plurality of expandable components into the aneurysm prior to the severing.
The method of Embodiment 172, wherein each of the plurality of components is interconnected in series by the coupling.
The method of Embodiment 172, wherein the severing comprises proximally withdrawing the catheter relative to a second catheter such that the coupling between the first and second components is pinched between a distal end of the catheter and a rim of the second catheter.
The method of Embodiment 172, wherein the plurality of expandable components is arranged in descending size, and the advancing comprises allowing an initial expandable component deployed into the aneurysm to expand prior to advancing a subsequent expandable component into the aneurysm.
The method of Embodiment 177, wherein the advancing comprises observing a fit of expanded components within the aneurysm to determine whether to advance additional components into the aneurysm.
The method of Embodiment 178, wherein the device comprises a radiopaque material.
The method of Embodiment 178, wherein the couplings between the plurality of expandable components comprise a radiopaque material.
The method of Embodiment 178, wherein each of the plurality of expandable components of the device comprises a radiopaque material.
It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory and are intended to provide further explanation of the subject technology.
The accompanying drawings, which are included to provide further understanding of the subject technology and are incorporated in and constitute a part of this specification, illustrate aspects of the disclosure and together with the description serve to explain the principles of the subject technology.
In the following detailed description, numerous specific details are set forth to provide a full understanding of the subject technology. It should be understood that the subject technology may be practiced without some of these specific details. In other instances, well-structures and techniques have not been shown in detail so as not to obscure the subject technology.
Intrasaccular implant devices and procedures for treating aneurysms can be improved by manipulating one or more physical characteristics of the implant material. Such characteristics can include the porosity, composition, material, shape, size, interconnectedness, inter-engagement, coating, etc. By modifying one or more such characteristics, the morphology or attributes of a target aneurysm and orientation of any connecting arteries can be specifically considered and addressed to achieve superior treatment.
According to some embodiments, the porosity, composition, or material of the intrasaccular device can facilitate in the treatment of an aneurysm. The intrasaccular device can comprise an expandable component. The intrasaccular device can expand from a first, compressed configuration to a second, expanded configuration when released into the aneurysm.
Optionally, the intrasaccular device can comprise an expandable component having an average porosity that changes from a first end of the component to a second end opposite the first end. Optionally, the intrasaccular device can comprise a composite structure having first and second sections or materials having different porosities. For example, the first and second sections can be separated by a transition zone. The transition zone can comprise an immediate change in porosity or a gradual transition in which the porosity spatially varies between a first porosity and a second porosity from one end of the transition zone to another, opposite end of the transition zone.
As used herein, “porosity” can generally refer to an average porosity, which can be sampled across a given portion or section of an expandable component. “Porosity” can be defined as the ratio of the volume of the pores of in a component to the volume of the component as a whole. Porosity can be measured by a fluid displacement test. For example, liquid or gas testing can be used, as necessary or desirable, according to skill in the art. In some embodiments, a chromatography chamber can be used to measure displacement of a gas within the chamber, enabling the calculation of an average porosity of a given intrasaccular device or portion thereof. Other methods and systems can be used to measure porosity of portions of or the entirety of an expandable component.
In some embodiments, a composite structure of the intrasaccular device can comprise three materials having different porosities. Further, the composite structure of the intrasaccular device can comprise for, five, six, or more different materials having different porosities.
According to some embodiments, one or more of intrasaccular devices can be released into a target aneurysm and, in some embodiments, specifically oriented relative to the aneurysm ostium or neck and/or one or more perforating vessels (e.g., perforating arteries or arterioles) adjacent to the aneurysm.
In some embodiments, the intrasaccular device can be repositioned within the aneurysm as the device is expanding. The repositioning of the device can allow a clinician to position a lower porosity section of the device adjacent to the neck of the aneurysm. The repositioning of the device can also allow a clinician to position a higher average porosity section of the device adjacent to one or more perforating vessels (e.g., perforating arteries or arterials) adjacent to the aneurysm. The repositioning of the device can also allow a clinician to position a lower porosity portion of the device adjacent to a bifurcation. The repositioning of the device can also allow a clinician to position a higher average porosity portion of the device toward or in the fundus of the aneurysm.
Intrasaccular implant devices and procedures for treating aneurysms disclosed herein can also comprise manipulating a shape or size of the intrasaccular device. According to some embodiments, a single expandable component having a specific or selected shape or size, which can be tailored to the shape or size of the aneurysm, can be implanted into an aneurysm. Further, multiple expandable components, each having such a specific or selected shape or size can also be implanted into an aneurysm. The shape or size of the expandable component(s) can be selected from a variety of spherical or non-spherical shapes. Each shape can be solid or hollow.
According to some embodiments, a composite intrasaccular device can be provided that comprises at least two mating expandable components (e.g., a plurality of interconnectable or engageable expandable components). Each of the expandable components can comprise one or more engagement structures configured to interact with a corresponding engagement structure of another mating expandable component.
For example, the mating expandable components can each comprise an engagement structure configured to interact with a corresponding engagement structure of another mating expandable component. The mating expandable components can be delivered into the aneurysm and arranged in situ such that the engagement structures are aligned and interconnected appropriately such that the expandable components are mated. In some embodiments, the mating of the expandable components can interlock the components as a unit. For example, expansion of a portion of a component within a recess of another component can cause the components to be interlocked with each other. Further, in some embodiments, the mating components can restrict at least one degree of freedom of movement of another component.
According to some embodiments in which a plurality of expandable components is used, the expandable components (whether interconnected by wires or filaments, or not interconnected, thereby moving independently of each other) can be arranged in a pattern to provide a composite component. The composite component can provide desired characteristics that may be difficult to achieve in a single component formed from a single, continuous piece of material.
A variety of delivery systems and procedures can be implemented to deliver an intrasaccular device having a specific size or shape and, in some embodiments, having a plurality of expandable components. Examples of these systems and procedures are discussed further herein.
In accordance with some embodiments of the delivery procedure, the target aneurysm can be imaged and analyzed in order to determine a three-dimensional shape of the aneurysm. Based on the shape of the target aneurysm, one or more expandable components can be selected, having a unique porosity, composition, material, shape, size, interconnectedness, inter-engagement, or coating, etc. Imaging devices can include 3-D CTA or MRI (MRA) imaging, through which the size and shape of the aneurysm can be ascertained. Such imaging can provide a basis for selection of one or more correspondingly shaped intrasaccular device(s) for insertion within the aneurysm. Different combinations of expandable components or their characteristics can be used.
Optionally, in some embodiments, the intrasaccular device can have a predetermined configuration, whether or not the intrasaccular device has only a single or multiple expandable components. The predetermined configuration can be based on typical aneurysm shapes, thereby allowing selection of a specific intrasaccular device. However, individual components of an intrasaccular device can also be arranged based on their properties. Accordingly, the clinician can determine the shape of the aneurysm and create a desired intrasaccular device configuration for treating the aneurysm.
In some embodiments, an expandable component of an intrasaccular device may be molded or manufactured into a variety of geometrical or partial geometrical shapes.
For example, in order to accommodate a variety of aneurysm configurations, the shape or size of the expandable component(s) can be selected from a variety of spherical or non-spherical shapes, including, cylinders, hemispheres, noodles, polyhedrons (e.g., cuboids (types), tetrahedrons (e.g. pyramids), octahedrons, prisms), coils, prolate spheroids, oblate spheroids, plates (e.g., discs, polygonal plates), bowls (e.g., an open container, such as a hollow, hemispherical container or other open, hollow containers, whether hemispherical, rounded, or otherwise), hollow structures (e.g., a container of any shape with an inner cavity or void, which can be, for example, greater in size than a width of any of the walls of the structure), clover shapes (a plurality of radially extending protrusions, having rounded or smooth corners), non-spherical surfaces of revolution (e.g., toruses, cones, cylinders, or other shapes rotated about a center point or a coplanar axis), and combinations thereof. Each shape(s) can be solid or hollow.
In accordance with some embodiments, at least a portion of the intrasaccular device can comprise a coating or material for enhancing therapeutic, expansive, or imaging properties or characteristics of at least one or every expandable component of the intrasaccular device.
In some embodiments, the intrasaccular device can be configured such that an expandable component thereof is coated with a biocompatible material to promote endothelialization or provide a therapeutic effect.
Optionally, the expandable component can also comprise an expansion-limiting coating that slows expansion of the component from its natural rate of expansion to a slower rate of expansion such that in the process of expanding, the position of the component can be adjusted within the aneurysm or the component can be removed from the aneurysm, if necessary. Examples of polymers that can be used as expansion-limiting coatings can include hydrophobic polymers, organic non-polar polymers, PTFE, polyethylene, polyphenylene sulfide, oils, and other similar materials.
Various delivery systems and procedures can be implemented for delivering an intrasaccular device comprising one or more expandable components, as discussed herein. Further, a system and method are provided for delivery of an intrasaccular device to an aneurysm and/or recapturing the device for removal or repositioning.
Intrasaccular implant devices and procedures for treating aneurysms can comprise interconnecting individual components of the intrasaccular device. According to some embodiments, a plurality of expandable components can be interconnected along a wire, filament, or other disconnectable or breakable material. The expandable components can be connected in a linear configuration, a planar matrix, or in a three-dimensional matrix. The expandable components of such interconnected linear, planar, or three-dimensional matrices can be sized and configured in accordance with desired porosity, size, shape, radiopacity, or other characteristics disclosed herein.
In some embodiments, methods are provided by which interconnected expandable components can be released into an aneurysm. The interconnected components can be preconfigured (e.g., a plurality of components can be joined together to form a single, unitary device, or a select plurality of components can be removed from a larger strand or array of components) prior to implantation and later inserted into a delivery catheter. Thereafter, the entire strand or assembly of interconnected expandable components of the intrasaccular device can be ejected or released into the aneurysm and allowed to expand within the aneurysm.
However, in accordance with some embodiments, an entire strand or array of components can be loaded into a delivery catheter, and while implanting and observing the packing behavior, a clinician can determine that a select portion of the interconnected expandable components is sufficient for a given aneurysm. Thereafter, the select portion of the interconnected expandable components can be broken or cut in situ so as to be released into the aneurysm.
Additionally, although in some embodiments, a single expandable component can be used alone to fill the aneurysm and provide a desired packing density, a plurality of expandable components can also be used to fill the aneurysm and provide a desired packing density. Optionally, a liquid embolic and/or a framing component can be used in combination with one or more expandable components to facilitate delivery, engagement with the aneurysm, or increase of the packing density. Any of these embodiments can allow increased packing density to avoid recanalization of the aneurysm.
Referring now to the drawings,
A cerebral aneurysm may present itself in the shape of a berry, i.e., a so-called berry or saccular aneurysm, which is a bulge in the neurovascular vessel. Berry aneurysms may be located at bifurcations or other branched vessels. Other types of aneurysms, including fusiform aneurysms, can also be treated using embodiments of the intrasaccular devices disclosed herein.
The intrasaccular device 10 can comprise at least one expandable component. In some embodiments, the intrasaccular device 10 can comprise a plurality of expandable components. Further, a given expandable component of the intrasaccular device 10 can have one or more different characteristics than another of the expandable components of the intrasaccular device 10.
An expandable component can be formed from a material that can be highly compressed and later expanded when released into the aneurysm and contacted by a fluid, such as a fluid within the aneurysm. In some embodiments, the expandable component can be formed at least in part of biocompatible, solid foam. As disclosed herein, “foam” can include a solid or semisolid gel, a swellable material (whether swellable upon hydration or swellable/self-expanding without hydration), a material having pores and interstices. “Foam” can include hydrophobic or hydrophilic materials. “Foam” can also include materials that can be highly compressed and configured to expand upon contact with a fluid, upon exposure to a thermal agent, upon exposure to a chemical agent, or self-expanding, upon release from engagement with the delivery mechanism. In some embodiments, the foam material can be configured to expand by about two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, or more times its collapsed size when expanding to its expanded size.
For example,
Other materials can also be used to form one or more portions of an intrasaccular device or an expandable component thereof. Such materials can include, but are not limited to polyvinyl alcohol (PVA) materials, water-soluble synthetic polymers, such as poly ethylene glycol (PEG), polyvinyl pyrrolidone (PVP), and other similar materials.
The porosity of the expandable component may vary along any portion(s) thereof, including any combination of pore sizes of 1 micron or greater. Further, the pore sizes can range from about 1 μm to about 400 μm, from about 5 μm to about 300 μm, from about 8 μm to about 200 μm, from about 10 μm to about 150 μm, from about 15 μm to about 80 μm, or in some embodiments, from about 20 μm to about 50 μm. Further, at least a portion or section of the device can comprise an average porosity of between about 1 μm and about 150 μm. Further, at least a portion or section can comprise an average porosity of between about 100 μm and about 200 μm. Furthermore, at least a portion or section can comprise an average porosity of between about 200 μm and about 300 μm. When a composite expandable component is formed using multiple sections or portions, each section or portion can have an average porosity within any of the ranges discussed above.
According to some embodiments, in a compressed state, an expandable component of the intrasaccular device may be compressed down to 50%, 40%, 30%, 20%, 10% or less of its expanded state (which can be measured by its maximum diameter or cross-sectional dimension) for delivery through a standard microcatheter. In some embodiments, the foam material can be configured to expand by about two to twenty times its collapsed size when expanding to its expanded size.
In the event the intrasaccular device is not self-expandable, but expandable through a chemical reaction, a chemical may be introduced within the lumen of the delivery catheter for delivery to the intrasaccular device. In the alternative, the delivery catheter may include a separate lumen for introduction of the catalyst. Thermally expansive foam may be activated through introduction of heated saline or some other suitable biocompatible fluid through any of the aforementioned lumens of the delivery catheter. In the alternative, a heating element may be incorporated within the delivery catheter to deliver heat to the foam structure to cause corresponding expansion. A suitable heating element, identified schematically as reference numeral, may include resistive element(s), a microwave antenna, radio-frequency means, ultrasonic means or the like.
As noted above, some embodiments of the expandable component can be configured to provide a specific porosity profile. The porosity profile can comprise a single, consistent average porosity throughout the entire expandable component, or multiple average porosity zones, portions, or materials having different average porosities that are joined to form a composite expandable component.
For example, the embodiment illustrated in
Conversely, as porosity increases, the packing density decreases, which compared to low porosity structures, provides less support for thrombogenesis due to lower resistance to flow therethrough. Nevertheless, the realization of some embodiments disclosed herein is that high porosity structures can also support the aneurysm wall, beneficially aid in healing and thrombogenesis for select aneurysm morphologies, permit flow to other vessels (e.g., branch vessels, perforating arteries, or arterioles), and/or permit the introduction of other materials, such as a liquid embolic, etc.
Further, in some embodiments, composite, variable, or multi-porosity expandable components (whether using a single expandable component having multiple porosities or using multiple expandable components each having different porosities) can advantageously allow the intrasaccular device to mimic natural function of the vasculature while promoting healing through thrombogenesis, pressure moderation or reduction, or aneurysm deflation. Further, in embodiments using a single expandable component, the single expandable component can be configured to advantageously secure the intrasaccular device within a wide-neck aneurysm by facilitating engagement with a sufficient amount of the aneurysm wall, thereby avoiding dislodgement or herniation of the device from the aneurysm into the parent vessel.
One suitable liquid embolic is the Onyx™ liquid embolic system manufactured by Covidien LP, Irvine, Calif. Onyx™ liquid embolic system is a non-adhesive liquid used in the treatment of brain arteriovenous malformations. Onyx™ liquid embolic system is comprised of an EVOH (ethylene vinyl alcohol) copolymer dissolved in DMSO (dimethyl sulfoxide), and suspended micronized tantalum powder to provide contrast for visualization under fluoroscopy. Other liquid embolic solutions are also envisioned.
For example,
The foam composites may be formed to provide different support and/or flow profiles. As addressed herein, a material, such as bismuth or tantalum, can be blended with the foam to provide radiopacity. Also, radiopaque markers can be attached to the foam by bonding or mechanically crimping them to the foam.
As noted above, in some embodiments, only a single expandable component would be required for introduction into an aneurysm. In some embodiments, this may prove advantageous over conventional methodologies such as the insertion of, for example, multiple embolic coils, by significantly reducing time for performance of the embolization procedure.
Additionally, in some embodiments, multiple expandable components can be provided for insertion into an aneurysm. For example, a plurality of expandable components, having different average porosities, can be implanted into an aneurysm and have a composite or cumulative porosity profile spatially across the aneurysm, which can allow the plurality of expandable components to operate as a unit in much the same way as a single expandable component, if packing the same aneurysm itself, would operate. Such embodiments are discussed in greater detail below in
Further, in some embodiments, the expandable component(s) can include one or more flow regions. The flow region can be used alone or combination with any of the variable porosity profiles disclosed herein, including those illustrated in
For example,
According to some embodiments, the flow regions 32, 42 can comprise a passage, channel, or elongate void within the body 34, 44. Further, in embodiments wherein the flow regions 32, 42 comprise a material, the material of the flow regions 32, 42 can have a much higher porosity than that of the surrounding areas within the body 34, 44. Although
In some embodiments, the flow region can be separated from other portions of the body by a partial or full barrier. For example, the flow region can comprise a lumen formed through the body and the lumen can comprise an inner wall (not shown) extending therealong. The inner wall can comprise a continuous surface. However, the inner wall can also comprise one or more perforations extending through the wall, by which the lumen of the flow region is in fluid communication with the surrounding areas of the body. Thus, the flow region can provide isolated flow through the body or a flow that is in communication with other areas of the body of the expandable component.
In particular, in some embodiments, an intrasaccular device can be provided that comprises first and second expandable components of which at least one has a shape selected from the group consisting of cylinders, hemispheres, polyhedrons, prolate spheroids, oblate spheroids, plates, bowls, hollow structures, clover shapes, non-spherical surface of revolution, and combinations thereof. Additional expandable components can be provided that have substantially spherical shapes.
In accordance with some embodiments, an intrasaccular device can comprise first and second expandable components having different shapes. Further, the first and second expandable components can have different sizes. A third expandable component can be used, which can have the same or different sizes or shapes compared to either or both of the first and second expandable components. Thus, the first, second, and third expandable components can each have a different size and/or shape compared to each other. Such principles can apply to additional components, such as fourth, fifth, sixth components, and so forth.
Further, the shapes mentioned above can be solid or at least partially hollow (e.g., having a cavity or void therewithin). Hollow expandable components can comprise braided structures (e.g., braided spheres), foam structures, and the like. A hollow expandable component can be released into the aneurysm by itself or in combination with other occlusive material, such as a liquid embolic, additional expandable components, or coils.
For example,
Additionally, in some embodiments, the intrasaccular device 150a, 150b, 150c can be configured to comprise an aperture 156a, 156b, 156c in communication with the cavity 154a, 154b, 154c to permit introduction of, e.g., at least one additional expandable component, a liquid embolic, or embolic coils to further pack and/or support the aneurysm. In lieu of an aperture 156a, 156b, 156c, the clinician may perforate the intrasaccular device 150a, 150b, 150c before or during the procedure. In such a capacity or procedure, the intrasaccular device 150a, 150b, 150c can function as an intrasaccular framing device.
For example, the intrasaccular device 150a, 150b, 150c can be expanded within the aneurysm such that the intrasaccular device 150a, 150b, 150c extends across the neck of the aneurysm with the aperture 156a, 156b, 156c being accessible through the neck (see e.g.,
Alternately, the aperture 156a, 156b, 156c may permit the introduction of a second smaller expandable component having a hollow interior. A third expandable component, smaller than the second expandable component, may then be introduced into the hollow interior of the second expandable component. Additional smaller foam structures may be added in a similar manner.
In alternate embodiments, the intrasaccular device 150a, 150b, 150c may receive any of the aforedescribed solid foam structures of the prior embodiments until the cavity 154a, 154b, 154c is packed to the desired capacity.
The intrasaccular devices 160a, 160b shown in
Further, in embodiments having only two interconnecting portions, such interconnecting portions can be configured to restrict at least two degrees of freedom of motion of the opposing portion. Motion can be restricted in two or more of the following directions: up-and-down translation, forward and backward translation, left and right translation, side to side pivoting or rolling, left and right rotating or yawing, and forward and backwards tilting or pitching. Further, in some embodiments, such as those illustrated in
The mating expandable components, such as those embodiments illustrated in
As noted above, in accordance with some embodiments, at least a portion of the intrasaccular device can comprise a coating or material for enhancing therapeutic, expansive, or imaging properties or characteristics of at least one or every expandable component of the intrasaccular device.
The intrasaccular device can be configured such that an expandable component thereof is coated with a biocompatible material to promote endothelialization or provide a therapeutic effect.
For example,
The coating 194 may include thrombogenic coatings such as fibrin, fibrinogen or the like, anti-thrombogenic coatings such as heparin (and derivatives thereof), urukinase or t-PA, and endothelial promoting coatings or facilitators such as, e.g., VEGF and RGD peptide, and/or combinations thereof. Drug eluting coatings and a drug eluting foam composite, such as anti-inflammatory or antibiotic, coatings are also envisioned. These drug eluting components may include nutrients, antibiotics, anti-inflammatory agents, antiplatelet agents, anesthetic agents such as lidocaine, and anti-proliferative agents, e.g. taxol derivatives such as paclitaxel. Hydrophilic, hygroscopic, and hydrophobic materials/agents are also envisioned.
As also noted above, in some embodiments, the expandable component can also comprise an expansion-limiting coating that slows expansion of the component from its natural rate of expansion to a slower rate of expansion such that in the process of expanding, the position of the component can be adjusted within the aneurysm or the component can be removed from the aneurysm, if necessary. Examples of polymers that can be used as expansion-limiting coatings can include hydrophobic polymers, organic non-polar polymers, PTFE, polyethylene, polyphenylene sulfide, oils, and other similar materials.
In embodiments, only specific segments of the intrasaccular device may be embedded or coated with an agent to provide desired characteristics to the expandable component(s). For example, as depicted in
Optionally, the coated area 202 can also comprise radiopaque material to assist the surgeon in visualization and placement of the expandable component 206 in a desired orientation relative to the aneurysm. The expandable component 206 can have radiopacity characteristics either by adding radiopaque filler to the material (which in some embodiments comprises a foam material), such as bismuth, or attaching radiopaque markers. Alternatively, a radiopaque material can be attached to the expandable component 206, such as by dipping, spraying, or otherwise mechanically, chemically, or thermally attached, injected into, or blended into to the expandable component 206.
Once the expandable component is delivered into the aneurysm, it can expand back to its full size or expanded state, confined within the neck of the aneurysm with minimal herniation within the parent vessel. The foam could be self-expandable, chemically expandable, thermally expandable, or expandable in response to pH changes or to light. Shape memory foams such as polyurethane foam can be used.
Various delivery systems and procedures can be implemented for delivering an intrasaccular device comprising one or more expandable components, as discussed herein. Further, a system and method are provided for delivery of an intrasaccular device to an aneurysm and/or recapturing the device for removal or repositioning.
For example, in accordance with some embodiments,
A carrier assembly 320 can be configured to engage an intrasaccular device 330 and deliver the intrasaccular device 330 into the aneurysm 306. The carrier assembly 320 can comprise a core member 322 and an engagement member 324. The core member 322 can be interconnected with the engagement member 324. The engagement member 324 can comprise at least two arm members 340 having a closed position (see
The carrier assembly 320, disposed within a lumen of the delivery catheter 300, can be advanced distally through the catheter 300 until reaching the distal end 304 of the catheter 300. Upon reaching the distal end 304, the carrier assembly 320 can be actuated to release an intrasaccular device 330 into the aneurysm 306, as shown in
The arm members 340 can be spring-loaded or configured to spring open from the closed position upon being advanced out of or distally beyond the distal end 304 of the catheter 300. However, the arm members 340 can also be manually actuated using a proximal control mechanism, thereby allowing the arm members 340 to continue engaging the intrasaccular device 330 even after the arm members 340 have moved out of the lumen of the catheter 300. For example, such a proximal control mechanism can comprise a proximally extending wire coupled to a first of the arm members 340, the proximal retraction of which causes the first arm member 342 retract into the catheter 300, thus releasing the intrasaccular device 330. Various other control mechanisms, such as those disclosed herein, can also be implemented in accordance with some embodiments.
After the intrasaccular device 330 has been released into the aneurysm 306, the intrasaccular device 330 can begin to expand. The clinician can carefully monitor the orientation of the intrasaccular device 330 relative to the neck or surrounding the vasculature of the aneurysm 306.
According to some embodiments, if the intrasaccular device 330 has a specific characteristic, such as a porosity profile, coating, shape, etc., intended for placement in a certain location of the aneurysm 306, the clinician can position the intrasaccular device 330 by manually rotating, moving, maintaining the position of, or otherwise adjusting the position of the intrasaccular device 330 within the aneurysm 306 as the intrasaccular device 330 expands. This procedure is illustrated in
In the performance of such procedures, the intrasaccular device 330 can beneficially be coated with an expansion-limiting coating, such as those discussed above. In such embodiments, the expansion-limiting coating can allow the intrasaccular device 332 slowly expand, thus providing the clinician with a greater, and in some cases, a specified or expected period of time after releasing the intrasaccular device 330 to adjust the position of the intrasaccular device 330 within the aneurysm 306.
For example,
Referring now to
As discussed above with respect to the engagement mechanism of
In some embodiments, the delivery/retrieval member 680 can comprise the Alligator Retrieval Device, manufactured by Covidien LP, generally represented in
In use, an access catheter is advanced within the neurovasculature as is conventional in the art. A suitable microcatheter adaptable for navigation through the tortuous neurovascular space to access the treatment site is disclosed in commonly assigned U.S. Pat. No. 7,507,229, the entire contents of which are hereby incorporated herein.
The gripping elements 684 of the delivery/retrieval member 680 are positioned about the intrasaccular device 650 (
The delivery/retrieval member 682 is advanced through the introducer sheath 630 whereby upon clearing the distal end of the introducer sheath 630 the gripping elements 684 of the delivery/retrieval member 682 open to release the intrasaccular device 650. In the event the intrasaccular device 650 is not properly positioned within the aneurysm or is dislodged, the gripping elements 684, in the open configuration, and extended beyond the introducer sheath 630, are positioned to circumscribe the intrasaccular device 650 within the vasculature. The delivery/retrieval member 682 is withdrawn into the introducer sheath 630 whereby the gripping elements 684 compress the foam material of the intrasaccular device 650 to permit reception of the device 650 within the lumen of the introducer sheath 630. Thereafter, the intrasaccular device 650 can be removed from the neurovasculature or repositioned within the aneurysm by deployment of the delivery/retrieval member 682 in the manner discussed herein.
The delivery catheter 732 may be introduced within the neurovasculature and advanced to the treatment site. Once appropriately oriented with respect to the aneurysm, the pusher element 734 is actuated by, e.g., advancing a handle or actuator operatively connected to the proximal end of the pusher element 734 to cause the distal or remote end of the pusher element 734 to eject the intrasaccular device 720. The intrasaccular device 720 can expand to pack the aneurysm.
Additionally, in accordance with some embodiments, the pusher element 734 can comprise a radiopaque material or component 736 disposed on a contact member 738 of the pusher element 734. As the pusher element 734 is advanced within the lumen of the catheter 732, the radiopaque material 736 can enable the clinician to visualize the location of the intrasaccular device 720 to ensure proper positioning of the pusher element 734 within the lumen of the catheter 732.
These intrasaccular devices or pellets 770a, 770b may be smaller in dimension than the aforedescribed intrasaccular devices to enable multiple and strategic deployment within the aneurysm. Any of the embodiments of the aforedescribed intrasaccular devices may be incorporated within the pellets 770a, 770B. Further, the delivery member 764 can incorporate one or more radiopaque materials are components 772 to facilitate visualization of the location of the delivery member 764 within the sheath 762.
When initially inserted into the aneurysm, prior to expansion, both the first and second expandable components 842, 844 easily fit into the aneurysm 830. Upon expansion, neither the first nor second expandable components 842, 844 entirely packs the aneurysm 830. Thus, if either of the first or second expandable components 842, 844 were positioned by itself in the aneurysm 830, significant movement and potential herniation of the respective component could occur from within the aneurysm 830. However, as the first and second expandable components 842, 844 expand within the aneurysm 830, the first and second mating surfaces 852, 854 can cause the first and second expandable components 842, 844 to become aligned within the aneurysm 830. Such alignment, as illustrated in
According to some embodiments, an intrasaccular the first and second mating surfaces 852, 854 can be substantially flat. However, as illustrated in
As noted above with respect to
For example,
In some embodiments, the outer surface 908 of the hollow component 902 can contact against a first section of the aneurysm wall 912 adjacent to the aneurysm neck 920, as well as against a second section of the aneurysm wall 912 adjacent to the aneurysm dome 918, opposite the aneurysm neck 920. For example, the aneurysm 904 or aneurysm wall 912 can be considered in terms of quadrants, and the outer surface 908 can contact at least three quadrants of the aneurysm wall 912. In some embodiments, the outer surface 908 can be caused to contact at least a portion of each quadrant of the aneurysm wall 912. The contact of the outer surface 908 against the aneurysm wall 912 can tend to secure the hollow component 902 within the aneurysm 904 to avoid dislocation or herniation of any portion of the hollow component 902 from the aneurysm 904.
Referring still to
In accordance with some embodiments, the support or framing component can comprise a stent that extends along a lumen adjacent to an aneurysm. The aneurysm can be a saccular or berry, wide neck, or fusiform aneurysm. For example, a stent can be used in combination with any of the variety of intrasaccular devices illustrated above, such as those shown in
When expanded into contact against the inner wall of the lumen 954, the stent 952 can isolate, separate, or divide the inner cavity 956 of the fusiform aneurysm 950 from a central portion of the lumen 954.
When the stent 952 is in place, at least one expandable component 960 can be released into the inner cavity 956 between the inner wall of the aneurysm 950 and an outer surface 962 of the stent 952. The expandable component(s) 960 can be inserted into the cavity 956 through an opening in a wall of the stent 952 (or if the stent 952 is braided, through an interstice of the braid).
As discussed herein, the expandable component(s) 960 can have one or more characteristics that improve the effectiveness of the intrasaccular device 940. Further, the characteristics of the expandable component 960 can be selected based on the shape or configuration of the aneurysm 950, as discussed above. As shown in
In accordance with some embodiments, after an intrasaccular device has been implanted into an aneurysm, a material such as a liquid embolic (as discussed above), a drug, a radiopaque material, a contrast agent, or other agent can be injected or inserted into the aneurysm. The injection or insertion can occur prior to, concurrently with, or after expansion of the intrasaccular device within the aneurysm. As such, the material can be absorbed into at least a portion of the intrasaccular device or pack any remaining voids within the aneurysm around the intrasaccular device. The injection of a liquid embolic can advantageously increase the overall packing density of the device.
For example,
Thus, various materials can be injected or inserted into the aneurysm to supplement or complement the treatment provided by an intrasaccular device.
In one embodiment, the closed end 1104 of the framing structure is sealed via a clamp 1108, an adhesive, or may be heat welded via known techniques. The closed end 1104 may be inverted relative to the remaining framing structure 1102a and depend inwardly within the interior thereof. The open end 1106 of the framing structure 1102a may be in diametrical opposed relation to the closed end 1104. The individual filaments ends 1110 of the framing structure at the open end 1106 also may be inverted and disposed within the interior of the framing structure 1102a.
As shown in the embodiment of
The framing structure 1102a, combined with coils, an expandable component, or other materials, can also provide the benefit of providing good neck coverage while preventing embolic devices from herniating into the parent artery. Additionally, the use of such a system can also increase packing volume efficiency and achieve stasis.
As illustrated, the framing structure 1102a may provide a support or scaffold for the supplemental intrasaccular components or materials, including coils, expandable components, or other materials (e.g., a liquid embolic, drug, radiopaque material, contrast agent, or other agent). The coils 1120 or expandable component 1130 may contain or be coated with bioactive coating that promotes specific clinical theory such as endothelialization, thrombosis, etc.
Referring briefly to
Referring again to
In implementing a method for placing a framing structure within an aneurysm and injecting coils, expandable component(s), or other materials into the framing structure, the open end or widest interstices of the framing structure can be positioned at the neck of the aneurysm so as to facilitate insertion of the distal end 1114 of the catheter 1112 into the open end or between the filaments (i.e., into an interstice) of the framing structure. In embodiments having a braided material for the framing structure, the braid pattern can be properly aligned to facilitate entry of the materials into the framing structure. As in other embodiments disclosed herein, the framing structure can comprise a radiopaque material or component that facilitates visualization and enables the clinician to align the framing structure as needed within the aneurysm.
As illustrated in
The composite effect of the coils, expandable component, and/or other materials inserted into the framing structure can provide the advantages and benefits discussed above with respect to various other expandable components. As such, the clinician can determine and control various intrasaccular implant characteristics, including porosity, composition, material, shape, size, interconnectedness, inter-engagement, coating, etc.
According to some embodiments, systems or kits having a framing structure and at least one coil, expandable component, and/or other material can be provided.
Intrasaccular implant devices and procedures for treating aneurysms can be improved by interconnecting individual components of the intrasaccular device. According to some embodiments, a plurality of expandable components can be interconnected along a wire, filament, or other disconnectable or breakable material. The expandable components can be connected in a linear configuration (see
In some embodiments, methods are provided by which interconnected expandable components can be released into an aneurysm. The interconnected components can be preconfigured (e.g., a select number of components can be removed from a larger strand or array of components) prior to implantation and later inserted into a delivery catheter. Thereafter, the entire strand or assembly of interconnected expandable components of the intrasaccular device can be released into the aneurysm.
However, in accordance with some embodiments, an entire strand or array of components (which would, in their expanded state, exceed the available space in the aneurysm) can be loaded into a delivery catheter, and while implanting and observing the packing behavior, a clinician can determine that a select portion of the interconnected expandable components is sufficient for a given aneurysm. Thereafter, the select portion of the interconnected expandable components can be broken or cut in situ so as to be released into the aneurysm.
Referring now to
The expandable components 1302a, 1302b, 1302c, 1302d may be interconnected along one or more strings, filaments, carriers, indentations, reduced size sections, or perforation lines (which may include or be devoid of a filament or string) 1304a, 1304b, 1304c, 1304d. For example,
In accordance with some embodiments, the strings, filaments, carriers, indentations, reduced size sections, or perforation lines extending between adjacent expandable components can enhance pushability of the intrasaccular device 1300a, 1300b, 1300c, 1300d into the aneurysm.
Further, as illustrated in
Further, in accordance with some embodiments, consecutive expandable components of an intrasaccular device 1300a, 1300b, 1300c, 1300d can descend in size, which can allow selection of a subset of the expandable components of the intrasaccular device 1300a, 1300b, 1300c, 1300d based on a specific target aneurysm size or shape.
Similar to the embodiment illustrated in
The advantageous features of intrasaccular devices having strip configurations can allow a clinician to quickly and readily assess a target aneurysm and tailor an intrasaccular device specifically for the procedure. The customization of an intrasaccular device strip can be done before implantation or in situ. Further, the interconnectedness of the components tends to ensure that no component is lost.
Prior to initiating the implantation of an strip of interconnected intrasaccular device, a clinician, through imaging means, can determine the size and dimension of an aneurysm 1500. Once the dimensioning is determined, the clinician can determine decide upon a configuration for the intrasaccular device or strip 1502 of interconnected expandable components to be implanted. As shown in
In some embodiments of the delivery procedure, after determining the configuration for the strip 1502, the clinician can prepare the strip 1502 by separating any unnecessary expandable components there from prior to inserting the strip 1502 into the delivery assembly 1504. Thereafter, the strip 1502 is then introduced within the aneurysm in accordance with any of the aforedescribed methodologies.
However, in some embodiments of the delivery procedure, the clinician can load a strip 1502 into the catheter 1506 before trimming any expandable components from the strip 1502. The clinician can then push the strip 1502 out through a distal end 1510 of the catheter 1506, which causes the individual expandable components 1520 to begin to expand within the aneurysm 1500. As the expansion is taking place, the clinician can determine whether additional expandable components 1520 should be deployed into the aneurysm 1500. If needed, the pusher component 1508 can be moved distally to urge one or more additional expandable components 1520 out of the catheter 1506. When it is determined that a sufficient number of expandable components 1520 are inserted into the aneurysm 1500, the clinician can break or separate the strip 1502 by separating the respective expandable components 1520 via trimming or tearing along the breaks, indentations or score lines and separating the expandable components 1520.
The breaking or separating of adjacent expandable components can be performed by actuating the cutting device 1540. In some embodiments, the cutting device 1540 can comprise a second catheter 1542 that is nested within the catheter 1506. The second catheter 1542 can comprise a distal portion 1544 having an opening 1546 that extends from a side of the second catheter 1542. The distal portion 1544 can have a rounded shape that can guide the expandable components 1520 out through the opening 1546. In order to trim the strip 1502, the second catheter 1542 can be retracted proximally relative to the catheter 1506, thus causing the opening 1546 to close against the distal end 1510 of the catheter 1506, thereby severing a tie or filament extending between adjacent expandable components 1520.
Thereafter, the distal portion 1544 of the second catheter 1542 can be further withdrawn into the catheter 1506 and the delivery assembly 1504 can be removed from the target site.
Many of the features discussed herein can be used with any of the disclosed embodiments. For example, any of the embodiments can comprise an average porosity that varies spatially, any of the variety of disclosed shapes, any of the various disclosed materials or coatings, any of the disclosed 2-D or 3-D interconnected configurations, any of the disclosed inter-engagement configurations or structures, any of the disclosed delivery systems, etc.
The apparatus and methods discussed herein are not limited to the deployment and use of a medical device or stent within the vascular system but may include any number of further treatment applications. Other treatment sites may include areas or regions of the body including any hollow anatomical structures.
The foregoing description is provided to enable a person skilled in the art to practice the various configurations described herein. While the subject technology has been particularly described with reference to the various figures and configurations, it should be understood that these are for illustration purposes only and should not be taken as limiting the scope of the subject technology.
There may be many other ways to implement the subject technology. Various functions and elements described herein may be partitioned differently from those shown without departing from the scope of the subject technology. Various modifications to these configurations will be readily apparent to those skilled in the art, and generic principles defined herein may be applied to other configurations. Thus, many changes and modifications may be made to the subject technology, by one having ordinary skill in the art, without departing from the scope of the subject technology.
It is understood that the specific order or hierarchy of steps in the processes disclosed is an illustration of exemplary approaches. Based upon design preferences, it is understood that the specific order or hierarchy of steps in the processes may be rearranged. Some of the steps may be performed simultaneously. The accompanying method claims present elements of the various steps in a sample order, and are not meant to be limited to the specific order or hierarchy presented.
As used herein, the phrase “at least one of” preceding a series of items, with the term “and” or “or” to separate any of the items, modifies the list as a whole, rather than each member of the list (i.e., each item). The phrase “at least one of” does not require selection of at least one of each item listed; rather, the phrase allows a meaning that includes at least one of any one of the items, and/or at least one of any combination of the items, and/or at least one of each of the items. By way of example, the phrases “at least one of A, B, and C” or “at least one of A, B, or C” each refer to only A, only B, or only C; any combination of A, B, and C; and/or at least one of each of A, B, and C.
Terms such as “top,” “bottom,” “front,” “rear” and the like as used in this disclosure should be understood as referring to an arbitrary frame of reference, rather than to the ordinary gravitational frame of reference. Thus, a top surface, a bottom surface, a front surface, and a rear surface may extend upwardly, downwardly, diagonally, or horizontally in a gravitational frame of reference.
Furthermore, to the extent that the term “include,” “have,” or the like is used in the description or the claims, such term is intended to be inclusive in a manner similar to the term “comprise” as “comprise” is interpreted when employed as a transitional word in a claim.
The word “exemplary” is used herein to mean “serving as an example, instance, or illustration.” Any embodiment described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other embodiments.
A reference to an element in the singular is not intended to mean “one and only one” unless specifically stated, but rather “one or more.” Pronouns in the masculine (e.g., his) include the feminine and neuter gender (e.g., her and its) and vice versa. The term “some” refers to one or more. Underlined and/or italicized headings and subheadings are used for convenience only, do not limit the subject technology, and are not referred to in connection with the interpretation of the description of the subject technology. All structural and functional equivalents to the elements of the various configurations described throughout this disclosure that are known or later come to be known to those of ordinary skill in the art are expressly incorporated herein by reference and intended to be encompassed by the subject technology. Moreover, nothing disclosed herein is intended to be dedicated to the public regardless of whether such disclosure is explicitly recited in the above description.
Although the detailed description contains many specifics, these should not be construed as limiting the scope of the subject technology but merely as illustrating different examples and aspects of the subject technology. It should be appreciated that the scope of the subject technology includes other embodiments not discussed in detail above. Various other modifications, changes and variations may be made in the arrangement, operation and details of the method and apparatus of the subject technology disclosed herein without departing from the scope of the present disclosure. Unless otherwise expressed, reference to an element in the singular is not intended to mean “one and only one” unless explicitly stated, but rather is meant to mean “one or more.” In addition, it is not necessary for a device or method to address every problem that is solvable (or possess every advantage that is achievable) by different embodiments of the disclosure in order to be encompassed within the scope of the disclosure. The use herein of “can” and derivatives thereof shall be understood in the sense of “possibly” or “optionally” as opposed to an affirmative capability.
This application is a continuation of U.S. application Ser. No. 14/079,591, filed Nov. 13, 2013, now U.S. Pat. No. 10,327,781, which claims the benefit of U.S. Provisional Application No. 61/725,768, filed Nov. 13, 2012, both of which are incorporated herein by reference in their entireties.
| Number | Name | Date | Kind |
|---|---|---|---|
| 5041090 | Scheglov | Aug 1991 | A |
| 5250071 | Palermo | Oct 1993 | A |
| 5284488 | Sideris | Feb 1994 | A |
| 5326350 | Li | Jul 1994 | A |
| 5354295 | Guglielmi et al. | Oct 1994 | A |
| 5405379 | Lane | Apr 1995 | A |
| 5417708 | Hall et al. | May 1995 | A |
| 5645558 | Horton | Jul 1997 | A |
| 5669931 | Kupiecki et al. | Sep 1997 | A |
| 5725552 | Kotula et al. | Mar 1998 | A |
| 5733294 | Forber et al. | Mar 1998 | A |
| 5741333 | Frid | Apr 1998 | A |
| 5749891 | Ken et al. | May 1998 | A |
| 5749894 | Engelson | May 1998 | A |
| 5749895 | Sawyer et al. | May 1998 | A |
| 5749919 | Blanc | May 1998 | A |
| 5814062 | Sepetka et al. | Sep 1998 | A |
| 5823198 | Jones et al. | Oct 1998 | A |
| 5846261 | Kotula et al. | Dec 1998 | A |
| 5911731 | Pham et al. | Jun 1999 | A |
| 5916235 | Guglielmi | Jun 1999 | A |
| 5925060 | Forber | Jul 1999 | A |
| 5928260 | Chin et al. | Jul 1999 | A |
| 5935148 | Villar et al. | Aug 1999 | A |
| 5941249 | Maynard | Aug 1999 | A |
| 5944738 | Amplatz et al. | Aug 1999 | A |
| 5951599 | McCrory | Sep 1999 | A |
| 5964797 | Ho | Oct 1999 | A |
| 5976169 | Imran | Nov 1999 | A |
| 5980554 | Lenker et al. | Nov 1999 | A |
| 6022374 | Imran | Feb 2000 | A |
| 6033423 | Ken et al. | Mar 2000 | A |
| 6036720 | Abrams et al. | Mar 2000 | A |
| 6063070 | Eder | May 2000 | A |
| 6063104 | Villar et al. | May 2000 | A |
| 6086577 | Ken et al. | Jul 2000 | A |
| 6090125 | Horton | Jul 2000 | A |
| 6093199 | Brown et al. | Jul 2000 | A |
| 6096021 | Helm et al. | Aug 2000 | A |
| 6123715 | Amplatz | Sep 2000 | A |
| 6139564 | Teoh | Oct 2000 | A |
| 6152144 | Lesh et al. | Nov 2000 | A |
| 6159531 | Dang et al. | Dec 2000 | A |
| 6165193 | Greene et al. | Dec 2000 | A |
| 6168615 | Ken et al. | Jan 2001 | B1 |
| 6168622 | Mazzocchi | Jan 2001 | B1 |
| 6238403 | Greene et al. | May 2001 | B1 |
| 6299619 | Greene et al. | Oct 2001 | B1 |
| 6309367 | Boock | Oct 2001 | B1 |
| 6322576 | Wallace et al. | Nov 2001 | B1 |
| 6344048 | Chin et al. | Feb 2002 | B1 |
| 6346117 | Greenhalgh | Feb 2002 | B1 |
| 6350270 | Roue | Feb 2002 | B1 |
| 6368339 | Amplatz | Apr 2002 | B1 |
| 6371980 | Rudakov et al. | Apr 2002 | B1 |
| 6375668 | Gifford et al. | Apr 2002 | B1 |
| 6379329 | Naglreiter | Apr 2002 | B1 |
| 6383174 | Eder | May 2002 | B1 |
| 6391037 | Greenhalgh | May 2002 | B1 |
| 6428558 | Jones et al. | Aug 2002 | B1 |
| 6447531 | Amplatz | Sep 2002 | B1 |
| 6451050 | Rudakov et al. | Sep 2002 | B1 |
| 6454780 | Wallace | Sep 2002 | B1 |
| 6494884 | Gifford et al. | Dec 2002 | B2 |
| 6506204 | Mazzocchi | Jan 2003 | B2 |
| 6511468 | Cragg et al. | Jan 2003 | B1 |
| 6547804 | Porter et al. | Apr 2003 | B2 |
| 6551303 | Van et al. | Apr 2003 | B1 |
| 6569179 | Teoh et al. | May 2003 | B2 |
| 6579303 | Amplatz | Jun 2003 | B2 |
| 6585748 | Jeffree | Jul 2003 | B1 |
| 6589256 | Forber | Jul 2003 | B2 |
| 6589265 | Palmer et al. | Jul 2003 | B1 |
| 6591472 | Noone et al. | Jul 2003 | B1 |
| 6592605 | Lenker et al. | Jul 2003 | B2 |
| 6599308 | Amplatz | Jul 2003 | B2 |
| 6602261 | Greene et al. | Aug 2003 | B2 |
| 6605101 | Schaefer et al. | Aug 2003 | B1 |
| 6605102 | Mazzocchi et al. | Aug 2003 | B1 |
| 6605111 | Bose et al. | Aug 2003 | B2 |
| 6613074 | Mitelberg et al. | Sep 2003 | B1 |
| 6626939 | Burnside et al. | Sep 2003 | B1 |
| 6635068 | Dubrul et al. | Oct 2003 | B1 |
| 6652555 | Vantassel et al. | Nov 2003 | B1 |
| 6652556 | Vantassel et al. | Nov 2003 | B1 |
| 6666882 | Bose et al. | Dec 2003 | B1 |
| 6669717 | Marotta et al. | Dec 2003 | B2 |
| 6669721 | Bose et al. | Dec 2003 | B1 |
| 6682546 | Amplatz | Jan 2004 | B2 |
| 6689150 | Vantassel et al. | Feb 2004 | B1 |
| 6689486 | Ho et al. | Feb 2004 | B2 |
| 6723112 | Ho et al. | Apr 2004 | B2 |
| 6723116 | Taheri | Apr 2004 | B2 |
| 6730108 | Van et al. | May 2004 | B2 |
| 6746468 | Sepetka et al. | Jun 2004 | B1 |
| 6746890 | Gupta et al. | Jun 2004 | B2 |
| 6780196 | Chin et al. | Aug 2004 | B2 |
| 6802851 | Jones et al. | Oct 2004 | B2 |
| 6811560 | Jones et al. | Nov 2004 | B2 |
| 6855153 | Saadat | Feb 2005 | B2 |
| 6855154 | Abdel-Gawwad | Feb 2005 | B2 |
| 6878384 | Cruise et al. | Apr 2005 | B2 |
| 6905503 | Gifford et al. | Jun 2005 | B2 |
| 6936055 | Ken et al. | Aug 2005 | B1 |
| 6949113 | Van et al. | Sep 2005 | B2 |
| 6991617 | Hektner et al. | Jan 2006 | B2 |
| 6994092 | Van et al. | Feb 2006 | B2 |
| 6994717 | Konya et al. | Feb 2006 | B2 |
| 7011671 | Welch | Mar 2006 | B2 |
| 7014645 | Greene et al. | Mar 2006 | B2 |
| 7029487 | Greene et al. | Apr 2006 | B2 |
| 7029949 | Farnworth et al. | Apr 2006 | B2 |
| 7070609 | West | Jul 2006 | B2 |
| 7083632 | Avellanet et al. | Aug 2006 | B2 |
| 7128073 | Van et al. | Oct 2006 | B1 |
| 7128736 | Abrams et al. | Oct 2006 | B1 |
| 7153323 | Teoh et al. | Dec 2006 | B1 |
| 7169177 | Obara | Jan 2007 | B2 |
| 7195636 | Avellanet et al. | Mar 2007 | B2 |
| 7229461 | Chin et al. | Jun 2007 | B2 |
| 7232461 | Ramer | Jun 2007 | B2 |
| 7306622 | Jones et al. | Dec 2007 | B2 |
| 7326225 | Ferrera et al. | Feb 2008 | B2 |
| 7331980 | Dubrul et al. | Feb 2008 | B2 |
| 7367986 | Mazzocchi et al. | May 2008 | B2 |
| 7410482 | Murphy et al. | Aug 2008 | B2 |
| 7419503 | Pulnev et al. | Sep 2008 | B2 |
| 7481821 | Fogarty et al. | Jan 2009 | B2 |
| 7491214 | Greene et al. | Feb 2009 | B2 |
| 7569066 | Gerberding et al. | Aug 2009 | B2 |
| 7572288 | Cox | Aug 2009 | B2 |
| 7597704 | Frazier et al. | Oct 2009 | B2 |
| 7601160 | Richter | Oct 2009 | B2 |
| 7608088 | Jones et al. | Oct 2009 | B2 |
| 7695488 | Berenstein et al. | Apr 2010 | B2 |
| 7699056 | Tran et al. | Apr 2010 | B2 |
| 7708754 | Balgobin et al. | May 2010 | B2 |
| 7727189 | Vantassel et al. | Jun 2010 | B2 |
| 7744583 | Seifert et al. | Jun 2010 | B2 |
| 7744652 | Morsi | Jun 2010 | B2 |
| 7976527 | Cragg et al. | Jul 2011 | B2 |
| RE42625 | Guglielmi | Aug 2011 | E |
| 7993364 | Morsi | Aug 2011 | B2 |
| RE42758 | Ken et al. | Sep 2011 | E |
| 8012210 | Lin et al. | Sep 2011 | B2 |
| 8043326 | Hancock et al. | Oct 2011 | B2 |
| 8062379 | Morsi | Nov 2011 | B2 |
| 8075585 | Lee et al. | Dec 2011 | B2 |
| 8137293 | Zhou et al. | Mar 2012 | B2 |
| 8142456 | Rosqueta et al. | Mar 2012 | B2 |
| 8202280 | Richter | Jun 2012 | B2 |
| 8211160 | Garrison et al. | Jul 2012 | B2 |
| 8221445 | Van et al. | Jul 2012 | B2 |
| 8333783 | Braun et al. | Dec 2012 | B2 |
| 8343167 | Henson | Jan 2013 | B2 |
| 8361104 | Jones et al. | Jan 2013 | B2 |
| 8361138 | Adams | Jan 2013 | B2 |
| 8372062 | Murphy et al. | Feb 2013 | B2 |
| 8398670 | Amplatz et al. | Mar 2013 | B2 |
| 8425541 | Masters et al. | Apr 2013 | B2 |
| 8470013 | Duggal et al. | Jun 2013 | B2 |
| 8597320 | Sepetka et al. | Dec 2013 | B2 |
| 8603128 | Greene et al. | Dec 2013 | B2 |
| 8715317 | Janardhan et al. | May 2014 | B1 |
| 8834515 | Win et al. | Sep 2014 | B2 |
| 8906057 | Connor et al. | Dec 2014 | B2 |
| 8974512 | Aboytes et al. | Mar 2015 | B2 |
| 8998947 | Aboytes et al. | Apr 2015 | B2 |
| 9211202 | Strother et al. | Dec 2015 | B2 |
| 9301769 | Brady et al. | Apr 2016 | B2 |
| 9314248 | Molaei | Apr 2016 | B2 |
| 9486224 | Riina et al. | Nov 2016 | B2 |
| 9629636 | Fogarty et al. | Apr 2017 | B2 |
| 9681861 | Heisel et al. | Jun 2017 | B2 |
| 9833309 | Levi et al. | Dec 2017 | B2 |
| 9844380 | Furey | Dec 2017 | B2 |
| 9907684 | Connor et al. | Mar 2018 | B2 |
| 9962146 | Hebert et al. | May 2018 | B2 |
| 10028745 | Morsi | Jul 2018 | B2 |
| 10130372 | Griffin | Nov 2018 | B2 |
| 11179159 | Cox et al. | Nov 2021 | B2 |
| 20010000797 | Mazzocchi | May 2001 | A1 |
| 20010001835 | Greene et al. | May 2001 | A1 |
| 20020026210 | Abdel-Gawwad | Feb 2002 | A1 |
| 20020042628 | Chin et al. | Apr 2002 | A1 |
| 20020062145 | Rudakov et al. | May 2002 | A1 |
| 20020119177 | Bowman et al. | Aug 2002 | A1 |
| 20020147462 | Mair et al. | Oct 2002 | A1 |
| 20020165572 | Saadat | Nov 2002 | A1 |
| 20020169473 | Sepetka et al. | Nov 2002 | A1 |
| 20020193812 | Patel et al. | Dec 2002 | A1 |
| 20020193813 | Helkowski et al. | Dec 2002 | A1 |
| 20030004533 | Dieck et al. | Jan 2003 | A1 |
| 20030004568 | Ken et al. | Jan 2003 | A1 |
| 20030018294 | Cox | Jan 2003 | A1 |
| 20030028209 | Teoh | Feb 2003 | A1 |
| 20030040772 | Hyodoh et al. | Feb 2003 | A1 |
| 20030055440 | Jones | Mar 2003 | A1 |
| 20030093111 | Ken et al. | May 2003 | A1 |
| 20030113478 | Dang et al. | Jun 2003 | A1 |
| 20030114918 | Garrison et al. | Jun 2003 | A1 |
| 20030149490 | Ashman | Aug 2003 | A1 |
| 20030171739 | Murphy | Sep 2003 | A1 |
| 20030187473 | Berenstein et al. | Oct 2003 | A1 |
| 20030195553 | Wallace et al. | Oct 2003 | A1 |
| 20030212419 | West | Nov 2003 | A1 |
| 20040034386 | Fulton et al. | Feb 2004 | A1 |
| 20040044361 | Frazier et al. | Mar 2004 | A1 |
| 20040044391 | Porter | Mar 2004 | A1 |
| 20040064093 | Hektner et al. | Apr 2004 | A1 |
| 20040098027 | Teoh et al. | May 2004 | A1 |
| 20040106945 | Thramann et al. | Jun 2004 | A1 |
| 20040115164 | Pierce et al. | Jun 2004 | A1 |
| 20040122467 | Vantassel et al. | Jun 2004 | A1 |
| 20040133222 | Tran et al. | Jul 2004 | A1 |
| 20040138758 | Kronengold et al. | Jul 2004 | A1 |
| 20040161451 | Pierce et al. | Aug 2004 | A1 |
| 20040181253 | Sepetka et al. | Sep 2004 | A1 |
| 20050021077 | Chin et al. | Jan 2005 | A1 |
| 20050049625 | Shaya et al. | Mar 2005 | A1 |
| 20050131443 | Abdel-Gawwad | Jun 2005 | A1 |
| 20050222580 | Gifford et al. | Oct 2005 | A1 |
| 20050267510 | Razack | Dec 2005 | A1 |
| 20050267511 | Marks et al. | Dec 2005 | A1 |
| 20050267527 | Sandoval et al. | Dec 2005 | A1 |
| 20050277978 | Greenhalgh | Dec 2005 | A1 |
| 20050278023 | Zwirkoski | Dec 2005 | A1 |
| 20060034883 | Dang et al. | Feb 2006 | A1 |
| 20060052816 | Bates et al. | Mar 2006 | A1 |
| 20060064151 | Guterman et al. | Mar 2006 | A1 |
| 20060106421 | Teoh | May 2006 | A1 |
| 20060116709 | Sepetka et al. | Jun 2006 | A1 |
| 20060116712 | Sepetka et al. | Jun 2006 | A1 |
| 20060116713 | Sepetka et al. | Jun 2006 | A1 |
| 20060116714 | Sepetka et al. | Jun 2006 | A1 |
| 20060122548 | Abrams | Jun 2006 | A1 |
| 20060155323 | Porter et al. | Jul 2006 | A1 |
| 20060190070 | Dieck et al. | Aug 2006 | A1 |
| 20060200234 | Hines | Sep 2006 | A1 |
| 20060206140 | Shaolian et al. | Sep 2006 | A1 |
| 20060206198 | Churchwell et al. | Sep 2006 | A1 |
| 20060206199 | Churchwell et al. | Sep 2006 | A1 |
| 20060241686 | Ferrera et al. | Oct 2006 | A1 |
| 20060247680 | Amplatz et al. | Nov 2006 | A1 |
| 20060271162 | Vito et al. | Nov 2006 | A1 |
| 20070003594 | Brady et al. | Jan 2007 | A1 |
| 20070010850 | Balgobin et al. | Jan 2007 | A1 |
| 20070014831 | Sung et al. | Jan 2007 | A1 |
| 20070083226 | Buiser et al. | Apr 2007 | A1 |
| 20070100426 | Rudakov et al. | May 2007 | A1 |
| 20070135907 | Wilson et al. | Jun 2007 | A1 |
| 20070167876 | Euteneuer et al. | Jul 2007 | A1 |
| 20070167877 | Euteneuer et al. | Jul 2007 | A1 |
| 20070167972 | Euteneuer et al. | Jul 2007 | A1 |
| 20070175536 | Monetti et al. | Aug 2007 | A1 |
| 20070179507 | Shah | Aug 2007 | A1 |
| 20070179520 | West | Aug 2007 | A1 |
| 20070185442 | Euteneuer et al. | Aug 2007 | A1 |
| 20070185443 | Euteneuer et al. | Aug 2007 | A1 |
| 20070185444 | Euteneuer et al. | Aug 2007 | A1 |
| 20070185457 | Euteneuer et al. | Aug 2007 | A1 |
| 20070191924 | Rudakov | Aug 2007 | A1 |
| 20070198059 | Patel et al. | Aug 2007 | A1 |
| 20070198075 | Levy | Aug 2007 | A1 |
| 20070219619 | Dieck et al. | Sep 2007 | A1 |
| 20070265656 | Amplatz et al. | Nov 2007 | A1 |
| 20070270902 | Slazas et al. | Nov 2007 | A1 |
| 20070276426 | Euteneuer | Nov 2007 | A1 |
| 20070276427 | Euteneuer | Nov 2007 | A1 |
| 20070282373 | Ashby et al. | Dec 2007 | A1 |
| 20070288083 | Hines | Dec 2007 | A1 |
| 20080033366 | Matson et al. | Feb 2008 | A1 |
| 20080065145 | Carpenter | Mar 2008 | A1 |
| 20080081763 | Swetlin et al. | Apr 2008 | A1 |
| 20080082176 | Slazas | Apr 2008 | A1 |
| 20080086196 | Truckai et al. | Apr 2008 | A1 |
| 20080109057 | Calabria et al. | May 2008 | A1 |
| 20080114391 | Dieck et al. | May 2008 | A1 |
| 20080114436 | Dieck et al. | May 2008 | A1 |
| 20080125852 | Garrison et al. | May 2008 | A1 |
| 20080132820 | Buckman et al. | Jun 2008 | A1 |
| 20080140177 | Hines | Jun 2008 | A1 |
| 20080195137 | Alleyne et al. | Aug 2008 | A1 |
| 20080200945 | Amplatz et al. | Aug 2008 | A1 |
| 20080200979 | Dieck et al. | Aug 2008 | A1 |
| 20080221600 | Dieck et al. | Sep 2008 | A1 |
| 20080281350 | Sepetka | Nov 2008 | A1 |
| 20090018637 | Paul et al. | Jan 2009 | A1 |
| 20090024224 | Chen et al. | Jan 2009 | A1 |
| 20090025820 | Adams | Jan 2009 | A1 |
| 20090043375 | Rudakov et al. | Feb 2009 | A1 |
| 20090056722 | Swann | Mar 2009 | A1 |
| 20090062899 | Dang et al. | Mar 2009 | A1 |
| 20090076540 | Marks et al. | Mar 2009 | A1 |
| 20090112249 | Miles et al. | Apr 2009 | A1 |
| 20090112251 | Qian et al. | Apr 2009 | A1 |
| 20090125119 | Obermiller et al. | May 2009 | A1 |
| 20090148492 | Dave et al. | Jun 2009 | A1 |
| 20090155367 | Neuwirth et al. | Jun 2009 | A1 |
| 20090187214 | Amplatz et al. | Jul 2009 | A1 |
| 20090264978 | Dieck et al. | Oct 2009 | A1 |
| 20090270974 | Berez et al. | Oct 2009 | A1 |
| 20090275974 | Marchand et al. | Nov 2009 | A1 |
| 20090287291 | Becking et al. | Nov 2009 | A1 |
| 20090287292 | Becking et al. | Nov 2009 | A1 |
| 20090287294 | Rosqueta et al. | Nov 2009 | A1 |
| 20090287297 | Cox | Nov 2009 | A1 |
| 20090297582 | Meyer et al. | Dec 2009 | A1 |
| 20090306702 | Miloslavski et al. | Dec 2009 | A1 |
| 20090318892 | Aboytes et al. | Dec 2009 | A1 |
| 20090318941 | Sepetka et al. | Dec 2009 | A1 |
| 20090319023 | Hildebrand et al. | Dec 2009 | A1 |
| 20100023048 | Mach | Jan 2010 | A1 |
| 20100030200 | Strauss et al. | Feb 2010 | A1 |
| 20100036410 | Krolik et al. | Feb 2010 | A1 |
| 20100106178 | Obermiller et al. | Apr 2010 | A1 |
| 20100131002 | Connor et al. | May 2010 | A1 |
| 20100139465 | Christian et al. | Jun 2010 | A1 |
| 20100144895 | Porter | Jun 2010 | A1 |
| 20100160949 | Takuma | Jun 2010 | A1 |
| 20100174269 | Tompkins et al. | Jul 2010 | A1 |
| 20100185271 | Zhang | Jul 2010 | A1 |
| 20100228184 | Mavani et al. | Sep 2010 | A1 |
| 20100249830 | Nelson | Sep 2010 | A1 |
| 20100256527 | Lippert et al. | Oct 2010 | A1 |
| 20100256528 | Lippert et al. | Oct 2010 | A1 |
| 20100256601 | Lippert et al. | Oct 2010 | A1 |
| 20100256602 | Lippert et al. | Oct 2010 | A1 |
| 20100256603 | Lippert et al. | Oct 2010 | A1 |
| 20100256604 | Lippert et al. | Oct 2010 | A1 |
| 20100256605 | Lippert et al. | Oct 2010 | A1 |
| 20100256606 | Lippert et al. | Oct 2010 | A1 |
| 20100262014 | Huang | Oct 2010 | A1 |
| 20100268201 | Tieu et al. | Oct 2010 | A1 |
| 20100274276 | Chow et al. | Oct 2010 | A1 |
| 20100298791 | Jones et al. | Nov 2010 | A1 |
| 20100312061 | Hess et al. | Dec 2010 | A1 |
| 20110022149 | Cox et al. | Jan 2011 | A1 |
| 20110046658 | Connor et al. | Feb 2011 | A1 |
| 20110077620 | Debeer | Mar 2011 | A1 |
| 20110125110 | Cotton | May 2011 | A1 |
| 20110137332 | Sepetka et al. | Jun 2011 | A1 |
| 20110137405 | Wilson et al. | Jun 2011 | A1 |
| 20110144669 | Becking et al. | Jun 2011 | A1 |
| 20110152993 | Marchand et al. | Jun 2011 | A1 |
| 20110166588 | Connor et al. | Jul 2011 | A1 |
| 20110196415 | Ujiie et al. | Aug 2011 | A1 |
| 20110202085 | Loganathan et al. | Aug 2011 | A1 |
| 20110208227 | Becking | Aug 2011 | A1 |
| 20110224776 | Sepetka et al. | Sep 2011 | A1 |
| 20110245862 | Dieck et al. | Oct 2011 | A1 |
| 20110251699 | Ladet | Oct 2011 | A1 |
| 20110265943 | Rosqueta et al. | Nov 2011 | A1 |
| 20110319926 | Becking et al. | Dec 2011 | A1 |
| 20120010644 | Sideris et al. | Jan 2012 | A1 |
| 20120022572 | Braun et al. | Jan 2012 | A1 |
| 20120041472 | Tan et al. | Feb 2012 | A1 |
| 20120101510 | Lenker et al. | Apr 2012 | A1 |
| 20120116350 | Strauss et al. | May 2012 | A1 |
| 20120143237 | Cam et al. | Jun 2012 | A1 |
| 20120143243 | Hill et al. | Jun 2012 | A1 |
| 20120165919 | Cox et al. | Jun 2012 | A1 |
| 20120197283 | Marchand et al. | Aug 2012 | A1 |
| 20120239074 | Aboytes et al. | Sep 2012 | A1 |
| 20120283768 | Cox et al. | Nov 2012 | A1 |
| 20120283769 | Cruise et al. | Nov 2012 | A1 |
| 20120310269 | Fearnot et al. | Dec 2012 | A1 |
| 20120316598 | Becking et al. | Dec 2012 | A1 |
| 20120316632 | Gao | Dec 2012 | A1 |
| 20120323271 | Obermiller et al. | Dec 2012 | A1 |
| 20120330341 | Becking et al. | Dec 2012 | A1 |
| 20120330347 | Becking et al. | Dec 2012 | A1 |
| 20120330348 | Strauss et al. | Dec 2012 | A1 |
| 20130066357 | Aboytes et al. | Mar 2013 | A1 |
| 20130066360 | Becking et al. | Mar 2013 | A1 |
| 20130073026 | Russo et al. | Mar 2013 | A1 |
| 20130085522 | Becking et al. | Apr 2013 | A1 |
| 20130116722 | Aboytes et al. | May 2013 | A1 |
| 20130274866 | Cox et al. | Oct 2013 | A1 |
| 20140012307 | Franano et al. | Jan 2014 | A1 |
| 20140058420 | Hannes et al. | Feb 2014 | A1 |
| 20140135810 | Divino et al. | May 2014 | A1 |
| 20140135811 | Divino et al. | May 2014 | A1 |
| 20140135812 | Divino et al. | May 2014 | A1 |
| 20140257360 | Keillor | Sep 2014 | A1 |
| 20140257374 | Heisel et al. | Sep 2014 | A1 |
| 20140316012 | Freyman et al. | Oct 2014 | A1 |
| 20140371734 | Truckai | Dec 2014 | A1 |
| 20150216684 | Enzmann et al. | Aug 2015 | A1 |
| 20150250628 | Monstadt et al. | Sep 2015 | A1 |
| 20150272589 | Lorenzo | Oct 2015 | A1 |
| 20150272590 | Aboytes et al. | Oct 2015 | A1 |
| 20150313605 | Griffin | Nov 2015 | A1 |
| 20150313737 | Tippett et al. | Nov 2015 | A1 |
| 20150327843 | Garrison | Nov 2015 | A1 |
| 20150342613 | Aboytes et al. | Dec 2015 | A1 |
| 20160022445 | Ruvalcaba et al. | Jan 2016 | A1 |
| 20160030050 | Franano et al. | Feb 2016 | A1 |
| 20160066921 | Seifert et al. | Mar 2016 | A1 |
| 20160135984 | Rudakov et al. | May 2016 | A1 |
| 20160206320 | Connor | Jul 2016 | A1 |
| 20160206321 | Connor | Jul 2016 | A1 |
| 20170150971 | Hines | Jun 2017 | A1 |
| 20170156734 | Griffin | Jun 2017 | A1 |
| 20170156903 | Shobayashi | Jun 2017 | A1 |
| 20170189035 | Porter | Jul 2017 | A1 |
| 20170224355 | Bowman et al. | Aug 2017 | A1 |
| 20170266023 | Thomas | Sep 2017 | A1 |
| 20170340333 | Badruddin et al. | Nov 2017 | A1 |
| 20170354421 | Maguire et al. | Dec 2017 | A1 |
| 20170367708 | Mayer et al. | Dec 2017 | A1 |
| 20180049859 | Stoppenhagen et al. | Feb 2018 | A1 |
| 20180125686 | Lu | May 2018 | A1 |
| 20180140305 | Connor | May 2018 | A1 |
| 20180161185 | Kresslein et al. | Jun 2018 | A1 |
| 20180193025 | Walzman | Jul 2018 | A1 |
| 20180193026 | Yang et al. | Jul 2018 | A1 |
| 20180206852 | Moeller | Jul 2018 | A1 |
| 20190053811 | Garza et al. | Feb 2019 | A1 |
| 20190223876 | Badruddin et al. | Jul 2019 | A1 |
| 20190223881 | Hewitt et al. | Jul 2019 | A1 |
| 20190282242 | Divino et al. | Sep 2019 | A1 |
| 20190343532 | Divino et al. | Nov 2019 | A1 |
| 20200061099 | Li et al. | Feb 2020 | A1 |
| 20200113576 | Gorochow et al. | Apr 2020 | A1 |
| 20210128162 | Rhee et al. | May 2021 | A1 |
| 20210128169 | Li et al. | May 2021 | A1 |
| 20210129275 | Nguyen et al. | May 2021 | A1 |
| 20210153872 | Nguyen et al. | May 2021 | A1 |
| 20210196284 | Gorochow et al. | Jul 2021 | A1 |
| 20210212698 | Connor | Jul 2021 | A1 |
| 20220304696 | Rhee et al. | Sep 2022 | A2 |
| Number | Date | Country |
|---|---|---|
| 101460102 | Jun 2009 | CN |
| 102083493 | Jun 2011 | CN |
| 102202585 | Sep 2011 | CN |
| 202313544 | Jul 2012 | CN |
| 102740799 | Oct 2012 | CN |
| 105105812 | Dec 2015 | CN |
| 102011102933 | Dec 2012 | DE |
| 0717969 | Jun 1996 | EP |
| 1188414 | Mar 2002 | EP |
| 1813213 | Aug 2007 | EP |
| 2208483 | Jul 2010 | EP |
| 2468348 | Oct 2016 | EP |
| 2005261951 | Sep 2005 | JP |
| 2008521492 | Jun 2008 | JP |
| 9406502 | Mar 1994 | WO |
| 9905977 | Feb 1999 | WO |
| 03011151 | Feb 2003 | WO |
| 2006034149 | Mar 2006 | WO |
| 2007006139 | Jan 2007 | WO |
| 2007079402 | Jul 2007 | WO |
| 2007121405 | Oct 2007 | WO |
| 2008074027 | Jun 2008 | WO |
| 2009014528 | Jan 2009 | WO |
| 2009134337 | Nov 2009 | WO |
| 2010009019 | Jan 2010 | WO |
| 2010027363 | Mar 2010 | WO |
| 2010028300 | Mar 2010 | WO |
| 2010077599 | Jul 2010 | WO |
| 2011066962 | Jun 2011 | WO |
| 2011095966 | Aug 2011 | WO |
| 2012034135 | Mar 2012 | WO |
| 2013112944 | Aug 2013 | WO |
| 2013138615 | Sep 2013 | WO |
| 2013138615 | Sep 2014 | WO |
| 2015160721 | Oct 2015 | WO |
| 2017074411 | May 2017 | WO |
| 2018051187 | Mar 2018 | WO |
| Entry |
|---|
| International Search Report and Written Opinion dated Feb. 23, 2021, International Application No. PCT/US20/70743, 14 pages. |
| Number | Date | Country | |
|---|---|---|---|
| 20190282242 A1 | Sep 2019 | US |
| Number | Date | Country | |
|---|---|---|---|
| 61725768 | Nov 2012 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 14079591 | Nov 2013 | US |
| Child | 16412967 | US |
