The present disclosure relates to a stent and method for stenting the ductus arteriosus in order to keep the ductus arteriosus open. More particularly, the present disclosure relates to a stent configured to be positioned across the ductus arteriosus in a pediatric human patient in order to keep the ductus arteriosus open and ensure adequate blood flow.
Patent ductus arteriosus (PDA) is a congenital disorder in the heart wherein a neonate's ductus arteriosus fails to close after birth. In a developing fetus, the ductus arteriosus is the vascular connection between the pulmonary artery and the aortic arch that allows most of the blood flow from the right ventricle to bypass the fetus' fluid-filled compressed lungs. During fetal development, this shunt protects the right ventricle from pumping against the high resistance in the lungs, which can lead to right ventricular failure if the ductus arteriosus closes in utero.
When a newborn takes his or her first breath, the lungs open and the pulmonary vascular resistance decreases. After birth, the placenta is separated from the infant reducing prostaglandin which keeps the ductus arteriosus open in-utero. In addition, the lungs release bradykinin to constrict the smooth muscle wall of the ductus arteriosus and reduce blood flow through the ductus arteriosus as it narrows and completely closes, usually within the first few weeks of life. If the patent ductus arteriosus does not close, long-term complications can arise, such as pulmonary hypertension, heart failure, and bacterial endocarditis.
In certain forms of congenital heart disease it is necessary to keep the ductus arteriosus open. In the short term this can be accomplished with IV prostaglandin. However, for long term patency, cardiologists have relied on vascular stents. These stents require a large stent to blood vessel surface area ratio in order to provide support, as these stents are not specifically designed to keep a ductus arteriosus patent. When the vascular stents are implanted in the PDA, they become incorporated into the vascular tissue. Once incorporated, the vascular stents can be difficult to remove, resulting in trauma to the vessels and surrounding structures. Thus, a stent specifically designed to keep the ductus arteriosus open, and that can be removed in an atraumatic manner, is desirable.
In one aspect of the present disclosure, a stent is provided for use in keeping the ductus arteriosus open in a pediatric patient. In a further aspect, the stent is a retrievable stent configured to be positioned across the ductus arteriosus in a pediatric human patient to keep the ductus arteriosus open and ensure adequate blood flow. The retrievable stent can include a proximal end connector and a distal end tip disposed about a longitudinal axis. The proximal end connector can include one or more retrieval mechanisms and a proximal end connector lumen that runs the length of the proximal end connector. The distal end tip can have a distal end tip lumen that runs the length of the distal end tip. The retrievable stent can include a plurality of 4 to 8 struts that extend from the proximal end connector to the distal end tip. Each of the struts can have a curved proximal strut end and a curved distal strut end where the curved proximal strut end and the curved distal strut end extend radially outward from the longitudinal axis and toward one another. Each of the struts can also have an elongated strut body portion that extends from the curved proximal strut end to the curved distal strut end. The elongated strut body portions can extend parallel to each other. When the stent is positioned in the ductus arteriosus, the curved proximal strut ends and the curved distal strut ends engage the ductus arteriosus to provide the radial force necessary to keep the ductus arteriosus open while the elongated strut body portions of each of the 4 to 8 struts minimally engage the ductus arteriosus to prevent invagination into the vascular wall of the ductus arteriosus and thus allow for subsequent retrieval.
In another aspect of the present disclosure, a method of stenting the ductus arteriosus in a pediatric human patient in order to ensure adequate blood flow is provided. One step of the method can include providing a retrievable stent. The retrievable stent can include a proximal end connector and a distal end tip disposed about a longitudinal axis. The proximal end connector can include one or more retrieval mechanisms and a proximal end connector lumen that runs the length of the proximal end connector. The distal end tip can have a distal end tip lumen that runs the length of the distal end tip. The retrievable strut can also include a plurality of 4 to 8 struts extending from the proximal end connector to the distal end tip, each of the struts having a curved proximal strut end and a curved distal strut end where the curved proximal strut end and the curved distal strut end extend radially outward from the longitudinal axis and toward one another. Each of the struts can have an elongated strut body portion that extends from the curved proximal strut end to the curved distal strut end. The elongated strut body portions can extend parallel to each other. Another step of the method can include positioning the retrievable stent in the ductus arteriosus of the pediatric human patient so that the stent struts are parallel with the vascular wall of the ductus arteriosus and so that the curved proximal strut ends and the curved distal strut ends engage the ductus arteriosus to provide the radial force necessary to keep the ductus arteriosus open while the elongated strut body portions of each of the 4 to 8 struts minimally engage the ductus arteriosus to prevent invagination into the vascular wall of the ductus arteriosus.
The foregoing and other features of the present disclosure will become apparent to those skilled in the art to which the present disclosure relates upon reading the following description with reference to the accompanying drawings, in which:
The present disclosure relates generally to a stent configured to keep the ductus arteriosus open in a pediatric human patient. The ductus arteriosus is a unique blood vessel that typically closes naturally within 10 days after birth. In many forms of congenital heart disease, such as with cyanotic heart defects, it is critical to keep the ductus arteriosus open (i.e., patent) in order to ensure either adequate systemic or pulmonary blood flow, depending on the cardiac lesion. As used herein, the term “patent” is a medical term that refers to a structure that is generally open and/or unobstructed, and which is not substantially closed. Cyanotic heart defects are a type of congenital heart defect in which a patient appears blue (cyanotic) due to deoxygenated blood bypassing the lungs and entering the systemic circulation. Cyanotic heart defects include, but are not limited to, hypoplastic left heart syndrome (HLHS), Tetralogy of Fallot (ToF), total anomalous pulmonary venous connection, transposition of the great arteries (d-TGA), truncus arteriosus, tricuspid atresia, interrupted aortic arch, coarctation of aorta, pulmonary atresia (PA), and pulmonary stenosis. The patent ductus arteriosus provides a pathway to ensure either adequate systemic or pulmonary circulation, depending on the specific type of congenital heart disease. Keeping the ductus arteriosus open is necessary until a pediatric patient is able to grow and become a better candidate for surgical repair.
Current mechanical methods for keeping the ductus arteriosus open use a peripheral vascular stent or a coronary stent in an off-label fashion. These currently available stents are far from optimal for keeping the ductus arteriosus open because these stents need to be removed surgically and they cannot be left in place for an extended period of time. These currently available stents are also problematic because they have extensive metal crosslinking latticework that becomes densely incorporated into the blood vessel wall. As a result, surgical removal becomes difficult and hazardous, and can result in vascular injury and/or nerve damage. As representative of one aspect of the present disclosure,
The proximal end connector 102 can include one or more retrieval mechanisms. As shown in
The retrievable stent 100 can include 4 to 8 struts 114 that can extend from the proximal end connector 102 to the distal end tip 106. In one instance, the retrievable stent 100 can have 4 struts. In another instance, the retrievable stent 100 can have 5 struts. In a further instance, the retrievable stent 100 can have 6 struts. In yet another instance, the retrievable stent 100 can have 7 struts. In another instance, the retrievable stent 100 can have 8 struts. Each of the struts 114 can have a curved proximal strut end 116 and a curved distal strut end 118, wherein the curved proximal strut end and the curved distal strut end extend radially outward from the longitudinal axis A and toward one another. In one instance, the curved proximal strut end 116 and the curved distal strut end 118 can have a sigmoidal curve shape. In some instances, the curved proximal strut end 116 and the curved distal strut end 118 can comprise a single sigmoidal curve. In other instances, the curved proximal strut end 116 and the curved distal strut end 118 can comprise a single arc.
Each of the struts 114 can further comprise an elongated strut body portion 120 that extends from the curved proximal strut end 116 to the curved distal strut end 118. In one instance the elongated strut body portions 120 of each of the struts 114 can extend in a straight line. In certain instances when the elongated strut body portions 120 extend in a straight line, the elongated strut body portions can extend parallel to each other.
The struts 114 can have any suitable cross-sectional shape. In some instances, the struts 114 can have a generally square cross-sectional shape. Other examples of suitable cross-sectional shapes include a generally circular cross-sectional shape, a generally rectangular cross sectional shape, a generally triangular cross-sectional shape, and a generally ovoid cross-sectional shape. In certain instances, the struts 114 can be e.g., from 0.25 mm to 0.45 mm wide and from 0.2 mm to 0.35 mm thick. In one specific instance, the struts 114 can be 0.36 mm wide and 0.25 mm thick.
Experience has demonstrated that the entire length of the ductus arteriosus needs to be supported by the stent to prevent closure. Failure to adequately cover the length of the ductus arteriosus with the stent can allow natural constriction to occur, resulting in ductal closure despite the presence of the stent, and resultant death of the pediatric human patient. In one aspect, the retrievable stent 100 can have a length anywhere from 15 mm to 30 mm. In some instances, the length of retrievable stent 100 can be any length from 18 mm to 24 mm.
In one aspect, the diameter of retrievable stent 100 is large enough to span the vascular walls of the patent ductus arteriosus in the pediatric human patient. In some instances the diameter of retrievable stent 100 can be anywhere from 4 mm to 20 mm. In certain instances, the diameter of retrievable stent 100 can be from e.g., 4 mm to 12 mm or from 6 mm to 10 mm. In one specific instance, the diameter of retrievable stent 100 can be 8 mm. In certain instances, the diameter of the retrievable stent 100 can vary along the longitudinal axis A such that the diameter of the retrievable stent 100 increases towards the distal end tip 106. In another instance, the diameter of the retrievable stent 100 can vary along the longitudinal axis A such that the diameter of the retrievable stent 100 increases towards the proximal end connector 102. In other instances in which struts 114′ have an elongated strut body portion 120′, the diameter of the retrievable stent 100 can vary along the longitudinal axis in accordance with the curve of the strut. In instances when the diameter of the retrievable stent varies along the longitudinal axis A, the diameter of retrievable stent 100 can vary anywhere from 4 mm to 20 mm. When retrievable stent 100 is positioned in the ductus arteriosus, the curved proximal strut ends 116 and the curved distal strut ends 118 can engage the ductus arteriosus to provide the radial force necessary to keep the ductus arteriosus open while the elongated strut body portions 120 of each of the struts 114 can minimally engage the ductus arteriosus to prevent endothelialization. In instances in which an elongated strut body portion 120′ that curves towards the longitudinal axis A′ is used, the elongated strut body portions only very minimally engage the vascular walls of the ductus arteriosus. One skilled in the art will appreciate that the length and diameter of the retrievable strut 100 used in a pediatric human patient can depend on the size of the pediatric human patient.
In another aspect, the plurality of 4 to 8 struts 114 used in retrievable stent 100 can be evenly spaced in a radial configuration.
The proximal end connector lumen 104 and the distal end tip lumen 108 can each have a diameter large enough to allow a guide wire to run through their respective lumens. In certain instances, the diameter of the proximal end connector lumen 104 and the distal end tip lumen 108 can be between 4 mm to 16 mm. In certain instances, the diameter of the proximal end connector lumen 104 and the distal end tip lumen 108 are the same. In other instances, the diameter of the proximal end connector lumen 104 and the distal end tip lumen 108 are different.
The struts 114 can be formed of any suitable resilient material acceptable for use in implantable medical devices. Examples of suitable materials include, but are not limited to, stainless steel, nitinol, nickel-cobalt-chromium alloys, nickel-cobalt-chromium-molybdenum alloys, polymeric materials, and other biocompatible materials. Nickel-cobalt-chromium-molybdenum alloys, such as MP35N®, can be used in some instances. In one instance, the struts 114 can comprise a shape memory material, such as nitnol. In one specific instance, the struts 114 are formed of nitinol.
The proximal end connector 102 and the distal end tip 106 can each be formed from the same material or different materials than that of the struts 114. In one instance, retrievable stent 100 comprises struts 114 made of nitinol and a proximal end connector 102 and a distal end tip 106 formed of stainless steel.
In one aspect, method 200 as shown in
In certain instances, a percutaneous method or other minimally invasive technique can be used to deliver the retrievable stent 100 to the ductus arteriosus 302. A guidewire can be inserted into a femoral access site, such as the femoral vein. Where the guidewire is inserted into a femoral access site, image guidance (e.g., fluoroscopy, ultrasound, magnetic resonance, computed tomography, or combinations thereof) can be used to direct the guidewire and catheter into and through the ductus arteriosus and into the descending aorta or pulmonary artery, ensuring stable guidewire position.
After the guidewire is secured in the pediatric human patient's heart, the guidewire can be passed through the proximal end connector lumen 104 and the distal end tip lumen 108 of retrievable stent 100 (
Upon reaching the ductus arteriosus 302, the retrievable stent 100 can be freed from the delivery cable. Upon retraction of the delivery cable, the retrievable stent 100 can return to its original shape. As the retrievable stent 100 is freed from the delivery cable, the position of the retrievable stent 100 within the ductus arteriosus can be monitored, controlled, and/or quality assured by imaging systems of various kinds. For example, X-ray machines, fluoroscopic machines, ultrasound, CT, MRI, PET, and other imaging devices may be used.
Once the retrievable stent 100 is freed from the delivery cable, the retrievable stent 100 may be appropriately positioned in the ductus arteriosus 302. More particularly, the retrievable stent 100 can be positioned so that it covers the length of the ductus arteriosus as seen in
Once the retrievable stent 100 is positioned in the ductus arteriosus 302 of the pediatric human patient, the retrievable stent 100 can be disconnected from the delivery cable by disconnecting the threaded fastener. The delivery cable and guidewire can then be withdrawn from the pediatric human patient's vasculature. In certain instances in which the retrievable stent 100 is determined to be in a suboptimal position following disconnection of the delivery cable, the delivery cable can reengage and recapture the retrievable stent 100 either before or after the delivery cable has been removed from the pediatric human patient. Following reengagement and recapture of the retrievable stent 100, the retrievable stent 100 can then be repositioned in the ductus arteriosus. This process can be repeated as many times as necessary in order to achieve optimal placement of the retrievable stent 100.
Exemplary guidewires and delivery cables are known in the art. In one example, the delivery cable can be a catheter. The catheter can have a dimeter of e.g., 5 or 6 French.
The retrievable stent 100 may remain in the ductus arteriosus of the pediatric human patient for up to 360 days. For example, the retrievable stent 100 may remain in the ductus arteriosus of the pediatric human patient for 1 to 360 days.
In one aspect, retrievable stent 100 can be removed from the pediatric human patient in an atraumatic manner. Atraumatic removal is facilitated by the features of retrievable stent 100, including e.g., the lack of extensive metal latticework, the parallel orientation of the struts 114 along the vascular wall, and the central location of the retrieval mechanism. The parallel orientation of the struts 114 along the vascular wall aids in atraumatic removal of retrievable stent 100 because the force required to remove any overgrown tissue is significantly less than that which would be required with a cross-linked stent structure. The single path of the struts 114 results in only one line of tissue being broken at any point, with minimal or no tissue being removed. In contrast, a cross-linked stent will tend to pull a patch of the inner tissue at each cross-link, resulting in significant damage to the vascular wall.
In certain instances, a cutting element may be needed to facilitate separation of the retrievable stent 100 from any overgrown tissue. Any known cutting elements can be used.
As shown in
Any known retrieval devices can be used to remove the retrievable stent 100 from the pediatric human patient. For example, in instances where retrievable stent 100 includes a hook retrieval mechanism 110, a snare device can engage the hook retrieval mechanism and remove the retrievable 100 from the pediatric human patient. One skilled in the art would appreciate that any known snare devices can be used.
Unless otherwise defined, all technical terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the present disclosure pertains.
In the context of the present disclosure, the singular forms “a,” “an” and “the” can include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” and/or “comprising,” as used herein, can specify the presence of stated features, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups thereof.
As used herein, the term “and/or” can include any and all combinations of one or more of the associated listed items.
As used herein, phrases such as “between X and Y” and “from X to Y” can be interpreted to include X and Y. In the instance that X and Y are numerical values, “between X and Y” or “from X to Y” can be interpreted to include X and Y and all intervening values and ranges therein.
As used herein, when terms “distal” and “proximal” are used to refer to a portion of the stent, they refer to the device in its delivery configuration. The term “proximal” can refer to close to the operator (less into the body) and “distal” can refer to remote from the operator (further into the body).
From the above description of the invention, those skilled in the art will perceive improvements, changes and modifications. Such improvements, changes, and modifications are within the skill of the art and are intended to be covered by the appended claims.
This application claims the benefit of U.S. Provisional Patent Application Ser. No. 62/830,641, filed Apr. 8, 2019, entitled “PATENT DUCTUS STENT”. This provisional application is hereby incorporated by reference in its entirety for all purposes.
Filing Document | Filing Date | Country | Kind |
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PCT/US2020/027187 | 4/8/2020 | WO | 00 |
Number | Date | Country | |
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62830641 | Apr 2019 | US |