FIELD
The disclosure relates to a self-expanding intravascular medical device. In particular, the present disclosure is directed to a self-expanding intravascular medical device such as a mechanical thrombectomy device that promotes embedding in the clot, full retrieval of the clot into a catheter, minimizes fragmentation of the clot and other improvements to the overall successful performance of the medical device.
BACKGROUND
Acute ischemic stroke is caused by a thrombotic or embolic occlusion (e.g., blockage) in a cerebral artery which blocks the flow of blood to the brain. The occlusion is typically caused by a blood clot liberated from another part of the body which travels through the vessel and eventually become lodged in the cerebral artery of the brain.
One procedure used to restore blood flow in such conditions is administration of a drug (e.g., a tissue plasminogen activator (tPA)) that helps to dissolve or breakdown the clot. However, the success of restoring blood flow using such a drug alone requires that the medication be given in a relatively short period of time and is suitable only for relatively small clot sizes. Thus, drug treatment is not a viable option in all ischemic stroke cases.
In such other circumstances, a mechanical device is generally deployed intravascularly during a thrombectomy procedure to restore blood flow through the vessel and thereafter physically remove the thrombus, clot, occlusion or blockage into a receiving catheter in a less invasive manner than open surgery. Such mechanical devices may be used alone or in combination with a clot dissolving/busting drug. Typically, the mechanical device used to capture the clot is a self-expanding mesh scaffolding, skeleton, cage or tube (e.g., a stent retriever or stentriever) attached to a wire that is deployed through a catheter to a desired target location.
Thrombectomy treatment or procedure is typically performed on patients within a relative short period of time following a stroke (e.g., less than an approximately 48-hour period after the occurrence of a stroke) and is best suited for large vessel occlusions typically with a diameter greater than approximately 1.0 mm. Non-invasive imaging, for example, MR and non-contrast CT is typically used to determine early ischemic changes in patients to determine if thrombectomy treatment is suitable for that particular patient.
During the thrombectomy procedure or treatment a physician or interventionalist endovascularly introduces a guidewire through the vasculature, typically in an artery located in the groin or arm, or by direct access through the carotid artery. The guidewire is advanced through the vasculature to the target location of the clot, blockage or occlusion. Once the guidewire is properly positioned, a microcatheter with an outer diameter typically less than approximately 1.0 mm, tracks over the guidewire passing through a lumen defined axially through the microcatheter. The guidewire and microcatheter are used to cross the clot or occlusion using standard intervention techniques. While in a compressed state, a stent or mechanical thrombectomy device may be guided through the lumen of the microcatheter to the target site. Upon deployment from the microcatheter the stentriever or mechanical thrombectomy device automatically expands to its original enlarged state. Stentrievers or mechanical thrombectomy devices are typically made of a biocompatible material such as stainless steel, nickel-titanium or tantalum.
It is desirable to develop an improved thrombectomy device with enhanced thrombectomy performance based on one or more factors such as: (i) optimization of embedding of the stent in the clot for clot dislodgement and retention (ii) minimization of clot compression; (iii) minimization of clot fragmentation; (iii) restoration of blood flow; (iv) stabilization of the clot within the stent during retrieval; and (v) reduction of shear force imposed on the clot during retrieval into a catheter. In addition to designing a mechanical thrombectomy device that takes one or more of such factors into consideration, it is also advantageous to design the improved mechanical thrombectomy device to be suitable for use with smaller size catheters.
SUMMARY
An aspect of the present disclosure is directed to an improved mechanical thrombectomy device having enhanced performance based on one or more of the factors discussed above.
Another aspect of the present disclosure relates to a self-expanding intravascular medical device including a multi-component assembly with a self-expanding outer cage component comprising a plurality of struts; and a single cell wave shape component disposed within the self-expanding outer cage component forming a channel therein. The proximal end of the single cell wave shape component is connected to the self-expanding outer cage component at a proximal joint.
Still another aspect of the present disclosure is directed to a self-expanding intravascular medical device having a multi-component assembly including a self-expanding outer cage component comprising a plurality of struts; and an inner component disposed within the self-expanding outer cage component forming a cylindrical channel therein, wherein a proximal end of the inner component is connected to the self-expanding outer cage component at a proximal joint. Each of the self-expanding outer cage component and a circular cross-section of the cylindrical channel formed by the inner component differ in diameter and are formable from a single cut tube or cut pattern, wherein the single cut tube or cut pattern has a primary diameter equal to an expandable diameter of primary struts forming the self-expanding outer cage component while the single cut tube or cut pattern is heat settable to a secondary diameter smaller than the primary diameter to form the circular cross-section of the cylindrical channel formed by the inner component.
Yet another aspect of the present disclosure relates to a self-expanding intravascular medical device including a multi-component assembly comprising (i) a self-expanding outer cage component comprising a plurality of struts; (ii) a wave shape component disposed within the self-expanding outer cage component; and (iii) an expanded distal closed-end mesh section. The expanded distal closed-end mesh section is attached directly to the wave shape component. There is no direct physical connection between the expanded distal closed-end mesh section and the self-expanding outer cage component.
While still another aspect of the present disclosure is directed to a self-expanding intravascular medical device including a self-expanding outer cage component comprising a plurality of struts. Each of the plural struts having a wedge shape radial cross-section having a curved outer surface forming part of an outer diameter of the expandable outer cage and a curved inner surface forming part of an inner diameter of the self-expanding outer cage; wherein a portion of the curved outer surface is removed.
While yet another aspect of the present disclosure relates to a self-expanding intravascular medical device made from an everted concave sheet or plate cut into a desired pattern comprising a plurality of struts. Each of the plural struts of the everted cut tube has a wedge shape radial cross-section that is widest at a concave inner radial surface and tapers smaller until reaching a concave outer radial surface.
Still another aspect of the present disclosure is directed to a method for manufacturing a self-expanding outer cage component of a self-expanding intravascular medical device. A desired pattern is cut in a concave sheet or plate. The cut concave sheet or plate is then inverted. Thereafter, the everted cut concave sheet or plate is shape set around a mandrel of a predetermined diameter drawing opposing free edges of the everted cut concave sheet or plate towards one another to form a radial stent comprising a plurality of struts. Each of the plural struts has a wedge shape radial cross-section that is widest at a concave inner radial surface and tapers smaller until reaching a concave outer radial surface.
To the accomplishment of the foregoing and related ends, certain illustrative aspects are described herein in connection with the following description and the appended drawings. These aspects are indicative, however, of but a few of the various ways in which the principles of the claimed subject matter may be employed and the claimed subject matter is intended to include all such aspects and their equivalents. Other advantages and novel features may become apparent from the following detailed description when considered in conjunction with the drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
The disclosure will be more clearly understood from the following description of some embodiments thereof, given by way of example only with reference to the accompanying drawings in which:
FIG. 1A is a plan view of a 2-cell outer cage of a mechanical thrombectomy device;
FIG. 1B is an end view of the 2-cell outer cage of FIG. 1A;
FIG. 1C is a side view of the 2-cell outer cage of FIG. 1A;
FIG. 2A is a plan view of a single cell wave-shape component of a mechanical thrombectomy device in accordance with the present disclosure;
FIG. 2B is an end view of the single cell wave-shape component of FIG. 2A;
FIG. 2C is a side view of the single cell wave-shape component of FIG. 2A;
FIG. 2D is an isometric view of the single cell wave-shape component of FIG. 2A;
FIG. 2E is an isometric view representational of either the raw material tubing from which the single cell wave-shape component is laser cut or alternatively, the tubular channel formed by the single cell wave-shape component;
FIG. 2F is an enlarged representation of the dashed circular area 2F in the isometric view of the laser cut single cell wave-shape component of FIG. 2D;
FIG. 2G is an isometric view of an alternative single cell wave-shape component wherein the cell pattern twists or rotates about a central axis extending longitudinally through the component;
FIG. 2H is a side view of the single cell wave-shape component of FIG. 2G;
FIG. 3A is an isometric view of a dual structure assembly mechanical thrombectomy device in accordance with the disclosure including the 2-cell outer cage of FIGS. 1A-1C and the single cell wave-shape component of FIGS. 2A-2D disposed therein, wherein the distal end of the wave-shape component is attached to the outer cage;
FIG. 3B is an end view of the dual structure assembly mechanical thrombectomy device of FIG. 3A;
FIG. 3C is a side view of the dual structure assembly mechanical thrombectomy device of FIG. 3A;
FIG. 3D is an isometric view of an alternative dual structure assembly mechanical thrombectomy device in accordance with the present disclosure including the 2-cell outer cage of FIGS. 1A-1C and the single cell wave-shape component of FIGS. 2A-2D disposed therein, wherein a distal mesh connected to the distal end of the outer cage provides distal fragment protection and the wave-shape component is floating or free relative to the outer cage;
FIG. 3E is an isometric view of the outer cage in FIG. 3D without the wave-shape component;
FIG. 3F is an isometric view of fragment protection provided by a distal mesh connected to the distal end of the wave-shape component while the distal end of the outer cage remains floating relative to the distal mesh;
FIG. 3G is an isometric view of distal fragment protection provided by a distal mesh, wherein the wave-shape component has been eliminated, the distal mesh is connected via a wire or extension of the proximal shaft;
FIG. 3H is an isometric view of distal fragment protection provided by a clump or ball of fibers or wire, wherein the ball is connected to the distal end of the wave-shape component while the distal end of the outer cage remains floating relative to the distal mesh;
FIG. 4 is an isometric view of an alternative 2-cell outer cage configuration of a mechanical thrombectomy device in accordance with the present disclosure, wherein one of the primary struts forming the outer cage has been removed (as denoted by the dashed line);
FIG. 5 is a plan view while in an unrolled, flat state of another exemplary 2-cell outer cage mechanical thrombectomy device, wherein two struts have been removed;
FIG. 6A is a side view of a wave-shape of the single cell wave-shape component of the mechanical thrombectomy device in accordance with the disclosure, wherein the wave-shape varies in height along the length of the component;
FIG. 6B is an isometric view of one configuration of the single cell wave-shape component of the mechanical thrombectomy device in accordance with the disclosure, wherein both the amplitude (height) and corresponding cell size varies along the length of the component;
FIG. 6C is an isometric view of another example of the single cell wave-shape component of the mechanical thrombectomy device in accordance with the present disclosure; wherein each cell size is substantially the same, but the substantially uniform cut cells are heat set to a desired shape to produce a varying wave amplitude (height) along the length of the component;
FIG. 7A is a plan view while in an unrolled, flat state of the dual structure assembly mechanical thrombectomy device in accordance with the present disclosure; wherein the outer cage and inner component are manufactured from a single cut tube or cut pattern;
FIG. 7B is an isometric view while in the expanded state of the dual structure assembly mechanical thrombectomy device of FIG. 7A;
FIG. 7C is a radial cross-sectional view of the dual structure assembly mechanical thrombectomy device of FIG. 7B along lines VIIC-VIIC;
FIG. 8A is an exploded view of an exemplary dual structure assembly of the mechanical thrombectomy device in accordance with the present disclosure having a reduced diameter when compressed or loaded into a catheter;
FIG. 8B is an assembled view of the exemplary dual structure assembly of the mechanical thrombectomy device of FIG. 8A;
FIG. 8C is a flat, unrolled view of a radial section of the proximal first cell/segment outer cage of FIG. 8A with the connector strut between the first and distal second cell/segment of the outer cage identified, this connector strut may be eliminated in the distal second section to maximize adjacent strut widths;
FIG. 9A is a prior art strut cross-section geometry of a single wedge shape strut comprising a stent laser cut from a Nitinol tube;
FIG. 9B is a strut cross-section geometry of a single wedge shape strut of a stent in accordance with the present disclosure laser cut from a Nitinol concave sheet;
FIG. 10 is a radial cross-sectional view depicting the longitudinal slit or open seam of the everted laser cut concave sheet or plate deformed about a mandrel and heat set, wherein each strut has a cross-sectional geometry shown in FIG. 9B;
FIG. 11A is a partial longitudinal view of the device in accordance with the present disclosure laser cut from a Nitinol concave sheet rolled about the mandrel depicting the seam in the body segments along the connection struts with eyelets;
FIG. 11B is a partial longitudinal view of the device in accordance with the present disclosure laser cut from a Nitinol concave sheet rolled about the mandrel depicting the seam in the body segments along the connection struts without eyelets;
FIG. 12A a perspective view of a strut laser cut from a Nitinol tube, wherein a notch, groove or channel is cut into or removed from the outer diameter surface of the strut thereby reducing the outer surface contact area of the strut;
FIG. 12B is an end view of the strut of FIG. 12A;
FIG. 13A is a perspective view of another example of a strut laser cut from a Nitinol tube having chamfered cuts to the corners of the outer surface (outer diameter) of the strut thereby reducing the outer surface contact area of the strut;
FIG. 13B is an end view of the strut of FIG. 13A;
FIG. 13C is an end view of the strut of FIG. 13A illustrating by dashed lines the corners that have been removed; and
FIG. 14 is an illustration of an exemplary strut of the mechanical thrombectomy device to define the measurements of strut length, width and thickness.
DETAILED DESCRIPTION
Some aspects of the present disclosure relate to a self-expanding intravascular medical device and method for using the device. Although example embodiments of the present disclosure are explained in detail herein, it is to be understood that other embodiments are contemplated. Accordingly, it is not intended that the present disclosure be limited in its scope to the details of construction and arrangement of components set forth in the following description or illustrated in the drawings. The present disclosure is capable of other embodiments and of being practiced or carried out in various ways.
A detailed description of aspects of the present disclosure will now be provided with reference to the accompanying drawings. The drawings form a part hereof and show, by way of illustration, specific embodiments or examples. In referring to the drawings, like numerals represent like elements throughout the several figures.
The self-expanding framework, cage, skeleton or scaffolding of the mechanical thrombectomy device (stentriever) disclosed herein are made from a material capable of recovering its shape automatically once released from a highly strained delivery configuration. A biocompatible superelastic material such as Nitinol or an alloy of similar properties is particularly suitable. The material may be in many forms such as wire, strip, plate, sheet or tube. A particularly suitable manufacturing process is to laser cut a Nitinol tube and then heat-set and electropolish the resultant structure to create an expandable framework, cage, skeleton or scaffolding comprising of struts and connecting elements. This framework may be any of a diverse range of shapes as disclosed herein and may be rendered visible under fluoroscopy through the addition of alloying elements (such as Platinum for example) or through a variety of other coatings or marker bands.
Current self-expanding mechanical stent devices, in particular, mechanical thrombectomy devices (e.g., stentrievers), for use during intravascular medical procedures, such as the medical treatment of acute ischemic stroke, face several challenges or problems when trying to engage and dislodge a target clot, occlusion or blockage and thereafter fully retrieve the clot into an intermediate catheter, guide catheter or sheath under aspiration. The features of the mechanical thrombectomy device in accordance with the present disclosure discussed in detail herein overcome such challenges associated with conventional mechanical thrombectomy devices.
One problem addressed by the present disclosure is that the diameter of the access or intermediate catheter is typically smaller than the diameter of the targeted clot, occlusion or blockage so there is a resistance to clot retraction therethrough and a risk that shear forces may cause the clot to fragment during retrieval. This is an issue with all mechanical thrombectomy devices and shear forces on the clot, occlusion or blockage increase as the diameter of the intermediate catheter decreases. Some clots, occlusions or blockages pose a greater challenge to full retrieval into the intermediate or access catheter such as friable clots which are prone to fragmentation, and organized fibrin rich clots which are less compressible than spontaneous clots.
It has been discovered through experimental testing that the cut pattern of a mechanical thrombectomy device influences clot embedding and the ability of the device to dislodge and retrieve a clot fully into an intermediate catheter, guide catheter or sheath. In an example of the present disclosure the mechanical thrombectomy device has a dual structure assembly configuration. An expandable outer cage 100 of the mechanical thrombectomy device, as illustrated in the exemplary plan view depicted in FIG. 1A, has a 2-cell (or 2-segment) pattern but may contain a range of 2-6 cells, wherein the number of cells present in the outer cage is measured in a circumferential direction. The cut pattern forming the outer cage 100 in FIG. 1A has an open strut configuration comprising a minimal number of Nitinol struts to maximize cell area and preferably includes U-shaped crown/saddle points 110 to optimize clot engagement on deployment and improve retention performance and retrieval into the catheter. This open strut configuration minimizes clot compression on deployment thereby minimizing friction between the clot and interior surface of vessel wall. While the relatively large reception spaces 105 (e.g., large cell size or area) allow the clot, occlusion or blockage to embed deeply therein aiding in retraction into the access or intermediate catheter while minimizing clot shear. The crowns 110 also aid in retrieving the clot into the tip of the intermediate or guide catheter. Distal radiopaque coils or markers may be attached to the outer cage to improve visibility of the device during imaging (e.g., fluoroscopy).
The 2-cell configuration of the outer cage has a reduced maximum outer diameter when radially compressed thereby enhancing the wrapping efficiency allowing the device to be loaded and delivered through relatively small size microcatheters with an inner diameter less than or equal to approximately 0.021 inches, preferably less than or equal to approximately 0.017″. When loaded into a microcatheter, the 2-cell outer cage configuration ensures a maximum of 4 struts aligned circumferentially side by side in comparison to the typical 4-cell mechanical thrombectomy device having 8 struts aligned circumferentially side by side.
Disposed within the 2-cell outer cage 100 of the dual structure mechanical thrombectomy device is a single cell wave-shape component 310, the single cell configuration being clearly illustrated in the plan view of FIG. 2A and isometric view of FIG. 2D. The wave-shape component 310 may be laser cut from a tube of raw material 330 (FIG. 2E) to form the wave-shape component (FIG. 2F). Alternatively, the wave-shape component may be cut from a smaller diameter tube and expanded to the desired outer diameter. A different configuration of the single cell wave-shape component 310′ is shown in isometric and side views provided in FIGS. 2G and 2H, respectively, wherein the cell pattern twists or rotates about a central axis (A) extending longitudinally through the component.
Upon deployment, the wave-shape component 310 opens a channel through the clot facilitating immediate restoration of partial flow of blood through the clot. This channel is evident when viewed end-on and is typically circular in shape when freely expanded, as seen in FIG. 2B. The wave profile of the wave-shape component, as depicted in the side view in FIG. 2C, promotes engagement of the clot on dislodgement and during retention into the catheter. The wave-shape component also stabilizes relatively small and friable clots which migrate fully or partially inside the outer cage 100 during retrieval. The wave-shape component stabilizes the clot minimizing movement to the distal end of the thrombectomy device, where fragments may be lost or captured in the fragment protection zone. In addition, the wave-shape component is also deflectable to the side when clots are being pulled into the intermediate guide catheter. As a result, the wave-shape component enhances performance without inhibiting the ability of the device to retrieve clots into local aspiration or intermediate catheters.
To maximize the cell area or clot reception spaces in the outer cage of the mechanical thrombectomy device and thereby improve embedding of the clot therein, one or more struts may be removed. In the exemplary illustration of the outer cage 400 in an expanded state depicted in the isometric view of FIG. 4, the dotted or dashed line represents a single strut that has been removed from the outer cage. With the removal of one or more struts, the laser cut pattern of the outer cage tubing is no longer symmetrical, i.e., asymmetrical or lacking symmetry. Removal of one or more struts enlarges the cell area and potential reception space for the clot to embed in the outer cage. Such enlarging of spaces allows the clot to embed more deeply and, as a result, minimizes the potential for dislodgement hence increasing the probability of full or entire clot retrieval into the intermediate catheter. However, the laser cut pattern retains sufficient contact with the clot to prevent loss of the clot into a side branch or during retrieval around a challenging bend in the vessel. FIG. 5 depicts in an unrolled state (laser cut pattern) another exemplary embodiment of the outer cage 500 with two struts removed (505, 505′) creating two enlarged cells or reception spaces in which the clot may embed. It is contemplated and within the intended scope of the present disclosure to remove any number of one or more struts from the outer cage.
FIGS. 3A-3C depict an isometric view, an end view, and side view, respectively, of the dual structure assembly of the 2-cell outer cage and single cell wave-shape component, shown in FIGS. 1A-1C and 2A-2D, respectively. The wave-shape component 310 disposed inside the outer cage 305 is connected to the shaft 315 at the proximal joint 320. At an opposite distal end 325, the two components (305, 310) are connected to one another, but may otherwise be free or floating relative to one another.
A distal fragment protection member may be included in the mechanical thrombectomy device to provide a distal fragment protection zone. Referring to FIG. 3D, a distal mesh section 335 comprising a plurality of struts heat set in shape to have a tapered distal end and attached to the distal end of the outer cage 305 provides distal fragment protection. Disposed within the outer cage 305 is the wave-shape component 310 whose distal end 325 is floating (e.g., unattached, untethered, unsecured, unconnected) relative to both the outer cage and the distal mesh section. FIG. 3E is an isometric view of the outer cage and distal mesh section of FIG. 3D without the wave-shape component. In still another variation illustrated in FIG. 3F, distal fragment protection is provided by distal mesh section 335 connected to the distal end of the wave-shape component 310 while the distal end of the outer cage 305 is floating, free or unconnected relative to the distal mesh section 335. Whereas, in FIG. 3G, since the wave-shape component has been eliminated, distal mesh section 335 is connected via a wire or extension of the proximal shaft 315. Rather than a distal mesh section being an expanded skeleton having a plurality of struts, distal fragment protection may be provided by a distal clump, ball or sphere 335′ of intertwined strands (e.g., biocompatible fibers or wire such as Nitinol wire), as depicted in FIG. 3H. The intertwined strands forming the clump 335′ need not necessarily be in the shape of a ball or sphere, but may take on any amorphous or geometric shape. The distal clump of intertwined strands 335′ is connected to the distal end of the wave-shape component 310 while the distal end of the outer cage 305 is floating, free or unconnected relative to the distal clump 335′.
The wave pattern of the wave-shape component 310 may be varied in a number of different ways. In a first configuration shown in the isometric view of FIG. 6B, the tube may be laser cut into cells of different sizes that are then heat set into a variable wave shape whose amplitude (height) varies along the length of the component. Referring to the side view in FIG. 6A, the amplitude (height) “B” is greater than that of the amplitude (height) “A” in the wave shape. In this configuration in which the wave shape varies in both amplitude (height) and corresponding cell size or length, crowns at the connection points between cells are positioned at the peak and trough of each wave. Another possible configuration of the wave shape is shown in FIG. 6C, wherein the tube is cut into cells substantially uniform in size and then heat set to produce a varying wave amplitude (height) along the length of the wave-shape component. Unlike the embodiment in FIG. 6B, crowns at the connection points between cells in the wave-shape component structure in FIG. 6C are not always positioned at the peak or trough of each wave. More connection points and hence more crowns are present in the configuration of FIG. 6C promoting engagement with the clot. Variation in amplitude and/or length of the single cell of the wave-shape component provides additional protection against fragmentation of the clot and, when assembled within the outer cage, optimizes clot stabilization performance.
The outer cage 305 and wave-shape component 310 differing in diameter, as depicted in FIGS. 3A-3C, are each manufactured from two separately cut tubes or cut patterns of different diameters thereafter assembled together to form the dual structure assembly. Alternatively, the present disclosure contemplates the outer cage and inner component being formed or manufactured from a single cut tube or cut pattern, rather than two separately cut tubes or cut patterns. A single cut tube or cut pattern used to form both the primary and secondary struts in accordance with the disclosure reduces the overall cost of manufacture while maintaining the benefits associated with the dual structure assembly (e.g., outer cage and inner component). Specifically, the single cut tube or cut pattern is deformed and heat set into the inner component and the outer cage, respectively, with the same benefits and advantages discussed above with respect to the two separately cut tubes or cut patterns then assembled together. FIG. 7A depicts part of the single cut tube or cut pattern while in an unrolled (flattened) state. This novel configuration of the dual structure assembly manufactured from a single cut tube or cut pattern is achieved by primary struts 700 forming the outer cage component being expanded and heat set to a primary diameter approximately 3.0 mm-approximately 6.0 mm (preferably, approximately 5.0 mm) while the secondary struts 705 comprising the inner component are expanded and heat-set to form a circular channel having a smaller secondary diameter approximately 1.0 mm-approximately 3.0 mm (preferably, approximately 1.25 mm), during respective expansion steps. FIG. 7B is an isometric view of the dual structure assembly formed from a single cut tube or cut pattern while in a rolled expanded state, wherein the assembly includes formed primary struts 700 defining an outer cage and inwardly radially deformed secondary struts 705 comprising the inner component defining a cylindrical channel. A radial cross-sectional view of the dual structure assembly of FIG. 7B along lines VII(C)-VII(C) is illustrated in FIG. 7C.
Alternatively, the single cut tube or cut pattern may have a diameter equal to the preferred expanded diameter of the primary struts 700 forming the outer cage (e.g., approximately 5.0 mm) and a heat-set process applied to reduce in diameter (e.g., approximately 1.25 mm) the single cut tube or cut pattern to form the secondary struts 705 of the inner component. Thus, no expansion nor reduction in diameter of the single cut tube or cut pattern is necessary to form the primary struts of the outer cage. Accordingly, a single raw material cut tube or cut pattern (e.g., Nitinol) can be varied to any desired preferential primary and secondary diameter, respectively, to form the outer cage and inner component of the dual structure assembly mechanical thrombectomy device.
It is further desirable for the dual structure assembly mechanical thrombectomy device to collapse/reduce/wrap-down sufficiently small in diameter to be receivable within a smaller size (e.g., approximately 0.017″) microcatheter. However, mechanical thrombectomy devices that collapse to smaller diameter sizes face several challenges. In order to allow construction of the proximal bond of the dual structure mechanical thrombectomy device and ensure an appropriate device crossing profile (i.e., cross-sectional area) (preferably less than approximately 0.0165″ for compatibility with 0.017″ microcatheters), a smaller diameter Nitinol cut tube raw material is preferred. An inherent problem to be solved or overcome in accordance with the present disclosure when utilizing smaller diameter cut tube raw material is accommodation of sufficient strut width and thickness for the outer cage to exert sufficient radial force when engaging the clot in the vessel to restore blood flow and facilitate clot removal. Wherein the measurements of strut length, width and thickness are defined by the illustration in FIG. 14.
It is therefore desirable to maximize strut width to exert sufficient radial force while simultaneously configuring the outer cage to efficiently wrap down reducing in diameter to be receivable within a smaller size microcatheter (e.g., 0.017″ microcatheter). To achieve these goals, the mechanical thrombectomy device in accordance with the present disclosure has a multi-component assembly 800 (as seen in FIGS. 8A & 8B, depicting exploded and assembled views, respectively) including: an outer cage 805, a wave-shape component 810 (similar to that shown in FIGS. 2A-2D) and an expanded distal tapered-end mesh section 815. In the illustrative example shown in FIG. 8A, outer cage 805 is preferably a 2-segment design or configuration (i.e., 2-segment outer cage 805 comprising a first segment 890 connected to a second segment 890′ by a connector strut 895); however other configurations are contemplated and within the intended scope of the present disclosure. Outer cage 805 may be manufactured from a raw material (e.g., Nitinol) cut tube having a diameter of approximately 0.36 mm to approximately 2.0 mm to provide appropriate strut geometry. The wave-shape component 810 may be manufactured from a smaller diameter (approximately 0.15 mm) raw material (e.g., Nitinol) cut tube to facilitate efficient wrapping of the device during loading into a microcatheter, and assembly of the proximal joint with a profile compatible with 0.017″ microcatheters. In particular, maximization of strut width of the outer cage 805 in the multi-component configuration of FIGS. 8A & 8B is realized by having the wave-shape component 810 form a wave pattern (similar to that shown in FIGS. 2A-2D) expand or extend axially into the distal section which contains a distal fragment protection member (e.g., expanded distal tapered-end mesh section 815). In addition, the connector strut 895 connecting the second segment 890′ of the outer cage 805 to the expanded distal tapered-end mesh section 815 (as depicted in FIG. 8C) has been eliminated, replaced by the wave-shape component 810. Elimination of the connector strut also optimizes efficiency of wrap-down of the outer cage to be receivable within smaller size microcatheters (e.g., 0.017″ microcatheters). The strut 895 connecting the second segment 890′ of the outer cage 805 to the distal mesh section 815 is able to be eliminated in the accordance with the present disclosure because the expanded distal tapered-end mesh section 815 is attached directly to the wave-shape component 810 providing a distal fragment protection zone and also serving as a distal anchor for intermediate catheter support during the procedure, rather than the outer cage 805. Functionality provided by the outer cage and wave-shape component have been discussed in detail above. The expanded distal tapered-end mesh section 815 maintains the clot in place during retrieval so that it does not fragment. Preferably, the laser cut tube forming the expanded distal tapered-end mesh section has a reduced diameter to aid in securing it on its closed distal end 820.
During manufacture of conventional mechanical thrombectomy devices, a laser beam used to cut a desired tube pattern remains stationary while a raw material (e.g., Nitinol) cut tube forming the stent is rotated. FIG. 9A represents a standard or conventional strut cross-section geometry when laser cut from a raw material tube (e.g., Nitinol tube). Rotation is guided or dictated by the desired laser cut flat pattern.
As is clearly evident from FIG. 9A, the radial cross-section of the conventional wedge shape strut is widest along its outer surface (e.g., outer diameter) and tapers smaller until reaching its inner surface (e.g., inner diameter). That is, the conventional wedge shape strut has a smallest arc length (i.e., measure of the distance along the curved line making up the inner arc) denoted as “IA” along the inner surface (inner arc forming the inner diameter of the tube) and a largest arc length (i.e., measure of the distance along the curved line making up the outer arc) denoted as “OA” along the outer surface of the cross-section (outer arc forming the outer diameter of the tube). In other words, the arc length increases from the inner surface (inner diameter of the tube) to the outer surface (outer diameter of the tube). Accordingly, the arc length is longest (greatest contact surface area) along the outer surface (OA) of the radial cross-section of the conventional strut and the arc length is shortest (smallest contact surface area) along the inner surface (IA) of the cross-section of the conventional strut. Such conventional design results in an outward radial force of the stent being applied over a larger surface area, hence reducing outward radial pressure per strut surface area and clot embedding. Enhanced or improved embedding of the clot in the mechanical thrombectomy device may be realized in accordance with the present disclosure by modifying the strut geometry of the outer cage, specifically reducing the contact surface area of the outer surface (OA).
Rather than being cut from the Nitinol tube, as was the conventional strut cross-section depicted in FIG. 9A, in accordance with the disclosure, the desired pattern of the stent may be laser cut on a concave Nitinol sheet or plate, while rotation of the concave sheet is controlled in an X-Y plane. FIG. 9B depicts the radial cross-section geometry of a laser cut single strut of an everted concave Nitinol sheet in accordance with the present disclosure. To achieve this geometry, a desired pattern is laser cut in the concave Nitinol sheet or plate. Thereafter, the laser cut concave Nitinol sheet or plate is everted (turned inside out), formed around a mandrel of the desired diameter drawing the free edges towards one another to form a radial stent, and heat set to maintain this shape. FIG. 10 illustrates a radial cross-sectional view of the configured stent after the everted laser cut concave Nitinol sheet or plate has been wrapped about a mandrel, shape set to form a tube, and its opposing longitudinal edges 1000, 1000′ drawn toward one another to define a longitudinal slit or open seam 1110 allowing overlap when the stent is wrapped-down/reduced in diameter. Alternatively, the opposing longitudinal edges can be joined together, e.g., laser welded, soldered or similar mechanical joining process.
Contrary to that of the conventional cross-section wedge shape strut laser cut from a Nitinol tube (FIG. 9A), the laser cut concave Nitinol sheet in accordance with the present disclosure forms a wedge shape strut that is widest along its inner surface (inner diameter) and tapers smaller until reaching its outer surface (outer diameter), as seen in FIG. 9B. That is, the wedge shape strut in accordance with the present disclosure has a largest arc length (i.e., measure of the distance along the curved line making up the outer arc) denoted as (IA′) along the inner surface (inner arc forming the inner diameter of the tube) and a smallest arc length (i.e., measure of the distance along the curved line making up the outer arc) denoted as (OA′) along the outer surface of the cross-section (outer arc forming the outer diameter of the tube). Hence, the arc length decreases from the inner surface (IA′) to the outer surface (OA′). Accordingly, the arc length is shortest (smallest contact surface area) along the outer surface (OA′) of the cross-section of the strut in accordance with the present disclosure and the arc length is longest (largest contact surface area) along the inner surface (IA′) of the cross-section of the strut. Such strut in accordance with the disclosure results in maintaining an outward radial force of the stent being applied over a smaller or reduced contact surface area of the outer surface (OA′) in contact with the clot than the contact surface area of the outer surface (OA) of the conventional strut depicted in FIG. 9A, hence increasing outward radial pressure and clot embedding.
FIG. 11A is a partial longitudinal view in accordance with the disclosure of the laser cut Nitinol concave sheet of a stent with eyelets, rolled about the mandrel depicting the laser welded seam in the body segments aligned with the connection struts along the center-line of the device. While FIG. 11B is a similar view in accordance with the present disclosure of the laser cut Nitinol concave sheet of a stent without eyelets. The seam may be welded or soldered to form a cylindrical device from the inverted laser cut concave sheet. If eyelets are included in the body segments/cells of the stent (FIG. 11A), the eyelet may be closed by laser welding the seam together.
Another way to realize the aforementioned goal of reducing the strut contact surface area along the outer surface (outer diameter) of the stent is by removing a portion of the outer surface (outer diameter) from the cut tubing. In FIGS. 12A & 12B, a notch, groove or channel is cut into or otherwise removed (e.g., grinding) from the outer diameter surface of the Nitinol tubing strut thereby reducing the contact surface area along its outer surface (outer diameter) with that of the clot. The notch, groove or channel may be a predefined radius, V-shaped, U-shaped or any other desired shape. Despite removing a portion of the outer surface (outer diameter) of the strut, if desired, the thickness of the strut can be increased to maintain the overall cross-sectional area of the strut. The two thinner struts formed along the outer surface or profile (outer diameter) on either side of the notch, groove or channel each has a smaller contact surface area (in comparison to the outer surface area without the notch, groove or channel) promoting the clot to more easily to embed. Alternatively, or in combination therewith, a chamfer edge or secondary off-axis cut can be made in each corner of the outer surface (outer diameter) of the Nitinol tubing strut, as shown in FIGS. 13A-13C, once again with the shared goal of reducing the outer surface contact area of the strut. Referring to the end view of the Nitinol tubing formed strut in FIG. 13C the removal of the corners (denoted by dashed lines) reduces the overall contact surface area arc length along the outer surface (outer diameter) from a conventional prior art width Lo (before making the secondary cuts) to the reduced arc length Li (after making the secondary cuts) in accordance with the present disclosure. What results is depicted in the end and perspective views shown in FIGS. 13A & 13B, respectively, having a reduced contact surface area along the outer surface (outer diameter) of the strut.
Each of the present disclosure geometry strut configurations may be used independently or in any combination thereof to improve clot removal performance by improving embedding of the clot in the thrombectomy device. Also, features associated with some aspects of the present disclosure mechanical thrombectomy device are applicable for use in a wide range of different size catheters, even those having a relatively small diameter.
The device in accordance with the present disclosure has been illustrated and described for use in a mechanical thrombectomy procedure but is applicable for use in other intravascular medical procedures in which a self-expanding mesh, cage, scaffolding or skeleton is utilized.
It must also be noted that, as used in the specification and the appended claims, the singular forms “a,” “an” and “the” include plural referents unless the context clearly dictates otherwise. Ranges may be expressed herein as from “about” or “approximately” one particular value and/or to “about” or “approximately” another particular value. When such a range is expressed, other exemplary embodiments include from the one particular value and/or to the other particular value.
By “comprising” or “containing” or “including” is meant that at least the named compound, element, particle, or method step is present in the composition or article or method, but does not exclude the presence of other compounds, materials, particles, method steps, even if the other such compounds, material, particles, method steps have the same function as what is named.
In describing example embodiments, terminology will be resorted to for the sake of clarity. It is intended that each term contemplates its broadest meaning as understood by those skilled in the art and includes all technical equivalents that operate in a similar manner to accomplish a similar purpose. It is also to be understood that the mention of one or more steps of a method does not preclude the presence of additional method steps or intervening method steps between those steps expressly identified. Steps of a method may be performed in a different order than those described herein without departing from the scope of the present disclosure. Similarly, it is also to be understood that the mention of one or more components in a device or system does not preclude the presence of additional components or intervening components between those components expressly identified.
Some references, which may include various patents, patent applications, and publications, are cited in a reference list and discussed in the disclosure provided herein. The citation and/or discussion of such references is provided merely to clarify the description of the present disclosure and is not an admission that any such reference is “prior art” to any aspects of the present disclosure described herein. In terms of notation, “[Il]” corresponds to the nth reference in the list. All references cited and discussed in this specification are incorporated herein by reference in their entireties and to the same extent as if each reference was individually incorporated by reference.
The descriptions contained herein are examples illustrating the solution and are not intended to limit the scope. As described herein, the solution contemplates many variations and modifications of a system, device, and/or method that can be used to analyze one or more clots and individualize treatment based on the analysis. Variations can include but are not limited to alternative geometries of elements and components described herein, utilizing any of numerous materials for each component or element (e.g. radiopaque materials, memory shape metals, etc.), utilizing additional components, utilizing additional components to perform functions described herein, or utilizing additional components to perform functions not described herein, for example. These modifications would be apparent to those having ordinary skill in the art to which this disclosure relates and are intended to be within the scope of the claims which follow.
The specific configurations, choice of materials and the size and shape of various elements can be varied according to particular design specifications or constraints requiring a system or method constructed according to the principles of the disclosed technology. Such changes are intended to be embraced within the scope of the disclosed technology. The presently disclosed embodiments, therefore, are considered in all respects to be illustrative and not restrictive. It will therefore be apparent from the foregoing that while particular forms of the disclosure have been illustrated and described, various modifications can be made without departing from the spirit and scope of the disclosure and all changes that come within the meaning and range of equivalents thereof are intended to be embraced therein.
Patent Application
20240115279
