Patent Application
20230277189
This application relates generally to medical devices, and more specifically, to apparatuses, systems and methods for the treatment of aneurysms and other vascular abnormalities.
Implantable medical devices exist for treating a number of diseases and conditions associated with body lumens. Occlusive devices can be used to at least partially fill or occupy certain vascular or other anatomical spaces (e.g., vascular aneurysms). Vascular aneurysms, for example, which can develop as a result of a weakening in the arterial wall, can lead to internal bleeding. Occlusion of aneurysms and other such spaces using implant devices can be used to treat such potentially dangerous and lethal conditions.
According to some embodiments, a vascular embolic implant (e.g., a vaso-occlusive implant or device) comprises a coil configured to assume an elongated or substantially straight or linear shape for delivery into a subject and configured to assume an implanted or non-elongated (e.g., expanded or three-dimensional) shape when positioned into a targeted vascular defect of the subject, wherein the coil is configured to form six sides when in the non-elongated (e.g., expanded, three-dimensional or non-linear) shape, wherein at least one side formed by the implanted coil comprises a large loop, and wherein at least one side formed by the implanted coil comprises two or more small loops.
According to some embodiments, a diameter of the large loop is at least 70% of a width of a corresponding side of the implant. In some embodiments, the diameter of the large loop is at least 75% of the width of the corresponding side of the implant. In some embodiments, the diameter of the large loop is at least 80% of the width of the corresponding side of the implant.
According to some embodiments, a diameter of each of the small loops is less than 50% of a width of a corresponding side of the implant. In some embodiments, the diameter of each of the small loops is less than 40% of the width of a corresponding side of the implant. In some embodiments, the diameter of each of the small loops is less than 30% of the width of a corresponding side of the implant. In some embodiments, the diameter of each of the small loops is less than 20% of the width of a corresponding side of the implant.
According to some embodiments, the implant comprises three sides that include a large loop and three sides that include two or more small loops. In other embodiments, the implant comprises two sides that include a large loop and four sides that include two or more small loops, or vice versa. In other embodiments, the implant comprises one side that includes a large loop and five sides that include two or more small loops, or vice versa.
According to some embodiments, the coil is configured to transition from a first side to an immediately adjacent side for all sides of the implant. In some embodiments, the transition includes a 90-degree transition to the adjacent side. In some embodiments, a six-sided implant includes a coil that comprises five sequential immediately-adjacent (e.g., 90-degree or substantially 90-degree) transitions. According to some embodiments, two or more of the sides of an implant can be configured to daisy chain onto a single side. In some embodiments, such a configuration can increase the length of the implant.
According to some embodiments, the at least one side comprising two or more small loops comprises at least three loops. In some embodiments, the at least one side comprising two or more small loops comprises at least four loops (e.g., 4, 5, more than 5, etc.).
According to some embodiments, the coil comprises a shape memory material. In some embodiments, the shape memory material comprises a platinum tungsten alloy.
According to some embodiments, the coil is configured to be delivered to the targeted vascular defect of the subject using a delivery tool. In some embodiments, the delivery tool comprises a pusher member and a tether member.
According to some embodiments, the tether member is configured to be releasable secured to a portion of the coil. In some embodiments, the tether member is configured to be compromised to release the tether member from the coil after the implant has been delivered to the targeted vascular defect of the subject. In some embodiments, the tether member is configured to be compromised mechanically, thermally, chemically or electrolytically.
These and other features, aspects and advantages of the present application are described with reference to drawings of certain embodiments, which are intended to illustrate, but not to limit, the present disclosure. It is to be understood that these drawings are for the purpose of illustrating the various concepts disclosed herein and may not be to scale.
Although the various embodiments of an implant have specific relevance to vaso-occlusive devices to treat cerebral aneurysms and other vascular abnormalities, the features, advantages and other characteristics disclosed herein may have direct or indirect applicability in other applications, such as, for example, medical devices, mechanical devices and/or the like.
Several embodiments disclosed herein are particularly advantageous because they include one, several or all of the following benefits: provide for an vaso-occlusive implant device with an enhanced shape, provide a vaso-occlusive implant device having greater strength properties, the implant is intended to have enhanced shape memory properties, e.g., the implant having the necessary stiffness such that it can, more predictably, reliably and in an improved manner, form a basket in the aneurysm to its pre-determined shape. In some embodiments, the implant is shaped, designed and otherwise configured to have more loops for increased neck coverage. In some configurations, the smaller loops of the implant combined with the enhanced shape memory properties can result in an improved covering of the targeted anatomical area (e.g., neck or other portion of the aneurysm).
The treatment of intracranial and/or other aneurysms with the use of microcoils and/or other implants has certain benefits over other approaches (e.g., surgical clipping). In some embodiments, a microcatheter or other intraluminal device is advanced within the subject so that the tip is positioned adjacent the neck of the aneurysm. Subsequently, a microcoil or other implant can be delivered through the lumen of the microcatheter or other intraluminal device into the aneurysm or other vascular defect.
The present application discloses various embodiments of a microcoil device or other implant and the manner in which it is delivered into an aneurysm or other defect. The shape, size, configuration and/or other details regarding the implant can help ensure that the implant remains within the desired aneurysm following implantation.
The microcoil and/or other implant embodiments disclosed herein can be used with any size defect and/or to treat any indication, as desired or required. Further, as noted above, the implants can be delivered and released within the target anatomy of a subject using any desired protocol or technique.
With continued reference to the embodiment of
As illustrated (e.g., schematically) in
The implant 10 can comprise a single member 100 that is configured to assume the depicted shape upon release into the anatomy of a subject. The member 100 can include a helical member that includes a platinum tungsten alloy. For example, in some embodiments, the platinum tungsten alloy comprises an alloy of 92% platinum, 8% tungsten (92/8 Pt/W), other alloys and/or other shape memory material having superelastic properties. However, in some embodiments, the member 100 can include a non-helical shape and/or materials that are not shape memory materials, as desired or required.
According to some embodiments, the member 100 comprises inner or core wire member which is surrounded by an outer wire member. In some embodiments, the outer wire member is wound (e.g., helically) around the outside of the core wire. In some arrangements, one or more exterior layers or coatings can be positioned along the outside of both the outer wire member and the core wire. According to some embodiments, as illustrated in
With continued reference to
According to some embodiments, the implant 10 is configured to assume a wound shape as illustrated in
With continued reference to
In some embodiments, as depicted schematically in
As illustrated in
According to some embodiments, the configurations disclosed herein can result in greater neck or other coverage for a targeted aneurysm. Further, the increased or enhanced shape memory characteristics resulting from the expanded (e.g., non-linear) shape of the implant can improve basket formation to a pre-determined shape.
Therefore, as illustrated herein, a six-sided implant 10 can include three sides that comprise larger loops 110 and three sides that comprise smaller loops 120. In some embodiments, each side (e.g., Side A, C and E) that is formed by a larger loop 110 can include only a single loop 110. Further, in some embodiments, each side (e.g., Side B, D and F) that is formed by smaller loops 120 can include a plurality of loops 120.
In alternative arrangements, however, sides with larger loops 110 can include more than one loop 110. Likewise, sides with smaller loops 120 can include only a single loop or can include a plurality of loops 120. Therefore, a side can include one, two, three, four or more larger or smaller loops 110, 120, as desired or required for a particular application or use.
In some embodiments, a larger loop 110 is one that includes a diameter (e.g., along the loop or curve) that is at least 70% to 80% of the width or other cross-sectional dimension of the side in which the loop or curve 110 is located. Further, in some arrangements, a smaller loop 120 is one that includes a diameter (e.g., along the loop or curve) that is less than 50% (e.g., less than 50%, less than 45%, less than 40%, less than 35%, less than 30%, less than 25%, less than 20%, etc.) of the width or other cross-sectional dimension of the side in which the loop or curve 120 is located.
In the illustrated embodiments, the implant 10 comprises three sides (Sides A, C and E) with larger loops or curves 110 and three sides (Sides B, D and F) with smaller loops or curves 120. However, in other arraignments, an implant 10 comprises more or fewer sides with larger loops or curves 110 and/or more or fewer sides with smaller loops or curves 120, as desired or required. For instance, in one embodiment, an implant 10 can comprise one or two sides with larger loops or curves 110 and five or four sides with smaller loops or curves 120, or vice versa.
As shown schematically in
In some arrangements, the tether 220 comprises a thermoplastic elastomer, such as, for example, Engage®, a polyester strand (e.g., polyethylene terephthalate (PET)) and/or any other material. The diameter of the tether 220 can be 0.00075 inches to 0.0030 inches (e.g., 0.0015 to 0.0030, 0.0020 to 0.0025, 0.00075 to 0.0015, 0.0010, 0.0022 inches, values between the foregoing ranges, etc.).
The coil or other member 100 of the implant 10 can comprise a diameter or other cross-sectional dimension of 0.010 inches to 0.030 inches (e.g., 0.010 to 0.030 inches, 0.010 to 0.020 inches, 0.010 inches to 0.015, 0.011 to 0.013 inches, 0.012 inches, etc.). The length (when straight) of the coil or other member 100 can be 0.5 cm to 100 cm (e.g., 0.5 to 100, 0.5 to 75, 0.5 to 50, 1 to 40 cm, values between the foregoing, etc.), as desired or required.
According to some embodiments, delivery and deployment of the implant device 10 can be carried out by first compressing the implant device 10 for intravascular delivery through the subject. While disposed within a microcatheter or other intraluminal device, the implant's filamentary elements of layers may take on an elongated, non-everted configuration substantially parallel to each other and to a longitudinal axis of the microcatheter.
In some embodiments, once the implant device 10 is pushed out of the distal end of the microcatheter or other intraluminal device (or a radial constraint is otherwise removed relative to the wire or member 100 of the device 10), the distal ends of the filamentary elements may then axially contract towards each other, so as to assume a three-dimensional configuration within the aneurysm or other vascular defect. Any other method or technique can be used, however, to deliver the implant 10 to a desired anatomical location of the subject, as desired or required. The distal end of the microcatheter or intraluminal device can be positioned such that a distal port of the microcatheter is directed towards or disposed within a vascular defect (e.g., aneurysm) A to be treated and the delivery member (e.g., delivery wire) withdrawn. The implant device 10 secured to the delivery apparatus can be inserted (e.g., while in an elongated or substantially straight, linear or constrained orientation) into a proximal portion of the inner lumen of the microcatheter or other intraluminal device.
The implant 10 can then be advanced distally to the vascular defect through the inner lumen of the delivery device. In some embodiments, once the distal tip or deployment port of the delivery system is positioned in a desirable location adjacent or within a vascular defect, the implant device 10 may be deployed out of the distal end of the microcatheter, thus allowing the device to begin to assume a three-dimensional or implanted shape. As the implant device 10 emerges from the distal end of the delivery apparatus, and the microcatheter, the implant device 10 may start to assume an non-elongated or implanted (e.g., non-linear) state within the vascular defect. In some embodiments, to release the implant 10 within the aneurysm or other vascular defect, the implant device 10 can be detached from the delivery apparatus by compromising the tether. Such detachment can be accomplished using any known method, such as using heat or electrical energy to melt the tether, cutting or otherwise mechanically compromising the tether, chemically compromising the tether and/or the like.
As noted above, the microcoils and/or other implants disclosed herein can be detachable for purposes of delivery and implantation into a desired anatomical location. Any of a variety of known detachment methods or techniques can be used to deliver the implant within a desired anatomical location, as desired or required. Though detachment systems can include some dynamic process, some systems involve more physical movement of the system than others. For example, mechanical detachment systems, using pressure, unscrewing, axial pistoning release and/or the like tend to cause a finite amount of movement of the implant at the aneurysm during detachment.
In some arrangements, non-mechanical detachment systems (e.g., chemical, temperature, electrolytic, etc.) may include less movement. However, in some arrangements, such systems often suffer from less consistency. For example, a consistent short duration for a coil to detach can be experienced when using such systems. Though electrical isolation of the implant coil itself has aided in lower average coil detachment times, there is still some inconsistency in how quickly the coils will detach. In a larger aneurysm that might have ten or more coils implanted, the large or unpredictable detachment times are multiplied, and delay the procedure. Additionally, a single large detachment time may risk instability during the detachment, due to movement of the patient of the catheter system. Even systems that indicate that detachment has occurred, for example by the measurement of a current below a certain threshold, are not completely trusted by users.
A number of detachable systems include a particular structure at a junction between a pusher wire and detachably coupled microcoil implant. Of course, the delivery system and/or the implant can be sized, shaped and otherwise configured to permit for safe, predictable and reliable detachment to occur.
In some embodiments, one or more implants 10 can be positioned within a targeted aneurysm or other vascular defect. In some arrangements, the implant(s) can be used to fill or otherwise occupy a desired volume of the aneurysm. For example, the size, shape, quantity and/or details of the implant(s) can be selected to fill as much volume as possible of a targeted defect. In some arrangements, 80% to 100% of a targeted defect can be filled by the implant(s). However, in other embodiments, less than 80% of the defect may be filled by the implant(s). The comparatively soft nature of the implants 10 allows a sufficient amount of packing to achieve a desired level of thrombosis and occlusion, without creating potentially dangerous stresses on the wall of the aneurysm that could potentially least to rupture (or re-rupture).
Although several embodiments and examples are disclosed herein, the present application extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses and modifications and equivalents thereof. It is also contemplated that various combinations or subcombinations of the specific features and aspects of the embodiments may be made and still fall within the scope of the inventions. Accordingly, it should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the disclosed inventions. Thus, it is intended that the scope of the present inventions herein disclosed should not be limited by the particular disclosed embodiments described above, but should be determined only by a fair reading of the claims that follow.
While the inventions are susceptible to various modifications, and alternative forms, specific examples thereof have been shown in the drawings and are herein described in detail. It should be understood, however, that the inventions are not to be limited to the particular forms or methods disclosed, but, to the contrary, the inventions are to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the various embodiments described and the appended claims. Any methods disclosed herein need not be performed in the order recited. The methods summarized above and set forth in further detail below describe certain actions taken by a practitioner; however, it should be understood that they can also include the instruction of those actions by another party. The methods summarized above and set forth in further detail below describe certain actions taken by a user (e.g., a professional in some instances); however, it should be understood that they can also include the instruction of those actions by another party. Thus, actions such as “inserting an implant” or “delivering an implant” include “instructing inserting an implant” and “instructing delivering an implant.” The ranges disclosed herein also encompass any and all overlap, sub-ranges, and combinations thereof. Language such as “up to,” “at least,” “greater than,” “less than,” “between,” and the like includes the number recited. Numbers proceeded by a term such as “about” or “approximately” include the recited numbers. For example, “about 10 mm” includes “10 mm.” Terms or phrases preceded by a term such as “substantially” include the recited term or phrase. For example, “substantially parallel” includes “parallel.”
This application is a continuation of International Patent Application PCT/US2021/071217, filed Aug. 17, 2021, which claims priority to U.S. Provisional Application No. 63/067,016, filed Aug. 18, 2020, with the entirety of each of these applications hereby incorporated by reference herein.
| Number | Date | Country | |
|---|---|---|---|
| 63067016 | Aug 2020 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/US2021/071217 | Aug 2021 | US |
| Child | 18110550 | US |
