Stents or similar implantable devices are deployed within a vessel of a patient for various purposes, such as increasing the diameter of a narrowed vessel or to assist in the closure of an aneurysm. Two types of stents are commonly used for these treatments: woven stents and laser-cut stents. Woven stents are typically created with one or more wires that are woven or braided into a tubular structure, while laser-cut stents are typically formed by laser-cutting patterns into a metal tube.
Compared with laser-cut stents, woven stents tend to be relatively flexible which allows them to be positioned in both straight and curved portions of vessels. The relative strength of woven stents also allows them to be partially deployed, retracted back into the delivery catheter, and deployed again so that the physician can better achieve delivery to a target location. The use of different braiding patterns and wire sizes also allow a wide range of porosities to be achieved.
One disadvantage of woven stents is their tendency to foreshorten during deployment. For example,
In many woven stents the amount of foreshortening can be significant. For example, some woven stents currently approved for medical use have compressed lengths 10A that are about twice as long as their radially expanded lengths 10B. In this respect, it can be difficult for a physician to properly determine where the “landing zone” of the stent will be, since the stent is constantly changing its length during deployment. Stent treatments that are highly sensitive to proper stent placement, such as deployment to cover the opening of an aneurysm, can therefore be difficult for a physician to achieve.
In contrast, laser-cut stents exhibit significantly less foreshortening characteristics between their radially compressed and expanded configurations. Instead of braided wires moving past each other during radial expansion/contraction, laser-cut stents typically allow portions of their structure to fold or bend inwardly. While this can make laser-cut stents much more predictable to deploy, they often lack the strength, flexibility, and retractability associated with woven stents.
Another disadvantage of woven stents is that when they are deployed within a curved portion of a vessel, their weaving pattern can sometimes prevent their proximal end from opening. The reason for this is that woven stents tend to be woven by positioning a wire back and forth along the length of the stent in a helical, over-under pattern (i.e., as the wire encounters other wires or portions of itself, it is alternately positioned over the or underneath these portions in an alternating pattern).
When the stent is deployed in a curved configuration, the curve creates pressure between various portions of the wire that overlap each other, making it difficult for these portions of wire to move relative to each other. The longitudinal, helical positioning of the wires imparts the force of these wires against each other down to the proximal end of the stent. Without the ability of the wires to easily move relative to each other, any unexpanded portion of the stent may have difficulty expanding.
This problem is further compounded by the fact that most approved stents can only be retrieved or recaptured by the delivery catheter until about 75% of their length is deployed. After further deployment, the stent is unlikely to be retrievable. Therefore, it is possible that a woven stent may be irretrievably deployed with a closed proximal end in some curved vessels. In contrast, a laser-cut stent does not have braided, overlapping wires and therefore is not susceptible to this proximal deployment difficulty when delivering within a curved target vessel.
Therefore, an improved woven stent is needed that overcomes the above-discussed deployment disadvantages.
Generally, the present invention is directed to several different self-expanding woven stent embodiments that radially expand with minimal foreshortening and/or that more reliably open at their proximal end when deployed in a curved vessel.
In one embodiment of the present invention, a stent includes a plurality of adjacent stent regions that are each composed of a radially woven wire. For example, each stent portion may be composed of a wire forming a plurality of waves and that are connected to adjacent portions with an elongated portion of the wire.
In another example, each stent region forms a first set of waves and an overlapping second set of waves that are positioned opposite of the first set. The peaks of each stent region (i.e., the wire forming the peaks) are woven through or interlocked with the peaks from adjacent stent regions, connecting these regions together around their edge. The interlocked peaks of the stent regions are sized and positioned such that radial expansion of the stent regions do not substantially cause one stent region to pull another stent region in a longitudinal direction, thereby substantially preventing foreshortening of the stent during radial expansion.
In another example, a stent includes a main body region that is woven from one or more wires positioned in a longitudinal and helical location and being braided in an over-under pattern. A proximal end of the main body region includes a second stent region that is formed from one or more wires that are radially woven into one or more sets of wave shapes. This second stent region helps reduce foreshortening during deployment of the last portion of the stent and helps decouple any wire-on-wire stress created at other portions of the stent from deployment in a curved vessel.
In another example, a stent includes a plurality of separately woven stent portions that are each connected to each other via interlocking end loops. These stent portions can each be woven with one or more wires extending longitudinally helically in an over-under weaving pattern. Since the wires that make up each of the stent portions do not extend the full length of the stent, they are less likely to impart or communicate forces or friction created between overlapping wires when the stent is deployed in a curved vessel.
These and other aspects, features and advantages of which embodiments of the invention are capable will be apparent and elucidated from the following description of embodiments of the present invention, reference being made to the accompanying drawings, in which:
Specific embodiments of the invention will now be described with reference to the accompanying drawings. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the invention to those skilled in the art. In that respect, elements and functionality of one embodiment are not necessarily only limited to that embodiment and may be combined with other embodiments shown herein in any manner that would result in a functional embodiment. The terminology used in the detailed description of the embodiments illustrated in the accompanying drawings is not intended to be limiting of the invention. In the drawings, like numbers refer to like elements, including between different embodiments.
Typical woven stents utilize one or more wires that are wound in a longitudinal manner around a mandrel along the entire length of the stent, creating a number of wire crossing points along the length of the stent. These wire crossing points generally leave diamond shape openings or pores along the length of the stent, representing the area between the various wire crossing locations. Due to the large number of wire crossing points over the length of the stent, the stent can be considered as one contiguous structure as opposed to a plurality of connected sections. This means there is little independence of movement across the length of the stent, which accounts for the significant foreshortening associated with typical woven stents. The wire crossing-points also can create a chokepoint at the proximal end of the woven stent, as discussed in the background section above, which can contribute to poor opening at a proximal end of the stent in particular circumstances such as deployment in a tortuous vessel.
Though traditional woven stents are considerably more flexible than laser-cut stents, these issues highlighted above can make braided or woven stents difficult to use. The present invention addresses these issues by utilizing a different stent design to maintain the flexibility of woven stents while also minimizing foreshortening and improving expansion characteristics during deployment.
Generally, the present invention is directed to woven stents that have reduced foreshortening and more reliable opening of a proximal end of the stent in curved regions as compared with currently approved woven stent designs. The present invention is also directed to methods of making and deploying these stents.
As discussed in greater detail below, the stents of this specification reduce foreshortening between their radially compressed and radially expanded positions by forming a plurality of proximally and distally facing peaks formed by a circumferentially-oriented wire wound in a sinusoidal or wave-like pattern as opposed to a helical, longitudinal direction of most traditional stents (i.e., most traditional stents weave wires in a direction along an axis of the stent). The stent according to the present invention radially expands or compresses by increasing or decreasing the bend angle of each of the peaks instead of relying on longitudinal movement of the wires in helical, longitudinally woven stents, and therefore substantially maintains a constant length.
Additionally, these stents can include a plurality of discrete segments that are connected together in a non-woven manner. These segments help isolate tension between overlapping wires that may be created when deploying in a curved vessel, ensuring that the proximal end of a stent reliably opens after being deployed.
Unlike traditional woven stents which utilize a number of overlapping wire segments helically along the entire length of the stent, the regions 102 of stent 100 are connected to each other only via an elongated connection portion 102B. This single point of connection between adjacent regions 102 allows each of the regions 102 to expand and contract individually without further woven/braided connections that would otherwise cause additional longitudinal movement and thereby contribute further to foreshortening in traditional woven stents.
The pattern of the stent 100 starts with one end 102C of the wire. While this end is shown as being a straight, terminal end, it can alternately be formed into a curved shape or loop to help prevent a loose wire end damaging a patient's vessels (e.g., as shown in
This longer sizing of the elongated connection portion 1028 relative to the peak linking portion 102D allows the adjacent stent regions 102 to be spaced apart from each other when expanded. This spacing helps to minimize contact between these adjacent stent regions 102, thereby promoting independent movement between these regions 102 and in turn minimizing the effects of foreshortening. In some examples, the elongated connection portion 102 has a relatively linear shape, a curved shape, or an alternating wave type of shape.
For ease of visualization, the flattened mandrel is shown as having eight rows of posts used to create a stent having four sets of wave regions 102, however fewer or more rows of posts can be used to create various numbers of stent regions 102. It should be understood that a mandrel is typically a cylindrical shape with posts 112 extending radially away from its surface. Preferably, the diameter and material of the wire 101 are selected to both hold the shape of each stent region 102 and to prevent bending or kinking of the elongated connection portion 102B during deployment or retraction. For example, for a stent 100 having an outer diameter within a range of about 2.5 to 5.5 mm (or about 0.098 inches to 0.217 inches), a wire 101 having a diameter within a range of about 0.00075 inch to 0.0035 inch can be used. Good shape-memory materials, such as nitinol can be used for wire 101—other examples include stainless steel or cobalt-chromium. Radiopaque material (e.g. tantalum, platinum, palladium, or gold) may also be added to the stent at select locations to augment visualization of the stent.
The stent 100 is created, in one embodiment shown in
Please note the description and illustrative embodiment of
Furthermore, to the extent
Please note, this pattern is illustratively shown as being wound on a mandrel having eight rows of mandrel pins 112, to create four stent segments 102. Where more rows are used to create a “longer” stent (e.g., 5 or more stent segments 102) the elongated connection portion 102B would simply connect between the preceding stent section 102 and the next adjacent stent section 102, meaning it would span between either the first and second mandrel pin rows, and either the third and fourth mandrel pin rows (depending on the winding configuration, as described above) where this winding pattern continues along the length of the mandrel. In this context, the elongated section 102B serves to bridge a first section 102 of the stent with the next section 102 of the stent, such that each adjacent section is connected through a distinct elongated section 102B.
In one embodiment, the stent 100 is formed on a mandrel 110 capable of creating six peaks 102A for each stent portion 102. In another example, each stent portion 102 may have 4, 5, 6, 7, 8, 9, 10, 11, or 12 peaks 102A for each stent portion 102. In one example, each peak forms an angle within a range of about 25 to 70 degrees.
The embodiments of
In one example, a stent 120 has a compressed configuration of about 0.017 inches in diameter and a compressed peak angle of about 0-40 degrees, or about 5-20 degrees, and an expanded configuration of about 0.157 inches in diameter and an expanded peak angle of about 10-90 degrees, or about 30-60 degrees. The compressed configuration is when the stent is in the delivery catheter, and the expanded configuration is when the stent is freed from the delivery catheter.
Note,
The stent 120 is created, in one embodiment, by bending an end 122C of the wire 101 around a mandrel post 112 in the first row 112A (starting on the left in
Once the second pass around the circumference of the mandrel 110 in the specified pattern is complete, the wire 101 has formed a stent portion 122 having peaks 122A that open toward each other (i.e., “point” in opposite directions, either proximally facing or distally facing) and wound wire segments/peak linking segments 122D between the peaks which cross each other in an alternating pattern in which the second pass of the wire 101 is positioned over a prior wire segment 122D and under a prior wire segment 122D. This alternating pattern can be seen in
Next, the same wire pattern is continued between the second rows of posts 112B and third rows of posts 112C to create the next stent region 122 (see continuation points 123A, 123B, and 123C in
The mandrel 110 can have any number of posts 112 within each row (e.g., 6, 8, 10, or 12) which can affect the number of waves, weaving pattern, and similar aspects of the stent 120. Once completely woven on the mandrel 110, the stent 120 can be heat set to retain the woven shape. The free terminal ends of the wire 122C can be formed into a loop, welded, looped around adjacent portions of the wires 101, or otherwise connected to other portions of the stent 120.
In short, each stent 120 is composed of stent portions 122 in which the wire creates a first wave pattern and a second, wave pattern that is inverse or opposite of the first wave pattern, and further where each of the straight portions 122D cross each other so as to alternate between the first wave and then the second wave being on top of each other. Adjacent stent portions 122 have peaks 122A that are interlocked with the peaks 122A of immediately adjacent stent portions 122. Since these peaks are interlocked (meaning the wire comprising the peaks are intertwined due to the over/under winding pattern), the peaks cannot completely separate from each other, helping to minimize foreshortening as the stent expands from its collapsed configuration.
There are several ways to determine the H1 and H2 peak heights for a stent. One method is to measure the peak in both the stent's radial expanded and compressed configurations and perform the prior calculation. A second method is to use trigonometry equations to make use of other known measurements of the peaks to provide an estimate of the height, as discussed in detail below.
As can be appreciated in the context of
The region or cell formed between each set of interconnected peaks resembles a diamond, as discussed above, and as can be appreciated with regard to
Generally, this means foreshortening will be minimized in situations where peak angle and peak height do not change much as the stent adopts its expanded configurations. The sinusoidal profile can be designed in such a way to ensure this is the case, for instance by tailoring peak angle and peak height, adjusting the number of peaks in the waveform and the number of stent segments utilizing the waveforms, etc.
In one example calculation, if α1=2.5 degrees (5 degrees total peak angle) and α2=15 degrees (30 degrees total peak angle), the foreshortening is about 3.3%. If α1=5 degrees and α2=60 degrees, the foreshortening is about 13%. If α1=10 degrees (20 degrees total peak angle) and α2=15 degrees (30 degrees total peak angle), the foreshortening is about 2%. If α1=10 degrees (20 degrees total peak angle) and α2=30 degrees (60 degrees total peak angle), the foreshortening is about 12%. This means that peak angles within this range have an associated foreshortening of less than 15%, which is significantly less than traditional braided stents which can be in the range of 50%-70%. It should also be noted that the net of effect of foreshortening will tend to decrease along the length of the stent due to the cumulate impact of overlapping wires and associated friction along the stent length. Therefore, these calculations are done for a representative peak within the stent, but the overall foreshortening will likely be less than even what is calculated. Furthermore, the inclusion of more peaks in the waveform, more stent segments along the length of the stent, etc. may further reduce the overall foreshortening of the stent. Again, the foreshortening percentage should be construed as a function of the collapsed (e.g., sheathed) shape to the fully expanded shape, or in other words how much the overall length decreases as the stent expands from its collapsed delivery state to its released expanded state.
Note, these calculations have been generally described for a stent design utilizing the overlapping wire/peak concept of
The purpose of the stent can also affect the design. Flow diversion stents are placed against the neck of a treatment site (e.g., aneurysm) and utilize a low porosity profile to reduce blood flow into the aneurysm, promoting tissue growth over time. Where a sinusoidal-type stent is used in a flow diversion setting, more wave sections 102 along the length of the stent would be preferred to increase metal surface coverage and decrease open space. In some examples, a stent with a length of about 25 mm can have about 8-15 wave sections 102. Additionally, more peaks can be used along each wave section 120 (in order words, a higher frequency/lower wavelength type wave section 102 shape) to further increase the metal surface coverage.
Coil or embolic assist stents, on the other hand, are placed against a treatment site (e.g., aneurysm) and have relatively large pore space designed to allow embolic agents such as coils to be delivered through the stent and into the target area. The stent then acts as a scaffold to keep the embolic material within the treatment site. For this purpose, more porosity is desirable. For these purposes, a stent with a length of about 25 mm can have about 5-7 wave sections 102. The height of each wave will depend on the number of wave sections used, where 5 wave-like stent sections 102 are used across the length of the stent, for a length of 25 mm each wave (representing the distance between a peak facing in one direction to the adjacent peak facing in the opposed direction) would be about 5 mm. For a similar stent length, more wave sections would result in smaller wave/peak heights while fewer wave sections would result in larger wave/peak heights. Furthermore, the number of peaks can be tailored (e.g., fewer peaks) to increase the overall porosity of the stent.
Stent 100, 120 can, in various embodiments, be wound in a number of different ways, for instance winding in such a way that each section 102/122 of the stent is wound in the same direction (e.g., clockwise) or winding in such a way that each section 102/122 is wound in an alternating direction (e.g., a first section clockwise, the next section counter-clockwise, etc). Alternating the circumferential direction (e.g., one section clockwise, the next section counter-clockwise) that the portions 102/122 are woven may introduce some resistance between sections 102/122 which may help improve the structural integrity of the stents 100/102 to remain open within a vessel after deployment. Meanwhile, a more consistent circumferential winding pattern (e.g., every section wound clockwise, or every section wound counterclockwise) would generally reduce residual stiffness of the stent and thereby improve deployment and expansion from the delivery catheter in various vessel shapes. In other words, each technique offers an advantage, depending on the particular desired characteristics of the stent. For instance, where high flexibility is needed (e.g. where the stent is deployed across a tortuous blood vessel), a consistent circumferential wind pattern can be beneficial to promote flexibility. Where high structural strength is needed (e.g., propping open a diseased vessel, diverting flow from an aneurysm, or acting as a scaffold to keep embolic material within an aneurysm), an alternating wind pattern can be used to promote structural stability.
While the entire stent may be formed with the wavelike or sinusoidal pattern shown for stent 100 or 120, it is also possible that only smaller segments of the stent may include this pattern. For example,
In this respect, the stent 140 has a portion 142 that will foreshorten as it is deployed, but also includes the sinusoidal/wave-like portion 144 that will not substantially foreshorten. While portion 144 can be positioned at either the proximal or distal end of portion 142, it may be of most use on the proximal end to allow the final positioning of the stent to be more predictably determined by the physician.
In addition to providing more predictable foreshortening, the wave-like portion 144 provides a separate braid pattern relative to portion 142 that can help decouple the proximal end from forces created by deploying in a curved vessel. This is since the two portions 142, 144 are not connected together by a single braid pattern, but instead are only connected along spaced intervals as shown in
For example, a physician may initially deploy the distally-oriented stent portion 142 from a delivery catheter, allowing it to foreshorten. With most of the distal portion of the stent 140 is deployed in a desired position (i.e., the portion 142), the remaining proximal wave-like portion 144 will exhibit little foreshortening as it deploys, thereby making the final placement of the proximal end of the stent 140 more predictable. Additionally, if the entire portion 142 has deployed and fully expanded, the physician can be confident that proximally-oriented wave-like region 144 will also fully expand when deployed, since it is effectively decoupled from the braid pattern of portion 142.
Some embodiments may include multiple stent segments that are all traditionally woven with wires in longitudinal, helical patterns. These segments may not reduce foreshortening as much as segments with the circumferentially braided wires but may provide the previously discussed “decoupling” effects that allow a proximal end of a stent to reliably open when deployed within a curved vessel.
For example,
In one embodiment, the stent 150 is created by first weaving the middle portion 156 on a tubular mandrel utilizing a traditional helical/longitudinal winding technique to create a singular mesh element. In the present example, a relatively smaller wire size, such as in the range of 0.0005 to about 0.002 inch in diameter, can be used. The wire is woven in an over/under pattern helically and longitudinally to form the length of the middle portion.
Next, the intermediate woven portions 154 are woven. These portions 154 can be further woven on the same mandrel if sufficient space is provided or can be separately woven in the traditional back and forth pattern and attached to each end of the middle portion 156 (e.g., via welding, coils, or similar methods). In the present example, the wires of each portion 154 are woven through one or more of the cells of the middle portion 156 and then are further woven in an over/under pattern helically and longitudinally to form a length of each of the intermediate portions 154. Each intermediate portion 154 can be woven from a single wire having an example diameter size in the range of 0.001 inch through 0.010 inch, though weaving with a plurality of wires of that size is also possible.
Next, the terminal portions 152 are woven. These portions 152 can be further woven on the same mandrel as the prior portions if sufficient space is provided but can be separately woven and attached also. In the present example, the wires of each portion 152 are woven through one or more of the end loops on the free end of the intermediate portion 154 and then are further woven in an over/under pattern, in which the wire is helically and longitudinally positioned to form a length of each of each portion 153. Each terminal portion 152 can be woven from a single wire having an example diameter size in the range of 0.001 inch through 0.010 inch, though weaving with a plurality of wires that size is also possible. Once this weaving is complete, the end loops of the portion 152 facing the middle portion 156 are connected to the end loops of portion 154 facing away from the middle portion 156 so as to create an interface 159 or joint within the stent 150. The stent can be deployed in a manner similar to other stents in this specification, especially in a curved vessel.
It should be understood that different aspects of the embodiments of this specification can be interchanged and combined with each other. In other words, additional embodiments are also specifically contemplated by combining different feature from different embodiments. Therefore, while specific embodiments are shown in the Figures, it is not intended that the invention necessarily be solely limited to those specific combinations.
Although the invention has been described in terms of particular embodiments and applications, one of ordinary skill in the art, in light of this teaching, can generate additional embodiments and modifications without departing from the spirit of or exceeding the scope of the claimed invention. Accordingly, it is to be understood that the drawings and descriptions herein are proffered by way of example to facilitate comprehension of the invention and should not be construed to limit the scope thereof.
This application claims priority to U.S. Provisional Application Ser. No. 62/755,142 filed Nov. 2, 2018 entitled Stent, which is hereby incorporated herein by reference in its entirety.
Number | Date | Country | |
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62755142 | Nov 2018 | US |