|Publication number||US20070156170 A1|
|Application number||US 11/654,757|
|Publication date||Jul 5, 2007|
|Filing date||Jan 18, 2007|
|Priority date||Jan 23, 2001|
|Also published as||US6610077, US8366737, US20110106138|
|Publication number||11654757, 654757, US 2007/0156170 A1, US 2007/156170 A1, US 20070156170 A1, US 20070156170A1, US 2007156170 A1, US 2007156170A1, US-A1-20070156170, US-A1-2007156170, US2007/0156170A1, US2007/156170A1, US20070156170 A1, US20070156170A1, US2007156170 A1, US2007156170A1|
|Inventors||David Hancock, William Tremulis, Saypin Phonthalasa, Olin Palmer, Larry Voss, Gary Walker|
|Original Assignee||David Hancock, Tremulis William S, Saypin Phonthalasa, Olin Palmer, Larry Voss, Walker Gary A|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (4), Referenced by (5), Classifications (11)|
|External Links: USPTO, USPTO Assignment, Espacenet|
The present invention relates generally to filtering and thrombectomy devices and systems which can be used to capture embolic material or thrombi found in blood vessels. The filtering devices and systems of the present invention are particularly useful when performing balloon angioplasty, stenting procedures, laser angioplasty or atherectomy in critical vessels where the release of embolic debris into the bloodstream can occlude the flow of oxygenated blood to the brain or other vital organs, which can cause devastating consequences to the patient. The thrombectomy devices are suited for the removal of thrombus in a variety of vessels. While the embolic filtering and thrombectomy devices and systems of the present invention are particularly useful in the cerebral vasculature and neurovasculature, the inventions can be used in conjunction with any vascular interventional procedure in which there is an embolic risk.
A variety of non-surgical interventional procedures have been developed over the years for opening stenosed or occluded blood vessels in a patient caused by the build up of plaque or other substances on the wall of the blood vessel. Such procedures usually involve the percutaneous introduction of the interventional device into the lumen of the artery, usually through a catheter. In typical PTA procedures, a guiding catheter or sheath is percutaneously introduced into the cardiovascular system of a patient through the femoral artery and advanced to near the target vasculature. A guidewire and a dilatation catheter having a balloon on the distal end are introduced through the guiding catheter with the guidewire sliding within the dilatation catheter. The guidewire is first advanced out of the guiding catheter into the patient's vasculature and is directed across the arterial lesion. The dilatation catheter is subsequently advanced over the previously advanced guidewire until the dilatation balloon is properly positioned across the arterial lesion. Once in position across the lesion, the expandable balloon is inflated to a predetermined size with a radiopaque liquid at relatively high pressures to radially expand the atherosclerotic plaque of the lesion and thereby dilate the lumen of the artery. The balloon is then deflated to a small profile so that the dilatation catheter can be withdrawn from the patient's vasculature and the blood flow resumed through the dilated artery. As should be appreciated by those skilled in the art, while the above-described procedure is typical, it is not the only method used in angioplasty. Another procedure is laser angioplasty which utilizes a laser to ablate the stenosis by super heating and vaporizing the deposited plaque. Atherectomy is yet another method of treating a stenosed blood vessel in which cutting blades are rotated to shave the deposited plaque from the arterial wall. A vacuum catheter is usually used to capture the shaved plaque or thrombus from the blood stream during this procedure.
In the procedures of the kind referenced above, abrupt reclosure may occur or restenosis of the artery may develop over time, which may require another angioplasty procedure, a surgical bypass operation, or some other method of repairing or strengthening the area. To reduce the likelihood of the occurrence of abrupt reclosure and to strengthen the area, a physician can implant an intravascular prosthesis for maintaining vascular patency, commonly known as a stent, inside the artery across the lesion. The stent is crimped tightly onto the balloon portion of the catheter and transported in its delivery diameter through the patient's vasculature. At the deployment site, the stent is expanded to a larger diameter, often by inflating the balloon portion of the catheter.
Prior art stents typically fall into two general categories of construction. The first type of stent is expandable upon application of a controlled force, as described above, through the inflation of the balloon portion of a dilatation catheter which, upon inflation of the balloon or other expansion means, expands the stent to a larger diameter to be left in place within the artery at the target site. The second type of stent is a self-expanding stent formed from, for example, shape memory metals or super-elastic nickel-titanum (NiTi) alloys, which will automatically expand from a compressed state when the stent is advanced out of the distal end of the delivery catheter into the body lumen. Such stents manufactured from expandable heat sensitive materials allow for phase transformations of the material to occur, resulting in the expansion and contraction of the stent.
The above minimally invasive interventional procedures, when successful, avoid the necessity of major surgical operations. However, there is one common problem which can become associated with all of these types of procedures, namely, the potential release of embolic debris into the bloodstream that can occlude distal vasculature and cause significant health problems to the patient. For example, during deployment of a stent, it is possible that the metal struts of the stent can cut into the stenosis and shear off pieces of plaque which become embolic debris that can travel downstream and lodge somewhere in the patient's vascular system. Pieces of plaque material can sometimes dislodge from the stenosis during a balloon angioplasty procedure and become released into the bloodstream. Additionally, while complete vaporization of plaque is the intended goal during a laser angioplasty procedure, quite often particles are not fully vaporized and thus enter the bloodstream. Likewise, not all of the emboli created during an atherectomy procedure may be drawn into the vacuum catheter and, as a result, enter the bloodstream as well.
When any of the above-described procedures are performed in the vessels supplying blood to the brain, the release of emboli into the circulatory system can be extremely dangerous and sometimes fatal to the patient. Naturally occurring debris can also be highly dangerous to a patient. That is, debris which travels through the blood vessel as a natural result of bodily functions or disease states and not as a result of an intervention procedure. Debris that is carried by the bloodstream to distal vessels of the brain can cause these cerebral vessels to occlude, resulting in a stroke, and in some cases, death. Therefore, although cerebral percutaneous transluminal angioplasty has been performed in the past, the number of procedures performed has been limited due to the justifiable fear of causing an embolic stroke should embolic debris enter the bloodstream and block vital downstream blood passages.
Medical devices have been developed to attempt to deal with the problem created when debris or fragments that naturally occur or that enter the circulatory system following vessel treatment utilizing any one of the above-identified procedures. One approach which has been attempted is the cutting of any debris into minute sizes which are unlikely to occlude major vessels within the patient's vasculature. However, it is often difficult to control the size of the fragments which are formed, and the potential risk of vessel occlusion still exists, making such a procedure in the carotid arteries a high-risk proposition.
Other techniques which have been developed to address the problem of removing embolic debris include the use of catheters with a vacuum source which provides temporary suction to remove embolic debris from the bloodstream. However, as mentioned above, there have been complications with such systems since the vacuum catheter may not always remove all of the embolic material from the bloodstream, and a powerful suction could injure the patient's vasculature or remove more blood than is safe. Other techniques which have had some limited success include the placement of a filter or trap downstream from the treatment site to capture embolic debris before it reaches the smaller blood vessels downstream. However, there have been problems associated with conventional filtering systems. In particular, certain previously developed filtering devices do not optimize the area for embolic collection. That is, conventional filtering devices may not present a collection device that spans the entity of the vessel or it may include supporting structure that itself impedes emboli collection. Certain other devices are not effective when used in conjunction with a microcatheter.
Moreover, thrombectomy and foreign matter removal devices have been disclosed in the art. However, such devices have been found to have structures which are either highly complex or lacking in sufficient or effective expansion and retraction capabilities. Disadvantages associated with the devices having highly complex structure include difficulty in manufacturability as well as use in conjunction with microcatheters. Other less complex devices can pull through clots due to in part the lack of experience in using the same, or lack an adequately fine mesh for capturing clots or foreign bodies.
Furthermore, systems heretofore disclosed in the art are generally limited by size compatibility and the increase in vessel size as the emboli is drawn out from the distal vascular occlusion location to a more proximal location. If the thrombectomy device is too large for the vessel it will not deploy correctly to capture the clot or foreign body, and if too small in diameter it cannot capture thromboembolic material or foreign bodies across the entire cross section of the blood vessel. Thus, a thrombectomy device that can be expanded to a relatively large diameter from a relatively small diameter is desirable as is the ability to effectively control such expansion and contraction.
What has been needed is a reliable filtering or thrombectomy device and system for use when treating blood vessels. The filter devices should be capable of filtering any naturally occurring embolic debris or that which may be released into the bloodstream during an interventional treatment, while minimizing the area occupied by structure supporting the filter so as to minimally obstruct blood flow, and safely contain the debris until the filtering device is removed from the patient's vasculature. The thrombectomy devices should embody an expanded profile that completely occupies the vessel at the repair site as well as structure for effectively expanding and retracting the device. Moreover, such devices should be relatively easy to deliver through a microcatheter, as well as be deployed and removed from the patient's vasculature and also should be capable of being used in narrow and very distal vasculature such as the cerebral vasculature. The following invention addresses these needs.
Briefly and in general terms, the present invention is directed toward expandable devices for repairing blood vessels. The expandable devices are particularly suited for removing emboli or thrombi from the bloodstream of a human or animal. One significant advantage provided by the present invention is the potential use of the expandable devices in narrow and very distal vasculature.
In one aspect of the invention, there is provided a loop with an embolic filter attached thereto. The loop is configured to self-expand generally perpendicularly to and optionally offset to a longitudinal axis of a delivery catheter. A tether is provided to effect the deployment from and withdrawal into the delivery catheter. The self-expandable loop and filter structure advantageously expands to occupy the entire cross-section of the lumen into which it is deployed. When the device is in its expanded configuration, the shape of the loop is defined by the lumen and the tether is positioned near a wall of the lumen.
In another aspect, the present invention includes multiple loops that are connected by longitudinally extending fibers. The connecting fibers may be crossing or non-crossing and may terminate at a superior loop or continue distally to define a tapered distal end. A catheter is provided for deploying the double loop device as is a tether which effectuates the delivery and withdrawal of the device. The multiple loops are intended to self-expand to occupy the entirety of the cross-section of the blood vessel into which it is deployed, the loops assuming the geometry of the vessel. Additionally, when the device is in its expanded configuration, the tether is intended to generally lie adjacent a wall defining the lumen thereby accomplishing less blood flow obstruction. The distal loops may also provide internal support for an embolic filter, facilitating material entry into the filter.
In a third aspect of the invention, an embolectomy snare is provided which has the advantage of being able to assume a very small profile when packed within a delivery catheter. The embolectomy snare is characterized by including a basket that is formed from non-overlapping elongate members.
In a fourth aspect of the invention, improved expansion control and a means for optimizing expansion profiles is incorporated into a thrombectomy device. In particular, one or more stops are provided on an elongate member to cause a basket-like thrombectomy device configured coaxially about the elongate member to thereby open and close the basket. By varying the weave pattern of the basket of the thrombectomy device, upon expansion of the same, a concavity can be formed, the same being particularly useful for engaging and removing clots from a blood vessel.
These and other objects and advantages of the invention will become apparent from the following more detailed description, when taken in conjunction with the accompanying drawings of illustrative embodiments.
Turning now to the drawings, and particularly to
In one presently preferred embodiment, the expandable device 20 includes a loop 24 attached by conventional means to a distal end 26 of an elongate member 28. Attached to the loop 24 is an emboli filter 30. The loop 24 can be soldered to the elongate member 28 or can be affixed thereto using epoxy or other forms of adhesive. Alternatively, the loop 24 can be an integral part of the elongate member 28 (See
An elongate, tubular catheter 36, preferably a microcatheter or otherwise a lumen of a conventional stent delivery catheter, is also provided. The microcatheter 36 includes an internal bore 38 that is adapted to coaxially and slidably receive the elongate member 28 as well as the looped member 24 and emboli filter 30 assembly. The delivery catheter 36 is capable of being manipulated independent of the elongate member 28 and loop/filter assembly, for example, by holding the delivery catheter 36 in a particular longitudinal position while advancing the elongate member 28. Alternatively, the delivery catheter 36 can be withdrawn or advanced while maintaining a desired longitudinal position of the elongate member 28.
The loop 24 is preferably made from a looped length of superelastic wire. The elongate member 28 can be formed from a guide wire.
Significantly, the loop 24 is configured so that when it exits the distal end 40 of the delivery catheter 36, the loop 24 projects generally perpendicularly to longitudinal axes of the elongate member 28 and catheter 36. It is also contemplated, that for particular purposes, the loop 24 could project at an acute or obtuse angle respecting the elongate member 28. Accordingly, it is contemplated that the loop 21 also embodies shape retaining material and a material that permits the loop 24 to quickly and repeatedly return to a desirable pre-formed shape.
It is also highly significant that the loop 24 embodies sufficient flexibility so that upon ejection from the delivery catheter 36, the loop 24 generally conforms to an inside circumference of a blood vessel 42 into which it is deployed. In doing so, the elongate member 28 and distal portion 40 of the delivery catheter 36 are generally positioned adjacent walls 44 defining an interior lumen of the blood vessel 42. Thus, the expandable loop 24 spans the entirety of the circumference of the vessel 42. Moreover, the elongate member 28 and delivery catheter 36 are advantageously displaced from the center or median of the bloodflow, such that debris traveling through the vessel can avoid these components and must pass through the loop 24.
In an alternative embodiment (
The filter 30 includes a proximally directed opening 48 to an interior 50. The body 52 of the filter 30 can have any exterior profile but it is preferred that its exterior generally assume a hemispherical or conical shape. The fully expanded filter 30 has an opening 48 to the body 52 that is generally circular but can be modified for a particular application. In one preferred embodiment, the body 52 is made from a mesh-fabric material through which blood can readily flow. The mesh contains apertures or pores 54 through which the blood passes but which are small enough so that debris does not flow therethrough. Alternatively, the filter can embody laser cut mylar or is defined by ultrasonically welded polymer fibers. In yet another aspect, the fiber crossing can be bonded with flexible adhesive.
The filter sub-assembly 30 can be made from surgical mesh or alternatively the filter 30 can embody a network of braided members or fibers. For example, the filter can embody a braided expansion wire 50. In one presently preferred embodiment, the expandable device 20 consists of an elongate member 28 or guidewire with a metal braided basket (not shown) attached to a loop or otherwise directly attached to a superior end of the wire.
It is additionally contemplated that, as shown in
A shape set loop 24 is then threaded through the reversals 62. By doing so, the braided basket 56 is fixed to the loop 24. In a presently preferred embodiment, the polypropylene suture 58 has a diameter of 0.003 inches, the polymide tubing 66 has an inner diameter of 0.0318 inches and an outer diameter of 0.0364 inches, and the loop 24 is formed from 0.003 inch diameter nickel titanium wire.
It is contemplated that in one preferred embodiment the braided basket 56 comprises an 8-strand pattern that results in a closed net. The length of the basket 56 will vary depending on the size of the material to be removed. The diameter of the basket 56 will also vary from 2 mm to 50 mm depending on the lumen diameter of the vessel from which material is to be removed. The basket 56 is attached to a loop 24 which opens the proximal end of the basket 51, allowing entry of material into the basket 56. The loop 24 may be formed of a variety of elastic 24 or superelastic materials. The diameter of the loop 24 will match that of the basket 56. The loop 24 may be covered, in part or in full, with a platinum coil to minimize the potentiality of trauma caused by the device, and/or to enhance attachment of the basket 56 to the loop 24. The inner diameter of this coil corresponds to the outer diameter of the loop strand, allowing for clearance. A typical coil is 0.009 inches in inner diameter with a wire diameter of .0025 inches. The loop 24 is attached to the elongate member 28 via soldering and other joining technology.
The expandable devices 20 advantageously embody a simple structure that can assume a very small contracted profile. Thus, the device can be used in conjunction with a flexible microcatheter 36 that can traverse very narrow, tortuous and distal vasculature. Upon expansion, the self-expanding loop 24 assumes the contour of the vessel into which it is deployed thereby providing an optimized structure for capturing debris. Moreover, when the loop 24 is expanded, the microcatheter 36 and elongate member 28 lie adjacent a wall defining vessel and substantially out of the way of the flow path. Accordingly, the expandable device 20 can be used to effectively repair virtually any portion of a patient's vasculature by simply modifying the range of expanded loop 24 sizes.
Referring now to
In one preferred embodiment of the dual looped device 70, the elongate member 28 is comprised of Nitinol and includes a 0.004 inch outer diameter reduced section for receiving portions of the loops 72, 74. Platinum coils (not shown) are employed to accomplish affixing via soldering or similar means, the loops 72, 74 to the elongate member 28. The connecting fibers 76 comprise polypropylene strands. Further, in a preferred embodiment, the connecting fibers 76 are routed such that there are five (5) points of connection per loop 72, 74, however, few or as many as 10 or more points of connection are contemplated.
The dual-looped device 70 is also contemplated to be used with a generally tubular delivery catheter 76 that is adapted to slidably receive the elongate member 28 as well as receive compressed loops 72, 74. The dual-loop device 70 also embodies the advantages associated with the single loop design. That is, the loops 72, 74 self-expand to assume the entire contour of a blood vessel into which it is employed in such a manner that the delivery catheter 36 and elongate member 28 lie adjacent to the vessel wall that is substantially out of the flow path.
In use, the expandable devices depicted in
As the expandable device 20, 70 expands, it projects at a generally perpendicular angle (though any angle is possible) with respect to the elongate member 28 and the loop 24 or loops 72, 74 assume the contour of the interior of the vessel of lumen. Moreover, the filter body 52 is opened by the expansion of the loop 24 and in the case of the dual-looped device 70, the expansion of the loops 72, 74 facilitate the formation of the embolic receiving cavity 78.
Once it is in its fully deployed configuration, the expandable devices 20, 70 are capable of capturing emboli or other debris traveling antegrade in the bloodstream. The debris enters an opening to the filter body 52 or the emboli receiving cavity 76 and is captured therein. Once the debris is captured, the expandable device 20, 70 may be removed from the vasculature, or other means such as a suction device can be employed to independently first remove the debris and thereafter, the expandable device can be withdrawn.
With reference to
The snare device 80 advantageously embodies elements which are non-overlapping. To wit, snare device 80 can be packed very tightly within an interior 38 of the delivery catheter 36 such as a microcatheter. This feature is shown in
In use, the snare device 80 is placed in its compressed state within a delivery catheter 38 that is advanced within vasculature to a repair site. The snare device 80 is then ejected from a distal end 40 of the delivery catheter 36 and permitted to self-expand within the target vessel. The expanded snare device 80 is then brought into engagement with embolic material found in the bloodstream. The pocket defined by the basket profile 83 then receives and captures the embolic material, which is then capable of being removed from a patient's vasculature.
It is also to be recognized, however, that the devices described herein can also be delivered through a guidewire lumen of a balloon or stent catheter. This allows for direct placement without requiring the use of a micro-catheter.
Turning now to
A retainer 108 is provided at a distal end 110 of the basket device 100. The retainer 108 has a generally cylindrical profile and includes an internal bore (not shown). The retainer 108 functions to maintain the distal end 110 of the basket device in a closed configuration both when the basket 100 is unexpanded and when it is expanded.
The basket device assembly device 100 is adapted to be slidably placed about an elongate member 112 in a coaxial arrangement. The elongate member 112 is likewise received in the retainer 108 in a coaxial arrangement. Elongate member 112 includes a plurality of beads 114, the outer profile which is greater than the internal bore of the retainer 108 but smaller than an internal diameter of the elongate tubular member 106.
The beads 114 have a dual function. A proximally positioned bead 114 is employed, as shown in
As stated, the basket device 100 can also be used in combination with the microcatheter. In a first step of use, the microcatheter is employed to deliver an elongate wire 112 which includes only a single bead 114. The microcatheter is then completely withdrawn from a patient's vasculature and a basket device 100 is threaded over the elongate member 112. Once the retainer 108 of the basket device 100 is advanced sufficiently to engage the bead 114, the basket device 100 can be made to expand radially outwardly. In the event use of a microcatheter is essential to the specific application, this alternative approach allows for the use of a basket device 100 with an elongate tubular member that has a larger outer diameter than an inner diameter of the microcatheter, which advantageously allows for increased pushability and column strength on the elements 103 defining the basket portion 102.
In view of the foregoing, it is clear that the expandable devices of the present invention are useful for the repair of vasculature. In particular, the disclosed expandable devices are particularly useful for the capture of emboli as well as for use in thrombectomy procedures.
It will be apparent from the foregoing that, while particular forms of the invention have been illustrated and described, various modifications can be made without departing from the spirit and scope of the invention. Accordingly, it is not intended that the invention be limited, except by the appended claims.
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|International Classification||A61M29/00, A61F2/01|
|Cooperative Classification||A61F2002/016, A61F2002/018, A61F2230/0069, A61F2230/008, A61F2230/0097, A61F2230/0065, A61F2/013|