US20190015120A1 - Multi-pivot thrombectomy device - Google Patents
Multi-pivot thrombectomy device Download PDFInfo
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- US20190015120A1 US20190015120A1 US15/934,838 US201815934838A US2019015120A1 US 20190015120 A1 US20190015120 A1 US 20190015120A1 US 201815934838 A US201815934838 A US 201815934838A US 2019015120 A1 US2019015120 A1 US 2019015120A1
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- struts
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
- A61B17/12109—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/01—Filters implantable into blood vessels
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/01—Filters implantable into blood vessels
- A61F2/0108—Both ends closed, i.e. legs gathered at both ends
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/01—Filters implantable into blood vessels
- A61F2/012—Multiple filtering units
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/00336—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means with a protective sleeve, e.g. retractable or slidable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00743—Type of operation; Specification of treatment sites
- A61B2017/00778—Operations on blood vessels
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/22031—Gripping instruments, e.g. forceps, for removing or smashing calculi
- A61B2017/22034—Gripping instruments, e.g. forceps, for removing or smashing calculi for gripping the obstruction or the tissue part from inside
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
- A61B2017/2212—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having a closed distal end, e.g. a loop
Definitions
- vascular debris e.g., thrombus, embolus
- a thrombus is a stationary blood clot that is often found along the wall of a blood vessel and may cause vascular obstruction. Thrombus is usually formed in vivo as the final product of the blood coagulation step in hemostasis. In relatively large blood vessels, a thrombus will typically decrease the blood flow through that vessel. In smaller blood vessels, blood flow may be completely cut-off resulting in death of tissue supplied to that vessel.
- a dislodged thrombus is often referred to as an “embolus.”
- Vascular obstruction or ischemia is the insufficient supply of blood to an organ, usually due to a blocked blood vessel. Symptoms of vascular obstruction may include chest pains, loss of vision, and in some cases death.
- Thrombectomy is a surgical procedure that involves the removal of a thrombus from a patient's vasculature.
- Certain vascular devices are important for their intervening roles in patients with vascular debris in their vasculature.
- Some techniques for removing vascular debris utilize balloon catheters, aspiration catheters, and the like. These techniques may have safety (e.g., intimal lesions) and performance issues (e.g., use limited to certain arteries). Therefore, there is a need to provide additional systems and methods for removing vascular debris from a vasculature that are safe and overcome some of the existing performance issues.
- the subject technology may be used to remove any vascular debris that is compatible with one or more embodiments with the subject technology.
- Some embodiments provide a system for retrieving vascular debris in a vasculature comprising at least two segments radially expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; at least one intermediate portion, each intermediate portion comprising a pivot that connects adjacent segments, each pivot having a diameter comprising the radially largest region of the pivot; an outer lumen that is configured to at least partially encapsulate the segments in the compressed state; and a tether that is configured to retrieve a segment in the expanded state into the outer lumen.
- At least one segment is substantially spherical. In some embodiments, the segments comprises radially-expandable struts. In some embodiments, a segment comprises at least two struts. In some embodiments, a segment comprises at least three struts. In some embodiments, a segment comprises at least four struts. In some embodiments, a segment comprises at least five struts. In some embodiments, a segment comprises at least six struts. In some embodiments, a segment comprises at least seven struts. In some embodiments, a segment comprises at least eight struts. In some embodiments, a segment comprises at least nine struts. In some embodiments, a segment comprises at least ten struts.
- a segment comprises at least eleven struts. In some embodiments, a segment comprises at least twelve struts. In some embodiments, at least one strut diverges from the longitudinal axis, divides into at least two struts, merges with an adjacent strut, and converges toward the longitudinal axis.
- Some embodiments provide a system comprising at least three segments. Some embodiments provide a system comprising at least four segments. Some embodiments provide a system comprising at least five segments. Some embodiments provide a system comprising at least six segments. Some embodiments provide a system comprising at least seven segments. Some embodiments provide a system comprising at least eight segments. Some embodiments provide a system comprising at least nine segments. Some embodiments provide a system comprising at least ten segments.
- Some embodiments provide a system for retrieving vascular debris in a vasculature comprising at least three segments expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; at least two intermediate portion, each intermediate portion comprising a pivot that connects adjacent segments, each pivot having a diameter comprising the radially largest region of the pivot; an outer lumen that is configured to encase the segments in a compressed state; and a tether that is configured to retract the segments into the outer lumen.
- Some embodiments provide a method of retrieving vascular debris from a vasculature comprising inserting into the vasculature of a patient at least a portion of an outer lumen comprising a distal opening and encasing at least two or more segments expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; releasing at least a portion of a segment outside the distal opening wherein at least a portion of the segment expands to engage the vascular debris; and retrieving the segment and at least a portion of the vascular debris inside the outer lumen.
- the vascular debris is a thrombus or an embolus.
- the outer diameter of the outer lumen is no larger than 50% of the diameter of the vasculature.
- FIG. 1 illustrates embodiments of a vascular intervention device.
- FIG. 2 illustrates a partial end view of the device of FIG. 1 , taken along the direction indicated by the arrows 2 - 2 in FIG. 1 .
- FIG. 3 illustrates a partial end view of the device of FIG. 1 , taken along the direction indicated by the arrows 3 - 3 in FIG. 1 .
- FIG. 4 illustrates an example configuration of a widened portion for use on struts of device of FIG. 1 .
- FIG. 5 illustrates a cut pattern for use in making embodiments of the device.
- FIG. 6 illustrates a detail view of a proximal section of the cut pattern of FIG. 5 .
- FIG. 7 illustrates a detail view of a distal section of the cut pattern of FIG. 5 .
- FIG. 8 illustrates a device made with the cut pattern of FIGS. 5, 6, and 7 .
- FIG. 9 illustrates a detail view of the proximal section of the device of FIG. 8 .
- FIG. 10 illustrates a proximal end view of the proximal section of the device of FIG. 8 .
- FIG. 11 illustrates a detail view of the distal section of the device of FIG. 8 .
- FIG. 12 illustrates a distal end view of the distal section of the device of FIG. 8 .
- FIGS. 13A and 13B illustrate embodiments of a vascular intervention device.
- FIGS. 14A, 14B, and 14C illustrate embodiments of a vascular intervention device delivery system in a vasculature.
- FIGS. 15A, 15B, and 15C illustrate embodiments of a vascular intervention device delivery system in a vasculature.
- FIGS. 1-3 illustrate an example embodiment of a vascular intervention device 50 that may be used to remove vascular debris (e.g., thrombus) that can obstruct the normal flow of blood in a vasculature.
- the device 50 comprises two segments (a proximal segment 52 and a distal segment 56 ) and a pivot section 54 .
- the device 50 can be delivered via a sheath such as a catheter 144 into the vasculature and positioned at or near a target site in order to expand, engage and retrieve vascular debris (thrombus 142 ).
- the device 50 may be more compliant than the vasculature in which it is deployed such that it may be somewhat misshapen after being deployed, and that certain shapes described herein are when the device 50 is an expanded (e.g., further expanded) state with no restriction.
- the device 50 may comprise any number of segments that is compatible with one or more embodiments of the subject technology.
- the total number of segments may range from about 2 to about 15 or more depending on the a number of factors such as, but not limited to, size, shape, and location of the vascular debris within a vasculature. It is generally desirable that the device 50 is at least as long as the targeted vascular debris.
- FIGS. 13A-15C illustrate other embodiments of the vascular intervention device 50 that include three or more segments.
- the vascular intervention device 50 may have three segments, namely a proximal segment 52 , a distal segment 56 , and an intermediate segment 134 a.
- FIGS. 13B and 15A-15C illustrate a vascular intervention device 50 having four segments, namely a proximal segment 52 , a distal segment 56 , and two intermediate segments 134 a and 134 b.
- a vascular intervention device having a plurality of segments may provide a number of advantages related to the removal of vascular debris in a vasculature.
- certain segments e.g., distal, intermediate
- a plurality of segments may also provide a greater margin for error when positioning and deploying the vascular intervention device 50 near a target site.
- the proximal segment 52 can be radially self-expanding and may comprise a plurality of radially self-expanding struts 58 .
- Six struts 58 are depicted in the proximal segment 52 of FIGS. 1-2 (and only four of the struts 58 are visible in FIG. 1 ), but more or fewer struts may be employed in the proximal segment 52 , as described in further detail herein.
- the proximal segment of FIG. 13A includes 8 struts (only five of which are visible).
- the struts 58 converge toward the radial center of the proximal segment 52 at the distal end of the proximal segment 52 , where the proximal segment 52 joins the proximal end of the pivot section 54 , and at the proximal end of the proximal segment 52 , where the proximal segment 52 joins a proximal end portion 60 of the device 50 .
- the proximal end portion 60 located at the proximal end of the device 50 , may comprise an interconnection of the proximal ends of the struts 58 , which in turn can be coupled to a tether 140 ( FIGS. 14A-15C ) or other suitable means that facilitate deployability and/or re-sheathability and re-positionability of the device 50 .
- a tether 140 may be configured to connect the device 50 to a delivery member such as a pusher wire (not shown).
- the proximal struts 58 extend radially outward as they advance from the proximal and distal ends of the proximal segment 52 , thereby forming proximal and distal tapering portions or faces 62 , 64 of the proximal segment.
- the struts 58 reach their radially outermost extent in a waist portion 66 of the proximal segment 52 , between the proximal and distal faces 62 , 64 . It will be appreciated that the distal and intermediate segments may have analogous features.
- the struts 58 are curved and form curving radial crests or peaks.
- the struts 58 can be flat and generally straight and parallel, to form an elongate and/or cylindrical waist 66 .
- the struts 58 of the proximal segment 52 can have a substantially rectangular or flat cross section (e.g., where the struts 58 comprise uncut portions of a metallic tube or sheet).
- the struts 58 can alternatively have a substantially round (e.g., circular, elliptical, ovoid) cross section (e.g., where the struts 58 comprise round filaments).
- the proximal segment 52 can comprise two or more struts 58 , or between two and twelve struts 58 .
- the proximal segment can alternatively comprise two, three, four, five, six, seven, eight, nine, ten, eleven, or twelve struts 58 . Still other numbers of struts are possible.
- the proximal struts 58 may be equally angularly spaced and/or oriented around the central longitudinal axis of the device 50 (e.g., six struts 60.degree. apart from each adjacent strut as shown in FIG. 2 , two struts 180.degree. apart from each other, three struts 120.degree. apart, four struts 90.degree. apart, etc.).
- the arrangement of the struts are shown in the figures as substantially isometric, the arrangement can place the struts in various angles relative to each other (e.g., six struts varying about 20.degree., about 40.degree., about 50.degree., about 70.degree., and about 80.degree. apart from each adjacent strut).
- Each of the segment may be reversibly expandable from a collapsed state to an expanded state, which allows portions of the device 50 to expand after deployment and also enables the device 50 to be retrieved after deployment ( FIGS. 14C and 15C ).
- the tapered proximal face 62 of the proximal segment 52 may allow the device 50 or portions thereof (e.g., the proximal segment 52 ) to be retrieved back (e.g., in the proximal direction) into a delivery catheter via a distal opening thereof.
- the tapered proximal face 62 may radially compress the proximal segment 52 .
- the ability to retrieve the device 50 or proximal segment 52 facilitates removal or re-positioning of the device 50 if an initial placement is not satisfactory. It will be appreciated that the distal and/or intermediate segments have similar features that also enable or facilitate the retrieval of the device into a delivery catheter via a distal opening thereof.
- the distal segment 56 can be radially self-expanding and comprise a plurality of radially self-expanding struts 68 .
- Eight struts 68 are depicted in the distal section 56 of FIGS. 1, 3, and 13A-13B (and only five of the struts 68 are visible in FIG. 1 ), but more or fewer struts may be employed in the distal segment 56 , as will be described in further detail below.
- the struts 68 converge toward the radial center of the distal segment 56 at the proximal end of the distal segment 56 , where the distal segment 56 joins the distal end of the pivot section 54 , and at the distal end of the distal segment 56 , where the distal segment 56 joins a distal end portion 70 of the device 50 .
- each segment may include struts that extend radially outward as they advance from one end of the segment to the other end, thereby forming tapering portions or faces.
- the distal struts 68 extend radially outward as they advance from the proximal and distal ends of the distal segment 56 , thereby forming proximal and distal tapering portions or faces 72 , 74 of the distal segment 56 .
- the struts 68 reach their radially outermost extent in a waist portion 76 of the distal segment 56 , between the proximal and distal faces 72 , 74 .
- any portion of the device such as the waist or tapering face of the distal, intermediate, and/or proximal segment may engage the vascular debris 142 ( FIGS. 14A-15C ).
- the waist portion 76 , the struts 68 are curved and form curving radial crests or peaks.
- the struts 68 can be flat and generally straight and parallel, to form an elongate and/or cylindrical waist 76 .
- the struts 68 of the distal segments can have a substantially rectangular or flat cross section (e.g., where the struts 68 comprise uncut portions of a metallic tube or sheet).
- FIGS. 1 and 13A-13B shows that struts 68 can alternatively have a substantially round (e.g., circular, elliptical, ovoid) cross section (e.g., where the struts 68 comprise round filaments).
- a circular, elliptical or ovoid cross-section may be imparted to otherwise square or rectangular struts 58 / 68 by processing steps such as electropolishing.
- the distal segment can comprise two or more struts 68 , or between two and twelve struts 68 .
- the distal segment 56 depicted in FIGS. 1-3 comprises eight struts 68
- the distal segment can alternatively comprise two, three, four, five, six, seven, eight, nine, ten, eleven, or twelve struts 68 . Still other numbers of struts are possible.
- the distal struts 68 may be equally angularly spaced and/or oriented around the central longitudinal axis of the device 50 (e.g., eight struts 45.degree. apart from each adjacent strut, two struts 180.degree. apart from each other, three struts 120.degree. apart, four struts 90.degree. apart, etc.).
- One or more of the struts of a segment(s) can optionally include or form widened portions or leaves 78 on the distal face 74 of the distal segment.
- the widened portions 78 can provide a blocking function to prevent or reduce the passage of materials or fluids through the distal face 74 .
- the widened portions 78 may be wider than a width of the struts forming the proximal face of the distal segment 56 . This feature enables certain segments to act as filters to capture or engage thrombi, emboli, or other structures that form or are present after deployment of the vascular intervention device 50 .
- FIG. 4 depicts one example of a widened portion 78 that may be employed with any of the embodiments of the device 50 disclosed herein.
- One, some or all of the widened portions 78 (and struts 68 ) of the device 50 may take the form depicted in FIG. 3 and further described herein.
- the strut 68 can be longitudinally split into sub-struts 82 that surround an opening 84 in the widened portion 78 .
- the widened portions may also alternate or vary in size from one strut 68 to the next.
- the struts 68 can be configured to form the sub-struts 82 and opening 84 via tapering portions 86 on either side of the opening 84 . Distal and proximal of the tapering portions 86 , the struts 68 can be of substantially uniform width. The proximal portion 88 of the strut 68 (proximal of the widened portion 78 ) can be wider than the distal portion 90 of the strut 68 (distal of the widened portion 78 ).
- the width of the proximal strut portion 88 can nonetheless be substantially uniform from the proximal tapering portion 86 to the intermediate portion 54
- the width of the distal strut portion 90 can be substantially uniform (but narrower than the width of the proximal strut portion 88 ) from the distal tapering portion 86 to the distal tip portion 70 of the device 50 .
- the distal face of the distal portion 56 can be made relatively compliant and therefore more easily conformable, while retaining a desired degree of stiffness in the proximal components of the device 50 .
- the widened portions 78 may comprise a first and second ramp, where the first ramp extends from an edge of the strut to an edge of the widened portion 78 , and the second ramp extends from the edge of the widened portion 78 to the edge of the strut.
- the widened portions 78 can increase the occlusiveness of the distal face when desirable.
- a mesh, membrane or other covering may be employed on the distal face 74 to perform similar function(s).
- the device 50 may optionally include intermediate segment(s).
- the intermediate segment 134 a, 134 b can be radially self-expanding and comprise a plurality of radially self-expanding struts 138 .
- Eight struts 138 are depicted in the intermediate segment 134 a, 134 b of FIGS. 13A-13B , but more or fewer struts may be employed in the intermediate segment 134 a, 134 b, as will be described in further detail below.
- the struts 138 converge toward the radial center of the intermediate segment 134 a at the proximal end of the intermediate segment 134 a, where the intermediate segment 134 a joins the distal end of the pivot section 54 a, and at the distal end of the intermediate segment 134 a, where the intermediate segment 134 a joins proximal end of pivot section 54 b.
- the struts 139 converge toward the radial center of the intermediate segment 134 b at the proximal end of the intermediate segment 134 b, where the intermediate segment 134 b joins the distal end of the pivot section 54 b, and at the distal end of the intermediate segment 134 b, where the intermediate segment 134 b joins proximal end of pivot section 54 c.
- each segment may include struts that extend radially outward as they advance from one end of the segment to the other end, thereby forming tapering portions or faces.
- the intermediate struts 138 extend radially outward as they advance from the proximal and distal ends of the intermediate segment 134 a, 134 b, thereby forming proximal and distal tapering portions or faces 172 , 174 of the intermediate segment 134 a, 134 b.
- the struts 138 reach their radially outermost extent in a waist portion 136 of the intermediate segment 134 a, 134 b, between the proximal and distal faces 172 , 174 .
- the struts 138 , 139 of the intermediate segment 134 a, 134 b can have a substantially rectangular or flat cross section (e.g., where the struts 138 , 139 comprise uncut portions of a metallic tube or sheet).
- FIGS. 13A-13B show that struts 138 , 139 can alternatively have a substantially round (e.g., circular, elliptical, ovoid) cross section (e.g., where the struts 68 comprise round filaments).
- a circular, elliptical or ovoid cross-section may be imparted to otherwise square or rectangular struts 58 / 68 by processing steps such as electropolishing.
- the intermediate segment 134 a, 134 b can comprise two or more struts 138 , 139 , or between two and twelve struts 138 , 139 .
- one or more segments may be substantially similar in shape.
- the proximal, distal, and intermediate segments have the same number of struts.
- the segments may comprise different number of struts.
- a segment may have the same number of struts as at least one other segment.
- the pivot section 54 connects adjacent segments (e.g., 52 and 5 in FIG. 1 ), and can be relatively short and relatively narrow (relative to the length and width of the proximal and distal segment 52 , 56 when they are expanded).
- the device may include one or more pivot sections that depend on the number of segments (proximal, distal, and intermediate).
- the device includes two pivot sections 54 a, 54 b that are similar in structure to the pivot section 54 shown in FIG. 1 .
- all segments and sections and their respective parts can form a single monolithic structure. As shown in FIG.
- segments 52 , 134 a, and 56 , sections 54 a and 54 b, and their respective parts can form a single monolithic structure.
- segments 52 , 134 a, 134 b, and 56 , sections 54 a, 54 b, and 54 c, and their respective parts can form a single monolithic structure.
- the pivot section (e.g., 54 , 54 a, 54 b, 54 c ) allows a relatively distal segment to pivot with respect to a relatively proximal segment and thereby allow the device 50 to be deployed in tortuous vasculature.
- the distal segment 56 can pivot with respect to proximal segment 52 .
- the distal segment 56 can pivot with respect to intermediate segment 134 a and the intermediate segment 134 a can pivot with respect to distal segment 56 .
- the pivot section 54 may permit “multiaxial” pivoting or tilting, e.g. at least about a first axis through the pivot section 54 and orthogonal to the plane of the page in FIG. 1 , and about a second axis through the pivot section 54 and orthogonal to the first axis.
- the pivot section 54 may permit “omniaxial” pivoting or tilting, about the first and second axes described above, and any radially-oriented axis passing through the pivot section 54 .
- the device may provide multiaxial or omniaxial pivoting or tilting up to relatively high deflection angles (e.g., up to 90 degrees) without significantly affecting the ability of the segments to maintain their expanded states and engage the vascular debris 142 ( FIGS. 14A-15C ).
- This capability can be facilitated by making the proximal struts 58 independent of the adjacent struts (e.g., distal struts 68 ) as depicted in FIG. 1 .
- the two groups of struts are independent of each other in that forces acting solely on, and/or deflections occurring solely in, the proximal struts 58 do not significantly affect the ability of the distal struts 68 to maintain their expanded state, and forces acting solely on, and/or deflections occurring solely in, the distal struts 68 do not significantly affect the ability of the proximal struts 58 to maintain their expanded state.
- one, some or all of the struts 58 can bend or pivot with respect to the pivot section 54 independently of one, some or all of the struts 68 and vice versa.
- the pivot section 54 may promote independence by interconnecting the struts 58 and the struts 68 in a radially central region of the device 50 , and physically and functionally separating them, absorbing bending stresses from the struts 58 and the struts 68 rather than transmitting them from the struts 58 to the struts 68 or vice versa.
- the struts 58 may be independent of each other (within the group of struts 58 ), and/or the struts 68 may be independent of each other (within the group of struts 68 ).
- the proximal struts 58 are independent of each other and the distal struts 68 are independent of each other.
- Each proximal strut 58 can bend or pivot with respect to the pivot section 54 independently of the other proximal struts 58
- each distal strut 68 can bend or pivot with respect to the pivot section 54 independently of the other distal struts 68 .
- Independence is promoted within each group of struts 58 , 68 by interconnecting them only at their proximal and distal ends, and in a radially central region of the device 50 .
- proximal struts 58 and/or the distal struts 68 can also be independent of each other, but only within a limited region of the segment(s).
- the proximal struts 58 may be independent of each other within the distal face 64 of the proximal segment, and/or the distal struts 68 may be independent of each other within the proximal face 72 of the distal segment 56 .
- tapered distal face 64 of the proximal segment 52 and tapered proximal face 72 of the distal segment 56 also allow the sections 52 , 56 to pivot significantly without contact between the segments 52 , 56 other than at the pivot section 54 .
- the pivot section can be rigid or flexible. Where the pivot section is rigid, the pivotability of the device 50 can be provided by the flexibility and/or independence of the struts 58 in the distal face 64 of the proximal segment 52 and of the struts 68 in the proximal face 72 of the distal segment 56 . In this example, the proximal and distal segments are able to pivot multiaxially relative to each other without requiring plastic deformation of the pivot section.
- Each of struts 58 and struts 68 may be capable of flexing, extending, bowing, straightening, bending, or other elastic or plastic deformation along the length or a portion thereof.
- segments 52 , 56 , 134 a, 134 b can pivot about pivot section and relative to each other.
- struts on one side of a section may flex (e.g., bend), and struts on an opposing side of a segment may extend (e.g., straighten), whereby the segment pivots about the region where the struts connect to pivot section.
- such action is facilitated along one or more segments and/or sections of the device.
- this pivot action is provided without requiring plastic deformation of pivot section or any action along the length of pivot section.
- the pivot section can comprise a short length of hypotube (e.g., a short length of uncut hypotube) which may be flexible or rigid.
- the pivot section can comprise a flexible coil, longitudinally oriented such that its winds spiral around the central longitudinal axis of the device 50 , or the pivot section can comprise a ball-and-socket joint, a length of flexible wire, or other flexible member.
- the device 50 can further comprise one or more radiopaque markers (e.g. coils) coupled to or wound around portions of the device.
- the device 50 can include radiopaque markers on one, two or all three of the proximal end portion 60 , pivot section 54 , and distal end portion 70 .
- the device 50 can include radiopaque markers on one or more of the struts 58 , and/or on one or more of the struts 68 .
- radiopaque material may be placed within some, one or all of those lumens to make the proximal end portion 60 , pivot section 54 , and distal end portion 70 radiopaque.
- radiopaque material maybe provided within a lumen of at least one of the proximal end portion 60 , pivot section 54 , and distal end portion 70 with securement at one or both of the ends of the lumen.
- the device can comprise a self-expanding, super elastic, and/or a shape-memory material (e.g., comprising Nitinol, CoCr alloy, shape memory polymers (e.g., polyglycolic acid, polylactic acid), etc.), thereby causing the device to be self-expanding under certain conditions (e.g., when not restrained by a catheter).
- a shape-memory material e.g., comprising Nitinol, CoCr alloy, shape memory polymers (e.g., polyglycolic acid, polylactic acid), etc.)
- the proximal segment, the pivot section, the distal segment, and/or intermediate segment(s) may comprise different materials.
- the distal segment 56 may comprise polymer material while the proximal segment and the pivot section comprise metallic material, a different polymer material, etc.
- the distal segment may comprise metallic material while the proximal segment and the pivot section comprise different metallic materials, polymer material, etc.
- Other combinations of materials are also possible.
- the device can assume a low profile compressed state (e.g., confined within a catheter) for delivery. When cut from a tube or sheet, the device may assume substantially the diameter of the tube or rolled sheet when in the compressed state. Upon deployment from the catheter, the device expands from the compressed state to an expanded state.
- the various versions of the vascular intervention device 50 disclosed herein can be manufactured in a process comprising cutting (or electrochemically etching) and shaping a metallic tube or sheet (e.g., a laser cut hypotube or sheet).
- a laser or electrochemical etcher may cut out portions of the tube, leaving in place the various structural elements of the proximal segment, the pivot section(s), the intermediate segment(s), and/or the distal segment.
- the proximal segment 52 , the pivot section 54 , and the distal segment 56 can be integrally formed from a metallic tube and not cut away from each other.
- the device 50 is of single-piece construction, taking the form of a single, partial tube or sheet.
- all segments and sections 52 , 54 , 56 and their respective parts can form a single monolithic structure.
- the proximal segment 52 , the pivot section 54 , and the distal segment 56 can form a single monolithic structure.
- the sections 52 , 54 , 56 can be formed separately and then assembled together using any suitable technique, such as welding, gluing, interlocking, crimping, swaging, braiding, deposition, etc.
- the pivot section 54 comprises a coil
- the segments 52 and 56 may be formed from the same or separate tubes, and then attached to either end of the coil using any such suitable technique.
- the device 50 or segments/section(s) 52 / 54 / 56 thereof may be reshaped and heat treated to impart shape setting to the device or segments/section(s).
- the shape setting process may include several steps comprising, for example, stretching and confining the cut tube into a new shape during the heat treatment. At the end of each heat treatment step, the cut tube assumes the shape in which it was confined during the heat treatment process. The final shape (e.g., expanded state) and size may obtained by several such steps.
- the device 50 or cut tube may be electropolished during manufacture, which can reduce the initial wall thickness of the tube to a final, desired thickness.
- FIGS. 5-12 depict a version of the device 50 (and a cut pattern 300 for constructing it) that can be similar to any of the other versions or embodiments of the device 50 disclosed or summarized herein, in structure, configuration, function, method of manufacture, method of use, and material choice, except as further discussed herein.
- the struts 58 of the proximal section 52 comprise a number (e.g. 6 , as depicted, or any other suitable number) of proximal strut portions 58 a and a corresponding number of distal strut portions 58 b.
- proximal portions 58 a and the distal portions 58 b are rotated or shifted laterally with respect to each other, such that each proximal portion 58 a opposes (e.g., approximately one-half of each of) two distal portions 58 b, and vice versa.
- two sub-struts 58 c extend distally to the two distal portions 58 b that oppose (or are longitudinally adjacent) the proximal portion 58 a from which the sub-struts 58 c extend.
- each proximal portion 58 a is connected to the two adjacent or opposing distal portions 58 b (and vice versa) via sub-struts 58 c.
- each strut may have a proximal end, a distal end, and a center portion therebetween, the center portion connected to adjacent struts.
- each strut may extend from an origination junction and be divided into a first and second branch, wherein the first branch is connected to a first adjacent strut and the second branch is connected to a second adjacent strut.
- a length of the first branch and a length of the second branch may be different such that a connecting point between the strut and the first adjacent strut is disposed at a different longitudinal position than a connecting point between the strut and the second adjacent strut.
- the length of the first branch and the length of the second branch may be the same.
- at least one strut may extend proximally from the intermediate section and be divided into a first and second branch at or near the waist of the proximal section.
- the first branch may be connected to the first adjacent strut and the second branch may be connected to the second adjacent strut.
- the first and second adjacent struts may extend proximally from the waist of the proximal section toward the radially central region of the device.
- one or more sections 52 , 56 may have a first plurality of struts extending from a proximal end of the section and a second plurality of struts extending from the distal end of the section.
- the first and second plurality of struts may be interconnected at the waist or middle portion of the section by a third plurality of struts.
- Each of the first plurality of struts may be connected to two or more of the third plurality of struts.
- Each of the second plurality of struts may be connected to two or more of the third plurality of struts.
- the number of the first plurality of struts may equal the number of the second plurality of struts.
- the number of the third plurality of struts may be double, triple, or another multiple of one or each of the number of the first plurality of struts and the number of the second plurality of struts.
- the sub-struts 58 c extend both longitudinally to interconnect the proximal end portion 60 and the intermediate section 54 , and laterally or circumferentially to each neighboring proximal or distal portion 58 a or 58 b.
- the resulting lateral or circumferential interconnection of the struts 58 of the proximal section 52 increases the outward radial force exerted by the proximal section 52 (and the inward radial force that the proximal section 52 can withstand without collapse) when expanded.
- the lateral/circumferential interconnection of the struts of the proximal section 52 reduces the tendency of the expanded struts 58 to bunch together in the vessel or “half-moon.” Further, the lateral/circumferential interconnection of the struts of the proximal section maintains the three dimensional shape of the proximal section. Moreover, the lateral/circumferential interconnection of the struts of the proximal section provides structural support for the interconnected struts
- the sub-struts 58 c (e.g., the peaks thereof) can form the waist 66 of the proximal segment 52 , or otherwise comprise the radially outermost portion of the proximal segment 52 .
- the sub-struts 58 c can optionally be approximately longitudinally centered on the longitudinal midpoint of the proximal segment 52 , such that the midpoint approximately evenly divides the sub-struts 58 c in the longitudinal direction. Such an arrangement is also depicted in FIGS. 5-6 and 8-9 .
- the widened portions 78 on the distal tapering portion 74 of the distal segment 56 can be formed via the lateral/circumferential interconnection arrangement employed in the proximal segment 52 and discussed above.
- the proximal strut portions 88 and distal strut portions 90 of the distal struts 68 are rotated or shifted laterally with respect to each other, such that each proximal portion 88 opposes (e.g., approximately one-half of each of) two distal portions 90 , and vice versa.
- each proximal portion 88 extends distally to the two distal portions 88 that oppose (or are longitudinally adjacent) the proximal portion 88 from which the sub-struts 82 extend. Accordingly, each proximal portion 88 is connected to the two adjacent or opposing distal portions 90 (and vice versa) via sub-struts 82 .
- at least one strut may extend distally from the intermediate section and be divided into a first and second branch at or near the waist of the distal section. The first branch may be connected to the first adjacent strut and the second branch may be connected to the second adjacent strut. The first and second adjacent struts may extend distally from the waist of the distal section toward the radially central region of the device.
- the sub-struts 82 extend both longitudinally to interconnect the pivot section 54 and the distal end portion 70 , and laterally or circumferentially to each neighboring proximal or distal strut portion 88 or 90 .
- the lateral/circumferential interconnection of the struts 68 of the distal segment 56 reduces the tendency of the expanded struts 68 to bunch together once deployed in the vessel or “half-moon.”
- the lateral/circumferential interconnection of the struts of the distal segment maintains the three dimensional shape of the distal section.
- the lateral/circumferential interconnection of the struts of the distal segment provides structural support for the interconnected struts.
- the widened portions 78 and the sub-struts 82 can be located on the distal face 74 of the distal portion 56 .
- the widened portions 78 and sub-struts 82 can optionally be located wholly distal of the waist 76 of the distal portion 56 .
- Such an arrangement is also depicted in FIGS. 5-6 and 8-9 .
- the widened portions may resemble the structures as disclosed elsewhere herein.
- the device 50 can have a contracted state (“collapsed state”) in which the proximal and distal segments 52 , 56 take on a smaller diameter than in the expanded state.
- the segments 52 , 56 in the contracted state can have a diameter small enough to fit within a delivery device, such as a microcatheter.
- the diameter of one or both of the proximal and distal segments 52 , 56 when in the contracted state can be substantially equal to the diameter of the tube from which the device 50 is cut, and/or substantially equal to the diameter of the pivot section 54 .
- the device may be of any dimension that is compatible with one or more embodiments of the subject technology.
- the diameter of the waist (e.g., 66 , 76 ) when expanded may be from about 2 mm to about 20 mm.
- the diameter of the waist when contracted may be from about 0.25 mm to about 0.75 mm.
- the length of the a segment when expanded may be from about 2 mm to about 20 mm.
- the width of a strut may be from about 0.075 mm to about 0.15 mm.
- the thickness of a strut may be from about 0.025 mm to about 0.10 mm.
- the length of the pivot section may be from about 0.01 mm to about 5 mm. In some embodiments, the diameter of the pivot section may be from about 0.25 mm to about 0.75 mm. In some embodiments, the wall thickness of the pivot section may be from about 0.025 mm to about 0.10 mm.
- the vascular intervention device 50 is at least partially encapsulated by a sheath (e.g., catheter 144 ) which has been inserted into a vasculature 146 .
- a sheath e.g., catheter 144
- the catheter 144 is positioned at or near vascular debris 142 which resides within a vasculature 146 .
- FIG. 14A represents one possible configuration of vascular intervention device 50 prior to its deployment from the catheter 144 .
- the thrombus 142 is adhered to an inner wall of the vasculature 146 .
- FIG. 14B shows a vascular intervention device 50 in a deployed or partially-deployed state.
- the distal segment 56 has been moved distally outside of the distal opening 150 of the catheter 144 and is now in an expanded state.
- a distal or proximal motion of the vascular intervention device 50 is generally initiated by a user who can controllably operate the device 50 at the proximal end (not shown) and may be accomplished by any number of means, for example, proximal motion of the catheter 144 , distal motion of the device 50 , or both.
- a user may operate an actuator which is coupled to a tether 140 which in turn is coupled to the device 50 as shown in FIGS. 14A-14C .
- FIG. 14A-14C As shown in FIG.
- the distal segment 56 can expand to the expanded state and engage a thrombus 142 .
- a portion of the vascular intervention device 50 is still encapsulated by the sheath.
- the vascular intervention device may be fully deployed, in which all of the segments have been pushed outside the distal opening 150 of the catheter 144 .
- FIG. 14C shows the vascular intervention device in a re-collapsed state. As shown in FIG. 14C , the vascular intervention device 50 has moved proximally (relative to FIG. 14B ) back into the catheter 144 through the distal opening 150 after engaging the thrombus 142 in FIG. 14B .
- proximal motion of the device 50 effectively retrieved the thrombus 142 into the catheter 144 .
- the proximal movement caused the expanded segment(s) to revert back to a collapsed state.
- Suction, aspiration, or negative pressure may be provided as thrombus 142 is brought near distal opening 150 , to facilitate capture of thrombus 142 within catheter 144 .
- balloon devices such as balloon catheters, may be provided and utilized to manage flow through the vasculature at the location of thrombus 142 .
- a balloon may be expanded proximal to distal opening 150 to substantially slow or stop flow downstream to the location of thrombus 142 .
- Use of a balloon and aspiration creates a flow path that facilitates capture of thrombus 142 within catheter 144 .
- the vascular intervention device 50 includes four segments that are at least partially encapsulated by the catheter 144 which has been inserted into a vasculature 146 .
- the segments are coupled to a tether 140 which can be manipulated by a user to causes proximal or distal translational motions of the device 50 .
- the vascular intervention device 50 is in a collapsed state and the catheter 144 is positioned at or near a thrombus 142 which resides within a vasculature 146 .
- FIG. 15B shows a vascular intervention device 50 in a deployed or partially-deployed state.
- the distal and the intermediate segments have been moved distally outside of the distal opening 150 of the catheter 144 and are now in an expanded state.
- the distal segment 56 has been deployed distal to the thrombus 142 while the intermediate segment is positioned to engage the thrombus 142 .
- the relatively distal segments may act as a filter by having, for example, widened portions that increase the occlusiveness of the distal segment.
- FIG. 15B shows a proximal portion of the vascular intervention device 50 in a re-collapsed state. As shown in FIG. 15C , the vascular intervention device 50 has moved proximally through the distal opening 150 after engaging the thrombus in FIG. 15B . The proximal movement caused the expanded segment(s) to revert back to a collapsed state and effectively retrieved the thrombus 142 into the catheter 144 .
- Some embodiments provide a device for retrieving vascular debris in a vasculature comprising: at least two segments radially expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; at least one intermediate portion, each intermediate portion comprising a pivot that connects adjacent segments, each pivot having a diameter comprising the radially largest region of the pivot; a sheath that is configured to encase the segments in the compressed state; and a tether that is configured to retract the expanded segment into the outer sheath.
- the struts are radially-expandable. In some embodiments, at least one strut diverges from the longitudinal axis, divides into at least two struts, merges with a circumferentially adjacent strut, and converges toward the longitudinal axis.
- Some embodiments provide a device comprising at least three segments. Some embodiments provide a device comprising at least four segments. Some embodiments provide a device comprising at least five segments. Some embodiments provide a device comprising at least six segments. Some embodiments provide a device comprising at least seven segments. Some embodiments provide a device comprising at least eight segments. Some embodiments provide a device comprising at least nine segments. Some embodiments provide a device comprising at least ten segments.
- Some embodiments provide a device for retrieving vascular debris in a vasculature comprising: at least three segments expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; at least two intermediate portion, each intermediate portion comprising a pivot that connects adjacent segments, each pivot having a diameter comprising the radially largest region of the pivot; a sheath that is configured to encase the segments in a compressed state; and a tether that is configured to retract the segments into the sheath.
- Some embodiments provide a method of retrieving vascular debris from a vasculature comprising: inserting into the vasculature of a patient at least a portion of a sheath comprising a distal opening and encasing at least two or more segments expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; releasing at least a portion of a segment outside the distal opening wherein at least a portion of the segment expands to engage the vascular debris; and retrieving the segment and at least a portion of the vascular debris inside the sheath.
- the vascular debris is a thrombus or an embolus.
- the sheath encapsulates at least three expandable segments. In some embodiments, the outer diameter of the sheath is no larger than 50% of the diameter of the vasculature.
- a phrase such as “an aspect” does not imply that such aspect is essential to the subject technology or that such aspect applies to all configurations of the subject technology.
- a disclosure relating to an aspect may apply to all configurations, or one or more configurations.
- An aspect may provide one or more examples of the disclosure.
- a phrase such as “an aspect” may refer to one or more aspects and vice versa.
- a phrase such as “an embodiment” does not imply that such embodiment is essential to the subject technology or that such embodiment applies to all configurations of the subject technology.
- a disclosure relating to an embodiment may apply to all embodiments, or one or more embodiments.
- An embodiment may provide one or more examples of the disclosure.
- a phrase such as “an embodiment” may refer to one or more embodiments and vice versa.
- a phrase such as “a configuration” does not imply that such configuration is essential to the subject technology or that such configuration applies to all configurations of the subject technology.
- a disclosure relating to a configuration may apply to all configurations, or one or more configurations.
- a configuration may provide one or more examples of the disclosure.
- a phrase such as “a configuration” may refer to one or more configurations and vice versa.
Abstract
A device may be used for capturing and retrieving vascular debris. The device may include: at least two segments radially expandable from a collapsed state to an expanded state, each of the at least two segments having (a) a waist including a radially largest region of the segment and (b) two longitudinal ends; at least one intermediate portion, each of the at least one intermediate portion including a pivot that connects adjacent segments, each pivot having a diameter less than a diameter of the waist; wherein each of the at least two segments includes at least two struts that extend longitudinally from a proximal end to a distal end of the segment, the at least two struts tapering from the waist radially inward toward a longitudinal axis of the device as the at least two struts approach an adjacent intermediate portion.
Description
- This application is a continuation of U.S. patent application Ser. No. 15/131,306, filed Apr. 18, 2016, which is a continuation of U.S. patent application Ser. No. 13/669,652, filed Nov. 6, 2012, both of which are hereby incorporated by reference in their entireties.
- The presence of vascular debris (e.g., thrombus, embolus) in a vasculature can cause a number of significant health problems. A thrombus is a stationary blood clot that is often found along the wall of a blood vessel and may cause vascular obstruction. Thrombus is usually formed in vivo as the final product of the blood coagulation step in hemostasis. In relatively large blood vessels, a thrombus will typically decrease the blood flow through that vessel. In smaller blood vessels, blood flow may be completely cut-off resulting in death of tissue supplied to that vessel. A dislodged thrombus is often referred to as an “embolus.” Vascular obstruction or ischemia is the insufficient supply of blood to an organ, usually due to a blocked blood vessel. Symptoms of vascular obstruction may include chest pains, loss of vision, and in some cases death. Thrombectomy is a surgical procedure that involves the removal of a thrombus from a patient's vasculature.
- Certain vascular devices are important for their intervening roles in patients with vascular debris in their vasculature. Some techniques for removing vascular debris utilize balloon catheters, aspiration catheters, and the like. These techniques may have safety (e.g., intimal lesions) and performance issues (e.g., use limited to certain arteries). Therefore, there is a need to provide additional systems and methods for removing vascular debris from a vasculature that are safe and overcome some of the existing performance issues.
- Although at least one embodiment is described herein with respect to thrombus and thrombectomy, the subject technology may be used to remove any vascular debris that is compatible with one or more embodiments with the subject technology.
- The subject technology is illustrated, for example, according to various aspects described below. Various examples of aspects of the subject technology are described as embodiments. These are provided as examples and do not limit the subject technology. It is noted that these embodiments may be combined in any combination.
- Some embodiments provide a system for retrieving vascular debris in a vasculature comprising at least two segments radially expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; at least one intermediate portion, each intermediate portion comprising a pivot that connects adjacent segments, each pivot having a diameter comprising the radially largest region of the pivot; an outer lumen that is configured to at least partially encapsulate the segments in the compressed state; and a tether that is configured to retrieve a segment in the expanded state into the outer lumen.
- In some embodiments, at least one segment is substantially spherical. In some embodiments, the segments comprises radially-expandable struts. In some embodiments, a segment comprises at least two struts. In some embodiments, a segment comprises at least three struts. In some embodiments, a segment comprises at least four struts. In some embodiments, a segment comprises at least five struts. In some embodiments, a segment comprises at least six struts. In some embodiments, a segment comprises at least seven struts. In some embodiments, a segment comprises at least eight struts. In some embodiments, a segment comprises at least nine struts. In some embodiments, a segment comprises at least ten struts. In some embodiments, a segment comprises at least eleven struts. In some embodiments, a segment comprises at least twelve struts. In some embodiments, at least one strut diverges from the longitudinal axis, divides into at least two struts, merges with an adjacent strut, and converges toward the longitudinal axis.
- Some embodiments provide a system comprising at least three segments. Some embodiments provide a system comprising at least four segments. Some embodiments provide a system comprising at least five segments. Some embodiments provide a system comprising at least six segments. Some embodiments provide a system comprising at least seven segments. Some embodiments provide a system comprising at least eight segments. Some embodiments provide a system comprising at least nine segments. Some embodiments provide a system comprising at least ten segments.
- Some embodiments provide a system for retrieving vascular debris in a vasculature comprising at least three segments expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; at least two intermediate portion, each intermediate portion comprising a pivot that connects adjacent segments, each pivot having a diameter comprising the radially largest region of the pivot; an outer lumen that is configured to encase the segments in a compressed state; and a tether that is configured to retract the segments into the outer lumen.
- Some embodiments provide a method of retrieving vascular debris from a vasculature comprising inserting into the vasculature of a patient at least a portion of an outer lumen comprising a distal opening and encasing at least two or more segments expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; releasing at least a portion of a segment outside the distal opening wherein at least a portion of the segment expands to engage the vascular debris; and retrieving the segment and at least a portion of the vascular debris inside the outer lumen.
- In some embodiments, the vascular debris is a thrombus or an embolus. In some embodiments, the outer diameter of the outer lumen is no larger than 50% of the diameter of the vasculature.
- Additional features and advantages of the subject technology will be set forth in the description below, and in part will be apparent from the description, or may be learned by practice of the subject technology. The advantages of the subject technology will be realized and attained by the structure particularly pointed out in the written description and claims hereof as well as the appended drawings.
- It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory and are intended to provide further explanation of the subject technology as claimed.
- The accompanying drawings, which are included to provide further understanding of the subject technology and are incorporated in and constitute a part of this specification, illustrate aspects of the subject technology and together with the description serve to explain the principles of the subject technology.
-
FIG. 1 illustrates embodiments of a vascular intervention device. -
FIG. 2 illustrates a partial end view of the device ofFIG. 1 , taken along the direction indicated by the arrows 2-2 inFIG. 1 . -
FIG. 3 illustrates a partial end view of the device ofFIG. 1 , taken along the direction indicated by the arrows 3-3 inFIG. 1 . -
FIG. 4 illustrates an example configuration of a widened portion for use on struts of device ofFIG. 1 . -
FIG. 5 illustrates a cut pattern for use in making embodiments of the device. -
FIG. 6 illustrates a detail view of a proximal section of the cut pattern ofFIG. 5 . -
FIG. 7 illustrates a detail view of a distal section of the cut pattern ofFIG. 5 . -
FIG. 8 illustrates a device made with the cut pattern ofFIGS. 5, 6, and 7 . -
FIG. 9 illustrates a detail view of the proximal section of the device ofFIG. 8 . -
FIG. 10 illustrates a proximal end view of the proximal section of the device ofFIG. 8 . -
FIG. 11 illustrates a detail view of the distal section of the device ofFIG. 8 . -
FIG. 12 illustrates a distal end view of the distal section of the device ofFIG. 8 . -
FIGS. 13A and 13B illustrate embodiments of a vascular intervention device. -
FIGS. 14A, 14B, and 14C illustrate embodiments of a vascular intervention device delivery system in a vasculature. -
FIGS. 15A, 15B, and 15C illustrate embodiments of a vascular intervention device delivery system in a vasculature. - In the following detailed description, numerous specific details are set forth to provide a full understanding of the subject technology. It will be apparent, however, to one ordinarily skilled in the art that the subject technology may be practiced without some of these specific details. In other instances, well-known structures and techniques have not been shown in detail so as not to obscure the subject technology.
- While some of the embodiments described herein specifically relate to a vascular intervention device having two segments, the described features may generally be extended to devices having two or more segments.
-
FIGS. 1-3 illustrate an example embodiment of avascular intervention device 50 that may be used to remove vascular debris (e.g., thrombus) that can obstruct the normal flow of blood in a vasculature. As illustrated inFIG. 1 , thedevice 50 comprises two segments (aproximal segment 52 and a distal segment 56) and apivot section 54. Referring toFIGS. 14A-15C , thedevice 50 can be delivered via a sheath such as acatheter 144 into the vasculature and positioned at or near a target site in order to expand, engage and retrieve vascular debris (thrombus 142). It will be appreciated that thedevice 50 may be more compliant than the vasculature in which it is deployed such that it may be somewhat misshapen after being deployed, and that certain shapes described herein are when thedevice 50 is an expanded (e.g., further expanded) state with no restriction. - While one or more embodiments described herein relate to a vascular intervention device having two segments, the
device 50 may comprise any number of segments that is compatible with one or more embodiments of the subject technology. The total number of segments (one proximal, one distal, and any number of intermediate segments starting from zero) may range from about 2 to about 15 or more depending on the a number of factors such as, but not limited to, size, shape, and location of the vascular debris within a vasculature. It is generally desirable that thedevice 50 is at least as long as the targeted vascular debris. -
FIGS. 13A-15C illustrate other embodiments of thevascular intervention device 50 that include three or more segments. As shown inFIGS. 13A and 14A-14C , thevascular intervention device 50 may have three segments, namely aproximal segment 52, adistal segment 56, and anintermediate segment 134 a.FIGS. 13B and 15A-15C illustrate avascular intervention device 50 having four segments, namely aproximal segment 52, adistal segment 56, and twointermediate segments - A vascular intervention device having a plurality of segments may provide a number of advantages related to the removal of vascular debris in a vasculature. For example, certain segments (e.g., distal, intermediate) may include widened portions 78 (
FIGS. 1 and 4 ) that may be positioned distal to the vascular debris and filter emboli that may be generated during the use of thedevice 50. Moreover, a plurality of segments may also provide a greater margin for error when positioning and deploying thevascular intervention device 50 near a target site. - Referring to the embodiment illustrated in
FIGS. 1 and 13A-13B , theproximal segment 52 can be radially self-expanding and may comprise a plurality of radially self-expandingstruts 58. Six struts 58 are depicted in theproximal segment 52 ofFIGS. 1-2 (and only four of thestruts 58 are visible inFIG. 1 ), but more or fewer struts may be employed in theproximal segment 52, as described in further detail herein. For example, the proximal segment ofFIG. 13A includes 8 struts (only five of which are visible). Thestruts 58 converge toward the radial center of theproximal segment 52 at the distal end of theproximal segment 52, where theproximal segment 52 joins the proximal end of thepivot section 54, and at the proximal end of theproximal segment 52, where theproximal segment 52 joins aproximal end portion 60 of thedevice 50. - The
proximal end portion 60, located at the proximal end of thedevice 50, may comprise an interconnection of the proximal ends of thestruts 58, which in turn can be coupled to a tether 140 (FIGS. 14A-15C ) or other suitable means that facilitate deployability and/or re-sheathability and re-positionability of thedevice 50. Such atether 140 may be configured to connect thedevice 50 to a delivery member such as a pusher wire (not shown). - When the
device 50 is in a fully-expanded configuration shown inFIGS. 1-3 and 13A-13B , the proximal struts 58 extend radially outward as they advance from the proximal and distal ends of theproximal segment 52, thereby forming proximal and distal tapering portions or faces 62, 64 of the proximal segment. Thestruts 58 reach their radially outermost extent in awaist portion 66 of theproximal segment 52, between the proximal anddistal faces waist portion 66, thestruts 58 are curved and form curving radial crests or peaks. Alternatively, in thewaist 66 thestruts 58 can be flat and generally straight and parallel, to form an elongate and/orcylindrical waist 66. - In one or more embodiments, the
struts 58 of theproximal segment 52 can have a substantially rectangular or flat cross section (e.g., where thestruts 58 comprise uncut portions of a metallic tube or sheet). Thestruts 58 can alternatively have a substantially round (e.g., circular, elliptical, ovoid) cross section (e.g., where thestruts 58 comprise round filaments). Theproximal segment 52 can comprise two ormore struts 58, or between two and twelve struts 58. Although theproximal segment 52 depicted inFIGS. 1-3 comprises sixstruts 58, the proximal segment can alternatively comprise two, three, four, five, six, seven, eight, nine, ten, eleven, or twelve struts 58. Still other numbers of struts are possible. As seen inFIG. 2 , the proximal struts 58 may be equally angularly spaced and/or oriented around the central longitudinal axis of the device 50 (e.g., six struts 60.degree. apart from each adjacent strut as shown inFIG. 2 , two struts 180.degree. apart from each other, three struts 120.degree. apart, four struts 90.degree. apart, etc.). Although the arrangement of the struts are shown in the figures as substantially isometric, the arrangement can place the struts in various angles relative to each other (e.g., six struts varying about 20.degree., about 40.degree., about 50.degree., about 70.degree., and about 80.degree. apart from each adjacent strut). - Each of the segment may be reversibly expandable from a collapsed state to an expanded state, which allows portions of the
device 50 to expand after deployment and also enables thedevice 50 to be retrieved after deployment (FIGS. 14C and 15C ). Referring toFIGS. 1 and 13A-13B , the taperedproximal face 62 of theproximal segment 52 may allow thedevice 50 or portions thereof (e.g., the proximal segment 52) to be retrieved back (e.g., in the proximal direction) into a delivery catheter via a distal opening thereof. For example, if thedevice 50 is being pulled into a catheter, the taperedproximal face 62 may radially compress theproximal segment 52. The ability to retrieve thedevice 50 orproximal segment 52 facilitates removal or re-positioning of thedevice 50 if an initial placement is not satisfactory. It will be appreciated that the distal and/or intermediate segments have similar features that also enable or facilitate the retrieval of the device into a delivery catheter via a distal opening thereof. - The
distal segment 56 can be radially self-expanding and comprise a plurality of radially self-expandingstruts 68. Eight struts 68 are depicted in thedistal section 56 ofFIGS. 1, 3, and 13A-13B (and only five of thestruts 68 are visible inFIG. 1 ), but more or fewer struts may be employed in thedistal segment 56, as will be described in further detail below. Thestruts 68 converge toward the radial center of thedistal segment 56 at the proximal end of thedistal segment 56, where thedistal segment 56 joins the distal end of thepivot section 54, and at the distal end of thedistal segment 56, where thedistal segment 56 joins adistal end portion 70 of thedevice 50. - When the device is in the fully-expanded configuration shown in
FIGS. 1-3 and 13A-13B , each segment may include struts that extend radially outward as they advance from one end of the segment to the other end, thereby forming tapering portions or faces. For example, inFIGS. 1 and 13A-13B , thedistal struts 68 extend radially outward as they advance from the proximal and distal ends of thedistal segment 56, thereby forming proximal and distal tapering portions or faces 72, 74 of thedistal segment 56. Thestruts 68 reach their radially outermost extent in awaist portion 76 of thedistal segment 56, between the proximal anddistal faces - When the
device 50 is deployed in a patient's vasculature, any portion of the device such as the waist or tapering face of the distal, intermediate, and/or proximal segment may engage the vascular debris 142 (FIGS. 14A-15C ). Referring toFIGS. 1 and 13A-13B , thewaist portion 76, thestruts 68 are curved and form curving radial crests or peaks. Alternatively, in thewaist 76 thestruts 68 can be flat and generally straight and parallel, to form an elongate and/orcylindrical waist 76. - The
struts 68 of the distal segments can have a substantially rectangular or flat cross section (e.g., where thestruts 68 comprise uncut portions of a metallic tube or sheet).FIGS. 1 and 13A-13B shows that struts 68 can alternatively have a substantially round (e.g., circular, elliptical, ovoid) cross section (e.g., where thestruts 68 comprise round filaments). A circular, elliptical or ovoid cross-section may be imparted to otherwise square orrectangular struts 58/68 by processing steps such as electropolishing. The distal segment can comprise two ormore struts 68, or between two and twelve struts 68. Although thedistal segment 56 depicted inFIGS. 1-3 comprises eightstruts 68, the distal segment can alternatively comprise two, three, four, five, six, seven, eight, nine, ten, eleven, or twelve struts 68. Still other numbers of struts are possible. As seen inFIG. 3 , thedistal struts 68 may be equally angularly spaced and/or oriented around the central longitudinal axis of the device 50 (e.g., eight struts 45.degree. apart from each adjacent strut, two struts 180.degree. apart from each other, three struts 120.degree. apart, four struts 90.degree. apart, etc.). - One or more of the struts of a segment(s) (preferably a distal and/or an intermediate segment) can optionally include or form widened portions or leaves 78 on the
distal face 74 of the distal segment. As seen inFIG. 3 , the widenedportions 78 can provide a blocking function to prevent or reduce the passage of materials or fluids through thedistal face 74. For example, in one aspect, the widenedportions 78 may be wider than a width of the struts forming the proximal face of thedistal segment 56. This feature enables certain segments to act as filters to capture or engage thrombi, emboli, or other structures that form or are present after deployment of thevascular intervention device 50. -
FIG. 4 depicts one example of a widenedportion 78 that may be employed with any of the embodiments of thedevice 50 disclosed herein. One, some or all of the widened portions 78 (and struts 68) of thedevice 50 may take the form depicted inFIG. 3 and further described herein. To form the widenedportion 78, thestrut 68 can be longitudinally split intosub-struts 82 that surround anopening 84 in the widenedportion 78. The widened portions may also alternate or vary in size from onestrut 68 to the next. - The
struts 68 can be configured to form the sub-struts 82 andopening 84 via taperingportions 86 on either side of theopening 84. Distal and proximal of the taperingportions 86, thestruts 68 can be of substantially uniform width. Theproximal portion 88 of the strut 68 (proximal of the widened portion 78) can be wider than thedistal portion 90 of the strut 68 (distal of the widened portion 78). In such a case, the width of theproximal strut portion 88 can nonetheless be substantially uniform from theproximal tapering portion 86 to theintermediate portion 54, and the width of thedistal strut portion 90 can be substantially uniform (but narrower than the width of the proximal strut portion 88) from thedistal tapering portion 86 to thedistal tip portion 70 of thedevice 50. By employingstruts 68 that are narrower in theirdistal portions 90 than in theirproximal portions 88, the distal face of thedistal portion 56 can be made relatively compliant and therefore more easily conformable, while retaining a desired degree of stiffness in the proximal components of thedevice 50. - In another aspect, the widened
portions 78 may comprise a first and second ramp, where the first ramp extends from an edge of the strut to an edge of the widenedportion 78, and the second ramp extends from the edge of the widenedportion 78 to the edge of the strut. In this manner, the widenedportions 78 can increase the occlusiveness of the distal face when desirable. Instead of or in addition to the widened portion(s) 78, a mesh, membrane or other covering may be employed on thedistal face 74 to perform similar function(s). - Referring to
FIGS. 13A-13B , thedevice 50 may optionally include intermediate segment(s). Theintermediate segment struts 138. Eight struts 138 are depicted in theintermediate segment FIGS. 13A-13B , but more or fewer struts may be employed in theintermediate segment - Referring to
FIG. 13A-13B , thestruts 138 converge toward the radial center of theintermediate segment 134 a at the proximal end of theintermediate segment 134 a, where theintermediate segment 134 a joins the distal end of thepivot section 54 a, and at the distal end of theintermediate segment 134 a, where theintermediate segment 134 a joins proximal end ofpivot section 54 b. Referring toFIG. 13B , thestruts 139 converge toward the radial center of theintermediate segment 134 b at the proximal end of theintermediate segment 134 b, where theintermediate segment 134 b joins the distal end of thepivot section 54 b, and at the distal end of theintermediate segment 134 b, where theintermediate segment 134 b joins proximal end ofpivot section 54 c. - When the device is in the fully-expanded configuration shown in
FIGS. 13A-13B , each segment may include struts that extend radially outward as they advance from one end of the segment to the other end, thereby forming tapering portions or faces. For example, inFIGS. 13A-13B , theintermediate struts 138 extend radially outward as they advance from the proximal and distal ends of theintermediate segment intermediate segment struts 138 reach their radially outermost extent in awaist portion 136 of theintermediate segment distal faces - Referring to
FIGS. 13A-13B , thestruts intermediate segment struts FIGS. 13A-13B show that struts 138, 139 can alternatively have a substantially round (e.g., circular, elliptical, ovoid) cross section (e.g., where thestruts 68 comprise round filaments). A circular, elliptical or ovoid cross-section may be imparted to otherwise square orrectangular struts 58/68 by processing steps such as electropolishing. Theintermediate segment more struts struts - In some embodiments, one or more segments (proximal, distal, and intermediate) may be substantially similar in shape. In the embodiment shown in
FIGS. 13A-13B , the proximal, distal, and intermediate segments have the same number of struts. In other embodiments, the segments may comprise different number of struts. In some embodiments, a segment may have the same number of struts as at least one other segment. - Referring to
FIG. 1 , thepivot section 54 connects adjacent segments (e.g., 52 and 5 inFIG. 1 ), and can be relatively short and relatively narrow (relative to the length and width of the proximal anddistal segment FIG. 13A , the device includes twopivot sections pivot section 54 shown inFIG. 1 . For example, all segments and sections and their respective parts can form a single monolithic structure. As shown inFIG. 13A ,segments sections FIG. 13B ,segments sections - So configured, the pivot section (e.g., 54, 54 a, 54 b, 54 c) allows a relatively distal segment to pivot with respect to a relatively proximal segment and thereby allow the
device 50 to be deployed in tortuous vasculature. For example, referring toFIG. 1 , thedistal segment 56 can pivot with respect toproximal segment 52. InFIG. 13A , thedistal segment 56 can pivot with respect tointermediate segment 134 a and theintermediate segment 134 a can pivot with respect todistal segment 56. - Referring to
FIG. 1 , thepivot section 54 may permit “multiaxial” pivoting or tilting, e.g. at least about a first axis through thepivot section 54 and orthogonal to the plane of the page inFIG. 1 , and about a second axis through thepivot section 54 and orthogonal to the first axis. Thepivot section 54 may permit “omniaxial” pivoting or tilting, about the first and second axes described above, and any radially-oriented axis passing through thepivot section 54. - The device may provide multiaxial or omniaxial pivoting or tilting up to relatively high deflection angles (e.g., up to 90 degrees) without significantly affecting the ability of the segments to maintain their expanded states and engage the vascular debris 142 (
FIGS. 14A-15C ). This capability can be facilitated by making the proximal struts 58 independent of the adjacent struts (e.g., distal struts 68) as depicted inFIG. 1 . The two groups of struts are independent of each other in that forces acting solely on, and/or deflections occurring solely in, the proximal struts 58 do not significantly affect the ability of thedistal struts 68 to maintain their expanded state, and forces acting solely on, and/or deflections occurring solely in, thedistal struts 68 do not significantly affect the ability of the proximal struts 58 to maintain their expanded state. - While some of the embodiments described herein specifically relate to a vascular intervention device having two segments, the described features may generally be extended to devices having two or more segments.
- Referring again to
FIG. 1 , one, some or all of thestruts 58 can bend or pivot with respect to thepivot section 54 independently of one, some or all of thestruts 68 and vice versa. Thepivot section 54 may promote independence by interconnecting thestruts 58 and thestruts 68 in a radially central region of thedevice 50, and physically and functionally separating them, absorbing bending stresses from thestruts 58 and thestruts 68 rather than transmitting them from thestruts 58 to thestruts 68 or vice versa. - Instead of, or in addition to, independence of the proximal struts 58 as a group, from the
distal struts 68 as a group, thestruts 58 may be independent of each other (within the group of struts 58), and/or thestruts 68 may be independent of each other (within the group of struts 68). In thedevice 50 as depicted inFIGS. 1-3 , the proximal struts 58 are independent of each other and thedistal struts 68 are independent of each other. Eachproximal strut 58 can bend or pivot with respect to thepivot section 54 independently of the otherproximal struts 58, and eachdistal strut 68 can bend or pivot with respect to thepivot section 54 independently of the other distal struts 68. Independence is promoted within each group ofstruts device 50. - It should be noted, however, that independence as used herein does not exclude interconnecting independent components by members (e.g. membranes, very fine wires and the like) that are insufficiently rigid to cause one component to significantly affect the action of the other. The proximal struts 58 and/or the
distal struts 68 can also be independent of each other, but only within a limited region of the segment(s). For example, the proximal struts 58 may be independent of each other within thedistal face 64 of the proximal segment, and/or thedistal struts 68 may be independent of each other within theproximal face 72 of thedistal segment 56. - The tapered
distal face 64 of theproximal segment 52 and taperedproximal face 72 of thedistal segment 56 also allow thesections segments pivot section 54. - The pivot section can be rigid or flexible. Where the pivot section is rigid, the pivotability of the
device 50 can be provided by the flexibility and/or independence of thestruts 58 in thedistal face 64 of theproximal segment 52 and of thestruts 68 in theproximal face 72 of thedistal segment 56. In this example, the proximal and distal segments are able to pivot multiaxially relative to each other without requiring plastic deformation of the pivot section. Each ofstruts 58 and struts 68 may be capable of flexing, extending, bowing, straightening, bending, or other elastic or plastic deformation along the length or a portion thereof. - Referring to
FIGS. 1 and 13A-13B , as struts independently flex and extend,segments - According to embodiments, such action is facilitated along one or more segments and/or sections of the device. According to embodiments, this pivot action is provided without requiring plastic deformation of pivot section or any action along the length of pivot section. The pivot section can comprise a short length of hypotube (e.g., a short length of uncut hypotube) which may be flexible or rigid. According to embodiments, the pivot section can comprise a flexible coil, longitudinally oriented such that its winds spiral around the central longitudinal axis of the
device 50, or the pivot section can comprise a ball-and-socket joint, a length of flexible wire, or other flexible member. - The
device 50 can further comprise one or more radiopaque markers (e.g. coils) coupled to or wound around portions of the device. For example, thedevice 50 can include radiopaque markers on one, two or all three of theproximal end portion 60,pivot section 54, anddistal end portion 70. Instead of or in addition to those markers, thedevice 50 can include radiopaque markers on one or more of thestruts 58, and/or on one or more of thestruts 68. According to embodiments, when any of theproximal end portion 60,intermediate segment 54, ordistal end portion 70 defines a central lumen therethrough (e.g., when thedevice 50 is cut or etched from a tube or sheet), radiopaque material may be placed within some, one or all of those lumens to make theproximal end portion 60,pivot section 54, anddistal end portion 70 radiopaque. For example, radiopaque material maybe provided within a lumen of at least one of theproximal end portion 60,pivot section 54, anddistal end portion 70 with securement at one or both of the ends of the lumen. - The device can comprise a self-expanding, super elastic, and/or a shape-memory material (e.g., comprising Nitinol, CoCr alloy, shape memory polymers (e.g., polyglycolic acid, polylactic acid), etc.), thereby causing the device to be self-expanding under certain conditions (e.g., when not restrained by a catheter). In some embodiments, the proximal segment, the pivot section, the distal segment, and/or intermediate segment(s) may comprise different materials. For example, the
distal segment 56 may comprise polymer material while the proximal segment and the pivot section comprise metallic material, a different polymer material, etc. For another example, the distal segment may comprise metallic material while the proximal segment and the pivot section comprise different metallic materials, polymer material, etc. Other combinations of materials are also possible. The device can assume a low profile compressed state (e.g., confined within a catheter) for delivery. When cut from a tube or sheet, the device may assume substantially the diameter of the tube or rolled sheet when in the compressed state. Upon deployment from the catheter, the device expands from the compressed state to an expanded state. - The various versions of the
vascular intervention device 50 disclosed herein can be manufactured in a process comprising cutting (or electrochemically etching) and shaping a metallic tube or sheet (e.g., a laser cut hypotube or sheet). A laser or electrochemical etcher may cut out portions of the tube, leaving in place the various structural elements of the proximal segment, the pivot section(s), the intermediate segment(s), and/or the distal segment. In thedevice 50 depicted inFIGS. 1-3 and 12 , or thedevice 50 depicted inFIG. 4 , theproximal segment 52, thepivot section 54, and thedistal segment 56 can be integrally formed from a metallic tube and not cut away from each other. Indevices 50 in which all segments andsections device 50 is of single-piece construction, taking the form of a single, partial tube or sheet. As shown inFIGS. 1-12 , all segments andsections proximal segment 52, thepivot section 54, and thedistal segment 56 can form a single monolithic structure. Alternatively, thesections pivot section 54 comprises a coil, thesegments - After cutting from one or more tubes, the
device 50 or segments/section(s) 52/54/56 thereof may be reshaped and heat treated to impart shape setting to the device or segments/section(s). The shape setting process may include several steps comprising, for example, stretching and confining the cut tube into a new shape during the heat treatment. At the end of each heat treatment step, the cut tube assumes the shape in which it was confined during the heat treatment process. The final shape (e.g., expanded state) and size may obtained by several such steps. Thedevice 50 or cut tube may be electropolished during manufacture, which can reduce the initial wall thickness of the tube to a final, desired thickness. -
FIGS. 5-12 depict a version of the device 50 (and acut pattern 300 for constructing it) that can be similar to any of the other versions or embodiments of thedevice 50 disclosed or summarized herein, in structure, configuration, function, method of manufacture, method of use, and material choice, except as further discussed herein. In thedevice 50 ofFIGS. 5-12 , thestruts 58 of theproximal section 52 comprise a number (e.g. 6, as depicted, or any other suitable number) ofproximal strut portions 58 a and a corresponding number ofdistal strut portions 58 b. - The
proximal portions 58 a and thedistal portions 58 b are rotated or shifted laterally with respect to each other, such that eachproximal portion 58 a opposes (e.g., approximately one-half of each of) twodistal portions 58 b, and vice versa. From the distal end of eachproximal portion 58 a, two sub-struts 58 c extend distally to the twodistal portions 58 b that oppose (or are longitudinally adjacent) theproximal portion 58 a from which the sub-struts 58 c extend. Accordingly, eachproximal portion 58 a is connected to the two adjacent or opposingdistal portions 58 b (and vice versa) viasub-struts 58 c. For example, each strut may have a proximal end, a distal end, and a center portion therebetween, the center portion connected to adjacent struts. - In another example, each strut may extend from an origination junction and be divided into a first and second branch, wherein the first branch is connected to a first adjacent strut and the second branch is connected to a second adjacent strut. In this example, a length of the first branch and a length of the second branch may be different such that a connecting point between the strut and the first adjacent strut is disposed at a different longitudinal position than a connecting point between the strut and the second adjacent strut.
- According to embodiments, the length of the first branch and the length of the second branch may be the same. In another example, at least one strut may extend proximally from the intermediate section and be divided into a first and second branch at or near the waist of the proximal section. The first branch may be connected to the first adjacent strut and the second branch may be connected to the second adjacent strut. The first and second adjacent struts may extend proximally from the waist of the proximal section toward the radially central region of the device.
- According to embodiments, one or
more sections - When the
proximal section 52 of thedevice 50 is expanded, the sub-struts 58 c extend both longitudinally to interconnect theproximal end portion 60 and theintermediate section 54, and laterally or circumferentially to each neighboring proximal ordistal portion struts 58 of theproximal section 52 increases the outward radial force exerted by the proximal section 52 (and the inward radial force that theproximal section 52 can withstand without collapse) when expanded. In addition, the lateral/circumferential interconnection of the struts of theproximal section 52 reduces the tendency of the expanded struts 58 to bunch together in the vessel or “half-moon.” Further, the lateral/circumferential interconnection of the struts of the proximal section maintains the three dimensional shape of the proximal section. Moreover, the lateral/circumferential interconnection of the struts of the proximal section provides structural support for the interconnected struts - As depicted in
FIGS. 5-6 and 8-9 , the sub-struts 58 c (e.g., the peaks thereof) can form thewaist 66 of theproximal segment 52, or otherwise comprise the radially outermost portion of theproximal segment 52. The sub-struts 58 c can optionally be approximately longitudinally centered on the longitudinal midpoint of theproximal segment 52, such that the midpoint approximately evenly divides the sub-struts 58 c in the longitudinal direction. Such an arrangement is also depicted inFIGS. 5-6 and 8-9 . - As depicted in
FIGS. 7 and 11-12 , the widenedportions 78 on thedistal tapering portion 74 of thedistal segment 56 can be formed via the lateral/circumferential interconnection arrangement employed in theproximal segment 52 and discussed above. To accomplish this, theproximal strut portions 88 anddistal strut portions 90 of thedistal struts 68 are rotated or shifted laterally with respect to each other, such that eachproximal portion 88 opposes (e.g., approximately one-half of each of) twodistal portions 90, and vice versa. From the distal end of eachproximal portion 88, two sub-struts 82 extend distally to the twodistal portions 88 that oppose (or are longitudinally adjacent) theproximal portion 88 from which the sub-struts 82 extend. Accordingly, eachproximal portion 88 is connected to the two adjacent or opposing distal portions 90 (and vice versa) viasub-struts 82. For example, at least one strut may extend distally from the intermediate section and be divided into a first and second branch at or near the waist of the distal section. The first branch may be connected to the first adjacent strut and the second branch may be connected to the second adjacent strut. The first and second adjacent struts may extend distally from the waist of the distal section toward the radially central region of the device. - When the
distal segment 56 of thedevice 50 ofFIGS. 5-12 is expanded, the sub-struts 82 extend both longitudinally to interconnect thepivot section 54 and thedistal end portion 70, and laterally or circumferentially to each neighboring proximal ordistal strut portion struts 68 of thedistal segment 56 reduces the tendency of the expanded struts 68 to bunch together once deployed in the vessel or “half-moon.” Further, the lateral/circumferential interconnection of the struts of the distal segment maintains the three dimensional shape of the distal section. Moreover, the lateral/circumferential interconnection of the struts of the distal segment provides structural support for the interconnected struts. - As depicted in
FIGS. 5, 7 and 11-12 , the widenedportions 78 and the sub-struts 82 can be located on thedistal face 74 of thedistal portion 56. The widenedportions 78 andsub-struts 82 can optionally be located wholly distal of thewaist 76 of thedistal portion 56. Such an arrangement is also depicted inFIGS. 5-6 and 8-9 . In other aspects, the widened portions may resemble the structures as disclosed elsewhere herein. - Although the
device 50 is depicted in its expanded state inFIGS. 1-3 , thedevice 50 can have a contracted state (“collapsed state”) in which the proximal anddistal segments segments sections distal segments device 50 is cut, and/or substantially equal to the diameter of thepivot section 54. - The device may be of any dimension that is compatible with one or more embodiments of the subject technology. In some embodiments, the diameter of the waist (e.g., 66, 76) when expanded may be from about 2 mm to about 20 mm. In some embodiments, the diameter of the waist when contracted may be from about 0.25 mm to about 0.75 mm. In some embodiments, the length of the a segment when expanded may be from about 2 mm to about 20 mm. In some embodiments, the width of a strut may be from about 0.075 mm to about 0.15 mm. In some embodiments, the thickness of a strut may be from about 0.025 mm to about 0.10 mm. In some embodiments, the length of the pivot section may be from about 0.01 mm to about 5 mm. In some embodiments, the diameter of the pivot section may be from about 0.25 mm to about 0.75 mm. In some embodiments, the wall thickness of the pivot section may be from about 0.025 mm to about 0.10 mm.
- In the embodiment shown in
FIGS. 14A-14C , thevascular intervention device 50 is at least partially encapsulated by a sheath (e.g., catheter 144) which has been inserted into avasculature 146. As shown inFIG. 14A , thevascular intervention device 50 is in a collapsed state and thecatheter 144 is positioned at or nearvascular debris 142 which resides within avasculature 146.FIG. 14A represents one possible configuration ofvascular intervention device 50 prior to its deployment from thecatheter 144. As shown inFIGS. 14A-14B and 15A-15B , thethrombus 142 is adhered to an inner wall of thevasculature 146. -
FIG. 14B shows avascular intervention device 50 in a deployed or partially-deployed state. As shown inFIG. 14B , thedistal segment 56 has been moved distally outside of thedistal opening 150 of thecatheter 144 and is now in an expanded state. A distal or proximal motion of thevascular intervention device 50 is generally initiated by a user who can controllably operate thedevice 50 at the proximal end (not shown) and may be accomplished by any number of means, for example, proximal motion of thecatheter 144, distal motion of thedevice 50, or both. A user may operate an actuator which is coupled to atether 140 which in turn is coupled to thedevice 50 as shown inFIGS. 14A-14C . As shown inFIG. 14B , thedistal segment 56 can expand to the expanded state and engage athrombus 142. In the particular embodiment shown inFIG. 14B , a portion of thevascular intervention device 50 is still encapsulated by the sheath. In other embodiments, the vascular intervention device may be fully deployed, in which all of the segments have been pushed outside thedistal opening 150 of thecatheter 144.FIG. 14C shows the vascular intervention device in a re-collapsed state. As shown inFIG. 14C , thevascular intervention device 50 has moved proximally (relative toFIG. 14B ) back into thecatheter 144 through thedistal opening 150 after engaging thethrombus 142 inFIG. 14B . The proximal motion of thedevice 50 effectively retrieved thethrombus 142 into thecatheter 144. The proximal movement caused the expanded segment(s) to revert back to a collapsed state. Suction, aspiration, or negative pressure may be provided asthrombus 142 is brought neardistal opening 150, to facilitate capture ofthrombus 142 withincatheter 144. Further, balloon devices, such as balloon catheters, may be provided and utilized to manage flow through the vasculature at the location ofthrombus 142. For example, a balloon may be expanded proximal todistal opening 150 to substantially slow or stop flow downstream to the location ofthrombus 142. Use of a balloon and aspiration creates a flow path that facilitates capture ofthrombus 142 withincatheter 144. - In the embodiment shown in
FIGS. 15A-15C , thevascular intervention device 50 includes four segments that are at least partially encapsulated by thecatheter 144 which has been inserted into avasculature 146. The segments are coupled to atether 140 which can be manipulated by a user to causes proximal or distal translational motions of thedevice 50. As shown inFIG. 15A , thevascular intervention device 50 is in a collapsed state and thecatheter 144 is positioned at or near athrombus 142 which resides within avasculature 146. -
FIG. 15B shows avascular intervention device 50 in a deployed or partially-deployed state. As shown inFIG. 15B , the distal and the intermediate segments have been moved distally outside of thedistal opening 150 of thecatheter 144 and are now in an expanded state. In the embodiment shown inFIG. 15B , thedistal segment 56 has been deployed distal to thethrombus 142 while the intermediate segment is positioned to engage thethrombus 142. One of the advantages of multiple segments is that relatively less precision is required during the positioning process since any of the segments can engage the thrombus. Optionally, the relatively distal segments may act as a filter by having, for example, widened portions that increase the occlusiveness of the distal segment. Thus, parts of thrombus that may be broken up during the engagement of the intermediate segment to the thrombus may be filtered downstream by the distal segment. In the embodiment shown inFIG. 15B , a proximal portion of thevascular intervention device 50 is still encapsulated by thecatheter 144. In other embodiments, thevascular intervention device 50 may be fully deployed.FIG. 15C shows thevascular intervention device 50 in a re-collapsed state. As shown inFIG. 15C , thevascular intervention device 50 has moved proximally through thedistal opening 150 after engaging the thrombus inFIG. 15B . The proximal movement caused the expanded segment(s) to revert back to a collapsed state and effectively retrieved thethrombus 142 into thecatheter 144. - Some embodiments provide a device for retrieving vascular debris in a vasculature comprising: at least two segments radially expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; at least one intermediate portion, each intermediate portion comprising a pivot that connects adjacent segments, each pivot having a diameter comprising the radially largest region of the pivot; a sheath that is configured to encase the segments in the compressed state; and a tether that is configured to retract the expanded segment into the outer sheath.
- In some embodiments, the struts are radially-expandable. In some embodiments, at least one strut diverges from the longitudinal axis, divides into at least two struts, merges with a circumferentially adjacent strut, and converges toward the longitudinal axis.
- Some embodiments provide a device comprising at least three segments. Some embodiments provide a device comprising at least four segments. Some embodiments provide a device comprising at least five segments. Some embodiments provide a device comprising at least six segments. Some embodiments provide a device comprising at least seven segments. Some embodiments provide a device comprising at least eight segments. Some embodiments provide a device comprising at least nine segments. Some embodiments provide a device comprising at least ten segments.
- Some embodiments provide a device for retrieving vascular debris in a vasculature comprising: at least three segments expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; at least two intermediate portion, each intermediate portion comprising a pivot that connects adjacent segments, each pivot having a diameter comprising the radially largest region of the pivot; a sheath that is configured to encase the segments in a compressed state; and a tether that is configured to retract the segments into the sheath.
- Some embodiments provide a method of retrieving vascular debris from a vasculature comprising: inserting into the vasculature of a patient at least a portion of a sheath comprising a distal opening and encasing at least two or more segments expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; releasing at least a portion of a segment outside the distal opening wherein at least a portion of the segment expands to engage the vascular debris; and retrieving the segment and at least a portion of the vascular debris inside the sheath.
- In some embodiments, the vascular debris is a thrombus or an embolus. In some embodiments, the sheath encapsulates at least three expandable segments. In some embodiments, the outer diameter of the sheath is no larger than 50% of the diameter of the vasculature.
- The foregoing description is provided to enable a person skilled in the art to practice the various configurations described herein. While the subject technology has been particularly described with reference to the various figures and configurations, it should be understood that these are for illustration purposes only and should not be taken as limiting the scope of the subject technology.
- There may be many other ways to implement the subject technology. Various functions and elements described herein may be partitioned differently from those shown without departing from the scope of the subject technology. Various modifications to these configurations will be readily apparent to those skilled in the art, and generic principles defined herein may be applied to other configurations. Thus, many changes and modifications may be made to the subject technology, by one having ordinary skill in the art, without departing from the scope of the subject technology.
- Furthermore, to the extent that the term “include,” “have,” or the like is used in the description or the claims, such term is intended to be inclusive in a manner similar to the term “comprise” as “comprise” is interpreted when employed as a transitional word in a claim.
- A phrase such as “an aspect” does not imply that such aspect is essential to the subject technology or that such aspect applies to all configurations of the subject technology. A disclosure relating to an aspect may apply to all configurations, or one or more configurations. An aspect may provide one or more examples of the disclosure. A phrase such as “an aspect” may refer to one or more aspects and vice versa. A phrase such as “an embodiment” does not imply that such embodiment is essential to the subject technology or that such embodiment applies to all configurations of the subject technology. A disclosure relating to an embodiment may apply to all embodiments, or one or more embodiments. An embodiment may provide one or more examples of the disclosure. A phrase such as “an embodiment” may refer to one or more embodiments and vice versa. A phrase such as “a configuration” does not imply that such configuration is essential to the subject technology or that such configuration applies to all configurations of the subject technology. A disclosure relating to a configuration may apply to all configurations, or one or more configurations. A configuration may provide one or more examples of the disclosure. A phrase such as “a configuration” may refer to one or more configurations and vice versa.
- The word “exemplary” is used herein to mean “serving as an example, instance, or illustration.” Any embodiment described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other embodiments.
- A reference to an element in the singular is not intended to mean “one and only one” unless specifically stated, but rather “one or more.” All structural and functional equivalents to the elements of the various configurations described throughout this disclosure that are known or later come to be known to those of ordinary skill in the art are expressly incorporated herein by reference and intended to be encompassed by the subject technology. Moreover, nothing disclosed herein is intended to be dedicated to the public regardless of whether such disclosure is explicitly recited in the above description.
- While certain aspects and embodiments of the invention have been described, these have been presented by way of example only, and are not intended to limit the scope of the invention. Indeed, the novel methods and systems described herein may be embodied in a variety of other forms without departing from the spirit thereof. The accompanying claims and their equivalents are intended to cover such forms or modifications as would fall within the scope and spirit of the invention.
Claims (25)
1-20. (canceled)
21. A device for retrieving vascular debris in a vasculature, the device comprising:
at least three segments that are interlocked, the at least three segments being radially expandable from a collapsed state to an expanded state, each of the at least three segments having a waist comprising a radially largest region of the segment;
at least one intermediate portion, each of the at least one intermediate portion is positioned between adjacent segments and has a diameter less than a diameter of the waist;
wherein each of the at least three segments comprises a proximal end and a distal end that are connected by only struts and sub-struts, the struts and sub-struts extending radially outside the diameter of the at least one intermediate portion, wherein, in each of the at least three segments, at least one strut extends proximally from the distal end and along a first longitudinal region of the segment and divides into at least two sub-struts, the at least two sub-struts being entirely within a second longitudinal region of the segment that is outside the radially largest region of the segment, the struts tapering from the waist radially inwardly toward a longitudinal axis of the device as the struts approach an adjacent intermediate portion, and
wherein each intermediate portion forms a circumferentially continuous hollow cylinder.
22. The device of claim 21 , wherein each of the at least three segments have substantially similar waist dimensions in the expanded state.
23. The device of claim 21 , wherein each of the at least three segments have substantially similar waist dimensions in the collapsed state.
24. The device of claim 21 , wherein each of the at least three segments have the same number of struts.
25. The device of claim 21 , wherein a total number of the sub-struts is double a total number of the struts that are connected to proximal sides of the sub-struts and double a total number of the struts that are connected to distal sides of the sub-struts.
26. The device of claim 21 , wherein the diameter of the waist in the expanded state is at least five times larger than the diameter of the at least one intermediate portion.
27. The device of claim 21 , wherein at least one strut is configured to flex along its length, allowing the at least three segments to pivot multiaxially about their respective intermediate portion.
28. A system for retrieving vascular debris in a vasculature, the system comprising:
at least three segments that are interconnected, the three segments being expandable from a collapsed state to an expanded state, each of the at least three segments having a waist comprising a radially largest region of the segment;
at least two intermediate portions, each of the at least two intermediate portions positioned between adjacent segments and having a diameter less than a diameter of the waist;
a sheath configured to encase the at least three segments in the collapsed state; and
wherein each of the at least three segments comprises, between a proximal end and a distal end thereof, only struts and sub-struts, the struts and sub-struts extending radially outside the diameter of the at least two intermediate portions, wherein, in each of the at least three segments, at least one strut extends proximally from the distal end and along a first longitudinal region of the segment and divides into at least two sub-struts, the at least two sub-struts being entirely within a second longitudinal region of the segment that is outside the radially largest region of the segment, and
wherein each intermediate portion forms a circumferentially continuous hollow cylinder.
29. The system of claim 28 , wherein each of the at least three segments have substantially similar waist dimensions in the expanded state.
30. The system of claim 28 , wherein each of the at least three segments have substantially similar waist dimensions in the collapsed state.
31. The system of claim 28 , wherein each of the at least three segments comprises at least two struts that extend from a proximal end to a distal end of the segment.
32. The system of claim 31 , wherein each of the at least two struts tapers from the waist toward a longitudinal axis as it approaches an adjacent intermediate portion.
33. The system of claim 31 , wherein a total number of the sub-struts is double a total number of the struts that are connected to proximal sides of the sub-struts and double a total number of the struts that are connected to distal sides of the sub-struts.
34. The system of claim 28 , wherein the at least three segments comprises at least four segments.
35. A method of retrieving vascular debris from a vasculature, the method comprising:
inserting into the vasculature of a patient at least a portion of a sheath comprising a distal opening and encasing at least two segments that are interlocked, the at least two segments being expandable from a collapsed state to an expanded state, each of the at least two segments having a waist comprising a radially largest region of the segment and at least one intermediate portion positioned between the segment and an axially adjacent segment, wherein each of the at least two segments comprises, between a proximal end and a distal end thereof, only struts and sub-struts, the struts and sub-struts extending radially outside a diameter of the at least one intermediate portion, wherein, in each of the at least two segments, at least one strut extends proximally from the distal end and along a first longitudinal region of the segment and divides into at least two sub-struts, the at least two sub-struts being entirely within a second longitudinal region of the segment that is outside the radially largest region of the segment, wherein each intermediate portion forms a circumferentially continuous hollow cylinder;
expanding at least a portion of the at least two segments into vascular debris; and
retrieving the at least two segments and the vascular debris to within the sheath.
36. The method of claim 35 , wherein the vascular debris is engaged with a proximalmost segment of the at least two segments.
37. The method of claim 35 , further comprising: capturing, within a distal segment, vascular debris dislodged from a proximal segment.
38. The method of claim 35 , wherein the at least a portion of the at least two segments becomes engaged throughout the vascular debris.
39. The method of claim 35 , wherein each of the at least two segments expands to substantially similar outer diameters.
40. The method of claim 35 , wherein each of the at least two segments comprises at least two struts that extend from a proximal end to a distal end of the segment.
41. The method of claim 40 , wherein expanding at least a portion of the at least two segments is performed by retracting the sheath relative to the at least two segments.
42. The method of claim 40 , wherein a total number of the sub-struts is double a total number of the struts that are connected to proximal sides of the sub-struts and double a total number of the struts that are connected to distal sides of the sub-struts.
43. The method of claim 40 , wherein at least one strut is configured to flex along its length, allowing the at least two segments to pivot multiaxially about their respective intermediate portion.
44. The method of claim 35 , wherein the sheath encases at least three expandable segments.
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WO2014074318A1 (en) | 2014-05-15 |
EP3130297B1 (en) | 2018-03-07 |
CN104768479B (en) | 2017-10-24 |
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CN104768479A (en) | 2015-07-08 |
EP2916747B1 (en) | 2016-12-07 |
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