Methods of managing neurovascular obstructions
First Claim
1. A method of managing a thrombus in neurovasculature without distal embolic protection for the treatment of acute ischemic stroke, the method comprising:
- identifying an occluded artery of the neurovasculature of a subject having a thrombus;
inserting a balloon guide catheter within the subject and advancing a distal end of the balloon guide catheter to an arterial location proximal to the occluded artery;
inserting a guidewire through the balloon guide catheter and advancing a distal end of the guidewire within the occluded artery and through or to the side of the thrombus,inserting a distal access catheter through the guide catheter and advancing a distal end of the distal access catheter to a location within the occluded artery proximate the thrombus;
inserting a microcatheter through the distal access catheter and advancing a distal end of the microcatheter through or to the side of the thrombus;
positioning the distal end of the microcatheter 0.5 to 10 mm past a distal end of the thrombus;
inserting an expandable tip assembly comprising a self-expandable scaffold tethered to a distal end of an elongate delivery member through the microcatheter,wherein said self-expandable scaffold has an open downstream end and comprises a generally cylindrical body comprised of a plurality of struts and bridges forming a plurality of cells,wherein the cells are sized and shaped to impact, compress and engage thrombus material upon radial expansion of the self-expandable scaffold;
retracting the microcatheter proximally, thereby causing the self-expandable scaffold to span at least a segment of the length of the thrombus;
wherein said expansion impacts and compresses the thrombus against a wall of the occluded artery,wherein said compression of the thrombus restores blood flow within the occluded artery,wherein said restored blood flow facilitates natural lysis of the thrombus;
while the expandable tip remains stationary, macerating the thrombus by resheathing the self-expandable scaffold and unsheathing the self-expandable scaffold, thereby facilitating mechanical lysis and fragmentation of the thrombus to release embolic particles,wherein the embolic particles flow in the direction of the blood flow and are not captured by any distal embolic protection member, but are instead lysed through the natural lysis process due to the restored blood flow; and
removing said expandable tip assembly from the subject, thereby removing any portions of the thrombus engaged by the self-expandable scaffold from the occluded artery.
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Accused Products
Abstract
Systems, methods, and devices for the treatment of acute ischemic stroke that provide immediate blood flow restoration to a vessel occluded by a clot and, after reestablishing blood flow, address the clot itself. Immediate blood flow restoration advantageously can facilitate natural lysis of the clot and also can reduce or obviate the concern for distal embolization due to fragmentation of the clot. Several embodiments of the invention provide for progressive, or modular, treatment based upon the nature of the clot. For example, the progressive treatment can include immediate restoration of blood flow, in-situ clot management, and/or clot removal depending on the particular circumstances of the treatment. The in-situ clot management can include, for example, lysis, maceration, and/or removal.
565 Citations
18 Claims
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1. A method of managing a thrombus in neurovasculature without distal embolic protection for the treatment of acute ischemic stroke, the method comprising:
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identifying an occluded artery of the neurovasculature of a subject having a thrombus; inserting a balloon guide catheter within the subject and advancing a distal end of the balloon guide catheter to an arterial location proximal to the occluded artery; inserting a guidewire through the balloon guide catheter and advancing a distal end of the guidewire within the occluded artery and through or to the side of the thrombus, inserting a distal access catheter through the guide catheter and advancing a distal end of the distal access catheter to a location within the occluded artery proximate the thrombus; inserting a microcatheter through the distal access catheter and advancing a distal end of the microcatheter through or to the side of the thrombus; positioning the distal end of the microcatheter 0.5 to 10 mm past a distal end of the thrombus; inserting an expandable tip assembly comprising a self-expandable scaffold tethered to a distal end of an elongate delivery member through the microcatheter, wherein said self-expandable scaffold has an open downstream end and comprises a generally cylindrical body comprised of a plurality of struts and bridges forming a plurality of cells, wherein the cells are sized and shaped to impact, compress and engage thrombus material upon radial expansion of the self-expandable scaffold; retracting the microcatheter proximally, thereby causing the self-expandable scaffold to span at least a segment of the length of the thrombus; wherein said expansion impacts and compresses the thrombus against a wall of the occluded artery, wherein said compression of the thrombus restores blood flow within the occluded artery, wherein said restored blood flow facilitates natural lysis of the thrombus; while the expandable tip remains stationary, macerating the thrombus by resheathing the self-expandable scaffold and unsheathing the self-expandable scaffold, thereby facilitating mechanical lysis and fragmentation of the thrombus to release embolic particles, wherein the embolic particles flow in the direction of the blood flow and are not captured by any distal embolic protection member, but are instead lysed through the natural lysis process due to the restored blood flow; and removing said expandable tip assembly from the subject, thereby removing any portions of the thrombus engaged by the self-expandable scaffold from the occluded artery. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9)
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10. A thrombus management method for the treatment of acute ischemic stroke, the method comprising:
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identifying an occluded artery in the neurovasculature of a subject having a thrombus; inserting a guide catheter within the subject and advancing a distal end of the guide catheter to an arterial location proximal to the occluded artery; inserting a microcatheter through the guide catheter and advancing a distal end of the microcatheter through or to the side of the thrombus; inserting an expandable tip assembly comprising a self-expandable scaffold, tethered to a distal end portion of an elongate delivery member, through the microcatheter such that a distal end of the expandable tip assembly is distal to a distal end of the thrombus, wherein said self-expandable scaffold has an open downstream end and forms a plurality of cells, retracting the microcatheter proximally such that the self-expandable scaffold expands at the location of the thrombus and against the thrombus; while the expandable tip remains stationary, resheathing the self-expandable scaffold and unsheathing the self-expandable scaffold, thereby facilitating fragmentation of the thrombus to release embolic particles; and wherein the embolic particles flow in the direction of the blood flow and are not captured by any distal embolic protection member; and removing said expandable tip assembly from the subject, thereby removing a captured portion of the thrombus engaged by the self-expandable scaffold from the occluded artery. - View Dependent Claims (11, 12, 13, 14, 15)
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16. A thrombus management method without distal embolic protection for the treatment of ischemic stroke, the method comprising:
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identifying an occluded blood vessel having a thrombus; inserting a microcatheter within a guide catheter to a location of the thrombus; positioning a distal end of the microcatheter 0.5 to 20 mm past a distal end of the thrombus; inserting an expandable tip assembly comprising a self-expandable scaffold permanently tethered to a distal end of a flexible, elongate delivery member through the microcatheter, the self-expandable scaffold having an open downstream end; advancing the expandable tip assembly within the microcatheter to a position within the microcatheter such that, upon retraction of the microcatheter, the self-expandable scaffold will at least partially span the thrombus; retracting the microcatheter proximally, thereby causing the self-expandable scaffold to expand across at least a segment of the length of the thrombus; wherein said expansion radially compresses the thrombus against a wall of the blood vessel; wherein said radial compression of the thrombus restores blood flow within the blood vessel; wherein said restored blood flow facilitates natural lysis of at least outer layers of the thrombus; while the expandable tip remains stationary, macerating the thrombus by resheathing the scaffold and unsheathing the scaffold, thereby facilitating mechanical lysis and fragmentation of the thrombus to release embolic particles; wherein the embolic particles flow in the direction of the blood flow and are not captured by any distal embolic protection member, but are instead lysed through the natural lysis process due to the restored blood flow; engaging a remaining core portion of the thrombus after said maceration on an external surface of the self-expandable scaffold; and extracting said remaining core portion of the thrombus from the blood vessel by removing the expandable tip assembly from the subject. - View Dependent Claims (17, 18)
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Specification