Methods and systems for treatment of acute ischemic stroke

• US 10,646,239 B2
• Filed: 08/30/2018
• Issued: 05/12/2020
• Est. Priority Date: 08/05/2011
• Status: Active Grant

• Current Assignee: Route 92 Medical, Inc.
• Original Assignee: Route 92 Medical, Inc.
• Inventors: Garrison, Michi E., Chou, Tony M.
• Primary Examiner(s): Mensh, Andrew J
• Application Number:
  US16/117,753
• Publication Number:
  US 20190046218A1
• Time in Patent Office: 621 Days
• Field of Search: 604 8, 604 4, 604508, 604509, 604523, 606159
• CPC Class Codes: A61B 17/22 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 dilators A61M29/00
• CPC Class Codes: A61B 17/221 Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions surgical snare instruments A61B17/32056
• CPC Class Codes: A61B 17/32037 for removing obstructions from inner organs or blood vessels, e.g. for atherectomy
• CPC Class Codes: A61B 2017/22034 for gripping the obstruction or the tissue part from inside
• CPC Class Codes: A61B 2017/22038 with a guide wire
• CPC Class Codes: A61B 2017/22039 eccentric
• CPC Class Codes: A61B 2017/22044 with a pointed tip
• CPC Class Codes: A61B 2017/22054 with two balloons
• CPC Class Codes: A61B 2017/22084 stone- or thrombus-dissolving
• CPC Class Codes: A61B 2017/22094 for crossing total occlusions, i.e. piercing
• CPC Class Codes: A61B 2017/2212 having a closed distal end, e.g. a loop
• CPC Class Codes: A61B 2017/2217 single wire changing shape to a gripping configuration
• CPC Class Codes: A61F 2/013 Distal protection devices, i.e. devices placed distally in combination with another endovascular procedure, e.g. angioplasty or stenting
• CPC Class Codes: A61M 1/3621 Extra-corporeal blood circuits single-needle circuits A61M1/30
• CPC Class Codes: A61M 1/82 Membrane pumps, e.g. bulbs
• CPC Class Codes: A61M 2025/0681 Systems with catheter and outer tubing, e.g. sheath, sleeve or guide tube
• CPC Class Codes: A61M 25/0068 Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
• CPC Class Codes: A61M 25/0169 Exchanging a catheter while keeping the guidewire in place
• CPC Class Codes: A61M 25/0662 Guide tubes
• CPC Class Codes: A61M 60/43 using vacuum at the blood pump, e.g. to accelerate filling

Abstract

Described are methods for performing a medical procedure at a treatment site in a cerebral vessel of a patient. The methods include positioning a system of devices into an advancement configuration, the system including a catheter and an inner member sized and shaped to slide within the catheter lumen. The inner member defines a single lumen and has a distal portion, the distal portion having a first outer diameter that tapers distally to a second outer diameter that is smaller than the first outer diameter. When positioned in the advancement configuration, the inner member extends coaxially through the catheter lumen and the distal portion of the inner member is positioned distal to the distal end of the catheter. The method further includes advancing the system of devices distal to a petrous portion of an internal carotid artery while the system of devices is positioned in the advancement configuration.

Claims

1. A method of performing a medical procedure at a treatment site in a cerebral vessel of a patient, the method comprising:

positioning a system of devices into an advancement configuration, the system of devices comprising;

a catheter having a catheter lumen, an inner diameter and a distal end; and

an inner member sized and shaped to slide within the catheter lumen, wherein the inner member defines a single lumen and has a distal portion, the distal portion having a first outer diameter that tapers distally to a second outer diameter that is smaller than the first outer diameter, wherein the inner member transitions in flexibility from a proximal end of the inner member to a distal end of the inner member, the distal end of the inner member being more flexible than the distal end of the catheter, and

wherein, when positioned in the advancement configuration, the inner member extends coaxially through the catheter lumen until the distal portion of the inner member is positioned distal to the distal end of the catheter and the inner member is held fixed relative to the catheter; and

concurrently advancing the catheter and the flexible inner member distal to a petrous portion of an internal carotid artery while the system of devices is positioned in the advancement configuration.

2. The method of claim 1, further comprising removing the inner member from the catheter lumen, and removing occlusive material while applying negative pressure to the catheter lumen to capture occlusive material at, within, or through the distal end of the catheter.

3. The method of claim 2, further comprising inserting a stent retriever through the catheter;

capturing occlusive material with the stent retriever; and

removing occlusive material from the treatment site.

4. The method of claim 1, further comprising delivering a treatment through the single lumen of the inner member to the treatment site.

5. The method of claim 4, wherein the treatment comprises capturing material with a stent retriever.

6. The method of claim 4, wherein the treatment comprises delivering a thrombolytic agent to the treatment site.

7. The method of claim 1, wherein, when the system of devices is positioned in the advancement configuration, a length of the distal portion of the inner member creates a smooth transition from the second outer diameter to the inner diameter of the distal end of the catheter.

8. The method of claim 1, wherein, when the system of devices is positioned in the advancement configuration, a flexibility of the distal portion of the inner member decreases proximally and creates a smooth transition in flexibility from the second outer diameter to the distal end of the catheter.

9. The method of claim 1, wherein a flexibility of the distal portion of the inner member decreases smoothly from the second outer diameter to the first outer diameter.

10. The method of claim 9, further comprising inserting a stent retriever through the catheter;

capturing occlusive material with the stent retriever; and

removing occlusive material from the treatment site.

11. The method of claim 9, further comprising delivering a stent retriever through the single lumen of the inner member to a treatment location in a cerebral vessel.

12. The method of claim 9, further comprising removing occlusive material while applying negative pressure to the catheter lumen to capture occlusive material at, within, or through the distal end of the catheter.

13. The method of claim 12, further comprising delivering a stent retriever through the single lumen of the inner member to the treatment location site.

14. The method of claim 1, wherein the first outer diameter substantially corresponds to the inner diameter of the distal end of the catheter.

15. The method of claim 14, wherein, when the system of devices is positioned in the advancement configuration, a flexibility of the distal portion of the inner member decreases proximally and creates a smooth transition in flexibility from the second outer diameter to the distal end of the catheter.

16. The method of claim 14, wherein a flexibility of the distal portion of the inner member decreases smoothly from the second outer diameter to the first outer diameter.

17. The method of claim 1, wherein, when the system of devices is positioned in the advancement configuration and a guidewire is positioned within the single lumen and extended out a distal opening of the distal portion, the inner member creates a smooth transition from an outer diameter of the guidewire to the inner diameter at the distal end of the catheter.

18. The method of claim 17, wherein a flexibility of the inner member decreases proximally and creates a smooth transition in flexibility between a flexibility of the guidewire to a flexibility of the distal end of the catheter.

19. The method of claim 1, wherein the inner member further comprises a flexible tubular extension extending distally past the distal portion, wherein a length of the tubular extension has a uniform outer diameter and wherein the single lumen has a distal opening at the distal end of the tubular extension.

20. The method of claim 19, further comprising advancing the uniform outer diameter of the tubular extension across an occlusion at the treatment site to deliver a stent retriever out the distal opening.

21. The method of claim 20, wherein the distal end of the catheter remains proximal to the occlusion when the tubular extension is advanced across the occlusion.

22. The method of claim 19, further comprising delivering a stent retriever though the single lumen of the inner member to the treatment site.

23. The method of claim 22, wherein, when the system of devices is positioned in the advancement configuration, a flexibility of the distal portion of the inner member decreases smoothly from the second outer diameter to the first outer diameter.

24. The method of claim 19, wherein, when the system of devices is positioned in the advancement configuration, a flexibility of the distal portion of the inner member decreases smoothly from the second outer diameter to the first outer diameter.

25. The method of claim 19, wherein, when the system of devices is positioned in the advancement configuration and a guidewire is positioned within the single lumen and extended out the distal opening of the tubular extension, a flexibility of the distal portion of the inner member decreases proximally and creates a smooth transition in flexibility from the second outer diameter to the distal end of the catheter.

26. The method of claim 25, wherein the first outer diameter substantially corresponds to the inner diameter of the distal end of the catheter.

27. The method of claim 19, wherein, when the system of devices is positioned in the advancement configuration and a guidewire is positioned within the single lumen and extended out the distal opening of the tubular extension, a flexibility of the inner member creates a smooth transition in flexibility from the distal end of the tubular extension to the distal end of the catheter.

28. The method of claim 19, wherein, when the coaxial system of devices is positioned in the advancement configuration, and a guidewire is positioned within the single lumen and extended out the distal opening of the tubular extension, a flexibility of the distal portion of the inner member decreases smoothly from the second outer diameter to the first outer diameter.

29. The method of claim 28, further comprising delivering a stent retriever though the single lumen of the inner member to the treatment site.

30. The method of claim 1, further comprising navigating past a location of a side-branch off of the internal carotid artery with the system of devices while the system of devices is positioned in the advancement configuration, wherein the side-branch is an ophthalmic artery.