Interfacial stent and method of maintaining patency of surgical fenestrations

• US 20070179426A1
• Filed: 05/09/2005
• Published: 08/02/2007
• Est. Priority Date: 05/11/2004
• Status: Abandoned Application

• Current Assignee: Oregon Health & Science University
• Original Assignee: Oregon Health & Science University
• Inventors: Selden, Nathan
• Application Number:
  US11/596,270
• Publication Number:
  US 20070179426A1
• Time in Patent Office: Days
• US Class Current: 604/8
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0293 with ring member to support retractor elements
• CPC Class Codes: A61B 17/11 for performing anastomosis; Buttons for anastomosis
• CPC Class Codes: A61B 2017/1107 for blood vessels
• CPC Class Codes: A61B 2017/1139 Side-to-side connections, e.g. shunt or X-connections
• CPC Class Codes: A61F 2/2493 Transmyocardial revascularisation [TMR] devices
• CPC Class Codes: A61F 2/86 Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
• CPC Class Codes: A61F 2/90 characterised by a net-like or mesh-like structure
• CPC Class Codes: A61F 2002/30062 (bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
• CPC Class Codes: A61F 2210/0004 bioabsorbable
• CPC Class Codes: A61F 2230/0078 hyperboloidal
• CPC Class Codes: A61F 2250/0037 differing in height or in length
• CPC Class Codes: A61F 2250/0039 differing in diameter

Abstract

A method according to one embodiment for maintaining patency of an opening inside the human body comprises introducing a radially self-expanding hollow stent into the opening through an endoscope that radially compresses the stent, wherein the stent has enlarged ends and a reduced intermediate portion. The stent is introduced into the opening such that its intermediate portion extends through the opening and the enlarged ends are positioned outside of the opening. Once deployed, the stent expands such that the enlarged ends of the stent abut against opposing faces of the opening to resist dislodgement of the stent from the opening after expansion. The stent is preferably biodegradable, such that it is eliminated from the surgical site over a period of weeks to months, by which time the patency of the opening is more assured. The method can be used in combination with, for example, an endoscopic surgical method such as endoscopic third ventriculostomy for treating hydrocephalus of a brain.

Claims

1. A method for maintaining patency of an opening inside the human body, comprising:

introducing a radially self-expanding hollow stent into the opening through an endoscope that radially compresses the stent, wherein the stent has enlarged ends and an intermediate portion having a reduced cross-sectional profile, and the stent is introduced into the opening with its intermediate portion extending through the opening and the enlarged ends positioned outside of the opening; and

allowing the self-expanding stent to expand for retention within the opening by the enlarged ends on opposing faces of the opening.

2. The method of claim 1, wherein the stent is bioabsorbable, and degrades over time within the body after a sufficient period of time to maintain patency of the opening.

3. The method of claim 1, further comprising forming the opening by forming a surgical fenestration inside the human body.

4. The method of claim 3, wherein the surgical fenestration is formed in a wall of a ventricle of the brain to establish a path of cerebrospinal fluid flow from the ventricle to a sub-arachnoid space.

5. The method of claim 4, wherein the surgical fenestration is formed in a floor of the third ventricle.

6. The method of claim 3, wherein introducing the radially self-expanding hollow stent into the opening takes place substantially immediately after the fenestration has been artificially created.

7. The method of claim 1, wherein the stent comprises a resilient material that is compressed by delivery through the endoscope, but which expands after delivery from the endoscope into the opening.

8. The method of claim 7, wherein the resilient material comprises L-lactide-glycolic acid co-polymer with a molar ratio of 80:

20 (SR-PLGA 80/20), a biocompatible polymer, a biocompatible elastomer, a resilient collagen material, a polysaccharide matrix, or a bioabsorbable gelatin film.

9. The method of claim 1, wherein the intermediate portion is a tapered intermediate portion.

10. The method of claim 9, wherein the stent is symmetric in shape.

11. The method of claim 10, wherein the stent comprises two joined frustoconical sections.

12. The method of claim 1, wherein the stent further comprises a material having shape memory such that the stent is stretchable into an elongated shape along a longitudinal direction and at least partially returns to a remembered shape through expanding along a radial direction.

13. The method of claim 12, wherein the stent comprises multiple longitudinally extending filaments made of the material having shape memory.

14. The method of claim 13, wherein the multiple filaments comprise an interstitial mesh.

15. The stent of claim 1, wherein the enlarged ends of the stent each comprise an elastic material.

16. The method of claim 1, further comprising withdrawing from the opening any surgical instrument used for introducing the stent into the opening to leave the stent in the opening.

17. The method of claim 1, wherein introducing the stent into the opening comprises introducing the stent using an endoscopic surgical procedure.

18. The method of claim 17, wherein using an endoscopic surgical procedure comprises providing a multifunctional telescopic port that is used for sequentially creating the opening and delivering the stent.

19. The method of claim 1, wherein the stent is introduced into the opening through an endoscopic delivery port, the stent being constrained within a tubular portion of the delivery port and held by a retractable release device before being introduced into the opening.

20. The method of claim 1, wherein the intermediate portion contacts an edge of the opening after the stent has expanded.

21. An endoscopic surgical method for treating hydrocephalus of a brain, comprising:

introducing an endoscope into the third ventricle of the brain;

fenestrating the floor of the third ventricle to create an opening fluidly communicating between the third ventricle and a subarachnoid space;

enlarging the opening;

placing a stent into the opening; and

retrieving from the opening any surgical instrument used for placing the stent into the opening to leave the stent in the opening to maintain the patency of the opening.

22. The method of claim 21, wherein the stent comprises a distal portion with a distal end, an intermediate portion, and a proximal portion with a proximal end, and after the stent has been introduced into the opening, the proximal end and the distal end each have a diameter greater than the opening, and the proximal end and the distal end are on two opposing sides of the opening while the intermediate portion passes through the opening.

23. The method of claim 22, wherein the intermediate portion of the stent has a diameter smaller than the diameters of the distal end and the proximal end.

24. The method of claim 23, wherein the stent tapers from the proximal end and the distal end toward the intermediate portion.

25. The method of claim 21, wherein the distal portion and the proximal portion each have a frustoconical or frustopyramidal shape.

26. The method of claim 21, wherein the stent is bioabsorbable.

27. The method of claim 21, wherein the stent is self-expandable.

28. The method of claim 21, wherein placing the stent into the opening further comprises:

delivering the stent through an endoscopic delivery port adjacent the opening, wherein the stent is advanced through the endoscopic delivery port by a retractable delivery device;

releasing the stent;

allowing the stent to expand such that the proximal end and the distal end each expand from a first diameter to a second diameter, wherein the second diameter of the proximal end and the second diameter of the distal end are both greater than the opening.

29. The method of claim 28, wherein the stent is delivered into the opening before it is released by the retractable delivery device.

30. A stent for maintaining patency of an opening at an interface in a human body, the stent comprising:

two enlarged ends; and

an intermediate portion defining a cross-sectional profile that is smaller than that of the enlarged ends;

wherein the stent is biodegradable and expandable;

wherein the stent comprises a substantially hollow body defined by an open surface structure which allows flow of a body fluid through the stent.

31. The stent of claim 30, wherein the stent is self-expandable.

32. The stent of claim 30, wherein the stent is bioabsorbable.

33. The stent of claim 30, wherein the stent tapers from the enlarged ends toward a location intermediate the enlarged ends.

34. The stent of claim 33, wherein the stent is symmetric in shape with respect to an axial direction.

35. The stent of claim 34, wherein the stent comprises two joined frustoconical sections.

36. The stent of claim 30, wherein the open surface structure is an interstitial mesh of filaments.

37. The stent of claim 30, wherein the stent comprises a resilient material.

38. The stent of claim 37, wherein the resilient material comprises L-lactide-glycolic acid co-polymer with a molar ratio of 80:

20 (SR-PLGA 80/20), a biocompatible polymer, a biocompatible elastomer, a resilient collagen material, a polysaccharide matrix, or a bioabsorbable gelatin film.

39. The stent of claim 30, wherein the stent comprises a material having shape memory.

40. The stent of claim 30, wherein the enlarged ends comprise an elastic material.

41. The stent of claim 30, wherein the stent comprises multiple filaments extending between the enlarged ends, the filaments being made of a resilient material.

42. The stent of claim 30, wherein when expanded the two enlarged ends have a diameter about the same or greater than a length of the stent.

43. An artificial fluid pathway created in a membrane in a biological body such as a human body to facilitate fluidic communication, comprising:

an artificially created opening in the membrane; and

a hollow stent situated in the opening, wherein the stent has enlarged ends and a constricted intermediate portion, the intermediate portion extending through the opening and the enlarged ends being positioned outside of the opening, and wherein the stent is capable of maintaining the patency of the opening for an extended period of time without support of an additional surgical member.