METHODS AND APPARATUS FOR LUMINAL STENTING

• US 20090287241A1
• Filed: 04/17/2009
• Published: 11/19/2009
• Est. Priority Date: 05/25/2004
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Chestnut Medical Technologies, Inc. (Medtronic Plc)
• Inventors: Tran, Quang Quoc, Berez, Aaron Lee
• Granted Patent: US 8,623,067 B2
• Time in Patent Office: Days
• US Class Current: 606/200
• CPC Class Codes: A61B 17/12 for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord specially adapted for vas deferens or fallopian tubes A61F6/20; materials for ligaturing blood vessels A61L17/00
• CPC Class Codes: A61B 17/12022 Occluding by internal devices, e.g. balloons or releasable wires plugging an opening in the wall of an organ A61B17/0057; occluders for the cervical canal A61F6/146; vas deferens occluders A61F6/20
• CPC Class Codes: A61B 17/12109 in a blood vessel
• CPC Class Codes: A61B 17/12118 for positioning in conjunction with a stent
• CPC Class Codes: A61B 17/12168 having a mesh structure A61B17/1214 takes precedence
• CPC Class Codes: A61B 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/1205 Introduction devices
• CPC Class Codes: A61B 2017/12054 Details concerning the detachment of the occluding device from the introduction device
• CPC Class Codes: A61B 2017/22001 Angioplasty, e.g. PCTA
• CPC Class Codes: A61F 2/01 Filters implantable into blood vessels
• 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: A61F 2/06 Blood vessels
• CPC Class Codes: A61F 2/07 Stent-grafts
• CPC Class Codes: A61F 2/82 Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents stent-grafts for tubular structures of the body other than blood vessels A61F2/04; stent-grafts for blood vessels A61F2/07; instruments specially adapted for placement or removal of stents or stent-grafts A61F2/95; for closing wounds, or holding wounds closed A61B17/04 - A61B17/115; dilators A61M29/00
• CPC Class Codes: A61F 2/844 folded prior to deployment
• CPC Class Codes: A61F 2/852 Two or more distinct overlapping stents
• 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 2/915 with bands having a meander structure, adjacent bands being connected to each other
• CPC Class Codes: A61F 2/95 Instruments specially adapted for placement or removal of stents or stent-grafts
• CPC Class Codes: A61F 2/9522 : Means for mounting a stent or stent-graft onto or into a placement instrument
• CPC Class Codes: A61F 2/958 : Inflatable balloons for placing stents or stent-grafts
• CPC Class Codes: A61F 2/966 : with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
• CPC Class Codes: A61F 2002/016 : made from wire-like elements
• CPC Class Codes: A61F 2002/018 : made from tubes or sheets of material, e.g. by etching or laser-cutting
• CPC Class Codes: A61F 2002/823 : Stents, different from stent-grafts, adapted to cover an aneurysm
• CPC Class Codes: A61F 2002/826 : more than one stent being applied sequentially
• CPC Class Codes: A61F 2002/91558 : connected peak to peak
• CPC Class Codes: A61F 2002/9505 : having retaining means other than an outer sleeve, e.g. male-female connector between stent and instrument
• CPC Class Codes: A61F 2002/9528 : for retrieval of stents
• CPC Class Codes: A61F 2002/9534 : for repositioning of stents
• CPC Class Codes: A61F 2002/9665 : with additional retaining means
• CPC Class Codes: A61F 2230/001 : Figure-8-shaped, e.g. hourglass-shaped
• CPC Class Codes: A61F 2230/0069 : cylindrical
• CPC Class Codes: A61F 2230/0078 : hyperboloidal
• CPC Class Codes: A61F 2230/008 : paraboloidal
• CPC Class Codes: A61F 2230/0091 : helically-coiled or spirally-coiled, i.e. having a 2-D spiral cross-section
• CPC Class Codes: A61F 2230/0095 : Saddle-shaped
• CPC Class Codes: A61F 2250/0015 : differing in density or specific weight
• CPC Class Codes: A61F 2250/0063 : Nested prosthetic parts

Abstract

Described herein are flexible implantable occluding devices that can, for example, navigate the tortuous vessels of the neurovasculature. The occluding devices can also conform to the shape of the tortuous vessels of the vasculature. In some embodiments, the occluding devices can direct blood flow within a vessel away from an aneurysm or limit blood flow to the aneurysm. Some embodiments describe methods and apparatus for adjusting, along a length of the device, the porosity of the occluding device. In some embodiments, the occluding devices allows adequate blood flow to be provided to adjacent structures such that those structures, whether they are branch vessels or oxygen-demanding tissues, are not deprived of the necessary blood flow.

Claims

1. A method, of implanting a stent in a patient'"'"'s blood vessel, comprising:

providing an elongate body, the elongate body comprising a proximal portion, a distal portion, and a lumen extending between the proximal portion and the distal portion;

inserting the distal portion in a blood vessel of a patient;

advancing the distal portion within the blood vessel until the distal portion is at a target site;

advancing, relative to the elongate body and within the lumen of the elongate body, a stent in a compressed configuration;

allowing a distal portion of the stent to expand to an expanded configuration and contact a vessel wall as a distal portion of the stent is advanced out of the distal portion of the elongate body; and

after the distal portion of the stent is in the expanded configuration and contacts the vessel wall, axially compressing the stent to change a porosity of the stent by advancing a proximal portion of the stent with respect to the distal portion of the stent.

2. The method of claim 1, further comprising positioning the stent at an aneurysm arising from the blood vessel.

3. The method of claim 1, wherein axially compressing the stent decreases the porosity of the stent.

4. The method of claim 2, wherein axially compressing the stent reduces blood flow to the vessel aneurysm.

5. The method of claim 2, wherein, after the allowing the distal portion to expand and axially compressing the stent, a proximal portion of the stent, proximal to the distal portion, is axially compressed more than the distal portion.

6. The method of claim 2, further comprising reducing the migration of blood clots from the aneurysm by decreasing the porosity of the stent adjacent the aneurysm.

7. The method of claim 1, further comprising compressing the distal portion of the stent back into the compressed configuration after allowing the distal portion of the stent to expand in the vessel.

8. The method of claim 7, wherein the distal portion of the stent is compressed by withdrawing the distal portion into the elongate body.

9. The method of claim 7, wherein the distal portion of the stent is compressed by advancing the elongate body over the distal portion.

10. The method of claim 7, further comprising:

moving the distal portion of the stent to a different location;

advancing the stent, relative to the elongate body and within the lumen of the elongate body; and

allowing a distal portion of the stent to automatically expand to an expanded configuration at the different location.

11. The method of claim 7, further comprising removing the stent from the vessel.

12. A method, of implanting a stent in a patient'"'"'s vessel, comprising:

providing a stent comprising a distal section and a proximal section and having a compressed configuration and an expanded configuration, the stent being configured to change from the compressed configuration to the expanded configuration and to have a variable porosity when in the expanded configuration;

advancing the stent within the patient'"'"'s vessel to a target site;

expanding the distal section of the stent at the target site;

varying a proximal section porosity with respect to a distal section porosity by advancing, after the expanding the distal section, the proximal section of the stent axially relative to the distal section; and

expanding the proximal section of the stent in the patient'"'"'s vessel.

13. The method of claim 12, further comprising positioning the stent at an aneurysm arising from the vessel.

14. The method of claim 13, further comprising reducing the migration of blood clots from the aneurysm by decreasing a porosity of the proximal section, relative to the distal section porosity, adjacent the aneurysm.

15. The method of claim 13, where the varying the proximal section porosity comprises decreasing the proximal section porosity with respect to the distal section porosity.

16. The method of claim 15, wherein the varying the proximal section porosity reduces blood flow to the vessel aneurysm.

17. The method of claim 12, wherein, after expanding the distal section and advancing the proximal section axially, a portion of the proximal section is axially compressed more than the distal section.

18. The method of claim 12, further comprising compressing the distal section of the stent back into the compressed configuration after expanding the distal section of the stent in the vessel.

19. The method of claim 18, wherein the distal section of the stent is compressed by withdrawing the distal section into an elongate body.

20. The method of claim 18, wherein the distal section of the stent is compressed by advancing an elongate body over the distal section.

21. The method of claim 18, further comprising:

moving the distal section of the stent to a different location; and

reexpanding the distal section of the stent within a vessel without removing the stent from the patient'"'"'s vasculature.

22. A method, of implanting a stent in a patient'"'"'s vessel, comprising:

providing a stent comprising a distal section and a proximal section and having a compressed configuration and an expanded configuration, the stent being configured to have an adjustable porosity;

expanding the distal section of the stent in the patient'"'"'s vessel such that the distal section has a first porosity; and

adjusting the proximal section such that, when expanded within the patient'"'"'s vessel, the proximal section has a second porosity different than the first porosity.

23. The method of claim 22, further comprising positioning the stent at an aneurysm arising from the vessel.

24. The method of claim 23, further comprising reducing the migration of blood clots from the aneurysm by decreasing a porosity of the proximal section, relative to the distal section porosity, adjacent the aneurysm.

25. The method of claim 24, wherein the adjusting the proximal section reduces blood flow to the vessel aneurysm.

26. The method of claim 22, where the adjusting the proximal section comprises decreasing the proximal section porosity with respect to the distal section porosity.

27. The method of claim 22, wherein, after expanding the distal section and adjusting the proximal section, a portion of the proximal section is axially compressed more than the distal section.

28. The method of claim 22, further comprising compressing the distal section of the stent back into the compressed configuration after expanding the distal section of the stent in the vessel.

29. A method, of implanting a stent in a patient'"'"'s vessel, comprising:

advancing a stent in a vessel to a treatment site;

expanding, on one side of the treatment site, a distal section of the stent in the vessel such that, after expanding, the distal section has a distal section wall with a first porosity;

after expanding the distal section of the stent, adjusting a middle section of the stent such that, when adjusted, the middle section has a middle section wall having a second porosity less than the first porosity; and

after adjusting the middle section, expanding a proximal section of the stent such that, after expanding, the proximal section has a proximal section wall having a third porosity.

30. The method of claim 29, further comprising positioning the stent at an aneurysm arising from the vessel.

31. The method of claim 30, wherein the expanded middle section wall is positioned at the aneurysm.

32. The method of claim 31, wherein the adjusting the middle section reduces blood flow to the vessel aneurysm.

33. The method of claim 31, wherein the middle section wall second porosity is adjusted to be less than at least one of the first porosity and the third porosity.

34. The method of claim 29, further comprising engaging the vessel with the distal section.

35. The method of claim 29, wherein the expanding the proximal section comprises expanding the proximal section radially.

36. The method of claim 34, further comprising engaging the vessel with the proximal section.

37. The method of claim 29, wherein the second porosity is adjusted to be less than at least one of the first porosity and the third porosity.

38. The method of claim 29, further comprising returning the distal section of the stent to a contracted configuration, thereby reducing contact between the distal section and the vessel, after allowing the distal section to expand in the vessel.

39. The method of claim 38, wherein the distal section of the stent is returned to the contracted configuration by withdrawing the distal section into the elongate body.

40. The method of claim 38, wherein the distal section of the stent is returned to the contracted configuration by advancing an elongate body over the distal section.

41. The method of claim 38, further comprising:

after returning the distal section of the stent to a contracted configuration, moving the distal section of the stent to a different location within the patient; and

expanding the distal section of the stent at the different location.

42. The method of claim 38, further comprising removing the stent from the vessel.

43. A method, of implanting a stent in a patient'"'"'s vessel, comprising:

expanding a stent in the vessel, the stent having a wall with an adjustable porosity that, when unrestrained, has a first porosity; and

adjusting the stent within the vessel such that a middle section of the wall has a second porosity different than the first porosity.

44. The method of claim 43, wherein the second porosity is less than a third porosity of a proximal section of the wall and a fourth porosity of a distal section of the wall.

45. The method of claim 43, further comprising positioning the stent at an aneurysm arising from the vessel.

46. The method of claim 45, wherein the middle section is positioned and expanded at the aneurysm.

47. The method of claim 43, wherein the second porosity is adjusted to be less than at least one of the first porosity, a third porosity of a proximal section of the wall, and a fourth porosity of a distal section of the wall.

48. The method of claim 43, further comprising compressing the stent to a contracted configuration after expanding the stent in the vessel.

49. The method of claim 48, wherein the stent compressed to the contracted configuration by withdrawing a distal section of the stent from the vessel into a delivery catheter.

50. The method of claim 48, further comprising:

after compressing the stent to the contracted configuration, moving the stent to a different location within a vessel of the patient; and

expanding the stent at the different location.

51. A method, of treating a patient'"'"'s vessel, comprising:

advancing a stent into a patient'"'"'s vessel, the stent having lumen extending between a proximal end of the stent and a distal end of the stent;

expanding the stent from a first state, having a first cross-sectional dimension to a second state, having a second cross-sectional dimension greater than the first cross-sectional dimension, the stent having a second state stent length less than a first state stent length; and

axially compressing a first portion of the stent to a third state, such that the stent has a third state stent length less than the second state stent length;

wherein the expanding the stent from the first state comprises permitting the stent to axially compress and radially expand by unrestraining the stent; and

wherein the axially compressing the first portion of the stent comprises applying an axially compressive force on the stent when the stent is in the second state.

52. The method of claim 51, further comprising permitting the stent to axially expand from the third state to the second state by unrestraining the stent.

53. The method of claim 51, wherein the stent, in the third state, has a third cross-sectional dimension that is substantially the same as the second cross-sectional dimension.