METHODS AND APPARATUS FOR LUMINAL STENTING

• US 20130172975A1
• Filed: 07/20/2012
• Published: 07/04/2013
• Est. Priority Date: 05/25/2004
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Tyco Healthcare Group LP (Medtronic Plc)
• Inventors: Berez, Aaron Lee, Tran, Quang Quoc
• Granted Patent: US 9,050,205 B2
• Time in Patent Office: Days
• US Class Current: 623/1.4
• 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 treating an aneurysm in a vessel of a patient, comprising:

expanding, in a vessel having an aneurysm, at least a portion of a stent, such that a first portion of the stent extends within the vessel along an opening of the aneurysm and a second portion of the stent, distal to the first portion, expands against a vessel wall distal to the aneurysm;

applying a first force to the first portion, whereby the first portion transitions from a first porosity to a second porosity, less than the first porosity, while (i) the first portion maintains a substantially similar cross-sectional dimension and (ii) movement of the second portion of the stent is impeded by a frictional force applied by the second portion against the vessel wall.

2. The method of claim 1, wherein the stent extends from a first location, proximal to the aneurysm, to a second location, distal to the aneurysm.

3. The method of claim 1, wherein applying the first force decreases flow of blood into the aneurysm.

4. The method of claim 1, wherein the second portion has a porosity greater than the second porosity.

5. The method of claim 1, wherein the first force is applied by an elongate member.

6. The method of claim 1, wherein the first force is an axially compressive force.

7. The method of claim 1, further comprising:

applying a second force to a third portion of the stent overlying a vessel branch, whereby the third portion transitions from a third porosity to a fourth porosity, greater than the third porosity, while (i) the third portion maintains a substantially similar cross-sectional dimension and (ii) movement of a fourth portion of the stent, distal to the third portion, is impeded by a frictional force applied by the fourth portion against a vessel wall distal to the vessel branch.

8. The method of claim 7, wherein the second force is an axially expansive force.

9. The method of claim 7, wherein the vessel branch is proximal to the aneurysm.

10. A method, of treating a vessel of a patient, comprising:

expanding, in a vessel having a vessel branch, at least a portion of a stent, such that a first portion of the stent extends within the vessel along an opening of the vessel branch and a second portion of the stent, distal to the first portion, expands against a vessel wall distal to the vessel branch;

applying a first force to the first portion, whereby the first portion transitions from a first porosity to a second porosity, greater than the first porosity, while (i) the first portion maintains a substantially similar cross-sectional dimension and (ii) movement of the second portion of the stent is impeded by a frictional force applied by the second portion against the vessel wall distal.

11. The method of claim 10, wherein applying the first force comprises pulling a proximal end of the stent proximally.

12. The method of claim 10, wherein the stent extends from a first location, proximal to the vessel branch, to a second location, distal to the vessel branch.

13. The method of claim 10, wherein applying the first force increases flow of blood into the vessel branch.

14. The method of claim 10, wherein the second portion has a porosity less than the second porosity.

15. The method of claim 10, wherein the first force is applied by an elongate member.

16. The method of claim 10, wherein the first force is an axially expansive force.

17. The method of claim 10, further comprising:

applying a second force to a third portion of the stent overlying an aneurysm, whereby the third portion transitions from a third porosity to a fourth porosity, less than the third porosity, while (i) the third portion maintains a substantially similar cross-sectional dimension and (ii) movement of a fourth portion of the stent, distal to the third portion, is impeded by a frictional force applied by the fourth portion against a vessel wall distal to the aneurysm.

18. The method of claim 17, wherein the second force is an axially compressive force.

19. The method of claim 17, wherein the vessel branch is proximal to the aneurysm.

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

expanding a distal portion of a stent against a vessel wall, whereby the distal portion of the stent has a distal portion porosity when expanded against the wall; and

after expanding the distal portion of the stent, adjusting a middle portion of the stent, proximal to the distal portion, while the distal portion of the stent is expanded against the wall, whereby the middle portion of the stent changes from a first porosity to a second porosity, different than the first porosity, while the distal portion substantially maintains the distal portion porosity.

21. The method of claim 20, wherein the second porosity is less than the first porosity.

22. The method of claim 20, wherein, after adjusting the middle portion, a proximal portion of the stent and the distal portion of the stent have a porosity greater than the second porosity.

23. The method of claim 20, wherein the middle portion is located at an aneurysm arising from the vessel.

24. The method of claim 20, wherein the middle portion is located at a vessel branch arising from the vessel.

25. The method of claim 20, wherein the stent comprises woven strands.

26. The method of claim 20, wherein adjusting the stent comprises moving the middle portion distally.

27. The method of claim 20, wherein the middle portion is adjusted by an elongate member.