METHODS FOR ADVANCING INVERTING MECHANICAL THROMBECTOMY APPARATUSES IN THE VASCULATURE

• US 20170303939A1
• Filed: 04/25/2017
• Published: 10/26/2017
• Est. Priority Date: 04/25/2016
• Status: Active Grant

• Current Assignee: Stryker Corporation
• Original Assignee: Stryker Corporation
• Inventors: Greenhalgh, E. Skott, Wallace, Michael P.
• Granted Patent: US 10,010,335 B2
• Time in Patent Office: Days
• 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 17/22031 Gripping instruments, e.g. forceps, for removing or smashing calculi A61B17/221 takes precedence
• 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 2017/00398 using powered actuators, e.g. stepper motors, solenoids
• CPC Class Codes: A61B 2017/22038 with a guide wire
• CPC Class Codes: A61B 2017/22075 with motorized advancing or retracting means
• CPC Class Codes: A61B 2017/22079 with suction of debris
• CPC Class Codes: A61B 2017/2215 having an open distal end
• CPC Class Codes: A61B 2017/3435 using everted sleeves

Abstract

Mechanical thrombectomy apparatuses (devices, systems, etc.) and methods for positioning them within a vessel and using them to remove a thrombus, e.g., clot, from within a vessel. In particular, described herein are methods of advancing an inverting tractor thrombectomy apparatus having a tractor comprising a flexible tube of material that inverts over itself as it rolls over a distal end opening of an elongate inversion support by extending the tractor region and/or a puller coupled to the tractor distally beyond the end of the catheter. Also described herein are power-driven mechanical thrombectomy apparatuses.

Claims

1. A method of removing a clot from a vessel using a mechanical thrombectomy apparatus including a catheter extending from a proximal end to a distal end, a puller extending distally within the catheter and a flexible and tubular tractor, wherein the tractor is coupled to a distal end region of the puller and further wherein the tractor is inverted over a distal end opening of the catheter so that the tractor extends proximally over the catheter, the method comprising:

advancing the puller distally within the catheter and within the vessel towards a clot, so that the tractor extends from the puller distally beyond the distal end opening of the catheter, forming a gap between the tractor and the distal end opening of the catheter;

advancing the catheter distally over the puller and into the gap;

repeating the advance steps until the distal end opening of the catheter is adjacent to the clot; and

drawing the clot into the catheter with the tractor by pulling the tractor proximally within the catheter so that the tractor rolls and inverts over the distal end opening of the catheter.

2. The method of claim 1, wherein repeating further comprises comprising pulling the pusher proximally within the catheter to invert a portion of the tractor over the distal end opening of the catheter.

3. The method of claim 1, wherein drawing the clot into the catheter further comprises advancing the catheter distally while pulling the pusher proximally.

4. The method of claim 1, wherein advancing the puller distally comprises advancing the puller without using a guidewire extending distal to the puller.

5. The method of claim 1, wherein advancing the puller comprises extending the distal end of the puller out of the distal end opening of the catheter.

6. The method of claim 1, wherein advancing the puller comprises extending the tractor distally within the vessel, further wherein the tractor comprises a woven flexible and tubular tractor.

7. The method of claim 1, wherein advancing the puller comprises extending the tractor distally within the vessel, further wherein the tractor comprises a knitted tractor.

8. The method of claim 1, wherein advancing the puller comprises extending the tractor distally within the vessel, further wherein the puller comprises a central lumen configured to pass a guidewire therethrough.

9. The method of claim 1, wherein advancing the puller comprises advancing the puller within an internal carotid artery.

10. A method of removing a clot from a vessel using a mechanical thrombectomy apparatus having a puller within a first catheter that is within a second catheter, wherein the puller and second catheter are connected by a flexible and tubular tractor, the method comprising:

advancing the puller distally through the first catheter and the second catheter and within the vessel towards a clot, so that the flexible and tubular tractor extends from the puller beyond a distal end opening of the first catheter and beyond a distal end opening of the second catheter;

advancing the outer catheter distally through the vessel by one or more of;

holding the position of the first catheter within the vessel and pulling the puller proximally within the first catheter;

or moving the first catheter distally relative to the puller; and

drawing the clot into the first catheter with the flexible and tubular tractor by pulling the flexible and tubular tractor proximally within the first catheter so that the flexible and tubular tractor rolls and inverts over the distal end opening of the catheter.

11. The method of claim 10, further comprising repeating the advancing steps until the clot is adjacent to the distal end of the puller.

12. The method of claim 10, wherein drawing the clot into the catheter further comprises advancing the first catheter distally while pulling the pusher proximally.

13. The method of claim 10, wherein advancing the puller distally comprises advancing the puller without using a guidewire extending distal to the puller.

14. The method of claim 10, wherein advancing the puller comprises extending the flexible and tubular tractor distally within the vessel further wherein the flexible and tubular tractor comprises a woven flexible and tubular tractor.

15. The method of claim 10, wherein advancing the puller comprises extending the flexible and tubular tractor distally within the vessel further wherein the flexible and tubular tractor comprises a knitted flexible and tubular tractor.

16. The method of claim 10, wherein advancing the puller comprises extending the flexible and tubular tractor distally within the vessel further wherein the puller has a central lumen configured to pass a guidewire therethrough.

17. The method of claim 10, wherein advancing the puller comprises advancing the puller within an internal carotid artery.

18. The method of claim 10, wherein drawing the clot into the first catheter comprises uncoupling the flexible and tubular tractor from the second catheter.

19. A mechanical thrombectomy apparatus for removing a clot from a vessel, the apparatus comprising:

a flexible catheter having a distal end and a distal end opening;

a tractor comprising a flexible belt that extends within the catheter, inverts over the distal end opening of the catheter and extends along the outer diameter of the catheter;

a power drive at a proximal end of the flexible catheter configured to drive the tractor around the catheter so that it inverts over the distal end opening of the catheter; and

a guidewire lumen through the catheter and the tractor configured to pass a guidewire.

20. The apparatus of claim 19, wherein the flexible belt comprises a flexible tube.

21. The apparatus of claim 19, wherein the tractor comprises a plurality of flexible belts that each extend within the catheter, invert over the distal end opening of the catheter and extend along the outer diameter of the catheter.

22. The apparatus of claim 19, wherein the power drive is configured to engage with the flexible belt on an outer surface of the catheter.

23. The apparatus of claim 19, wherein the power drive comprises an annular ring surrounding the catheter and the tractor.

24. The apparatus of claim 19, further comprising an outer catheter configured to enclose the flexible catheter and tractor, wherein the flexible catheter and tractor may be inserted through the body within the outer catheter.