Methods and apparatus for flow restoration

• US 8,679,142 B2
• Filed: 11/15/2012
• Issued: 03/25/2014
• Est. Priority Date: 02/22/2008
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Slee, Earl Howard, Wilder, Thomas III, McCarthy, Thomas, Ashby, Mark Philip
• Primary Examiner(s): McEvoy, Thomas
• Application Number:
  US13/678,464
• Publication Number:
  US 20130079796A1
• Time in Patent Office: 495 Days
• Field of Search: 606/127, 606/128, 606/159, 606/191, 606/194, 606/200, 606/110, 606/113
• US Class Current: 606/159
• 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 2017/22034 for gripping the obstruction or the tissue part from inside
• CPC Class Codes: A61B 2017/22094 for crossing total occlusions, i.e. piercing
• CPC Class Codes: A61B 2017/2215 having an open distal end
• CPC Class Codes: A61F 2/90 characterised by a net-like or mesh-like structure
• CPC Class Codes: A61F 2/91 made from perforated sheet material or tubes, e.g. perforated by laser cuts or etched holes
• CPC Class Codes: A61F 2/92 Stents in the form of a rolled-up sheet expanding after insertion into the vessel , e.g. with a spiral shape in cross-section

Abstract

Methods for restoring blood flow in occluded blood vessels using an apparatus having a self expandable distal segment that is pre-formed to assume a superimposed structure in an unconstrained condition but can be made to take on a volume-reduced form making it possible to introduce it with a microcatheter and a push wire arranged at the proximal end, with the distal segment in its superimposed structure assuming the form of a longitudinally open tube and having a mesh structure of interconnected strings or filaments or struts. In a preferred embodiment, the distal segment has a tapering structure at its proximal end where the strings or filaments or struts converge at a connection point.

Claims

1. A method for restoring localized blood flow in a cerebral blood vessel occluded with a thrombus, comprising:

delivering a thrombus-removal apparatus through a microcatheter to a site of the thrombus in the cerebral blood vessel, the apparatus comprising a self-expandable tubular structure having a plurality of cells, the structure being configured to assume an expanded configuration at the site, and to be modified into a compressed configuration for delivery through the microcatheter, the compressed configuration having a smaller cross-sectional dimension than the expanded configuration, the structure being configured to expand into the thrombus when transitioning from the compressed configuration to the expanded configuration; and

expanding the structure at the site, by proximally withdrawing the microcatheter from over the structure, such that at least an outer portion of the structure engages and applies an outward radial force on the thrombus, whereby the structure interlocks with at least a portion of the thrombus, the portion of the thrombus extending both inside of the structure and outside of the structure; and

removing the portion of the thrombus, by retracting the apparatus while the portion of the thrombus extends both inside of the structure and outside of the structure.

2. The method of claim 1, wherein a distal end of the structure has a greater diameter than a proximal end of the structure.

3. The method of claim 1, wherein expanding the apparatus improves the effectivity of natural lysing of the thrombus.

4. The method of claim 1, further comprising retracting the apparatus and at least a portion of the thrombus into the microcatheter.

5. The method of claim 1, wherein a distal end of the tubular structure is open in the expanded configuration.

6. The method of claim 1, wherein the tubular structure is permanently attached to a distal end of an elongate member by a plurality of struts.

7. The method of claim 1, wherein the structure penetrates the thrombus.

8. The method of claim 7, wherein the structure integrates with the thrombus.

9. The method of claim 1, wherein the structure is configured for attachment of the thrombus to the structure.

10. The method of claim 1, wherein the plurality of cells is configured for attachment of the thrombus to the structure.

11. A method for restoring localized blood flow in a cerebral artery occluded with a thrombus, comprising:

delivering a blood-flow-restoration apparatus with a microcatheter to a site radially adjacent to the thrombus in the cerebral artery, the apparatus comprising a self-expandable distal segment and a proximal elongate member, the distal segment comprising a tubular structure, the proximal elongate member is attached to the distal segment by a plurality of struts such that the proximal elongate member extends generally parallel to, and is offset from, a central longitudinal axis of the tubular structure, the structure being configured to assume an expanded configuration at the site, and to be modified into a compressed configuration for delivery through the microcatheter, the compressed configuration having a smaller cross-sectional dimension than the expanded configuration, the structure is configured to expand into the thrombus when transitioning from the compressed configuration to the expanded configuration; and

expanding the structure at the site, by proximally withdrawing the microcatheter from over the structure, such that at least an outer portion of the structure engages and applies an outward radial force on the thrombus, whereby the structure interlocks with at least a portion of the thrombus, the portion of the thrombus extending both inside of the structure and outside of the structure; and

removing the portion of the thrombus, by retracting the apparatus while the portion of the thrombus extends both inside of the structure and outside of the structure.

12. The method of claim 11, wherein the structure penetrates the thrombus.

13. The method of claim 12, wherein the structure integrates with the thrombus.

14. The method of claim 11, further comprising retracting the apparatus and at least a portion of the thrombus into the microcatheter.

15. The method of claim 11, wherein the self-expandable apparatus comprises cells of a first size at a first portion and cells of a second size at a second portion, the second size differing from the first size.

16. The method of claim 15, wherein the second size is larger than the first size and the cells of the second size are proximal of the cells of the first size.

17. The method of claim 11, wherein a distal end of the tubular structure is open in the expanded configuration.

18. The method of claim 11, wherein the tubular structure is permanently attached to a distal end of an elongate member by a plurality of struts.

19. The method of claim 11, wherein the structure is configured for attachment of the thrombus to the structure.

20. The method of claim 11, wherein the plurality of cells is configured for attachment of the thrombus to the structure.