Methods for placing a stent in a branched vessel

• US 9,204,958 B2
• Filed: 01/09/2006
• Issued: 12/08/2015
• Est. Priority Date: 01/10/2005
• Status: Active Grant

• Current Assignee: Taheri Laduca LLC
• Original Assignee: Taheri Laduca LLC
• Inventors: LaDuca, Robert, LaDuca, Paul, Arnault de La Menardiere, Brice Maxime
• Primary Examiner(s): Shi, Katherine M
• Assistant Examiner(s): BACHMAN, LINDSEY MICHELE
• Application Number:
  US11/329,384
• Publication Number:
  US 20060155358A1
• Time in Patent Office: 3,620 Days
• Field of Search: 623/1.11, 623/1.12, 623/1.23, 623/1.35, 606/194
• US Class Current: 1/1
• CPC Class Codes: A61F 2/06 Blood vessels
• CPC Class Codes: A61F 2/2418 Scaffolds therefor, e.g. support stents
• CPC Class Codes: A61F 2/844 folded prior to deployment
• CPC Class Codes: A61F 2/856 Single tubular stent with a side portal passage
• CPC Class Codes: A61F 2/90 characterised by a net-like or mesh-like structure
• CPC Class Codes: A61F 2/95 Instruments specially adapted for placement or removal of stents or stent-grafts
• CPC Class Codes: A61F 2/9517 handle assemblies therefor
• CPC Class Codes: A61F 2/954 for placing stents or stent-grafts in a bifurcation
• CPC Class Codes: A61F 2002/075 the stent being loosely attached to the graft material, e.g. by stitching
• CPC Class Codes: A61F 2002/9511 the retaining means being filaments or wires
• CPC Class Codes: A61F 2220/0008 Fixation appliances for connecting prostheses to the body
• CPC Class Codes: A61F 2220/0016 with sharp anchoring protrusions, e.g. barbs, pins, spikes
• CPC Class Codes: A61F 2220/0041 using additional screws, bolts, dowels or rivets, e.g. connecting screws
• CPC Class Codes: A61F 2220/0066 stapled
• CPC Class Codes: A61F 2220/0075 sutured, ligatured or stitched, retained or tied with a rope, string, thread, wire or cable
• CPC Class Codes: A61F 2250/0039 differing in diameter

Abstract

Methods for placing a stent in a branched vessel include stretching the stent, aligning the stent within a target location at a branched vessel and releasing it for expansion at the target location.

Claims

1. A method of placing a stent at a target site within vasculature comprising a main vessel and at least one side branch vessel in fluid communication with the main vessel, the stent comprising a main lumen and a at least one side branch lumen, the method comprising:

creating an incision within the vasculature;

advancing a sheath through the vasculature from the incision to a target site;

partially deploying the stent from the sheath at the target site wherein the stent is in a reduced dimension coupled to an inner member inside the sheath and expands to an expanded dimension in the vessel, and further wherein the stent comprises the main lumen and at least one side branch lumen where the side branch lumen is coupled to a side branch catheter being separate from the inner member where partially deploying the stent comprises selectively tensioning the main lumen by axial movement of the the inner member that extends through the main lumen and independently selectively tensioning the side branch lumen by axial movement of the the side branch catheter that extends through the side branch lumen such that the main lumen can be repositioned in the respective main vessel by expanding and reducing a diameter of the main lumen;

adjusting the side branch lumen relative to the main lumen using the side branch catheter to position the side branch lumen in the side branch vessel during partial deployment of the stent such that the side branch lumen can be repositioned in the side branch vessel by expanding and reducing a diameter of the side branch lumen; and

fully deploying the main lumen in the main vessel by releasing the main lumen from the inner member and fully deploying the side branch lumen in the side branch vessel by releasing the side branch lumen from the side branch catheter.

2. The method of claim 1 further comprising allowing graft material on the stent to integrate the stent into the target site.

3. The method of claim 1 wherein the stent is deployed without completely disrupting blood flow in the main vessel.

4. The method of claim 1 further comprising viewing at least one of the acts of the method using an imaging system.

5. The method of claim 4 wherein the imaging system comprises use of radiographic dye or fluoroscopy.

6. The method of claim 4 further comprising injecting a visualization material into the vessel.

7. The method of claim 4 wherein the imaging system comprises intravascular ultrasound.

8. The method of claim 7 further comprising employing a guidewire to implant the stent wherein the distal tip of the guidewire comprises at least one intravascular ultrasonic transducer.

9. The method of claim 1 wherein only a single incision is made.

10. A method of placing a stent at a target site within vasculature comprising a main vessel and at least one side branch vessel in fluid communication with the main vessel, the stent comprising a main lumen coupled to an inner member and a at least one side branch lumen coupled to a side branch catheter, the side branch catheter being separate from the inner member, the method comprising:

creating a first incision at a first location within the vasculature leading to the target site;

creating a second incision at a second location within the vasculature leading to the target site;

positioning the main lumen of the stent within the main vessel using at least one line extending from the first incision and the inner member; and

positioning a side branch lumen within the side branch vessel using at east one line extending from the second incision and the side branch catheter;

wherein selective tensioning of the lines to permit partially deploying the stent at the target site by expanding and reducing a diameter of each of the main lumen and side branch lumen through axial movement of the inner member that extends through the main lumen and axial movement of the side branch catheter that extends through the side branch lumen to allow for repositioning of the main lumen and side branch lumen; and

releasing the lines, releasing the main lumen from the inner member, and releasing the side branch lumen from the side branch catheter to fully deploy the stent at the target site.

11. The method of claim 10, further comprising placing a graft material around at least a portion of the stent prior to placing the stent in a vessel.

12. The method of claim 11, further comprising allowing the graft material to integrate the stent into the main vessel wall at the target site.

13. The method of claim 10, further comprising;

placing the stent in a sheath comprising a lumen having proximal and distal ends;

inserting the distal end of the sheath into the first incision; and

navigating the distal end of the sheath to the target site.

14. The method of claim 13, further comprising deploying the stent from the sheath.

15. The method of claim 13, further comprising imaging the vasculature using an imaging system.

16. The method of claim 15, further comprising adjusting the position of the stent at the target site using the imaging system and the first and second lines.

17. The method of claim 10, wherein the first incision is made in a femoral artery and the second is made at a location in the vasculature to provide access to at least one of the innominate artery, the left carotid artery and the left subclavian artery.

18. The method of claim 17, wherein the second incision is made in the brachiocephalic artery.

19. The method of claim 10, wherein the first incision is made in the brachiocephalic artery and the second incision is made in an iliac artery.

20. The method of claim 10, wherein the stent is positioned and deployed without completely disrupting blood flow in the vasculature.

21. A method of treating an aortic aneurysm of a human patient, comprising:

creating a first incision in a first location of a vessel leading to an aneurysm in a patient'"'"'s aortic artery;

creating a second incision in a second location of a vessel leading to the aneurysm;

moving a stent to a target site at the aneurysm using a first line connected to the stent and exiting the first incision and using a second line connected to the stent and exiting the second incision;

partially deploying the stent from a sheath at the target site wherein the stent is in a reduced dimension inside the sheath and expands to an expanded dimension in the vessel, and further wherein the stent comprises a main lumen coupled to an inner member and at least one side branch lumen coupled to a side branch catheter where partially deploying the stent comprises selectively tensioning the main lumen through axial movement of the inner member that extends through the main lumen and independently selectively tensioning the side branch lumen using the side branch catheter such that the main lumen can be repositioned in the respective main vessel by expanding and reducing a diameter of the main lumen; and

fully deploying the main lumen in the main vessel by releasing the main lumen from the inner member and fully deploying the side branch lumen in the side branch vessel by releasing the side branch lumen from the side branch catheter.

22. The method of claim 21, further comprising:

imaging the interior of a vessel while moving the stent to the target site.

23. The method of claim 21, further comprising:

tensioning the first and second lines and thereby reducing an outer dimension of the stent.

24. The method of claim 21, further comprising:

placing a graft material around at least a portion of the stent prior to placing the stent in a vessel.

25. The method of claim 24, further comprising:

allowing the graft material to integrate the stent into the main vessel wall at the target site.