Multi-component stent-graft system for aortic dissections
First Claim
1. Apparatus comprising a generally tubular stent-graft, which has distal and proximal stent-graft ends and comprises:
- a generally tubular support element, which comprises a plurality of structural stent elements; and
a covering element that is attached to and at least partially covers the support element,wherein when the stent-graft is unconstrained in a radially-expanded state;
the covering element and the support element are shaped so as to together define a lateral fenestration having distal and proximal fenestration ends,a first perimeter of the distal stent-graft end equals at least 200% of a second perimeter of the proximal stent-graft end, andthe stent-graft includes a dissection-reinforcement axial portion, which (a) includes a portion of the structural stent elements, (b) has (i) a distal dissection-reinforcement end and (ii) a proximal dissection-reinforcement end that is disposed along the stent-graft no more than 20 mm proximal to the proximal fenestration end, (c) extends along the stent-graft for a distance, and (d) has a radial strength that is at least 10% greater than an average radial strength of the entire stent-graft, wherein the distance is equal to between 5% and 32% of a greatest perimeter of the stent-graft distally to the distal fenestration end.
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Accused Products
Abstract
A generally tubular stent-graft (24) has distal and proximal stent-graft ends (36, 38) and includes a generally tubular support element (30) and a covering element (32). When the stent-graft (24) is unconstrained in a radially-expanded state: (1) the covering and support elements (32, 30) are shaped so as to together define a lateral fenestration (34) having distal and proximal fenestration ends (35, 37), (2) a perimeter (P1) of the distal stent-graft end (36) equals at least 200% of a perimeter (P2) of the proximal stent-graft end (38), and (3) the stent-graft (24) includes a dissection-reinforcement axial portion (48), which (a) has a proximal dissection-reinforcement end (52) that is disposed no more than 20 mm proximal to the proximal fenestration end (37), (b) extends along the stent-graft for a distance equal to between 5% and 32% of a greatest perimeter of the stent-graft (24) distally to the distal fenestration end (35), and (c) has a radial strength that is at least 10% greater than an average radial strength of the entire stent-graft (24). Other embodiments are also described.
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Citations
29 Claims
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1. Apparatus comprising a generally tubular stent-graft, which has distal and proximal stent-graft ends and comprises:
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a generally tubular support element, which comprises a plurality of structural stent elements; and a covering element that is attached to and at least partially covers the support element, wherein when the stent-graft is unconstrained in a radially-expanded state; the covering element and the support element are shaped so as to together define a lateral fenestration having distal and proximal fenestration ends, a first perimeter of the distal stent-graft end equals at least 200% of a second perimeter of the proximal stent-graft end, and the stent-graft includes a dissection-reinforcement axial portion, which (a) includes a portion of the structural stent elements, (b) has (i) a distal dissection-reinforcement end and (ii) a proximal dissection-reinforcement end that is disposed along the stent-graft no more than 20 mm proximal to the proximal fenestration end, (c) extends along the stent-graft for a distance, and (d) has a radial strength that is at least 10% greater than an average radial strength of the entire stent-graft, wherein the distance is equal to between 5% and 32% of a greatest perimeter of the stent-graft distally to the distal fenestration end. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. Apparatus comprising a generally tubular stent-graft, which has distal and proximal stent-graft ends and comprises:
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a generally tubular support element, which comprises a plurality of structural stent elements arranged as a plurality of circumferential stent springs; and a covering element that is attached to and at least partially covers the support element, wherein when the stent-graft is unconstrained in a radially-expanded state; the covering element and the support element are shaped so as to together define a lateral fenestration having distal and proximal fenestration ends, a first perimeter of the distal stent-graft end equals at least 200% of a second perimeter of the proximal stent-graft end, the stent-graft includes a dissection-reinforcement axial portion, which (a) includes a first plurality of the stent springs, (b) has (i) a distal dissection-reinforcement end and (ii) a proximal dissection-reinforcement end that is disposed along the stent-graft no more than 20 mm proximal to the proximal fenestration end, (c) extends along the stent-graft for a distance, and (d) is configured to be generally straight, wherein the distance is equal to between 5% and 32% of a greatest perimeter of the stent-graft distally to the distal fenestration end, the stent-graft includes a distal axial portion, which (a) includes a second plurality of the stent springs, (b) is disposed along the stent-graft distal and axially adjacent to the distal dissection-reinforcement end, (c) extends along the stent-graft for a distance, wherein the distance is equal to between 5% and 32% of the greatest perimeter of the stent-graft distally to the distal fenestration end, the stent springs have respective average heights, measured axially along the stent-graft, and an average of the average heights of the first plurality of the stent springs is less than 75% of the average height of a proximal-most one of the second plurality of the stent springs. - View Dependent Claims (14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27)
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28. A method for treating a patient comprising:
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endovascularly introducing a generally tubular stent-graft, while in a radially-compressed state, and positioning the stent-graft such that (a) a proximal stent-graft end of the stent-graft is positioned in a branch of an aortic arch selected from the group consisting of;
a left subclavian artery, and a left common carotid artery, and (b) a distal stent-graft end of the stent-graft is positioned in a descending aorta, wherein the stent-graft includes (a) a generally tubular support element, which includes a plurality of structural stent elements, and (b) a covering element that is attached to and at least partially covers the support element; andthereafter, transitioning the stent-graft to a radially-expanded state, in which (a) the covering element and the support element are shaped so as to together define a lateral fenestration that is disposed in the aortic arch, with the lateral fenestration facing upstream generally toward an ascending aorta, the lateral fenestration having distal and proximal fenestration ends, (b) a first perimeter of the distal stent-graft end of the stent-graft equals at least 200% of a second perimeter of the proximal stent-graft end, and (c) the stent-graft includes a dissection-reinforcement axial portion, which (i) includes a portion of the structural stent elements, (ii) has (x) a distal dissection-reinforcement end and (y) a proximal dissection-reinforcement end that is disposed along the stent-graft no more than 20 mm proximal to the proximal fenestration end, (iii) extends along the stent-graft for an axial distance, and (iv) has a radial strength that is at least 10% greater than an average radial strength of the entire stent-graft, wherein the axial distance is equal to between 5% and 32% of a greatest perimeter of the stent-graft distally to the distal fenestration end.
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29. A method for treating a patient comprising:
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endovascularly introducing a generally tubular stent-graft, while in a radially-compressed state, and positioning the stent-graft such that (a) a proximal stent-graft end of the stent-graft is positioned in a branch of an aortic arch selected from the group consisting of;
a left subclavian artery, and a left common carotid artery, and (b) a distal stent-graft end of the stent-graft is positioned in a descending aorta, wherein the stent-graft includes (a) a generally tubular support element, which includes a plurality of structural stent elements arranged as a plurality of circumferential stent springs, and (b) a covering element that is attached to and at least partially covers the support element; andthereafter, transitioning the stent-graft to a radially-expanded state, in which (a) the covering element and the support element are shaped so as to together define a lateral fenestration that is disposed in the aortic arch, with the lateral fenestration facing upstream generally toward an ascending aorta, the lateral fenestration having distal and proximal fenestration ends, (b) a first perimeter of the distal stent-graft end of the stent-graft equals at least 200% of a second perimeter of the proximal stent-graft end, (c) the stent-graft includes a dissection-reinforcement axial portion, which (i) includes a first plurality of the stent springs, (ii) has (x) a distal dissection-reinforcement end and (y) a proximal dissection-reinforcement end that is disposed along the stent-graft no more than 20 mm proximal to the proximal fenestration end, (iii) extends along the stent-graft for a distance, and (iv) is configured to be generally straight when the stent-graft is unconstrained in the radially-constrained state, wherein the distance is equal to between 5% and 32% of a greatest perimeter of the stent-graft distally to the distal fenestration end, (d) the stent-graft includes a distal axial portion, which (i) includes a second plurality of the stent springs, (ii) is disposed along the stent-graft distal and axially adjacent to the distal dissection-reinforcement end, (iii) extends along the stent-graft for a distance, wherein the distance is equal to between 5% and 32% of the greatest perimeter of the stent-graft distally to the distal fenestration end, (e) the stent springs have respective average heights, measured axially along the stent-graft, and (f) an average of the average heights of the first plurality of the stent springs is less than 75% of the average height of a proximal-most one of the second plurality of the stent springs.
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Specification