Methods and apparatus for treating neurovascular venous outflow obstruction

• US 9,675,457 B2
• Filed: 11/21/2014
• Issued: 06/13/2017
• Est. Priority Date: 07/27/2010
• Status: Active Grant

• Current Assignee: Incept LLC
• Original Assignee: Incept LLC
• Inventors: von Hoffmann, Gerard, Khosravi, Fred
• Primary Examiner(s): Miles, Jonathan
• Assistant Examiner(s): OBU, KENDRA NNEAMAKA
• Application Number:
  US14/550,748
• Publication Number:
  US 20150164642A1
• Time in Patent Office: 935 Days
• CPC Class Codes: A61B 17/12009 Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
• CPC Class Codes: A61F 2/01 Filters implantable into blood vessels
• CPC Class Codes: A61F 2/0105 Open ended, i.e. legs gathered only at one side
• CPC Class Codes: A61F 2/2418 Scaffolds therefor, e.g. support stents
• CPC Class Codes: A61F 2/2475 Venous valves
• CPC Class Codes: A61F 2/856 Single tubular stent with a side portal passage
• CPC Class Codes: A61F 2/915 with bands having a meander structure, adjacent bands being connected to each other
• CPC Class Codes: A61F 2002/016 made from wire-like elements
• CPC Class Codes: A61F 2002/91583 by a bridge, whereby at least one of its ends is connected along the length of a strut between two consecutive apices within a band
• 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 2220/005 using adhesives
• 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 2230/0006 circular
• CPC Class Codes: A61F 2230/0054 V-shaped
• CPC Class Codes: A61F 2230/0067 conical
• CPC Class Codes: A61F 2230/0091 helically-coiled or spirally-coiled, i.e. having a 2-D spiral cross-section
• CPC Class Codes: A61F 2230/0093 Umbrella-shaped, e.g. mushroom-shaped
• CPC Class Codes: A61M 2025/0175 having telescopic features, interengaging nestable members movable in relations to one another
• CPC Class Codes: A61M 2025/1015 having two or more independently movable balloons where the distance between the balloons can be adjusted, e.g. two balloon catheters concentric to each other forming an adjustable multiple balloon catheter system
• CPC Class Codes: A61M 2025/1047 : having centering means, e.g. balloons having an appropriate shape
• CPC Class Codes: A61M 2025/1086 : having a special balloon surface topography, e.g. pores, protuberances, spikes or grooves
• CPC Class Codes: A61M 2025/109 : having balloons for removing solid matters, e.g. by grasping or scraping plaque, thrombus or other matters that obstruct the flow
• CPC Class Codes: A61M 25/1011 : Multiple balloon catheters
• CPC Class Codes: A61M 25/104 : used for angioplasty

Abstract

Methods and devices are disclosed for treating neurovascular venous outflow obstructions, with or without implantation of a prosthetic valve. The valve may be carried by a support, such as a stent, which may be self-expandable or balloon expandable. Both transvascular and direct surgical access is contemplated.

Claims

1. A method of treating cerebrospinal venous insufficiency to treat the symptoms of multiple sclerosis, comprising the steps of:

identifying a human patient having at least a partial obstruction at a site in a vein of a venous outflow track from the brain;

removing the obstruction; and

implanting a first valve in the vein in fluid communication with the site, to permit venous outflow and reduce retrograde pressure;

wherein the valve comprises a self expandable tubular support having a radially outwardly extending projection having a deployed outside configuration such that the projection deforms a wall of the vein and wherein the implanting step comprises implanting the first valve in the vein such that the wall of the vein deformed by the projection provides an interference fit with a foramen in the base of the skull through which the vein extends to resist migration of the valve within the vein.

2. A method of treating cerebrospinal venous insufficiency as in claim 1, wherein the removing step comprises inflating a balloon at the site.

3. A method of treating cerebrospinal venous insufficiency as in claim 2, further comprising removing the balloon and thereafter performing the implanting a valve step.

4. A method of treating cerebrospinal venous insufficiency as in claim 1, wherein the removing step comprises surgically removing a section of vein.

5. A method of treating cerebrospinal venous insufficiency as in claim 1, wherein the implanting step comprises surgically attaching the valve.

6. A method of treating cerebrospinal venous insufficiency as in claim 5, wherein the implanting step comprises implanting a tubular graft having the valve mounted therein.

7. A method of treating cerebrospinal venous insufficiency as in claim 6, wherein the graft comprises a tubular ePTFE wall.

8. A method of treating cerebrospinal venous insufficiency as in claim 6, wherein the graft comprises a section of saphenous vein.

9. A method of treating cerebrospinal venous insufficiency as in claim 1, wherein a second valve is implanted in a left internal jugular vein.

10. A method of treating cerebrospinal venous insufficiency as in claim 1, wherein a second valve is implanted in a right internal jugular vein.

11. A method of treating cerebrospinal venous insufficiency as in claim 1, wherein a second valve is implanted in an azygos vein.

12. A method of treating cerebrospinal venous insufficiency as in claim 1, wherein a second valve is implanted in a superior vena cava.