Procedures for vascular occlusion

• US 9,867,723 B2
• Filed: 03/29/2016
• Issued: 01/16/2018
• Est. Priority Date: 06/23/2009
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Berez, Aaron, Tran, Quang Quoc
• Primary Examiner(s): FISHBACK, ASHLEY LAUREN
• Application Number:
  US15/083,529
• Publication Number:
  US 20160278908A1
• Time in Patent Office: 658 Days
• CPC Class Codes: A61B 17/12036 partial occlusion
• CPC Class Codes: A61B 17/12109 in a blood vessel
• CPC Class Codes: A61B 17/12118 for positioning in conjunction with a stent
• CPC Class Codes: A61B 17/12172 having a pre-set deployed three-dimensional shape methods of manufacturing A61B2017/00526
• CPC Class Codes: A61B 17/12177 comprising additional materials, e.g. thrombogenic, having filaments, having fibers or being coated
• CPC Class Codes: A61B 17/320758 with a rotating cutting instrument, e.g. motor driven A61B17/320725, A61B17/32075 and A61B17/320783 take precedence; for removing intra-ocular material A61F9/00763; endoscopic rotatable cutting instruments A61B17/32002
• CPC Class Codes: A61B 2017/00336 with a protective sleeve, e.g. retractable or slidable
• CPC Class Codes: A61B 2017/1205 Introduction devices
• CPC Class Codes: A61B 2017/12054 Details concerning the detachment of the occluding device from the introduction device
• CPC Class Codes: A61B 2017/22079 with suction of debris
• CPC Class Codes: A61B 2017/320716 comprising means for preventing embolism by dislodged material
• CPC Class Codes: A61B 2017/320766 eccentric
• CPC Class Codes: A61B 2017/320791 with cutter extending outside the cutting window
• CPC Class Codes: A61B 2090/3966 Radiopaque markers visible in an X-ray image
• CPC Class Codes: A61F 2/01 Filters implantable into blood vessels
• CPC Class Codes: A61F 2/011 Instruments for their placement or removal
• CPC Class Codes: A61F 2/013 Distal protection devices, i.e. devices placed distally in combination with another endovascular procedure, e.g. angioplasty or stenting
• CPC Class Codes: A61F 2/06 Blood vessels
• CPC Class Codes: A61F 2/82 Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents stent-grafts for tubular structures of the body other than blood vessels A61F2/04; stent-grafts for blood vessels A61F2/07; instruments specially adapted for placement or removal of stents or stent-grafts A61F2/95; for closing wounds, or holding wounds closed A61B17/04 - A61B17/115; dilators A61M29/00
• CPC Class Codes: A61F 2/852 Two or more distinct overlapping stents
• 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 2/966 : with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
• CPC Class Codes: A61F 2002/823 : Stents, different from stent-grafts, adapted to cover an aneurysm
• CPC Class Codes: A61F 2002/826 : more than one stent being applied sequentially
• CPC Class Codes: A61F 2002/9528 : for retrieval of stents
• CPC Class Codes: A61F 2230/0078 : hyperboloidal
• CPC Class Codes: A61F 2230/0091 : helically-coiled or spirally-coiled, i.e. having a 2-D spiral cross-section
• CPC Class Codes: A61F 2230/0095 : Saddle-shaped
• CPC Class Codes: A61F 2250/0018 : differing in elasticity, stiffness or compressibility
• CPC Class Codes: A61F 2250/0026 : differing in surface structures
• CPC Class Codes: A61F 2250/0065 : telescopic
• CPC Class Codes: A61M 25/00 : Catheters; Hollow probes dilators A61M29/00; peritoneal catheters A61M1/285; tracheal tubes A61M16/04; for drainage A61M27/00; for uterus, vagina or rectum A61M31/00 ; for measuring or testing A61B; materials for catheters A61L29/00
• CPC Class Codes: A61M 29/00 : Dilators with or without means for introducing media, e.g. remedies instruments for performing visual medical inspections of cavities or tubes of the body A61B1/00
• CPC Class Codes: A61M 5/007 : for contrast media

Abstract

A method of reducing blood flow within an aneurysm includes: injecting a contrast agent into a blood vessel including an aneurysm; deploying an occlusion device across the aneurysm; producing an image of the aneurysm including the contrast agent; and withdrawing the delivery device from the vessel after observing that the aneurysm has been stagnated by a desired amount. The image may be two-dimensional or three-dimensional. Observing that the aneurysm has been stagnated may include determining a degree of stagnation, for example by comparing an area or volume of the contrast agent in a first image and a second image. The desired amount may be a certain degree of stagnation, identification of a shape indicative of stasis such as a flat surface, an approximate hemisphere, a mushroom, or a crescent. If the occlusion device does not achieve the desired amount, a second occluding device may be deployed.

Claims

1. A method of reducing blood flow within an aneurysm, the method comprising:

expanding a stent, from a delivery device, across the aneurysm, such that a stagnated area forms in the aneurysm;

injecting a contrast agent into a blood vessel comprising an aneurysm;

imaging the stagnated area; and

upon observing that the stagnated area occupies more than 30% and less than 70% of a body of the aneurysm, withdrawing the delivery device from the vessel.

2. The method of claim 1, wherein, after withdrawing the delivery device, substantially all of the aneurysm progressively thromboses.

3. The method of claim 1, wherein the imaging is sufficient to determine that the expanding the stent is sufficient to lead to thrombosis of the aneurysm.

4. The method of claim 1, wherein the stent, when expanded, has a porosity that is configured to result in a delayed thrombosis of the aneurysm.

5. The method of claim 4, wherein the porosity is between about 60% and about 85%.

6. The method of claim 1, wherein the withdrawing is while the stagnated area occupies more than about 50% of the body of the aneurysm.

7. The method of claim 1, wherein the imaging comprises comparing a first image of the aneurysm before expanding the stent to a second image of the aneurysm after expanding the stent.

8. The method of claim 1, wherein withdrawing the delivery device from the vessel comprises releasing the stent from the delivery device.

9. The method of claim 1, further comprising expanding a second stent across the aneurysm while the stagnated area does not occupy more than 30% and less than 70% of the body of the aneurysm.

10. A method of reducing blood flow within an aneurysm, the method comprising:

expanding a stent, from a delivery device, across the aneurysm, such that a stagnated area forms in the aneurysm;

injecting a contrast agent into a blood vessel comprising an aneurysm;

imaging the stagnated area; and

upon observing that the stagnated area occupies more than 20% and less than 100% of a body of the aneurysm, withdrawing the delivery device from the vessel.

11. The method of claim 10, wherein, after withdrawing the delivery device, substantially all of the aneurysm progressively thromboses.

12. The method of claim 10, wherein the imaging is sufficient to determine that the expanding the stent is sufficient to lead to thrombosis of the aneurysm.

13. The method of claim 10, wherein the stent, when expanded, has a porosity that is configured to result in a delayed thrombosis of the aneurysm.

14. The method of claim 13, wherein the porosity is between about 60% and about 85%.

15. The method of claim 10, wherein the withdrawing is while the stagnated area occupies more than 50% of the body of the aneurysm.

16. The method of claim 10, wherein the withdrawing is while the stagnated area occupies more than 70% of the body of the aneurysm.

17. The method of claim 10, wherein the withdrawing is while the stagnated area occupies less than 90% of the body of the aneurysm.

18. The method of claim 10, wherein the withdrawing is while the stagnated area occupies less than 70% of the body of the aneurysm.

19. The method of claim 10, wherein the imaging comprises comparing a first image of the aneurysm before expanding the stent to a second image of the aneurysm after expanding the stent.