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    • 专利摘要:
    The present invention relates to a highly malleable stent-graft with an optional port for a lateral branching device. Said stent graft comprises: a graft carried on a stent, wherein said stent comprises undulations, each of which comprises apexes in opposite first and second directions; and a tape member connected to said stent and said graft so that its edge aligns with the edge of the apexes in the first direction of each of the undulations, thus confining the apexes in the first direction of the undulations to the graft, while the apexes in the second direction of the undulation are not confined to the graft; wherein said graft forms unidirectional creases when compressed longitudinally and wherein said apexes in the first direction of said undulations are disposed below an adjacent crease when compressed. The present invention also discloses and claims methods for making and using said highly malleable stent-graft, in addition to a method for forming the optional portal.
    公开号:BR112012007518B1
    申请号:R112012007518-7
    申请日:2010-10-08
    公开日:2021-05-04
    发明作者:Logan R. Hagaman；Cody L. Hartman；Jacoby L. Russell；Roark N. Wolfe；John Daugherty；Larry J. Kovach
    申请人:Gore Enterprise Holdings, Inc；
    IPC主号:
    专利说明:

    CROSS REFERENCE TO RELATED ORDERS
    This application claims benefit to United States Provisional Patent Application Serial No. 61/250,313, filed October 9, 2009; United States Patent Application Serial No. 12/818,551, filed June 18, 2010; and United States Patent Application Serial No. 12/818,575, filed June 18, 2010, all of which are incorporated herein by reference for all purposes. FIELD OF THE INVENTION
    One aspect of the present invention pertains to an improved modular bifurcated stenf-graft having an integrated support tube. Another aspect of the present invention relates to a highly malleable sfenf-graft with an optional bifurcation. BACKGROUND OF THE INVENTION
    Aneurysms occur in blood vessels where, because of the patient's age, disease, or genetic predisposition, the strength or resilience of the vessel wall is insufficient to prevent its swelling or stretching as the blood flows. If the aneurysm is not treated, the blood vessel wall can expand and rupture, often resulting in death.
    To prevent aneurysm rupture, a stenf-graft can be inserted into a blood vessel percutaneously and implanted so that it extends through the aneurysmal pocket. Stent-grafts include graft tissue attached to a frame or cylindrical structure of one or more stents. Stents provide rigidity and structure to keep the graft open in a tubular configuration, as well as the radial outward force necessary to create a seal between the graft and a healthy region of the vessel wall, thus providing resistance to migration. Blood flowing through the vessel can be channeled through the channeled surface of the stent-graft in order to lessen, if not eliminate, tension on the vessel wall at the site of the aneurysmal pocket. Stent-grafts decrease the risk of rupture of the blood vessel wall at the site of the aneurysm and allow blood to pass through the vessel without interruption.
    However, several endovascular repair interventions, such as the exclusion of an aneurysm, require a stent-graft to be implanted close to a vascular bifurcation. Often, the aneurysm expands to the bifurcation, requiring the sfent-graft to be placed there. In these cases, therefore, a bifurcated sfent-graft is necessary. Modular sfenf-grafts, with a separate main body and branch component, are generally preferred in these procedures because of the ease and accuracy of their implantation. See United States Patent Application No. 2008/0114446, in the name of Hartley et al., for example, which discloses a modular sfent-graft and distinct branching stent components. In the publication by Hartley et al., the main body stent features a custom-made sidewall fenestration to fit and secure to the side branch stent. In this configuration, the lateral branch stent fits by interference “line to line” in the fenestration of the main body, possibly compromising the fatigue strength of the stent-stent junction. United States Patent No. 6,645. 242, on behalf of Quinn, features a more robust stent-stent splice configuration. In Quinn's patent, a tubular support is incorporated within the main body stent to increase the reliability of the stent-stent junction. Quinn's inner tubular support gives an extended seal length as well as increased fatigue strength. However, the innermost tube is made by adding additional material in the form of a tube and sewn and/or adhered to the main graft component.
    In addition, aneurysms in the aorta, the largest artery in the human body, can occur in the chest (thoracic aortic aneurysm) or in the abdomen (abdominal aortic aneurysm). Due to the curvature of the aortic arch, the treatment of thoracic aortic aneurysms can be particularly challenging. Other parts of the vasculature, such as the common iliac artery, which extends from the aorta, can also be extremely tortuous. Therefore, preferably, a stent-graft implanted in these regions should be able to adapt to the vasculature. The high degree of adaptability allows the sfent-graft to bend and, optionally, oppose the native vessel and seal it. SUMMARY OF THE INVENTION
    One embodiment of the present invention relates to an improved modular bifurcated stent-graft having an integrated support tube. In another embodiment, the present invention relates to a highly malleable stent-graft with or without at least one port for a lateral branching device (e.g., a sfent-graft).
    One embodiment of the present invention comprises a multichannel sfent-graft comprising: a main channel, defined by a graft composed of an innermost tube with an opening and an outermost tube with an opening, said graft being carried in a main stent ; and a secondary channel disposed between the innermost tube and the outermost tube of said graft, said channel fluidly communicating through said openings. In one embodiment, said secondary channel comprises a secondary stent or secondary stent unit. In another embodiment, said secondary channel can accept another smaller stent-graft.
    Another embodiment of the present invention comprises a stent-graft for implantation in a bifurcated channel of the body with a main branch and a side branch, wherein the stent-graft comprises: a graft, said graft comprising an innermost tube with an opening and an outermost tube having an opening, said graft extending along the longitudinal axis from a distal end to a proximal end and defining a main channel extending therethrough, said graft being supported on a main stent; and a secondary channel disposed between the innermost tube and the outermost tube of said graft, said region of the secondary channel being disposed between the distal and proximal ends of said graft, said secondary channel fluidly communicating through said innermost and outermost tube openings. In one embodiment, said main stent is a self-expanding stent.
    Another embodiment of the present invention comprises a method with the steps of: coating a first mandrel, having a groove and a rear wall of said groove, with an innermost polymeric tube; making a slit in said polymeric tube along said back wall of said groove; inserting a second mandrel into said groove of the first mandrel and aligning it with the rear wall of the groove, thereby deforming the innermost polymeric tube; positioning an outermost polymeric tube over said innermost tube; and making an opening over said second smaller mandrel; wherein said outermost and innermost tubes comprise a graft member.
    Another embodiment of the present invention comprises a graft carried on a stent, wherein said stent comprises undulations, each of which comprises apexes in opposite first and second directions, and a tape member, with first and second longitudinal edges, attached to said stent and said graft so that its first edge substantially covers the apices in the first or second direction of each of the undulations, thus confining the apices in the first or second direction of the undulations to the graft, and wherein the apices in the first or second direction of the undulation are not confined to the graft. In one embodiment, said apexes in the first direction are confined to the graft and said apexes in the second direction are not. In another embodiment, said apexes in the second direction are confined to the graft and said apexes in the first direction are not. In another embodiment, said graft forms circumferentially oriented unidirectional pleats when compressed longitudinally. In another embodiment, said apexes in the first direction of said undulation are arranged under an adjacent fold when compressed. In another embodiment, said stent is made of a single continuous strand spirally wound around said graft. In one embodiment, said stent is a self-expanding stent. In another embodiment, said stent is made of nitinol. In another embodiment, said undulations are sinusoidal. In another embodiment, said graft comprises polytetrafluoroethylene.
    We will present other features and advantages of the present invention in the description below, which may also be learned by practicing the present invention. These other features and advantages of the present invention are embodied and attained by the structure particularly disclosed in the description and claims herein, as well as represented in the accompanying drawings.
    It should be understood that both the above general description and the detailed description below are exemplary and explanatory, therefore serving to better explain the claimed invention. BRIEF DESCRIPTION OF THE DRAWINGS
    The accompanying drawings, included to facilitate understanding of the present invention, are incorporated in and form a part of this descriptive report, illustrate embodiments of the present invention and, together with the description, serve to explain the principles of the present invention.
    In the drawings:
    Figure 1A is a perspective view of a bifurcated modular stent-graft that includes a main body stent, an internal support tube, and an aggregated side branch stent. Figures 1B, 1C, 1D and 1E illustrate a bifurcated sfent-graft whose main body comprises at least one lateral branching portal made in a part of the main body graft.
    Figures 2A and 2B illustrate perspective views of a mandrel used to construct a main body sfent-graft with an integrated support tube.
    Figures 3A and 3B illustrate perspective views of a mandrel used to construct a main body stent-graft with an integrated support tube and a secondary stent unit.
    Figures 4A and 4B illustrate schematic side views of a mandrel used to construct a main body stent-graft with an integrated support tube and a secondary stent unit.
    Figures 5A, 5B, 5C and 5D are side views of a mandrel and the process for manufacturing a stent.
    Figure 6 is a top view of a bifurcated stent-graft with a lateral branch port.
    Figure 7 is a perspective view of a three-part side branch stent constructed for specific purposes.
    Figure 8 illustrates a fully expanded stent-graft.
    Figure 9 illustrates a flexible stent-graft in a condition of full longitudinal compression, in which unidirectional folds form around the entire circumference of the stent-graft.
    Figures 10A and 10B illustrate a partial cross-sectional view of the stent-graft wall, along the transverse plane 3-3 of Figure 8, illustrating the unidirectional folds of the compressed stent-graft.
    Figure 11 illustrates a flexible stent-graft in a condition of partial longitudinal compression (or in a curved shape), in which unidirectional folds form over a portion of the circumference of the stent-graft (or in the inner meridian) and the meridian external presents parts of the graft without folds or straight.
    Figure 12 illustrates a “flat or unrolled” design of the cylindrical mandrel.
    Figure 13 illustrates a single-circle winding pattern.
    Figure 14 illustrates a stent-graft with a stent curled and spiral wound around a graft material. The stent is attached to the graft material by a spiral tape member. DETAILED DESCRIPTION OF ILLUSTRATED ACHIEVEMENTS
    One embodiment of the present invention relates to an improved modular bifurcated stent-graft having an integrated support tube. In another embodiment, the present invention relates to a highly malleable stent-graft with or without at least one port for a lateral branched device (e.g., a sfenf-graft).
    Generally speaking, most bifurcated sfenf-grafts have an inner tube to create the bifurcation or frenetration on the side of the sfent-graft into which the other tube or sfent-graft is inserted. See, for example, US Patent 6,645,242 in the name of Quinn and US Patent 6,077,296 in the name of Shokoohi. Figure 1 is a perspective view of a generic bifurcated modular stent-graft 100 that has a main body 102 with an inner tube 104. Generally speaking, most inner tubes (i.e., bifurcated tubes) are made of a material. additional, which is molded into the shape of a tube or bifurcation point and sewn and/or adhered to the inner side of the main body (usually the graft). Inner tube 104 is sized to engage and secure with a side branch device 106 shown protruding from a port 108 in main body 102. Main body 102 is shown implanted in main vessel 110 with the side branch stent implanted in a side branch 112. The present invention, as illustrated in Figures 1B to 7, comprises a bifurcated sfenf-graft whose main body comprises at least one side branch port made in a portion of the body graft main, wherein said at least a part with said portal constitutes an integral part of said graft and wherein at least a part of said portal does not have deformities in the main blood flow surface of the graft and/or weakened areas due to constructions discontinuous.
    Figures 1B to 1D illustrate an embodiment of the present invention. Figure 1B is a top view of a bifurcated sfenf-graft 120, which includes a main stent (or main body sfenf) 122 with a side branch portal 124. Also illustrated is a stent trace 121 that creates an area for the stent. side branch portal. In this embodiment, said dash is called "double W". In this embodiment, said "double W" helps to support the side branch portal and prevent it from breaking. In addition, this model creates a region for a side branch portal without creating a heavily deformed region in the stent body wrap pattern. Without sticking to any specific theory, this may be because the “double W” model does not depend on lower amplitude struts that strengthen the frame and result in greater deformations, which can cause fractures when the sfenf is tensioned. Portal 124 of main body 122 is dimensioned to engage and secure to a side branch sfenf, one embodiment of which is illustrated in Figure 7, 700.
    Figure 1C illustrates a side view of Figure 1B with a partial longitudinal section. This figure illustrates the main channel 128, a secondary channel 130, an outermost tube 132, an innermost tube 134, and an optional secondary stent 126. The opening 131 of the innermost tube 134 is also illustrated.
    Figure 1D illustrates the cross section of A-A in figure 1C. This figure illustrates primary stent 122, secondary stent 126, primary channel 128, and secondary channel 130. This figure also illustrates an outermost tube 132 and an innermost tube 134.
    Figure 1E is a close-up view of section D illustrated in figure 1D. As such, this figure is a close-up view of the cross-section of the side branch portal. This figure illustrates the primary stent 122, the secondary stent 126, and the secondary channel 130. This figure also illustrates an outermost tube 132 and an innermost tube 134. The graft 136 is composed of an innermost tube 134 and an outermost tube 132. Also illustrated is the blood flow surface 138 (i.e., the inner surface of the graft), the outer surface 140 of the innermost tube 134, and the inner surface 141 of the outermost tube 132.
    Thus, in one embodiment of the present invention, the bifurcated sfent-graft (with multiple channels) comprises a main channel 128, defined by a graft 136 composed of an innermost tube 134 with an opening 131 and an outermost tube 132 with a opening 124, said graft being carried on a main stent 122; and a secondary channel 130 disposed between the outermost tube 132 and the innermost tube 134 of said graft 136; wherein said secondary channel fluidly communicates through said apertures 131 and 124. In one embodiment, said secondary channel 130 comprises a secondary stent or secondary stent unit 126. As mentioned herein, said secondary stent unit is a secondary stent that is coated and may comprise additional traces such as radiopaque markers. In another embodiment, said secondary channel is disposed between the ends of the main stent-graft or main body. In another embodiment, part of said secondary stent or secondary stent unit makes contact with part of the innermost tube 134. In another embodiment, said secondary stent or secondary stent unit makes contact with part of the graft 136. In another embodiment, part of said secondary stent or secondary stent unit rests on the outer surface 140 of the innermost tube 134. In another embodiment, said secondary channel is defined in part by the innermost tube and in part by the outermost tube. In another embodiment, said secondary channel is defined in part by the outer surface 140 of the innermost tube 138 and in part by the inner surface 141 of the outermost tube 132.
    The stent-graft graft of the present invention can be made of any material suitable for use as a graft in the chosen channel of the body. Said graft can be composed of the same or different materials. Furthermore, said graft may comprise several layers of material which may be of the same material or of different materials. Although the graft may have more layers of material, it may have a layer in the shape of a tube (inner tube) and an outer layer in the shape of a tube (outer tube). In the context of the present invention, the outermost tube does not comprise a layer of tape that can be used to adhere a stent to a graft, as we will describe in more detail below. In one embodiment of the present invention, said graft comprises an innermost tube and an outermost tube.
    Many graft materials are known, particularly those that can be used in vascular grafts. In one embodiment, said materials are used in combination and brought together to form a graft. The graft materials used in a stent-graft can be extruded, coated, made from rolled films, or a combination of these. It is possible to use polymeric, biodegradable and natural materials can for specific applications.
    Examples of synthetic polymers include, among others, nylon, polyacrylamide, polycarbonate, polyformaldehyde, polymethylmethacrylate, polytetrafluoroethylene, polytrifluorochlorethylene, polyvinylchloride, polyurethane, organosilicon elastomeric polymers, polyethylene, polypropylene, polyurethane, polyglycolic acid, polyesters, polyamides, their mixtures, combinations and copolymers suitable for use as graft material. In one embodiment, said graft is made from a class of polyesters, such as polyethylene terephthalate, including DACRON® and MYLAR®, polyaramids such as KEVLAR®, polyfluorocarbons such as polytetrafluoroethylene (PTFE) with and without copolymerized hexafluoropropylene (TEFLON® or GORE-TEX®), and porous or non-porous polyurethanes. In another embodiment, said graft comprises expanded fluorocarbon polymer materials (especially PTFE), described in British Patent Nos. 1,355,373, 1,506,432 or 1,506,432 or in United States Patent Nos. 3,953. 566, 4,187,390 or 5,276,276, all of which are incorporated in full by reference. Included in the class of preferred fluoropolymers are polytetrafluoroethylene (PTFE), fluorinated ethylene-propylene (FEP), copolymers of tetrafluoroethylene (TFE) and perfluoro(propyl-vinyl-ether) (PFA), homopolymers of polychlorotrifluoroethylene (PCTFE) and their copolymers with TFE, ethylenechlorotrifluoroethylene (ECTFE), ethylene-tetrafluoroethylene (ETFE) copolymers, polyvinylidene fluoride (PVDF) and polyvinyl fluoride (PVF). ePTFE is especially preferred because of its widespread use in vascular prostheses. In another embodiment, said graft comprises a combination of said materials listed above. In another embodiment, said graft is substantially impermeable to bodily fluids. Said substantially impermeable graft may be made of materials substantially impermeable to bodily fluids or may be made of permeable materials treated or fabricated to be substantially impermeable to bodily fluids (e.g., layering different types of materials described above or known in the art) . In another embodiment, said outermost tube comprises ePTFE. In another embodiment, said innermost tube comprises ePTFE. In another embodiment, said innermost and outermost tubes comprise ePTFE film wound to form a tube. In another embodiment, said secondary stent is coated with any of the materials disclosed herein or known in the prior art. In another embodiment, the secondary stent coating comprises ePTFE.
    Additional examples of graft materials include, but are not limited to, vinylidene fluoride/hexafluoropropylene (HFP), tetrafluoroethylene (TFE), vinylidene fluoride, 1-hydropentafluoropropylene, perfluoro(methyl-vinyl-ether), chlorotrifluoroethylene (CTFE), pentafluoropropene, trifluoroethylene , hexafluoroacetone, hexafluoroisobutylene, polyethylene fluorinated with propylene (FPEP), polyhexafluoropropene (PHFP), polychlorotrifluoroethylene (PCTFE), polyvinylidene fluoride (PVDF), polyvinylidene fluoride with tetrafluoroethylene (PVDF-TFE), polyvinylidene fluoride with hexafluoropropene (PVDF-HFP ), polytetrafluoroethylene with hexafluoropropene (PTFE-HFP), polyhetrafluoroethylene with vinyl alcohol (PTFE-VAL), polytetrafluoroethylene with vinyl acetate (PTFE-VAC), polytetrafluoroethylene with propene (PTFEP) polyhexafluoropropene with vinyl alcohol (PHFP-VAL), polyethylene with tetrafluoroethylene (PETFE), polyethylene with hexafluoropropene (PEHFP), polyvinylidene fluoride with chlorotrifluoroethylene ( PVDF-CTFE) and combinations thereof, as well as additional polymers and copolymers described in patent publication 2004/0063805, incorporated by reference herein in its entirety for all purposes. Additional polyfluorocopolymers include tetrafluoroethylene (TFE)/perfluoroalkylvinylether (PAVE). PAVE may be perfluoromethylvinylether (PMVE), perfluoroethylvinylether (PEVE) or perfluoropropylvinylether (PPVE) as described primarily in US publication 2006/0198866 and US patent 7,049,380, both incorporated by reference herein in their entirety for all purposes. Other polymers and copolymers include polylactide, polycaprolactone-glycolide, polyorthoesters, polyanhydrides; polyamino acids; polysaccharides; polyphosphazenes; polyether-ester copolymers, for example PEO-PLLA or mixtures thereof, polydimethylsiloxane; polyethylene-vinyl-acetate; acrylate-based polymers or copolymers, for example, polyhydroxyethyl methyl methacrylate and polyvinyl pyrrolidone; fluorinated polymers such as polytetrafluoroethylene; cellulose esters and any polymer or copolymer described in United States publication 2004/0063805, incorporated by reference herein in its entirety.
    Said stents of the present invention are broadly cylindrical and comprise spirally arranged undulations with several spiral turns. Preferably, the dimples are aligned so that they are "in phase" with each other as shown in Figure 8. More specifically, the dimples comprise apexes in opposite first 814 and second 816 directions. When the ripples are in phase, the apexes of adjacent spiral turns are aligned so that they can be shifted towards the respective apexes of a corresponding ripple in an adjacent spiral turn. In one embodiment, said ripples are sinusoidal. In another embodiment, said dimples are U-shaped. In another embodiment, said dimples are V-shaped. In another embodiment, said dimples are oval. These formats are fully described in United States Patent 6,042,605, Figures 14A through 14E. United States Patent 6,042,605 is hereby incorporated by reference herein in its entirety for all purposes.
    In another embodiment of the present invention, said stent may be made from a variety of biocompatible materials, including widely known materials (or combinations of materials) used in the manufacture of implantable medical devices. Typical materials include 316L stainless steel, cobalt-chromium-nickel-molybdenum-steel (“cobalt-chromium”) alloy, other cobalt alloys such as L605 tantalum, nitinol or other biocompatible metals. In one embodiment, said stent-graft is an expandable balloon-type stent-graft. In another embodiment, said stent-graft is a self-expanding stent-graft. In another embodiment, said stent is a wire-wound stent. In another embodiment, said wire-wound stent comprises undulations.
    The wire-wound stent can be made of a material of reasonably high strength, i.e., one that is resistant to plastic deformation when under tension. In another embodiment, the stent member comprises a wire that is spirally wound around a mandrel with pins so that the undulations and spiral turns form at the same time, as will be described below. It is also possible to adopt other constructions. For example, a suitable shape can be made with a flat stock rolled into a cylinder or length of properly shaped tubing, or by laser cutting a sheet of material. In another embodiment, said stent is made of super-elastic alloy. There are several revelations that superelastic alloys such as nitinol are used in stents. See, for example, United States Patent Nos. 4,503,569, in the name of Dotter, 4,512,338, in the name of Baiko et al., 4,990,155, in the name of Wilkoff, 5,037,427, in the name of Harada and col., 5,147,370 on behalf of MacNamara et al., 5,211,658, on behalf of Clouse, and 5,221,261 on behalf of Termin et al.
    Various materials alternately metallic, superelastic alloys, such as nitinol, are suitable for use in the stents of the present invention. The main requirements of materials are that they are adequately elastic even when cut into very thin sheets or small diameter yarn. Various stainless steels physically, chemically or otherwise treated to obtain high elasticity are suitable, as well as other metallic alloys such as cobalt-chromium alloys (eg ELGILOY®), platinum/tungsten alloys and, in particular, alloys of nickel-titanium, known generically as “nitinol”.
    Nitinol is especially preferred because of its “super-elastic” or “pseudo-elastic” shape recovery properties, that is, the ability to withstand a significant amount of bending and bending and yet return to the original shape without deformation. permanent. These metals are characterized by their ability to change from an austenitic crystal structure to a stress-induced martensitic structure at certain temperatures and elastically return to an austenitic shape when the stress is removed. These alternating crystal structures give the alloy its super-elastic properties. These alloys are well known in addition to being described in US Patent Nos. 3,174,851, 3,351,463 and 3,753,700.
    Other suitable stent materials include certain polymeric materials, especially engineering plastics such as thermotropic liquid crystal polymers ("LCP's"). These polymers are high molecular weight materials that can exist in a so-called “liquid crystalline state”, in which the material has some of the properties of a liquid (is able to flow), but retains the distant molecular order of a crystal. The term “thermotropic” refers to the class of LCP's formed by temperature adjustment. LCP's can be prepared from monomers such as p,p'-dihydroxy-polynuclear-aromatics or dicarboxy-polynuclear-aromatics. LCP's are easily molded and maintain the interpolymer attraction at room temperature necessary to act as high-strength plastic artifacts as needed as a flexible stent. They are particularly suitable when bulked or filled with fibers such as the metals or alloys discussed below. It should be noted that the fibers do not need to be linear, but may have some preformation, such as corrugations that contribute to physical torsion, thus enhancing the composite's properties.
    Another embodiment of the present invention comprises a sfent-graft for implantation in a bifurcated channel of the body having a main branch and a side branch, wherein the sfent-graft comprises: a graft, said graft comprising an innermost tube with an opening and an outermost tube having an opening, said graft extending along the longitudinal axis from a distal end to a proximal end and defining a main channel therethrough, said graft being supported on a main stent; and a secondary channel between the innermost tube and the outermost tube of said graft, said region of the secondary channel disposed between the distal and proximal ends of said graft, said secondary channel fluidly communicating through said tube openings. more internal and more external. In one embodiment, said main stent is a self-expanding stent. In another embodiment, said self-expanding stent comprises a titanium-nickel alloy. In another embodiment, said stent consists of a single continuous strand spirally wound around said graft. In another embodiment, said single continuous strand comprises undulations. In another embodiment, said crimped yarn comprises a plurality of turns in said undulations, each of which comprises a plurality of apexes, with the crimping of one turn generally in phase with the crimping of an adjacent turn. In another embodiment, said dimples are U-shaped. In another embodiment, said dimples are V-shaped. In another embodiment, said dimples are oval. In another embodiment, said undulations are sinusoidal. In another embodiment, said stent attaches to said graft. In another embodiment, said stent is attached to said graft by a tape or strip. In another embodiment, said tape or strip adheres to a portion of said stent and a portion of said graft. In another embodiment, said tape or strip is arranged in a spiral configuration with several turns. In another embodiment, said tape or strip is arranged in a spiral configuration with several turns, each being spaced from another adjacent turn. In another embodiment, said spacing between said turns is uniform. In another embodiment, said tape covers part of said undulation. In another embodiment, said stent comprises undulations, each of which comprises an apex portion and a base portion, and said tape or strip connects to said stent so that it is positioned along the base portion of each. one of the dimples, thus confining the base part of the dimples to the graft, the apex part of the dimple being not confined.
    Figures 2 to 7 depict at least one method for fabricating a main body stent-graft with an integrated support tube.
    Figure 2A is a perspective view of a metal mandrel 200 with a slot or groove 202 formed at one end thereof. The groove 202 culminates in a rear wall 204. As shown in perspective in Figure 2B, an inner tube 206 is slidably fitted over the mandrel 200, covering part of the groove 202. The inner tube may comprise any biocompatible polymer that is deformable (a in order to allow for the subsequent introduction of a side branch stent) and may be extruded, coated or formed from rolled films. Suitable materials used for the inner tube include, but are not limited to, any of the materials described above, any biocompatible material widely known in the art, or a combination thereof.
    Figure 3A illustrates a perspective view of the mandrel 200 lined with the inner tube 206. The inner tube is cut by forming a slot 300 in the back wall 204 of the slot 202 of the mandrel 200. As shown in Figure 3B, a stent unit The secondary or side branch 302 is aligned with the slot 202 of the mandrel 200, the back wall 204 of the mandrel 200, and the slot 300 in the inner tube 206. A first support segment (described later) is inserted into the secondary stent unit and this (along with the first support segment) is then inserted into the groove 202 of the mandrel 200, thereby deforming the inner tube 206 towards the interior of the groove of the mandrel. The rear wall 204 defines the opening of the innermost tube (Fig. 1C, item 131).
    To control the deformed shape of the inner tube, the support segments are disposed within the secondary stent unit and within the mandrel groove, as shown in Figures 4A and 4B. Figure 4A illustrates a schematic side view of the mandrel 200, the slot 202 and the rear wall 204 of the slot 202. Figure 4B illustrates a schematic side view of the mandrel 200, the slot 202 of the mandrel 200 and the inner tube 206. The unit of secondary stent 302 has been disposed over a first support segment 400, which has an end shaped to match the rear wall 204 of slot 202 of mandrel 200. The opposite end of the first support segment has a tapered or angled wall, as illustrated. Figure 4B. A second support segment 402 is disposed within slot 202 of mandrel 200 below inner tube 206. The second support segment may have an angled wall coincident with the angled wall of the first support segment, although the second segment is not required. support has an angled wall. One of the purposes of this second support structure is to hold the first support segment 400 in place during fabrication. Inner tube 206 is shown deformed towards the interior of groove 202 of mandrel 200. Inner tube 206 is also shown with a tapered, beveled or angled portion 404 of its wall formed by the angled wall of support segment 400.
    To further strengthen the inner tube (figure 3A, item 206), it is possible to add additional layers of foil or film over it before introducing the secondary stent unit. For example, a square/rectangular thin film sheet with a high degree of biaxial strength can be disposed over the inner tube 206 and aligned with the mandrel groove. The sheet can be sized to be larger than the width of the mandrel groove and with a length close to the length of the mandrel groove. This strengthening layer will then be transformed into the mandrel groove, providing additional support to the inner tube/secondary stent unit. Various strengthening layers can be combined to enhance inner tube properties. Suitable materials used in the strengthening layers include, but are not limited to, any of the materials described above, any biocompatible material widely known in the art, or a combination thereof.
    Although the above methods describe the construction of a single-port bifurcated stent-graft, it is possible to form other portals using methods similar to those described above. Therefore, another embodiment of the present invention comprises a sfent-graft with at least two portals. In another embodiment, said sfent-graft of the present invention comprises three, frame, five, six or seven portals. Such a stent-graft can be useful, among others, for implantation in the abdominal aorta where the renal arteries bifurcate. Furthermore, as the stent-graft of the present invention is highly malleable, as we will see later, said sfent-graft of the present invention with three portals can be disposed in the aortic arch without blocking the blood flow to the left subclavicular artery, for the common carotid artery and to the baciocephalic artery. In another embodiment, said multiple portals may be positioned where desired longitudinally along the stent and/or circumferentially around the stent. Those skilled in the art can design such portals in any region of the vasculature.
    Figures 5A through 5D outline at least one method for building a secondary stent unit. As Figures 5A and 5B illustrate in side view, a polymeric tube 502 is slip fitted over a mandrel 500. A corrugated wire may take the form of an annular stent 506 by winding it onto a mandrel with protruding pins. The diameter of the mandrel and pins, along with the location of the pins, dictates the final configuration of the annular stent. After winding the wire over the mandrel, both are heat treated and tempered to define the shape of the stent. Then remove the thread from the mandrel. The ends of the wire are joined with a section of heat-shrinkable polymeric tubing, thus forming the 506 annular stent. Other methods can be adopted to construct the secondary stent (eg, laser cutting). Then, one or more of these annular stents 506 are disposed over the polymeric tube 502. Thereafter, optional radiopaque marker bands 504 are disposed over the polymeric tube 502. The wire or metallic tube used to construct the secondary stent is described above. In one embodiment, said secondary stent comprises nitinol.
    Then, as shown in Figure 5C, one end of the polymeric tube 502 is turned over and stretched over the annular wire stents 506 and optional radiopaque marker bands 504. Next, the mandrel, the polymeric tube, the annular stents, and the bands Radiopaque cells are heat treated to bond them together to form a stent unit. The unit is removed from the mandrel and has its length trimmed, thus forming a secondary stent unit 302, as shown in Figure 5D. The secondary stent unit is then disposed on a first support segment 400. Radiopaque markers include, but are not limited to, gold, platinum, platinum-tungsten, palladium, platinum-iridium, rhodium, tantalum, or alloys or composites of these materials.
    As previously described with reference to Figure 4B, the secondary stent (or secondary stent unit) and the first support segment are then inserted into the slot 202 of the mandrel 200, thereby deforming the inner tube 206 towards the interior of the mandrel slot. . Then, the unit illustrated in figure 4B is covered with an external polymeric tube. As described in this document, said tube may be extruded, coated or formed from rolled films.
    The unit is heat treated to join the inner tube to the outer tube. A portal or side branch opening (figure 1, item 108) is formed as described above. Next, a main wire stent is formed by winding a wire over a mandrel with protruding pins. The wire is heat treated to define its shape through a process similar to that used to form the secondary stent (Figure 5B). Soon after, the main stent is placed over the outer polymeric tube and wrapped by a polymeric wire. Afterwards, the unit is heat treated to join the components.
    Methods for attaching a stent to a graft are known in the art. One embodiment comprises a coupling member which is generally a flat tape or strip with at least one broadly flat surface. In another embodiment of the present invention, the tape member is made of expanded PTFE (ePTFE) coated with an adhesive. In another embodiment, said adhesive is a thermoplastic adhesive. In another embodiment, said thermoplastic adhesive is fluorinated ethylene propylene (FEP). In this embodiment, the FEP-coated side faces the external surfaces of the stent and the graft, making contact with them, thus connecting the stent to the graft. While we have illustrated and described a specific strip member configuration and pattern, other configurations and/or patterns can be used without departing from the scope of the present invention. Materials and methods for attaching a stent to the graft are discussed in United States Patent 6,042,602, in the name of Martin, incorporated by reference herein for all purposes.
    Figure 6 illustrates a top view of a bifurcated sfent-graft 120 with a lateral branch port 124. In this embodiment, the stent-graft comprises a spiral-wound main stent 122. The main stent 122 joins the graft 136. thanks to a rolled film 606, as described above. The stent has sealing cuffs 608 to the wrapped film 606 at the two opposite ends of the sfenf-graft unit 120. These mounting methods are disclosed in general terms, for example, in United States Patent No. 6,042,605, issued in the name to Martin et al., in United States Patent No. 6,361,637, issued to Martin et al., and United States Patent No. 6,520,986, issued to Martin et al., all incorporated by reference to the this document for all purposes.
    A side branch stent would ideally have a distal portion with a high degree of radial stiffness to allow for juxtaposition and sealing against a vessel wall. The lateral branching stent would also have a highly flexible and highly fatigue-resistant midsection due to the pulsating and cyclic loading imposed by the native vessels. The side branch stent would also have a proximal portion disposed within the main body stent. This proximal part of the side branch stent requires a high degree of radial stiffness in order to properly secure and secure within the main body portal.
    Figure 7 illustrates an embodiment of a side branch stent-graft 700 comprising a wire-wound metallic stent 702, a graft overlay 704 and radiopaque marker bands 706. The side branch stent has a distal portion 708, a middle portion. 710 and a proximal portion 712. The distal portion 708 has a high degree of radial stiffness to allow for juxtaposition and sealing against the wall of a side branch (Fig. 1, item 112). The middle part 710 is highly flexible and highly resistant to fatigue due to the pulsating and cyclic loading imposed by native vessels. Proximal portion 712, which is disposed within the main body stent (Figure 1, item 102), has a high degree of radial stiffness so that it attaches and secures properly within the main body portal and so that it can withstand compression and remain unobstructed if an additional device (eg, an extender) is implanted.
    The process adopted to fabricate a 700 side branch stent-graft can be used to fabricate the sfent-graft unit (Figure 6, item 120) as defined above. These assembly methods are disclosed in general terms, for example, in United States Patent No. 6,042,605, issued in the name of Martin et al., in United States Patent No. 6,361,637, issued in the name of Martin et al. , and U.S. Patent No. 6,520,986, issued to Martin et al. The stiffness, radial strength, flexibility, and fatigue life of a side branch stent can be controlled by the stent wire properties, wire wrap pattern geometries, graft properties, and wire-to-graft binding configurations . For example, in Fig. 7, the distal portion 708 of the side branch stent 700 has a crimped wire pattern with a relatively large crimp amplitude. The ripples are also relatively widely spaced. In comparison, the middle portion 710 of the side branch stent has a wavy wire pattern with a relatively small wavy amplitude. The undulations are spaced relatively close to adjacent strands. Finally, the proximal portion 712, which is disposed within the main body stent (Fig. 1, item 102), features a crimped wire pattern with a relatively large crimp amplitude. The undulations are also spaced relatively close to adjacent strands.
    Methods for joining the lateral branching stent-graft to the main stent-graft are known. These include, but are not limited to, friction fit, hooks and burrs, and/or protruding apexes on the stent. Additional methods are discussed in United States publication 2009/0043376 in the name of Hamer and Zukowski, incorporated by reference herein in its entirety for all purposes.
    The stent-graft can be implanted percutaneously, usually through the vasculature, after it has been compressed to a reduced diameter. After reaching the desired implant site, it is expanded to form a tarpaulin on the vessel wall. In one embodiment, the stent-graft compresses along its longitudinal axis and is prevented from opening like a spring. The stent-graft then expands when we remove the restriction mechanism, thus allowing it to open against the vessel walls. The stent-grafts of the present invention generally open automatically when expanded. If desired, an inflatable balloon catheter or similar means can be used to ensure full opening of the stent-graft under certain circumstances. In another embodiment, said stent-graft is an expandable balloon-type stent. The lateral branch can also be implanted percutaneously after being compressed to a reduced diameter.
    The stent-graft of the present invention can comprise at least one or two radiopaque markers to facilitate its correct positioning within the vasculature. These radiopaque markers can be used to correctly align the stent-graft both axially and rotationally to confirm that the lateral port is correctly aligned. Said radiopaque markers include, but are not limited to, gold, platinum, platinum-tungsten, palladium, platinum-iridium, rhodium, tantalum or alloys. Alternatively, as long as the implant catheter model has sufficient torque transmission, the rotational orientation of the graft can be coordinated by a marker indexed at the proximal end of the catheter so that the catheter can be rotated to correctly align the one or more side branches. Other methods for deploying the bifurcated stent-graft of the present invention and an associated lateral branch are disclosed in United States publication 2008/0269866, in the name of Hamer and Johnson, and in United States publication 2008/0269867, in the name of Johnson, both are incorporated by reference herein in their entirety for all purposes.
    Another embodiment of the present invention comprises a highly malleable stent-graft capable of adapting to highly tortuous sections of a native vessel. As an option, said stent-graft may contain at least one lateral branching portal.
    Referring to Figure 8, in general terms, the highly malleable sfenf-graft of the present invention 800 includes a graft 804, a stent 802 and a tape member (Figure 14, item 1406) for coupling the stent and the graft member to a to the other and is highly malleable. Preferably, the stent and graft are coupled together so that they are largely coaxial.
    In one embodiment of the present invention, the highly malleable stent-graft 800 has a sfenf of spirally formed strand 802 that surrounds an 804 graft. The sfenf shaped strand has opposite apexes of first 814 and second 816. 800 has a first end portion 806 which optionally comprises a sealing sleeve 808. Similarly, the sfenf-graft 800 has a second end portion 810 which optionally comprises a second sealing sleeve 812 (folded to back for elucidation) and a radiopaque marker 818. As shown in Figure 9, the flexible sfent-graft 800 has 900 unidirectional folds formed by longitudinal compression. In one embodiment, said stent-graft of the present invention has at least one port between its ends for the introduction of a lateral branching device. In another embodiment, said side branch device is a stent-graft.
    Figure 9 illustrates a flexible sfenf-graft 800 in a condition of longitudinal compression, in which unidirectional folds 900 form around the entire circumference of the sfenf-graft 800.
    Figure 10A illustrates a partial longitudinal sectional view of the wall of the sfenf-graft 800, along the transverse plane 3-3 of Figure 9, illustrating the unidirectional pleats of the compressed sfent-graft 800. The unidirectional pleats assume a common orientation and are all curved in the same direction. The sfenf of thread 802 is illustrated with opposite directional first apexes 814 retracted under an adjacent folded portion of the graft material 804, thus forming a unidirectional pleat 900. Arrow 1000 indicates the preferred direction of blood flow relative to the pleats in order to minimize flow disruption and turbulence. Figure 10B is an extended cross-sectional view, similar to Figure 10A, illustrating unidirectional folds 900 in addition to the preferred direction of blood flow 1000.
    Figure 11 illustrates a flexible 800 sfenf-graft in a curved shape that imparts compression to the graft wall along the inner meridian of the curvature (ie, partial longitudinal compression), where unidirectional folds 900 form part of the circumference. of the sfenf-graft (or in the internal meridian). The outer meridian has parts of the graft without folds or straight 1100. The arrow 1102 indicates the preferred direction of blood flow, as previously shown in figure 10.
    Another embodiment of the present invention comprises a graft carried on a stent, wherein said stent comprises undulations, each of which comprises apexes in opposite first and second directions, and a tape member, with first and second longitudinal edges, attached to said stent and said graft so that the first edge of the tape substantially covers the apexes in the first or second direction of each of the undulations, thus confining the apexes in the first or second direction of the undulations to the graft, and wherein the apexes in the first direction or second of the swell are not confined to the graft. In one embodiment, said apexes in the first direction are confined to the graft and apexes in the second direction are not. In another embodiment, said apexes in the second direction are confined to the graft, and apexes in the first direction are not. In another embodiment, said graft forms circumferentially oriented unidirectional pleats when compressed longitudinally. In another embodiment, said confined apexes (either in the first direction or in the second direction) of said undulations are disposed under an adjacent pleat when compressed. The term "confined apices" means that the apices are attached to the graft by a tape member or by other method known in the art. In another embodiment, said confined apexes are disposed under an adjacent fold, thus covering about 1%, about 2%, about 3%, about 4%, about 5%, about 10%, about 20%, about 30%, about 40%, about 50%, about 60%, about 70%, about 80% of the swell height 1312 (figure 13) of the apices in the first direction. Depending on the method of tape tying the stent to the graft, the stent model, the construction of the graft, and/or other consideration regarding the construction of the stent-graft, not all apexes need to be placed under an adjacent crease or they may differ by how much to crimp height 1312 which can be disposed behind an adjacent pleat. As such, there may be sections of the stent-graft that are not compressible in accordance with the present invention. Therefore, in another embodiment, only a section of the stent-graft can be compressed by placing the apexes confined under an adjacent crease. In another embodiment, only a portion of the stent-graft can be bent by placing the apices confined under an adjacent crease (in the inner meridian), as shown in Figure 11. Although the disclosed embodiment comprises the apices in the first direction positioned behind the creases The present invention also encompasses apexes in the second direction that attach to the graft and are positioned under an adjacent crease, whereas apexes in the first direction are not confined.
    An important aspect of the present invention is that the tape member, which comprises first and second longitudinal edges, secures the stent member to the graft member and only covers part of the stent member. More specifically, said tape member attaches to said stent and said graft so that its first edge substantially covers the apexes in the first direction of each of the undulations, thus confining the apexes in the first direction of the undulations to the graft. In one embodiment, the first edge of said tape member aligns with the edge of the apexes in the first direction 814 of each of the undulations, as figure 14 essentially illustrates. In this construction, when the stent-graft is compressed, the graft forms unidirectional folds in circumference and allows said apexes in said first direction 814 to be arranged under an adjacent fold, as shown in Figures 9 and 11. The formation of said unidirectional folds makes said stent-graft more malleable, thus giving it the ability to bend, as shown in Figure 11. In one embodiment, said stent-graft bends by at least 90° without bending (i.e., maintaining an essentially circular cross section on the channeled surface). In another embodiment, said stent-graft curves by at least 90° without tipping after in vivo implantation.
    The tape member features a broadly long and/or flat surface to interface with the stent and graft. This increases the potential binding surface area between the tape member and the graft member in order to improve the structural integrity of the stent-graft. The increased bonding surface area also helps to minimize tape member thickness. Furthermore, the tape member is arranged in a spiral configuration according to the embodiment illustrated in Figure 14 (spiral arranged tape member 1406). As illustrated, the tape member can be constructed of constant width and arranged with even spacing between turns. Tape member 1406 not only covers the apexes in the first direction of each of the dimples, but also covers part of each dimple. In another embodiment, there may be multiple tape members on a stent-graft fulfilling the same function described above. A non-limiting reason for having multiple tape members over a stent-graft is if there is a change in the stent pattern, such as a change in the stent pattern to make room for a portal for a side branch device, as illustrated in Figure 12, 1206, Figure 14, 1408, and Figure 1B, 121. In another embodiment, said tape member does not overlap an adjacent row of undulating stent members when the stent-graft is not compressed. Although the examples and figures show an embodiment in which the apexes in the first direction of each of the undulations connect to the stent-graft by the tape member, said apexes in the second direction can also connect to the stent-graft, whereas the apexes in the first sense do not connect.
    The width of the tape member has been found to influence the flexibility of the stent-graft. The larger the tape member, the less flexible the stent-graft. Thus, in one embodiment, said tape member covers about 10%, about 20%, about 30%, about 40%, about 50%, about 60%, about 70%, about 80% of the height of the 1312 ripples (figure 13). In another embodiment, the entire width of said tape member adheres to said stent and said graft. In another embodiment, said tape member does not touch or extend over an adjacent row of the waved stent members, for example, when compressed or partially compressed. In another embodiment, the width of said unidirectional pleats is the same as that of the tape member. Although the tape member may cover a portion of each curl, including confining the apexes in the first direction to the graft, as discussed above, the apexes in the second direction of the curl are not confined to the graft (eg, 816 in Figure 8). This construction allows the formation of folds where the stent-graft is compressed. The folds can be fully circumferential when the stent-graft is compressed in the longitudinal direction, as shown in Figure 9, or in the inner meridian of a curve, as shown in Figure 11. In another embodiment, said unidirectional circumferential folds are formed when initially tablets. In other words, no additional manipulation of the stent-graft is necessary to create these unidirectional circumferential folds. In another embodiment, said unidirectional circumferential pleats are formed in vivo when implanted. In another embodiment, said folds form on the internal meridian in vivo when said stent-graft is implanted. Said stent-graft of the present invention adapts, as described, to the aortic arch or other tortuous, curved or arcuate body canals. In another embodiment, the tape member (or separate parts thereof) also encircles the end portions of the stent-graft to secure the end portions of the graft member to the support structure formed by the stent member.
    In another embodiment of the present invention, the tape member is made of expanded PTFE (ePTFE) coated with an adhesive. In another embodiment, said adhesive is a thermoplastic adhesive. In another embodiment, said thermoplastic adhesive is fluorinated ethylene propylene (FEP). In this embodiment, the FEP-coated side faces the external surfaces of the stent and the graft, making contact with them, thus connecting the stent to the graft. While we have illustrated and described a specific strip member configuration and pattern, other configurations and/or patterns can be used without departing from the scope of the present invention.
    In another embodiment, said sfent-graft of the present invention comprises one or more radiopaque metallic fibers, such as gold, platinum, platinum-tungsten, palladium, platinum-iridium, rhodium, tantalum or alloys or composites of these metals that can be incorporated into the device, in particular, to the graft, to allow fluoroscopic visualization of the device.
    In another embodiment of the present invention, said stent-graft of the present invention comprises optional sealing cuffs 808 and 812, as shown in Figure 8. Each said sealing cuff consists of a cuff with a first end, fixed to the external surface of the stent -graft 800, and a second end, at least a part of which is not fixed to form a flange. In this configuration, the flange forms a one-way valve that circumferentially surrounds the 800 stent-graft and obstructs the flow around the stent-graft. In one embodiment, said sealing sleeve is disposed around said first end portion 806 of stent-graft 800. In another embodiment, said sealing sleeve is disposed around said second end portion 810 of stent-graft 800. In another embodiment, said sealing sleeve is disposed around the first end portion 806 and the second end portion 810 of the stent-graft 800. In another embodiment, the sealing sleeves (808, 812) comprise a hydrophilic material, preferably a foam-gel or hydrophilic polymer, which expands when exposed to water, such as blood or other body fluids containing water. In another embodiment, said sealing sleeves 808 and 812 comprise the materials described above. A description of the sealing cuffs is found in United States Patent 6,015,431, incorporated by reference herein in its entirety for all purposes.
    We will explain the present invention in more detail in the examples below, which should not be interpreted as limiting. The contents of all figures and mentions are incorporated into this document by reference.
    While we have described and illustrated specific embodiments of the present invention herein, it is not limited to such descriptions and illustrations. It is evident that changes and modifications may be incorporated and made as part of the present invention within the scope of the following claims. EXAMPLE 1 Construction of a highly malleable sfenf-graft
    We constructed a flexible stent-graft with the general configuration shown in Figure 8.
    The stent-graft was initially manufactured by extruding and expanding a polytetrafluoroethylene (PTFE) tube to form a base tube. The base tube had a length of about 60 mm, a wall thickness of about 0.06 mm and a diameter of about 26 mm. The base tube had a substantially fibril orientation in the longitudinal direction so that it was relatively strong in the longitudinal direction, although relatively weak in the radial direction. The base tube was stretched radially over a mandrel with a diameter of about 31 mm.
    To impart resistance to fluid permeation and to improve the radial strength of the base tube, we wrap a densified ePTFE film over it. The film was a tough, thin fluoropolymer; a particularly preferred material for this application is a non-porous ePTFE provided with a thermoplastic fluorinated ethylene-propylene (FEP) adhesive coating, hereinafter referred to as "substantially impermeable ePTFE/FEP insulating tape". The FEP was oriented down against the base tube. ePTFE is well known in the medical device field; it is generally made as described in US patents 3,953,566 and 4,187,390 in the name of Gore. The specific tape described in this document is cut from a substantially non-porous ePTFE/FEP film having a thickness of about 0.0064 mm, an isopropyl boiling point greater than about 0.6 MPa, a number of Gurley (permeability) greater than 60 (minute/1 square inch/100 cc); (or 60 (minute/6.45 square inches/100 cc)), a density of 2.15 g/cc, and a tensile strength of about 309 MPa in the length direction (ie, the strongest direction). The film had a width of about 19 mm with four spirally wound passes with a pitch angle of about 86°.
    To further increase the radial strength of the base tube and provide an open structure bonding layer, we apply an additional film layer. The ePTFE film showed a high level of strength in the longitudinal direction and a very open microstructure. The microstructure improved subsequent FEP/ePTFe binding of a stent frame to the graft. The film had a thickness of about 2.5 microns and a width of about 25.4 mm. Eight spirally wound layers were applied with a pitch angle of about 83°.
    Then the mandrel and wound films were heat treated in an air convection oven to join the films together.
    A stent frame was then formed by wrapping a nitinol wire over a mandrel with protruding pins. Figure 12 illustrates a "flat or unrolled" design of the cylindrical mandrel. There is illustrated an overall winding pattern 1200, detailing a first end portion 1202 and a second end portion 1204. Also illustrated is a "side branch portal" configuration. ” optional 1206 that can be incorporated into the general pattern if a branch portal is desired. The generic single-circle winding pattern indicated by the number 1206 can replace the optional side branch pattern 1206, if desired.
    Figure 13 illustrates a single-circumference winding pattern indicated by the numeral 1206. The pattern includes a linear pitch 1300, a pin diameter 1302, a wire diameter 1304, a wire apex angle 1306, a circumference 1308 and an apex at half frequency of base 1310. The illustrated pattern was repeated along the length of the stent, save for the first and second end portions previously illustrated in Figure 12 (1202, 1204). The configuration of the optional side branch portal (figure 12, 1206) has not been incorporated.
    The stent frame was formed according to the following dimensions, as defined in Figure 13: the linear pitch 1300 was about 9.7 mm, the pin diameter 1302 was about 1.6 mm, the diameter of strand 1304 was about 0.5 mm, the apex angle of strand 1306 was about 50.4°, circumference 1308 was about 97.3 mm, and the apex at half frequency of base 1310 was about of 5.3 mm.
    The mandrel with the wire wound was then heat treated in an air convection oven as is widely known in the art (eg see US patent 6,352,561 to the name of Leopold) and then tempered in water at room temperature.
    The wire stent was removed from the winding mandrel. The ends of the yarn (shown in Figure 12, 1202 and 1204) have been trimmed and tied together with high temperature fibers as shown in Figure 14, 1402 and 1404. The amplitude of the nested pair is greater than that of the adjacent apexes of so that when the wires are nested, the nested wires do not create an adversely too deformed region (see figure 14, 1410 and 1412). The stent was partially joined to the coiled tube by fusing the underlying PEF adjacent to portions of the stent wire using a weld steel. A final layer of an ePTFE tape, laminated with FEP, was wrapped over the wire stent according to the pattern shown in Figure 14 and placed in an oven to join the film to the underlying graft, thereby securing the stent to the graft.
    Figure 14 illustrates a sfent-graft 1400 with an 802 curled and spiral wire stent wrapped around an 804 graft material. The stent is attached to the graft material by a spirally applied tape member 1406. As shown, a first edge of spirally applied tape member 1406 covers opposite first apexes 814 of wire stent. An optional winding pattern section 1408 can be incorporated if a side branch portal is desired. Tape 1406 was an ePTFE/FEP laminate with a width of about 5.5 mm and a thickness of about 10 microns. The tape was partially joined to the coiled tube by fusing the underlying PEF adjacent to portions of the stent wire using a weld steel. A sacrificial compression tape was spirally wound over the stent-graft. The compression tape was about 51mm wide, about 0.5mm thick and was wound with an overlap close to 50%. An additional sacrificial film was rolled to assist in the subsequent heat treatment compression step. This film was an ePTFE tape with a fibril/longitudinal strength orientation, a thickness of about 2.5 microns and a width of about 51 mm. Five passes were applied with an overlap close to 50% between film layers.
    The unit was then heat treated in an air convection oven to bond the film layers together (as described, in essence, in US Patent 6,352,561 to Leopold). During this heat treatment cycle, the film was compressed down against the mandrel, causing the molten FEP to flow into the underlying film layers, thus joining the graft layers together along the wire stent. After cooling, the sacrificial film compression layers were removed, the ends of the graft material were trimmed in length, and the sfent-graft was removed from the mandrel. The resulting sfent-graft is illustrated in figure 8, except for the optional sealing cuffs (figure 8, 806, 810). EXAMPLE 2 Construction of a highly malleable stent-graft with an integrated side branch port
    Referring to figures 2A and 2B, we fabricate a metal chuck 200 with a slot or groove 202 formed in one of its ends. Slot 202 culminates in a back wall 204. The mandrel had a diameter of about 31 mm and the slot was about 12.5 mm wide, by about 10 mm deep and about 13 cm long. As shown in Figure 2B, an inner tube 206 was stretched radially over the mandrel 200, covering part of its groove 202. The inner tube was an extruded and expanded polytetrafluoroethylene (PTFE) tube. The inner tube had a length of about 60 mm, a wall thickness of about 0.06 mm and a diameter of about 26 mm. The inner tube had a substantially fibril orientation in the longitudinal direction so that it was relatively strong in the longitudinal direction, although relatively weak in the radial direction.
    As shown in Figure 3A, we cover the mandrel 200 with the inner tube 206. We cut the inner tube, forming a slit 300 in the back wall 204 of the groove 202 of the mandrel 200.
    To further strengthen the inner tube (Fig. 3A, 206), we added two additional polymer sheets over it before introducing the secondary stent unit. These strengthening layers were then deformed inwardly in the mandrel groove, providing additional support to the inner tube/secondary stent unit. The strengthening layers comprised densified ePTFE provided with a thermoplastic fluorinated ethylene-propylene (FEP) adhesive coating, hereinafter referred to as "substantially impermeable ePTFE/FEP insulating tape". The FEP of the strengthening layers was turned towards the base tube. ePTFE is well known in the medical device field; it is generally made as described in US patents 3,953,566 and 4,187,390 in the name of Gore. The specific strengthening layers described in this document were cut from a substantially non-porous ePTFE/FEP film having a thickness of about 0.0064 mm, an isopropyl boiling point greater than about 0.6 MPa, a Gurley number (permeability) greater than 60 (minutes/1 square inch/100 cc); (or 60 (minute/6.45 square inches/100 cc)), a density of 2.15 g/cc, and a tensile strength of about 309 MPa in the length direction (ie, the strongest direction). The first strengthening layer was about 25 mm wide by about 25 mm long and was centered over the mandrel slot about 15 mm from the rear wall of the slot (towards the end of the mandrel). The second strengthening layer was about 25 mm wide and about 40 mm long and was centered over the mandrel slot, making contact with the back wall 204 of the slot 202.
    As shown in Figure 3B, we have aligned a secondary stent unit 302 with slot 202 of mandrel 200, back wall 204 of mandrel 200, strengthening layers, and slot 300 of inner tube 206. A first support segment (described further below ) was disposed within the secondary stent unit and this (along with the first support segment) was then inserted into the mandrel groove 202, thereby deforming the inner tube 206 (and the strengthening layers) towards the interior of the mandrel groove. chuck. The rear wall 204 defined the opening in the innermost tube (130, Figure 1E).
    To control the deformed shape of the inner tube, we provided a support segment inside the secondary stent unit and inside the mandrel slot, as shown in Figures 4A and 4B. Figure 4A illustrates a schematic side view of the mandrel 200, the slot 202 and the rear wall 204 of the slot 202. Figure 4B illustrates a schematic side view of the mandrel 200, the slot 202 of the mandrel 200 and the inner tube 206. The unit of secondary stent 302 was disposed on a first support segment 400, which has an end shaped to coincide with the rear wall of slot 204 of mandrel 200. The opposite end of the first support segment had a tapered or angled wall, as shown in Figure 4B. A second support segment 402 was disposed within slot 202 of mandrel 200 under inner tube 206. The second support structure had flat walls and was used to hold first support structure 400 in place. Inner tube 206 is shown deformed towards the interior of groove 202 of mandrel 200. Inner tube 206 is also illustrated with a portion of its tapered, beveled or angled wall 404 formed by the angled wall of support segment 400.
    We constructed a secondary stent unit as sketched in figures 5A to 5D. As shown in Figures 5A and 5B, we slide-fit a polymeric tube 502 onto a mandrel 500. The tube was made with a film of the same material used in the strengthening layers as described above. We spiral the film onto a mandrel with a diameter of about 8 mm with the FEP layer facing away from the mandrel. We then treat the hot-rolled mandrel to fuse the FEP/ePTFE layers to form a tube. A crimped wire was turned into a 506 ring stent by winding it over a mandrel with protruding pins. The diameter of the mandrel and pins, together with the location of the pins, dictated the final configuration of the annular stent. The wire was nitinol and had a diameter of about 0.15 mm. The undulating stent pattern had an apex-to-apex length of about 5 mm. After winding the wire over the mandrel, both were heat treated and tempered at room temperature to define the shape of the stent. Then the wire was removed from the mandrel. The ends of the wire were joined with a section of thermo-shrinkable polymeric tubing, thus forming the ring stent 506. Two of these ring stents 506 were then placed over the polymeric tube 502. Radiopaque marker bands 504 were then placed over the polymeric tube. 502.
    Then, as shown in Figure 5C, we turned one end of the polymeric tube 502 and stretched it over the annular stents of wire 506 and radiopaque marker bands 504. We then treated the mandrel, the polymeric tube, the annular stents and the radiopaque bands hot to connect them together to form a stent unit. The unit was removed from the mandrel and had its length trimmed, thus forming a secondary stent unit 302, as shown in Figure 5D. The secondary stent unit was then placed over a first support segment 400.
    As described above (Figure 4B), the secondary stent (or secondary stent unit) and the first support unit were then inserted into the slot 202 of the mandrel 200, thus deforming the inner tube 206 towards the interior of the mandrel slot. A second support segment 402 was disposed within slot 202 of mandrel 200 under inner tube 206. We then coated the unit illustrated in Figure 4B with an outer support film. The support was made with a film of the same material used in the strengthening layers, as described above. The film was about 30 mm wide by about 27 mm long and was centered over the mandrel slit about 6 mm behind the back wall of the slit (in addition to the end of the mandrel). The FEP layer was oriented downwards towards the mandrel.
    To impart resistance to fluid permeation and to improve the radial strength of the base tube, we wrap a densified ePTFE film over it. The film was a tough, thin fluoropolymer; a particularly preferred material for this application is a non-porous ePTFE provided with a thermoplastic fluorinated ethylene-propylene (FEP) adhesive coating, hereinafter referred to as "substantially impermeable ePTFE/FEP insulating tape". The FEP was oriented down against the base tube. ePTFE is well known in the medical device field; it is generally made as described in US patents 3,953,566 and 4,187,390 in the name of Gore. The specific tape described in this document is cut from a substantially non-porous ePTFE/FEP film having a thickness of about 0.0064 mm, an isopropyl boiling point greater than about 0.6 MPa, a number of Gurley (permeability) greater than 60 (minutes/1 square inch/100 cc); (or 60 (minute/6.45 square inches/100 cc)), a density of 2.15 g/cc, and a tensile strength of about 309 MPa in the length direction (ie, the strongest direction). The film had a width of about 19 mm with four spirally wound passes with a pitch angle of about 86°.
    To further increase the radial strength of the base tube and provide an open structure bonding layer, we apply an additional film layer. The ePTFE film showed a high level of strength in the longitudinal direction and a very open microstructure. The microstructure improved subsequent FEP/ePTFe binding of a stent frame to the graft. The film had a thickness of about 2.5 microns (0.0001”) and a width of about 25.4 mm (1.0”). Eight spirally wound layers were applied with a pitch angle of about 83°.
    The mandrel and wound films were then heat treated in an air convection oven to join the film layers.
    A stent frame was then formed by wrapping a nitinol wire over a mandrel with protruding pins. Figure 12 illustrates a “flat or unrolled” design of the cylindrical mandrel. Therein, an overall winding pattern 1200 is illustrated, detailing a first end portion 1202 and a second end portion 1204. Also illustrated is a "side branch portal" configuration 1206 that has been incorporated into the overall pattern to form a branch portal.
    Figure 13 illustrates a single-circumference winding pattern indicated by the numeral 1206. The pattern includes a linear pitch 1300, a pin diameter 1302, a wire diameter 1304, a wire apex angle 1306, a circumference 1308 and an apex at half frequency of base 1310. The illustrated pattern was repeated along the length of the stent, save for the first and second end portions previously illustrated in Figure 12 (1202, 1204). Optional side branch portal configuration (figure 12, 1206) has been incorporated.
    The stent frame was formed according to the following dimensions, as defined in Figure 13: the linear pitch 1300 was about 9.7 mm, the pin diameter 1302 was about 1.6 mm, the diameter of strand 1304 was about 0.5 mm, the apex angle of strand 1306 was about 50.4°, circumference 1308 was about 97.3 mm, and the apex at half frequency of base 1310 was about of 5.3 mm.
    Next, the mandrel with the wire wound was heat treated in an air convection oven as is widely known in the art and then quenched in water at room temperature.
    The wire stent was removed from the winding mandrel. The ends of the wire (shown in Figure 12, 1202 and 1204) were trimmed and tied together with high temperature fibers, as shown in Figure 14, 1402 and 1404. We then placed the wire stent over the mandrel/tube previously wrapped with film. The stent was partially joined to the coiled tube by fusing the underlying PEF adjacent to portions of the stent wire using a weld steel. A final layer of an ePTFE tape, laminated with FEP, was wound over the wire stent according to the pattern shown in Figure 14.
    Figure 14 illustrates a stent-graft 1400 with an 802 curled-coil stent wrapped around an 804 graft material. The stent was attached to the graft material by a spiral-applied tape member 1406. As shown, first edge of spirally applied tape member 1406 covers opposite first apexes 814 of wire stent. Winding pattern section 1408 has been incorporated to form a side branch portal. Tape 1406 was an ePTFE/FEP laminate with a width of about 5.5 mm and a thickness of about 10 microns. The tape was partially joined to the coiled tube by fusing the underlying PEF adjacent to portions of the stent wire using a weld steel. A sacrificial compression tape was spirally wound over the stent-graft. The compression tape was about 51mm wide, about 0.5mm thick and was wound with an overlap close to 50%. An additional sacrificial film was rolled to assist in the subsequent heat treatment compression step. This film was an ePTFE tape with a fibril/longitudinal strength orientation, a thickness of about 2.5 microns and a width of about 51 mm. Five passes were applied with an overlap close to 50% between film layers.
    The unit was then heat treated in an air convection oven to join the film layers. During this heat treatment cycle, the film was compressed down against the mandrel, causing the molten FEP to flow into the underlying film layers, thus joining the graft layers together along the wire stent. After cooling, the sacrificial film compression layers were removed, the ends of the graft material had its length trimmed, and the stent-graft was removed from the mandrel. The resulting stent-graft is illustrated in figure 8, except for the optional sealing cuffs (figure 8, 806, 810).
    It will be evident to those skilled in the art that it is possible to make various modifications and variations to the present invention without departing from its essence or scope. Therefore, it is intended that the present invention encompass modifications and variations made thereto, provided that within the scope of the appended claims and their equivalents.
    权利要求:
    Claims (42)
    [0001]
    1. Multi-channel stent-graft characterized by comprising: a graft (136) formed by an innermost tube (134) with an opening (131) and an outermost tube (132) with an opening (124), the graft including : a main channel, having an outer surface being defined by a portion of the outermost tube (132) and an inner surface (138) defined by the inner surface of the innermost tube (134); a secondary channel (130) disposed between the innermost tube and the outermost tube of said graft (136) and having an outer surface being defined by a portion of the inner surface of the innermost tube (134) and a portion of a outer surface of the outermost tube (132), and an inner surface being defined by a portion of the outer surface (140) of the innermost tube (134) and a portion of an inner surface (141) of the outermost tube (131) wherein the secondary channel (130) is in fluid communication through said openings (131, 134); and a main stent (122) configured to support the graft (136).
    [0002]
    2. Stent-graft according to claim 1, characterized in that said secondary channel (130) comprises a secondary stent (126) or secondary stent unit.
    [0003]
    3. Stent-graft according to claim 1, characterized in that said outermost tube (132) comprises ePTFE.
    [0004]
    4. Stent-graft according to claim 1, characterized in that said innermost tube (134) comprises ePTFE.
    [0005]
    5. Stent-graft according to claim 1, characterized in that said main stent (122) is connected to said graft by a coupling member.
    [0006]
    6. Stent-graft according to claim 2, characterized in that said main stent (122) comprises a double W that creates a region for a lateral branching portal.
    [0007]
    7. Stent-graft according to claim 2, characterized in that said main stent (122) comprises dimples.
    [0008]
    8. Stent-graft, according to claim 7, characterized by the fact that said dimples are in phase.
    [0009]
    9. Stent-graft, according to claim 3, characterized in that said secondary stent (126) is coated.
    [0010]
    10. Stent-graft according to claim 9, characterized in that said secondary stent (126) comprises ePTFE.
    [0011]
    11. Stent-graft according to claim 2, characterized in that part of said secondary stent (126) or secondary stent unit couples to a part of the innermost tube (134).
    [0012]
    The stent-graft of claim 1, characterized in that it comprises cuffs (808, 812) at both its ends.
    [0013]
    13. Stent-graft, according to claim 1, characterized in that said secondary channel (130) can accept another smaller stent-graft.
    [0014]
    14. Stent-graft according to claim 13, characterized in that said other smaller stent-graft is trapped within said secondary channel (130).
    [0015]
    15. Stent-graft characterized by comprising: a graft (804) having an inwardly facing surface and an outwardly facing surface and being supported by a stent, wherein said stent comprises undulations, each of which comprises apexes in opposite directions first (814) and second (816); and a tape member, comprising first and second longitudinal edges, connected to said stent and said graft so that its first edge covers the apexes in the first or second direction of each of the undulations, thus confining the apexes in the first or second direction. second of the undulations to the graft, and wherein the apices in the first or second direction of the undulation are not confined to the graft; wherein said graft forms unidirectional folds (900) oriented in circumference along one of the inwardly and outwardly facing surfaces of the graft when compressed longitudinally along one of the inwardly and outwardly facing surfaces of the graft with the confined apexes positioned under an adjacent pleat and wherein said apexes in the first or second direction of said undulation are disposed under an adjacent pleat when compressed.
    [0016]
    16. Stent-graft according to claim 15, characterized in that said apices in the first direction (814) are confined to the graft and said apices in the second direction (816), no.
    [0017]
    17. Stent-graft according to claim 15, characterized in that said apices in the second direction (816) are confined to the graft and said apices in the first direction (814), no.
    [0018]
    18. Stent-graft according to claim 15, characterized in that said main stent (122) is made from a single continuous strand spirally wound around said graft.
    [0019]
    19. Stent-graft according to claim 15, characterized in that said stent is a self-expanding stent.
    [0020]
    20. Stent-graft according to claim 15, characterized in that said stent is made of nitinol.
    [0021]
    21. Stent-graft, according to claim 15, characterized in that said stent is an expandable balloon-type stent.
    [0022]
    22. Stent-graft, according to claim 15, characterized by the fact that said undulations are sinusoidal.
    [0023]
    23. Stent-graft according to claim 15, characterized in that said unidirectional folds (900) are formed in vivo after implantation.
    [0024]
    24. Stent-graft, according to claim 15, characterized in that said graft comprises polytetrafluoroethylene.
    [0025]
    25. Stent-graft, according to claim 24, characterized in that said polytetrafluoroethylene expands.
    [0026]
    26. Stent-graft according to claim 15, characterized in that said tape member comprises polytetrafluoroethylene.
    [0027]
    27. Stent-graft according to claim 15, characterized in that said tape member further comprises a thermoplastic adhesive.
    [0028]
    28. Stent-graft according to claim 27, characterized in that said thermoplastic adhesive is FEP.
    [0029]
    The stent-graft according to claim 15, characterized in that it comprises at least one sealing cuff (808).
    [0030]
    A stent-graft according to claim 15, characterized in that it comprises at least one radiopaque marker (818).
    [0031]
    31. Stent-graft according to claim 15, characterized in that it can bend at least 90° without spilling in vivo when implanted.
    [0032]
    32. Stent-graft according to claim 31, characterized in that it is arranged in a channel in the body with the direction of blood flow in the direction of the folds in order to minimize interruption and flow turbulence.
    [0033]
    A method of fabricating a multi-channel stent-graft as defined in any one of claims 1 to 32, characterized in that it comprises: coating a first mandrel comprising a groove and a rear wall of said groove with an innermost polymeric tube ; making a slit in said innermost polymeric tube along said back wall of said groove; inserting a second mandrel into said groove of the first mandrel and aligning it with the rear wall of the groove, thereby deforming the innermost polymeric tube; positioning an outermost polymeric tube over said innermost polymeric tube; and making an opening in said outermost polymeric tube over said second smaller mandrel; wherein said outermost and innermost polymeric tubes comprise a graft member.
    [0034]
    34. Method according to claim 33, characterized in that a main stent (122) is positioned on said graft member.
    [0035]
    35. The method of claim 34, wherein said main stent (122) attaches to said graft member by a coupling member.
    [0036]
    36. Method according to claim 34, characterized in that said main stent (122) comprises dimples.
    [0037]
    37. Method according to claim 36, characterized in that said ripples are in phase.
    [0038]
    38. Method according to claim 33, characterized in that said outermost polymeric tube comprises ePTFE.
    [0039]
    39. Method according to claim 33, characterized in that said innermost polymeric tube comprises ePTFE.
    [0040]
    40. The method of claim 33, wherein there is a secondary stent (126) or secondary stent unit around said second mandrel.
    [0041]
    41. The method of claim 40, wherein said secondary stent (126) or secondary stent unit makes contact with at least part of the innermost tube (134).
    [0042]
    42. Method according to claim 33, characterized in that the steps of making a slit in the innermost polymeric tube and making an opening in the outermost polymeric tube create a secondary channel (130) that makes fluid communication with said openings.
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    同族专利:
    公开号 | 公开日
    AU2010303311A1|2012-04-19|
    JP6491280B2|2019-03-27|
    US10653540B2|2020-05-19|
    JP6185542B2|2017-08-23|
    KR20120092627A|2012-08-21|
    JP2017189675A|2017-10-19|
    US9827118B2|2017-11-28|
    JP5727491B2|2015-06-03|
    RU2563435C2|2015-09-20|
    EP3610832A1|2020-02-19|
    CA2775786A1|2011-04-14|
    CA2775786C|2015-02-03|
    US20130268059A1|2013-10-10|
    CN102548506A|2012-07-04|
    JP2016047270A|2016-04-07|
    CA2872125A1|2011-04-14|
    US20110087318A1|2011-04-14|
    BR112012007518A2|2017-08-08|
    WO2011044459A3|2011-06-09|
    WO2011044459A2|2011-04-14|
    AU2016201154B2|2017-09-28|
    EP3067014B1|2019-08-21|
    US8474120B2|2013-07-02|
    ES2582033T3|2016-09-08|
    AU2010303311B2|2014-05-22|
    AU2016201154A1|2016-03-10|
    AU2014202791A1|2014-06-12|
    JP5844874B2|2016-01-20|
    EP2485681B1|2016-04-13|
    CN102548506B|2015-11-25|
    CA2872125C|2017-08-22|
    JP2015051313A|2015-03-19|
    RU2012118567A|2013-11-20|
    US20180042739A1|2018-02-15|
    EP3067014A1|2016-09-14|
    EP2485681A2|2012-08-15|
    JP2013507194A|2013-03-04|
    ES2752187T3|2020-04-03|
    US20110087319A1|2011-04-14|
    HK1167589A1|2012-12-07|
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    法律状态:
    2017-08-15| B15I| Others concerning applications: loss of priority|
    2017-10-24| B12F| Appeal: other appeals|
    2020-05-26| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|
    2020-07-07| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|
    2020-10-27| B07A| Technical examination (opinion): publication of technical examination (opinion) [chapter 7.1 patent gazette]|
    2021-03-09| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|
    2021-05-04| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 08/10/2010, OBSERVADAS AS CONDICOES LEGAIS. PATENTE CONCEDIDA CONFORME MEDIDA CAUTELAR DE 07/04/2021 - ADI 5.529/DF |
    优先权:
    申请号 | 申请日 | 专利标题
    US25031309P| true| 2009-10-09|2009-10-09|
    US61/250,313|2009-10-09|
    US12/818,551|US8474120B2|2009-10-09|2010-06-18|Bifurcated highly conformable medical device branch access|
    US12/818,551|2010-06-18|
    US12/818,575|2010-06-18|
    US12/818,575|US20110087318A1|2009-10-09|2010-06-18|Bifurcated highly conformable medical device branch access|
    PCT/US2010/051974|WO2011044459A2|2009-10-09|2010-10-08|Bifurcated highly conformable medical device branch access|
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