巴西专利BR112013014836B1 IMPLANT DEVICE INCLUDING A STENT

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专利摘要:
stent In one embodiment according to the present invention, a stent having a generally cylindrical body formed from a single strand of nitinol is described. the distal and proximal ends of the stent include a plurality of loops, some of which include marking elements for visualizing the position of the stent. in another embodiment, the stent described above includes an inner flow-bypass layer.
公开号:BR112013014836B1
申请号:R112013014836-5
申请日:2011-12-05
公开日:2021-06-15
发明作者:Tai D. Tieu；Gregory M. Cruise；Heather Griffith；Helen Nguyen；Minh Nguyen；Ponaka Pung；Shirley Vong
申请人:Terumo Corporation；
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[001] This application claims priority to U.S. Provisional Patent Application Serial Number 61/422 604, filed December 13, 2010, entitled "Stent"; to U.S. Provisional Patent Application Serial Number 61/425 175, filed December 20, 2010, entitled "Polymer Stent and Method of Manufacture"; for International Patent Application PCT/US2010/061627, with the International Filing Date of December 21, 2010, entitled "Stent"; to Provisional Patent Application Serial No. 61/427,773, filed December 28, 2010, entitled "Polymer Stent and Method of Manufacture 2"; and to U.S. Non-Provisional Patent Application Serial No. 13/003 277, filed January 7, 2011, entitled "Stent", all of which are incorporated herein by reference in their entirety. FUNDAMENTALS OF THE INVENTION
[002] The present invention relates to devices for the treatment of body cavities, such as embolization of vascular aneurysms or the like, and methods of manufacturing and using such devices.
[003] The occlusion of body cavities, blood vessels and other lumens by embolization is desired in numerous clinical situations. For example, occlusion of the fallopian tubes for sterilization purposes, as well as occlusive repair of cardiac defects such as a patent foramen ovale, patent ductus arteriosus and left atrial appendage, as well as atrial septal defects. The function of an occlusion device in such situations is to substantially block or inhibit the flow of bodily fluids into or through the cavity, lumen, vessel, space, or defect for the therapeutic benefit of the patient.
[004] Embolization of blood vessels is also desired to repair a number of vascular changes. For example, vascular embolization has been used to control vascular hemorrhage, occlude the blood supply to tumors, and occlude vascular aneurysms, particularly intracranial aneurysms.
[005] In recent years, vascular embolization for the treatment of aneurysms has received much attention. Several different treatment modalities have been shown in the prior art. One approach that has shown promise is the use of thrombogenic microcoils. These microcoils can be made of biocompatible metal alloys (typically a radio-opaque material such as platinum or tungsten) or a suitable polymer. Examples of microcoils are disclosed in the following patents: U.S. Patent No. 4,994,069 to Ritchart et al.; U.S. Patent No. 5,133,731 to Butler et al.; U.S. Patent No. 5,226,911 to Chee et al.; U.S. Patent No. 5,312,415 to Palermo; U.S. Patent No. 5,382,259 to Phelps et al.; U.S. Patent No. 5,382,260 to Dormandy, Jr. et al.; U.S. Patent No. 5,476,472 to Dormandy, Jr. et al.; U.S. Patent No. 5,578,074 to Mirigian; U.S. Patent No. 5,582,619 to Ken; U.S. Patent No. 5,624,461 to Mariant; U.S. Patent No. 5,645,558 to Horton; U.S. Patent No. 5,658,308 to Snyder; and U.S. Patent No. 5,718,711 to Berenstein et al.; all of which are incorporated herein by reference.
[006] Stents have recently also been used for the treatment of aneurysms. For example, as seen in US Patent No. 5,951,599 to McCrory and US Patent Publication No. 2002/0169473 to Sepetka et al., the contents of which are incorporated by reference, a stent it can be used to reinforce the vessel wall around the aneurysm, while micro-coils or other embolic material are advanced into the aneurysm. In another example seen in U.S. Publication No. 2006/0206201 by Garcia et al., and also incorporated by reference, a densely tissue stent is placed over the mouth of the aneurysm, which reduces blood flow through the interior of the aneurysm. aneurysm and ultimately results in a thrombosis. SUMMARY OF THE INVENTION
[007] In an embodiment according to the present invention, a stent is described that has a generally cylindrical body made of a single woven strand of nitinol. The proximal and distal ends of the stent include a plurality of loops, some of which include marking elements used to visualize the position of the stent.
[008] In another embodiment, in accordance with the present invention, an introducer device is described, having an outer catheter element and an inner pusher element disposed in a passageway of the catheter. The distal end of the pusher element includes a distal and a proximal marker strip that lie above adjacent portions of the body of the pusher element. The stent previously described can be compressed along the distal marker strip such that the proximal loops of the stent and proximal marker elements are disposed between the distal and proximal marker strips of the pusher element.
[009] In an example, the introducer device can be used to introduce the stent described above through an opening of an aneurysm. The aneurysm is preferably first filled with micro-coils or embolic material before or after insertion of the stent.
[010] In another embodiment, in accordance with the present invention, a dual-layer stent is described, having an outer anchoring stent similar to the stent previously described and a discrete inner mesh layer formed from a plurality of woven elements . The proximal ends of the outer stent and inner stent are connected to each other by means of connecting or snapping elements, allowing the remaining portions of the outer anchoring stent and inner mesh layer to change in length independently as each starts to expand in diameter. Alternatively, the inner mesh layer can only extend over a portion of the length of the outer stent and can be symmetrically or asymmetrically positioned between the proximal and distal ends of the outer stent.
[011] In one example, the double-layer stent can be introduced through the opening of an aneurysm in order to modify the blood flow entering the aneurysm. As the blood flow within the aneurysm becomes stagnant, a thrombosis forms in order to completely block the interior space of the aneurysm.
[012] In another embodiment, according to the present invention, a single or double layer stent can be created by polymerizing a liquid prepolymer inside a tube, a syringe or similar structure. Patterns can be created in the polymer structure by means of a pre-shaped mandrel on which the polymer structure is polymerized or by cutting the polymer structure after polymerization. BRIEF DESCRIPTION OF THE DRAWINGS
[013] These and other aspects, characteristics and advantages of which the embodiments of the present invention are capable will become evident or elucidated from the following description of the embodiments of the present invention, with reference being made to the attached drawings, in which: Figure 1 illustrates a side view of a stent in accordance with a preferred embodiment of the present invention; Figure 2 illustrates a front view of the stent of Figure 1; Figure 3 illustrates an enlarged view of area 3 of Figure 1; Figure 4 illustrates a enlarged view of area 4 of Figure 1; Figure 5 illustrates an enlarged view of area 5 of Figure 1; Figure 6 illustrates an enlarged view of area 6 of Figure 1; Figure 7 illustrates a side view of a pusher element according to with a preferred embodiment of the present invention; Figure 8 illustrates a partial cross-sectional view of the pusher element of Figure 7 with the stent of Figure 1 compressed along its distal end and being positioned in a catheter Figure 9 illustrates the stent of Figure 1 positioned over the opening of an aneurysm; Figure 10 illustrates a side view of a mandrel in accordance with the present invention that can be used to create the stent of Figure 1; 11 illustrates a side view of a stent in accordance with a preferred embodiment of the present invention; Figures 12 to 14 illustrate various views of a dual-layer stent in accordance with a preferred embodiment of the present invention; Figure 15 illustrates a sectional view a cross-sectional view of a delivery system for the dual-layer stent of Figures 12 to 14; Figure 16 illustrates a perspective view of the dual layer stent having an outer layer of the stent formed of a tube or sheet of material; Figure 17 illustrates a cross-sectional view of the dual-layer stent of Figure 15, showing various optional attachment points of both layers of the dual-layer stent; Figure 18 illustrates another preferred embodiment of a dual-layer stent in accordance with the present invention; Figure 19 illustrates a stent in accordance with the present invention, composed of a flow bypass layer; Figure 20 illustrates a dual-layer stent in accordance with the present invention, having a layer of shortened flow bypass; Figure 21 illustrates a dual-layer stent in accordance with the present invention, having an elongated flow bypass layer; Figure 22 illustrates a dual-layer stent in accordance with the present invention, having a layer of asymmetrically positioned flow bypass; Figures 23 and 24 illustrate an expandable wire for use with a flow bypass layer in accordance with the present invention; Figure 25 illustrates a portion of a flow bypass layer having an expandable wire incorporated in its structure; Figures 26 to 29 illustrate a process in accordance with the present invention for creating a polymer stent or stent layer; Figure 30 illustrates another process in accordance with the present invention for creating a polymer stent or stent layer, and Figures 31 to 36 illustrate another process in accordance with the present invention for creating a polymer stent or stent layer. DESCRIPTION OF MODALITIES
[014] The specific embodiments of the present invention will be described below with reference to the attached drawings. The present invention may, however, be embodied in many different ways and should not be construed as limited to the embodiments set forth herein, but rather, these embodiments are provided so that the present invention is thorough and complete, and fully conveys the scope application of the present invention to those skilled in the art. The terminology used in the detailed description of the embodiments illustrated in the accompanying drawings is not intended to represent a limitation of the present invention. In the drawings, like numbers refer to like elements.
[015] Unless defined otherwise, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by a person with simple knowledge of the art to which this invention belongs. It should also be understood that these terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning consistent with their meaning in the context of the technique in question and should not be interpreted in an idealized or excessively formal sense, except when expressly defined in this document.
[016] Figure 1 illustrates a stent 100 according to a preferred embodiment of the present invention. Stent 100 is woven or braided from a single strand 102 to produce a generally cylindrical shape with a plurality of loops 104 around the perimeter of both ends of the stent 100.
[017] As can be seen in area 5 of Figure 1 and Figure 5, the ends of the single wire 102 can be connected to each other by means of soldering (see soldering region 116), by bonding agents or by bonding agents. a similar adhesive mechanism. Since the ends are soldered or bonded, wire 102 has no "free" ends.
[018] Each of the loops 104 may contain one or more coil elements 106. Preferably, the coil elements 106 are arranged around the wire 102 of the loops 104, which, as shown in more detail below, indicate the proximal and distal ends of stent 100. In addition, these coil elements 106 can provide additional anchoring force within an introducer device, as described in more detail below.
[019] In one example, a distal end of the stent 100 includes at least two loops 104 each with two coil elements 106 and a proximal end of the stent 100 includes at least two loops 104 each with a coil element 106. However, it should be understood that stent 100 can include any number of coil elements 106 over any number of loops 104.
[020] Preferably, these coil elements 106 are positioned close to a central area of the loop 104, such that when the stent 100 is in a contracted state, the coil elements 106 are positioned close to the most distal end. or from the most proximal end of the stent 100.
[021] Preferably, each coil element 106 is composed of a wire 105 wrapped around a portion of the loop 104. Each coil element 106 may be composed of a discrete wire 105 (as seen in Figure 3) or a a single wire 105 could form multiple coil elements 106 (as seen in Figures 1, 3 and 6). In the present preferred embodiment, some coil elements 106 are composed of distinct sections of wire 105, while the other coil elements 106 at each end are formed from the same continuous wire 105. As seen in Figure 1, wire 105 can be connected to coil elements 106 over each end of stent 100 by being placed within the inner portion or lumen of stent 100. Alternatively, strand 105 may be woven onto strands 102 of stent 100.
[022] Preferably, the wire 105 of the coil elements 106 is composed of a radiopaque material such as platinum or tantalum. Wire 105 preferably has a diameter of about 0.05715 mm (0.00225 inches).
[023] Alternatively, the coil elements 106 may be a radiopaque sleeve that is disposed over and adhered to loop 104.
[024] In one embodiment, the loops 104 on the proximal end of the stent 100 have a coil 106 on each side of the loop 104 (as seen in Figure 3), while the distal end of the stent 100 includes only one coil. 106 on one side of each loop 104 (as seen in Figure 6).
[025] Preferably, the weave pattern of the stent 100 prevents the distal coils 106 from being exposed or "pointing" from an outer diameter of the stent 100 during a retraction. Thus, when the user decides to retract the stent 100 back into the catheter for repositioning and reuse, the distal coils 106 will not be able to reach or contact the distal edge of the catheter, thus minimizing damage to the stent 100, which otherwise way, they could occur during a retraction.
[026] A specific technique to minimize the exposure of the distal coils 106 during retraction is to weave the stent 100 in such a way that the portions of the wire 102 overlap (i.e., are positioned in a larger outer diameter position) than the side of loop 104 with spool 106. As can be seen in Figure 6, some smaller loops 107 are woven so as to overlap a first side 104A of loop 104 that includes spool 106 (see position 109), while others smaller loops 107 are woven under a second side 104B of loop 104 (see position 111).
[027] As a user retracts the stent 100 back into the catheter, the smaller loops 107 move inward (ie, towards the center of the stent passage), as the stent 100 compresses into diameter, thereby making an internal pressure on the first side 104A of the loop 104. In this regard, the smaller loops 107 exert an internal or compressive force on the first side 104A of the loop 104. This configuration ensures that the first side 104A of the loop 104 and therefore coil 106 are not positioned on an outer diameter of stent 100 during retraction and, in this way, reduces the likelihood that coils 106 will reach or hook over the distal end of the deployment catheter.
[028] As best seen in Figure 1 and Figure 2, loops 104 are tapered or tapered to an outer diameter 114 when fully expanded with respect to the diameter of the main body of the stent 100. These loops 104 can also be expanded to a diameter that is uniform with or less than that of the main body.
[029] The stent 100 preferably has a diameter 110 sized for a vessel 152 in the human body, as seen in Figure 9. More preferably, the diameter 110 is between about 2 mm and 10 mm. The length of stent 100 is preferably sized to extend beyond the mouth of an aneurysm 150, as also seen in Figure 9. More preferably, the length of stent 100 is between about 5 mm and 100 mm. .
[030] Figures 7 and 8 illustrate a delivery system 135, according to the present invention, which can be used for the delivery of the stent 100. A catheter or sheath 133 is positioned along an delivery pusher 130, which holds the stent 100 in its compressed position. Once the distal end of sheath 133 reaches a desired target position (i.e., adjacent to an aneurysm 150), sheath 133 can be retracted to release stent 100.
[031] The introduction impeller 130 is preferably composed of a core element 132, which tapers in diameter near its distal end (made of nitinol). A proximal area of the tapered end of the core element 132 includes a first spool of larger diameter wire 134, which is preferably made of stainless steel and welded or incorporated in place over the core element 132. Distal to the wound wire is found. a first marker tape 136 is secured to the core element 132 and is preferably made of a radiopaque material such as platinum.
[032] A second smaller diameter wire spool 138 is located distally to the marker tape 136 and is preferably made of stainless steel or a plastic sleeve. A second marker tape 140 is located distally to the second spool of wire 138, and is also preferably made of a radiopaque material, such as platinum. Distal to the second marker strip 140 is a narrow, exposed section 142 of core element 132. Finally, a curled distal tip element 144 is disposed over the distal end of core element 132 and is preferably composed of a radiopaque material such as platinum or tantalum.
[033] In one example, the inner diameter of sheath 133 is about 0.0685 mm (0.027 inches) at about 1 meter long. The introduce pusher 130 is also about 2 meters long. The sections of the push pusher 130 preferably have the following diameters: The proximal region of the core element 132 is about 0.4572 mm (0.0180 inches), the first spool of wire 134 is about 0.4572 mm (0.0180 inches), the first marker tape 136 is about 0.4445 mm (0.0175 inches), the second spool of wire 138 is about 0.127 mm (0.0050 inches), second marker tape 140 is about 0.3556 mm (0.0140 inches), distal core element section 142 is about 0.076 mm (0.003 inches) ), and the distal tip element 144 is about 0.254 mm (0.0100 inches). The insert pusher sections 130 are preferably of the following lengths: the proximal region of the core element 132 is about 1 meter, the first wire spool 134 is about 45 cm, the first marker strip 136 is about 0.508 mm (0.020 inches), the second spool of wire 138 is about 1.651 mm (0.065 inches), the second marker tape 140 is about 0.508 mm (0.020 inches), the distal core element section 142 is about 10 cm, and the distal tip element 144 is about 1 cm.
[034] As seen in Figure 8, the stent 100 is compressed over the distal end of the drive pusher 130 such that the coil elements 106 on the proximal end of the stent 100 are positioned between the first marker strip 136 and the second marker tape 140. Preferably, the proximal coil elements 106 do not contact the marker tape 136 or the marker tape 140 and are held by frictional forces between the sheath 133 and the second wound area 138 .
[035] When the distal end of the delivery pusher reaches an area adjacent to a desired target location (eg, near an aneurysm), the sheath 133 retracts closely relative to the delivery pusher 130. As the sheath 133 exposes stent 100, stent 100 expands against the walls of vessel 152, as seen in Figure 9.
[036] The stent 100 can also retract (when it has not been fully deployed / released) by retracting the impeller 130 in the proximal direction, thereby causing the marker strip 140 to contact the proximal marker strips 106 , and pulling stent 100 back into sheath 133.
[037] In an exemplary use, the stent 100 can be introduced by opening an aneurysm 150 after embolic devices or materials, such as embolic coils, are introduced into the aneurysm 150. In this regard, the stent 100 helps to prevent treatment devices from being thrust out of the aneurysm 150 and bring complications or reduce the effectiveness of the treatment.
[038] In one example, wire 102 is composed of an elastic shape memory material, such as nitinol, with a diameter between about 0.025 mm (0.001 inches) and 0.254 mm (0.010 inches).
[039] Wire 102 may also vary in diameter along the length of stent 100. For example, the diameter of wire 102 near the proximal and distal ends may be thicker than in the middle portion of stent 100. In another example , the proximal and distal ends may be thinner than the intermediate portion. In another example, the diameter of wire 102 may alternate between larger and smaller diameters along the length of stent 100. In yet another example, the diameter of wire 102 may gradually increase or decrease along the length of stent 100. In another example, loops 104 may be composed of wire 102 which has a greater or lesser diameter than wire 102 comprising the main body of stent 100. In a more detailed example, the diameter of wire 102 of loops 104 may be about 0.076 mm (0.003 inches), while wire 102 from the body of stent 100 can be about 0.050 mm (0.002 inches).
[040] In yet another example, selected areas of wire 102 may have a reduced thickness, in which wire 102 may traverse another section in a compressed and/or expanded configuration of stent 100. In this regard, the thickness of the stent 100 can be effectively reduced in certain configurations. For example, when sections of wire 102 are reduced in the areas where wire 102 overlaps when in a compressed configuration, the overall profile or thickness of stent 100 may be reduced, which will allow stent 100 to potentially fit into a smaller delivery catheter.
[041] This diameter variation of wire 102 can be achieved by electropolishing, etching with strong water or otherwise in order to reduce the portions of the mounted stent 100 so as to cause a reduction in diameter. Alternatively, the regions of the yarn 102 can be reduced before being wound or woven into the shape of the stent 100. In this regard, a desired weave pattern can be determined, whereby the desired reduced diameter regions after weave can be calculated and reduced, and finally the stent 100 can be woven with the modified yarn 102.
[042] In another variant, the pre-woven yarn 102 can be shortened along a single direction and woven together to form the stent 100.
[043] In an exemplary preparation, a nitinol wire with a diameter of 0.0884 mm (0.0035 inches) is wound or woven onto a mandrel 160. As seen in Figure 10, the mandrel 160 may have three pins 162, 164, 166 extending through each end such that a portion of each end of each pin extends outward from the mandrel body 160. Wire 102 starts at a pin and then is wound. 3.0625 clockwise rotations around mandrel body 160. Wire 102 is bent around a nearby pin, then wound 3.0625 clockwise rotations back to the other side of mandrel 160 passing over and under the previously wound section of wire 102. This process is repeated until eight loops are formed over each end.
[044] In another example, the mandrel 160 may have 8 pins and the wire 102 is wound 2375 revolutions. In another example, mandrel 160 may have 16 pins and wire 102 is wound 3.0625 revolutions. In yet another example, the mandrel can have between 8 and 16 pins and is wound between 2.375 and 3.0625 revolutions.
[045] Once coiled, the stent 100 is heat-set in the mandrel 160, for example, at about 500°C for about 10 minutes. The two free ends of the nitinol wire can be laser welded and electropolished so that the final wire diameter is about 0.0584 mm (0.0023 inches).
[046] Finally, the radiopaque wire 105 of about 0.05715 mm (0.00225 inches) in diameter is wound on different areas of the stent loops 104, forming the coil elements 106. Preferably, the wire 105 is wound a length of about 1.01 mm (0.04 inches) to create each coil element 106.
[047] In another embodiment, the stent 100 can be formed from a plurality of discrete wires rather than a single wire 102. The ends of this plurality of wires can be left free or can be soldered, adhered or fused between itself so as to form loops 104. In another embodiment, the stent 100 can be formed by laser cutting, etching, machining, or by any other known fabrication methods.
[048] Wire 102 is preferably composed of a shape memory metal such as Nitinol. Optionally, this shape memory metal can include a variety of different therapeutic coatings or a hydrogel coating that swells or expands when exposed to blood. Yarn 102 may also be composed of a biocompatible polymer material (eg, PET) or a hydrogel material.
[049] Figure 11 illustrates an embodiment of a stent 190 that is similar to the previously described stent 100, except that each end of stent 190 includes three loops 104 instead of the four loops 104 of the previous stent 100. the radiopaque wire 105 that forms each of the coils 106 is also preferably woven into the stent 190, connecting at least some of the coils 104 to each end of the stent 190. Finally, the wire 102 is woven back and forth about 12 times over the length of the 190 stent.
[050] Figure 12 illustrates a preferred embodiment of a dual-layer stent 200 according to the present invention. In general, the dual-layer stent 200 includes an outer-anchoring stent 100 that is similar to the stent 100 previously described and illustrated in Figures 1 to 9. The dual-layer stent 200 also includes an inner flow-shift layer 202 that is disposed within the inner lumen or passageway of the anchoring stent 100.
[051] Often, stents with relatively small wires do not provide adequate expansive forces and thus do not securely maintain their position in a target location. In addition, prior art fabric stents created with many strands can have loose ends that can prick or damage a patient's vessel. In contrast, wider strands are difficult to weave tightly enough (ie, with large spaces between adjacent strands) to modify blood flow at a desired location. The stent 200 attempts to overcome these disadvantages by including both a wider strand braid anchor stent 100 in order to provide a desired anchoring force, as well as a thinner strand braid flow bypass layer 202 in order to divert the blood.
[052] In one example, the flow deflection layer 202 is composed of at least 32 wires 204 with a diameter between about 0.0127 mm (0.0005 inches) and about 0.050 mm (0.002 inches) and made of an elastic memory material such as nitinol. These yarns 204 are woven or braided together in a tubular shape, with a pore size less than 0.254 mm (0.010 inches). Preferably, this braiding is made with a braiding machine, which is known in the art and can braid the yarns 204 into a regular pattern, such as a diamond-shaped pattern.
[053] The flow-bypass layer 202 may have areas of its wire 204 with a reduced diameter, similar to the patterns and techniques described above with respect to wire 102 of the stent 100. In addition, the flow-bypass layer 202 may be formed by laser cutting or etching with strong water from a thin tube.
[054] In the present example, the proximal and distal ends of the flow deflection layer 202 are perpendicular to the length of the layer 202. However, these ends can also be slanted to the length of the layer 202 in a corresponding angular configuration. , opposite or irregular.
[055] As best seen in Figures 13 and 14, the proximal end of the dual-layer stent 200 includes a plurality of fasteners 206 that connect the anchor stent 100 to the flow-shift layer 202. attachment 206 can be composed of tantalum wire (in this case 0.025 mm (0.001 inches) in diameter) and can be attached to the wire 102 and wire 202 portions. flux 202 may be secured to wires 102 of anchor stent 100. In another embodiment, portions of stent 100 and the flux bypass layer may be woven together for securing purposes. In yet another embodiment, stent 100 can be formed with loops with eyelets (eg, molded by laser cutting or etching) or with similar features sized to allow strands 202 to be woven for purpose. of fixation.
[056] Since the anchor stent 100 and flow bypass layer 202 may have different weave patterns or weave densities, both will decrease in length by different proportions as their diameters expand. In this regard, the fasteners 206 preferably locate at or near the proximal end of the anchor stent 100 and the flow bypass layer 202 as oriented in the introducer device (i.e., over the end opposite the anchoring member. distal tip 144). Therefore, as the stent 200 is introduced, both the anchoring stent 100 and the flow bypass layer 202 may decrease in length (or increase, by retracting the stent 200 back into an introducer device), although remain fixed to each other. Alternatively, the fasteners 206 may be positioned at one or more locations along the length of the double-layer stent 200 (e.g., at the distal end, at both ends, in the middle, or at both ends and in the intermediate region).
[057] In an exemplary embodiment of the stent 200, a flow-shift layer 202 comprises 48 strands with a density of about 145 ppi (weaves per inch) and fully expands to a diameter of about 3.9 mm. An outer stent 100 comprises a single strand wound in a 2.5-revolution winding pattern and fully expands to a diameter of about 4.5 mm. When both layers 100 and 202 are fully expanded, the lengths are about 17 mm and 13 mm, respectively. When both layers 100 and 202 are compressed into a 0.685 mm (0.027 inch) region of an introducer device, their lengths are about 44 mm and 37 mm, respectively. When both layers 100 and 202 are expanded into a 3.75 mm vessel, their lengths are about 33 mm and 21 mm, respectively.
[058] In a preferred embodiment of the double-layer stent 200, the flow bypass layer 202 is composed of wires 204 with a diameter between about 0.0127 mm (0.0005 inches) and about 0.0457 mm ( 0.0018 inches) and the wires 102 of the stent 100 have a diameter between about 0.0457 mm (0.0018 inches) and about 0.127 mm (0.0050 inches). Therefore, the preferred minimum ratio between the diameter of wire 102 and wire 204 is about 0.0457 mm (0.0018 inches) to 0.0457 mm (0.0018 inches), respectively, (or a ratio of about 1:1) and the preferred maximum ratio is about 0.127 mm (0.0050 inches) / 0.0127 mm (0.0005 inches) (or about 10:1).
[059] It should be noted that the 200-double-layer stent can produce a greater intensity of radial force (defined as the radial force exerted at about 50% of the radial compression of a stent) than the 100 stent or the stent layer. 200 flow bypass alone. This greater radial force allows the 200 double-layer stent to have better deployment and anchorage characteristics. In an exemplary test of a dual-layer stent modality, the outer stent 100 alone has an average radial force of about 0.13 N, the flow-shift layer 202 alone has an average radial force of about 0 .05 N and the 200-double-layer stent has an average radial force of about 0.26 N. In other words, the average radial force of the stent 200 is greater than or equal to that of the 202 flow-shift layer and that of the stent. stent 100 combined.
[060] It should be noted that the porosity (ie, the percentage of open space to unopened space) in the flow deflection layer 202 changes as it expands in the radial direction. In this regard, a desired porosity or pore size can be controlled by selecting different sizes of stent 200 (i.e., stents that fully expand to different diameters). Table 1 below illustrates different examples of porosity that the flow bypass layer 202 can achieve by varying the size of the stent 200 (ie, its fully expanded diameter) in a particular target vessel. It should be understood that modifying other aspects of the flow bypass layer 202, such as the number of yarns used, the wefts per inch (PPI), or the yarn size, can also modify the porosity. Preferably, the flow deflection layer 202 has a porosity of between about 45 to 70% when expanded.
[061] Similar techniques are also possible with regard to the porosity of the stent 100. Preferably, the stent 100 has a porosity that, when expanded, is between about 75% and 95% and, more preferably, in a range between about 80% and 88%. Stated differently, stent 100 preferably has a surface area or percent metal of between about 5% and 25% and more preferably between 12% and 20%.

[062] The stent 100 can be "oversized" or have a larger inner diameter than the outer diameter of the flow bypass layer 202 when in a fully expanded position in a target vessel (with a target diameter). Preferably, the difference between the inner surface of the stent 100 and the outer surface of the flow bypass layer 202 is between about 0.1 mm and about 0.6 mm (e.g., an opening of between about 0.05 mm and about 0.3 mm between the two). Generally speaking, the double-layer stent 200 may be slightly larger for a patient's target vessel. In this regard, the outer stent 100 can be pushed slightly into the target vessel tissue, allowing the "minor" flow bypass layer 202 to maintain a profile that is relatively close to or still touches the vessel tissue. This sizing may allow the stent 100 to better anchor within the vessel and make closer contact between the flow bypass layer 202 and the vessel tissue. It should also be noted that this "greater sizing" of the double-layer stent 200 can result in an increase of about 10 to 15% in the porosity of the flow-bypass layer 202 relative to the fully expanded (and unobstructed) position of the layer. of flow deviation 202, as seen in the exemplary data in Table 1.
[063] The 200 double-layer stent can provide better monitoring and deployment performance, especially when compared to a stent of similar size and thickness for the 202 flow bypass layer. For example, tests have shown that a reduced force intensity during deployment or retraction of the double-layer stent 200 from the introducer device compared to a stent similar to the flow-bypass layer alone. The inclusion of the outer stent 100 as part of the double-layer stent 200 reduces friction in the delivery system with respect to the radial strength and porosity of the stent 200.
[064] Preferably, the double-layer stent 200 can be deployed or retracted between about 0.09 kilograms (0.2 pounds) and about 0.27 kilograms (0.6 pounds) of force. By including the stent 100 on the outside of the flow bypass layer 202, the insertion force can be reduced by between about 10 to 50% compared to introducing/retracting the flow bypass layer 202 alone (i.e. , of an independent layer 202 used by itself, as can be seen in Figure 19). Since a lower insertion force is required for the double layer stent 200 compared to the force for a single flow bypass layer 202, more desirable introduction characteristics may be achieved by an implantation device.
[065] An exemplary deployment and retraction force test was performed on an exemplary dual-layer stent 200, as seen in Figures 12 through 14, and on a flow-bypass layer 202 alone, as shown in Figure 19. double-layer stent 200 required a maximum mean deployment force of about 0.14 kilograms (0.3 pounds) and a maximum mean retraction force of about 0.18 kilograms (0.4 pounds). The flow-bypass single-layer stent 202 had an average deployment force of about 0.32 kilograms (0.7 pounds). It should be noted that retraction of the stent from the flow bypass layer 202 was not possible in the tests due to the lack of a lock or release mechanism (for example, there are no spools 106 to contact the marker tape 140, as seen in Figure 15). Preferably, the dual-layer stent 200 includes differences in the diameter of the strand 102 of the outer stent 100, such as those described for the embodiment of Figures 1 to 10. Specifically, the strand 102 that constitutes the intermediate region of the stent 100 has a reduced diameter, while the wire 102 at the ends (eg in loops 104) has a larger diameter than in the intermediate region. For example, the intermediate region can be electropolished in order to reduce the diameter of wire 102, although the ends of stent 100 can be protected against electropolishing, maintaining their original diameter. In other words, the thickness of the stent 100 is thinner in the intermediate region. It should be noted that this reduced mid-range thickness is also applicable to non-wireless outer stent modalities (eg, a laser-cut tube stent seen in Figure 16). In test trials of an exemplary modality of the 200 double-layer stent with this diameter difference, relatively low deployment and retraction forces were demonstrated. These lower deployment and retraction forces can provide desirable monitoring, deployment, and retraction characteristics. Preferably, the intermediate region wires 102 are between about 0.0076 mm (0.0003 inches) and about 0.025 mm (0.001 inches) in diameter or thickness than those in the distal and/or proximal regions of the stent 100. Preferably, the strands 102 of the intermediate region are about 10% to about 40% smaller in diameter or thickness than those in the distal and/or proximal regions of the stent 100, and more preferably about 25% smaller.
[066] For example, one embodiment included ends composed of a 102 wire with a diameter of about 0.0635 mm (0.0025 inches) and an intermediate region composed of a 102 wire with a diameter of about 0.0533 mm (0.0021 inches). This modality had an average maximum implant force of about 0.14 kilograms (0.3 pounds) within a range of about 0.09 to 0.18 kilograms (from about 0.2 to 0.4 pounds) and an average maximum retract force of about 0.18 kilograms (0.4 pounds) within a range of about 0.14 to 0.18 kilograms (from about 0.3 to 0.4 pounds).
[067] Another embodiment included ends composed of a wire 102 with a diameter of about 0.0508 mm (0.0020 inches) and an intermediate region composed of a wire 102 with a diameter of about 0.0711 mm (0 .0028 inches). This modality exhibited an average maximum deployment force of about 0.09 kilograms (0.2 pounds) within a range of about 0.09 to 0.14 kilograms (0.2 to 0.3 pounds) and a average maximum retract force of about 0.14 kilograms (0.3 pounds) over a range of about 0.14 to 0.18 kilograms (0.3 to 0.4 pounds).
[068] Another embodiment included ends composed of a wire 102 with a diameter of about 0.0533 mm (0.0021 inches) and an intermediate region composed of a wire 102 with a diameter of about 0.0711 mm (0 .0028 inches). This modality had an average maximum deployment force of about 0.18 kilograms (0.4 pounds) within a range of about 0.14 to 0.18 kilograms (0.3 to 0.4 pounds) and a force of average maximum shrinkage of about 0.27 kilograms (0.6 pounds) over a range of about 12.7 mm to 15.2 mm (0.5 to 0.6 inches).
[069] Returning to Figure 15, an introducer device 210 is shown in accordance with the present invention for implanting the stent 200 within a patient. The introducer device 210 is generally similar to the previously described introducer device 135, including a sheath 133 disposed over an introducer pusher 130 in order to hold the stent 200 in a compressed position over marker tape 140.
[070] As with the previous device, a proximal end 201 of the stent 200 is disposed over the distal marker strip 140, and the proximal coil elements 106 are positioned between the marker strips 136 and 140. The stent 200 can be deployed to the retract the sheath 201 proximally with respect to the impeller 130. The stent 200 can also be retracted (if not yet fully deployed/released) by retracting the impeller 130 in a proximal direction, thereby causing the marker strip 140 contact the proximal coil elements 106, pulling the stent 200 back into the sheath 133.
[071] As previously described, the proximal end 201 of the stent 200 includes fasteners 206 (not shown in Figure 15) that connect the stent 100 to the flow bypass layer 202. In this regard, when the sheath 133 is retracted proximally during deployment and a distal portion 203 of the dual-layer stent 200 begins to expand radially, the stent 100 and flow-bypass layer 202 may decrease in length to different proportions.
[072] A portion of strand 105 can be woven along the length of stent 100 in a distinct pattern. This length can correspond to the length and position of the inner bypass layer 202, thereby indicating the length and position of the inner bypass layer 202 to the user during a procedure.
[073] In another preferred embodiment according to the present invention, the flow bypass layer 202 can be woven into the anchoring stent 100.
[074] Figure 16 illustrates another embodiment according to the present invention of a dual-layer stent 300 comprising an inner flow-shift layer 202 and an outer stent 302. Preferably, the outer stent 302 is formed by means of the cutting a pattern (for example, laser cutting or etching with strong water) into a sheet or tube composed of a shape memory material (for example, Nitinol). Figure 16 illustrates a pattern of a plurality of diamonds along the length of the outer stent 302. However, it should be understood that any cut pattern is possible, such as a plurality of connected ribbons, zigzag patterns, or slit patterns. waves.
[075] The cross-sectional view of the dual-layer stent 300 illustrates a plurality of exemplary positions for the fastener 206 to connect the outer stent 302 and the inner flow-bypass layer 202. As with any of the above embodiments described, the fasteners 206 (or other fastening methods, such as welding or adhesive) can be positioned in one or more of the exemplary locations shown. For example, the fasteners 206 may be located at the proximal end, the distal end, or in the middle. In another example, the fasteners 206 may be located at both the proximal and distal ends. As an alternative, no securing element 206 or securing mechanism is used in order to secure the inner flow bypass layer 202 to the outer stent 302.
[076] Figure 18 illustrates another embodiment of a dual-layer stent 400 according to the present invention. Stent 400 comprises an inner flow-shift layer 202 secured to an outer stent 402. Outer stent 402 comprises a plurality of radial, zigzag ribbons 404 that are attached or connected to longitudinal members 406. Preferably, stent 402 can be created by welding a plurality of elements together, laser cutting or etching that pattern into a sheet or tube, or by using vapor deposition techniques. As with the prior embodiments, the flow bypass layer 202 may be secured to the outer stent 402 near the distal end, the proximal end, the mid-region, or any combination of these positions.
[077] As can be seen more clearly in Figures 12 and 13, the flow bypass layer 202 preferably has a length that extends near the ends of the main body portion of the stent 100 and stops near the formation of loops 104. However, the flow bypass layer 202 may alternatively include any range of lengths and positions with respect to the stent 100. For example, Figure 20 illustrates a dual layer stent 200A in which the flow-bypass layer 202 is shorter in length than stent 100 and is longitudinally centered or symmetrically positioned.
[078] In another example, Figure 21 illustrates a dual layer stent 200B, in which the flow bypass layer 202 is greater in length than the stent 100. Although the flow bypass layer 202 is shown as centered on the longitudinally within the stent 100, asymmetric positioning of the flow bypass layer 202 is also contemplated.
[079] In yet another example, Figure 22 illustrates a dual-layer stent 200C, in which a flow-bypass layer 202 is shorter in length than stent 100 and is positioned asymmetrically within stent 100. In this example , the flow-bypass layer 202 is positioned along the proximal half of the stent 100, however, the flow-bypass layer 202 may also be positioned along the distal half of the stent 100. is shown extending over one-half the length of the stent 100, the flow bypass layer 202 may also span a third, a quarter, or any fractional portion of the stent 100.
[080] Again with reference to Figures 23 to 25, the flow deflection layer 202 may be constituted by one or more expandable yarns or filaments 500. Preferably, the expandable yarns 500 are composed of the above-described coated yarns 204 with a hydrogel liner 502 that expands on a patient's vessel. Wires 204 can be composed of a shape-memory metal (eg, nitinol), a shape-memory polymer, nylon, PET, or even an entirely hydrogel. As seen in Figure 25, hydrogel strands 500 can be woven between strands 204 that are not coated with hydrogel. Alternatively, the partial lengths of the strands can be hydrogel coated so as to coat only a specific region of the flow bypass layer 202 (e.g., the central region).
[081] In any of the above embodiments, one or more of the stent layers (for example, the stent 100 or the flow bypass layer 202) can be composed essentially of a polymer (for example, a hydrogel, PET (Dacron) ), nylon, polyurethane, teflon and PGA / PGLA). Generally speaking, a polymer stent can be produced by free radical polymerization of a liquid prepolymer solution within a container of a desired shape.
[082] An exemplary polymer stent fabrication technique can be seen in Figures 26 to 29. Beginning with Figure 26, a generally cylindrical mandrel 602 is placed within a tube 600. Preferably, the mandrel 602 can create a fluid-tight seal on at least one end of tube 600 and, preferably, the opposite end of tube 600 is also closed.
[083] In Figure 27, a liquid prepolymer is injected into the space between the 602 mandrel and the 600 tube. Polymerization is induced in the prepolymer solution (for example, heating from 40° to 80° C by 12 hours). Once polymerized, tube 600 and mandrel 602 are removed from solid polymer tube 606, shown in Figure 28. This tube 606 can be washed to eliminate residual monomers and dried over a mandrel to maintain its shape.
[084] Finally, the 606 polymer tube may be laser cut, CNC machined, etched with strong water or otherwise formed into a desired pattern, as seen in Figure 29. The length and thickness of the The final stent can also be modified during the manufacturing process by changing the diameter or length of tube 606 or mandrel 602.
[085] In another exemplary stent fabrication process seen in Figure 30, a centrifugal force is used in order to disperse the prepolymer solution throughout the interior of a 605 syringe tube. In specific terms, a plunger 603 is positioned in tube 605 and a predetermined amount of prepolymer solution 604 is introduced into syringe tube 605. Syringe tube 605 is connected to a mechanism that causes tube 605 to rotate in a horizontal orientation along an axis. longitudinal geometry of tube 605 (eg, a horizontally positioned overhead stirrer with its rotating element connected to tube 605).
[086] Once the tube 605 reaches a sufficient rotational speed (of, for example, about 1500 rpm), the syringe plunger 603 is pulled towards the end of the tube 605, introducing a gas, for example, air. Since the prepolymer solution now has more room to spread out, the centrifugal force causes a uniform coating to form on the wall of tube 605. Polymerization can be initiated using a heat source (for example, , a heat gun) and then heated (eg at 40° to 80°C for 12 hours). The solid polymer tube can then be removed from the 605 tube, washed to eliminate residual monomers, dried on a mandrel, and then laser cut, CNC machined, etched with strong water or otherwise formed into a desired pattern.
[087] Figures 31 to 36 illustrate yet another exemplary process for creating a polymer stent according to the present invention. Referring first to Figure 31, a plastic or degradable rod 608 is placed on tube 600 and luer adapters 610 are connected to each opening of tube 600. Rod 608 has an engraved or recessed pattern (eg, created by machining laser, CNC machining or by other appropriate method) onto its outer surface in the desired pattern for the final stent. When rod 608 is placed in tube 600, these patterns form the channels that will later be filled by prepolymer 604. In other words, the outer diameter of rod 608 and the inner diameter of tube 600 are such that the 604 prepolymer is prevented from moving out of the channels or patterned area.
[088] As can be seen in Figure 32, a syringe 612 is inserted into a Luer adapter 610 and the prepolymer solution 604 is injected into tube 600, as can be seen in Figure 33. The prepolymer solution -polymer 604 fills the pattern on the surface of rod 608. Syringe 612 is removed from Luer adapter 610 and polymerization is completed by heating the solution of prepolymer 604 (eg, at 40° to 80°C by approximately 12 hours).
[089] Stem 608 is removed from tube 600, as seen in Figure 34, and placed in an organic solvent bath 622, as seen in Figure 35. Organic solvent bath 622 dissolves stem 608, leaving only the 622 polymer stent (Figure 36), with the same pattern as the surface of the 608 rod.
[090] It should be noted that different aspects of the 622 stent can be controlled by changing the pattern on the surface of the 608 rod, the diameter of the 608 rod and the 600 tube, the length of the 608 rod and the 600 tube, and similar dimensions . Another modification is equally possible through laser cutting, CNC machining, etching, or similar processes.
[091] Although the present invention has been described in terms of certain embodiments and applications, a person skilled in the art, in light of this teaching, may generate other embodiments and modifications without departing from the spirit of or exceeding the scope of the claimed invention . Therefore, it is to be understood that the drawings and descriptions herein are offered by way of example in order to facilitate an understanding of the present invention and are not to be construed to limit its scope of application.

权利要求:
Claims (25)
[0001]
1. Implant device including a stent, said stent including a first stent (100), comprising:- a tubular portion, woven with a distal end and a proximal end, wherein said tubular portion is woven of at least one strand CHARACTERIZED by the fact that - a plurality of loops (104) formed by said at least one yarn at both said distal end and said proximal end of said woven portion; and - a plurality of spools (106) positioned on at least some of said plurality of loops (104) at both said distal end and proximal end of said woven portion.
[0002]
2. Implant device according to claim 1, CHARACTERIZED by the fact that said woven portion and said plurality of loops (104) of said first stent (100) are formed of only a single wire.
[0003]
3. Implant device according to claim 1 or 2, CHARACTERIZED by the fact that said first stent (100) is expandable to a fully expanded configuration in which an outer diameter (110) of a fully expanded main body portion is smaller than an outer diameter (114) of said plurality of loops (104).
[0004]
4. Implant device according to any one of claims 1 to 3, CHARACTERIZED by the fact that said coil elements (106) are arranged around said wire of said loops (104).
[0005]
5. Implant device according to any one of claims 1 to 4, CHARACTERIZED by the fact that said coil elements (106) are composed of a wire (105) wound around a portion of the loop (104).
[0006]
6. Implant device, according to any one of claims 1 to 5, CHARACTERIZED by the fact that said wire (105) is composed of a radiopaque material.
[0007]
7. Implant device according to any one of claims 1 to 6, CHARACTERIZED by the fact that said plurality of coils (106) comprises a first coil on a distal end of the first stent (100) and a second coil on a proximal end of the first stent (100) and wherein said first coil and said second coil are formed from a single wire (105).
[0008]
8. Implant device according to claim 7, CHARACTERIZED by the fact that said single strand (105) is also intertwined in said tubular woven portion of said first stent (100).
[0009]
9. Implant device according to any one of claims 1 to 8, CHARACTERIZED by the fact that a loop (104) has a central area and said coil element (106) is positioned close to said central area.
[0010]
10. Implant device according to any one of claims 1 to 9, CHARACTERIZED by the fact that said first stent (100) has a collapsed state in which said coil elements (106) are positioned respectively close to an end too distal or too proximal of the collapsed stent (100).
[0011]
11. Implant device, according to any one of claims 1 to 10, CHARACTERIZED by the fact that a diameter of said at least one wire is non-uniform along its length.
[0012]
12. Implant device according to any one of claims 1 to 11, CHARACTERIZED by the fact that a diameter of said at least one wire is greater at a proximal end and at a distal end of said first stent (100) than in an intermediate part of said first stent (100).
[0013]
13. Implant device according to any one of claims 1 to 12, CHARACTERIZED by the fact that said at least one wire forms a plurality of overlapping wire positions, and wherein said at least one wire has a reduced diameter at said overlapping wire positions.
[0014]
14. Implant device according to any one of claims 1 to 13, CHARACTERIZED by the fact that said plurality of loops (104) comprises a distal loop on said distal end of said woven portion; said distal loop having a first side connected to a distal coil and a second side.
[0015]
15. Implant device according to any one of claims 1 to 14, CHARACTERIZED by the fact that said stent is a double layer stent (200), wherein said tubular woven portion comprises: - a first woven layer that it has a first porosity and has a tubular shape with a space therethrough; and further including - a second stent being an inner stent formed from a second woven layer having a second porosity and located within said space within said tubular shape.
[0016]
16. Implant device according to claim 15, CHARACTERIZED by the fact that said second woven layer extends along a fractional length of said first woven layer.
[0017]
17. Implant device according to claim 15 or 16, CHARACTERIZED by the fact that said first woven layer has a porosity between 75% and 95%, and said second woven layer has a porosity between 45% and 70% .
[0018]
18. Implant device according to claim 15 or 16, CHARACTERIZED by the fact that said first woven layer has a surface area between 5% and 25%.
[0019]
19. Implant device according to claim 15 or 16, CHARACTERIZED by the fact that said second woven layer is asymmetrically positioned along an entire length of said first woven layer.
[0020]
20. Implant device according to claim 15 or 16, CHARACTERIZED in that said second woven layer is positioned between a first end of said first woven layer and an intermediate part of said first woven layer.
[0021]
21. Implant device according to any one of claims 15 to 20, CHARACTERIZED by the fact that said first stent (100) is an externally anchored stent including said loops (104) and coil elements (106), and said inner stent is formed from a plurality of woven elements.
[0022]
22. Implant device according to claim 21, CHARACTERIZED by the fact that a proximal end of the outer anchoring stent (100) and the inner stent are connected together by connecting elements (206) or fitting.
[0023]
23. Implant device according to claim 21 or 22, CHARACTERIZED by the fact that said inner stent forms an inner flow-bypass layer (202).
[0024]
24. Implant device according to claim 23, CHARACTERIZED by the fact that portions of the external anchoring stent (100) and said flow diversion layer are woven together for fixation with each other.
[0025]
25. Implant device according to any one of claims 15 to 24, CHARACTERIZED by the fact that said double-layer stent (200) is adapted to be delivered over an opening of an aneurysm.

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WO2012082440A1|2012-06-21|

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法律状态:
2020-12-08| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

2020-12-15| B25A| Requested transfer of rights approved|Owner name: TERUMO CORPORATION (JP) |

2021-04-27| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

2021-06-15| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 05/12/2011, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

申请号 | 申请日 | 专利标题

US42260410P| true| 2010-12-13|2010-12-13|

US61/422.604|2010-12-13|

US61/422,604|2010-12-13|

US201061425175P| true| 2010-12-20|2010-12-20|

US61/425,175|2010-12-20|

US61/425.175|2010-12-20|

USPCT/US2010/061627|2010-12-21|

PCT/US2010/061627|WO2012087301A1|2010-12-21|2010-12-21|Stent|

US201061427773P| true| 2010-12-28|2010-12-28|

US61/427.773|2010-12-28|

US61/427,773|2010-12-28|

US201113003277A| true| 2011-01-07|2011-01-07|

US13/003.277|2011-01-07|

US13/003,277|2011-01-07|

PCT/US2011/063330|WO2012082440A1|2010-12-13|2011-12-05|Stent|

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