SYSTEM FOR OCCLUSION OF THE BLOOD VESSEL SEGMENTS LUMEN

专利摘要:
expandable body device and method of use. Disclosed herein are medical devices comprising a thin-walled, single-lobe, expandable body ("ballstent" or "blockstent") and a flexible, elongated delivery device ("delivery catheter") and systems and methods of use for treating aneurysms vascular vasculature and methods of use for obstructing segments of blood vessels and other biological conduits. expandable bodies comprising gold, platinum or silver which can be compressed, positioned in the lumen of an aneurysm or blood vessel and expanded to conform to the shape of the aneurysm or segment of blood vessel or biological conduit are disclosed. *the outer surface of the expandable bodies can be configured to promote local thrombosis and promote tissue growth in and around the wall to reduce migration of the expandable body and to occlude and seal the aneurysm or biological conduit. .
公开号:BR112014017615B1
申请号:R112014017615-9
申请日:2012-07-17
公开日:2021-08-24
发明作者:Nicholas Franano；Katherine Stephenson
申请人:Artio Medical, Inc；
IPC主号:

专利说明:

CROSS REFERENCE TO RELATED ORDERS
[001] The present application claims priority of PCT International Patent Application No. PCT/US12/21620, which was filed January 17, 2012, entitled "Detachable Metal Balloon Delivery Device and Method," and claims priority of the Application Provisional US No. 61/433,305 ("the Order 305"). Application 305 was entitled "Detachable Metal Balloon Delivery Device and Method" and was filed on January 17, 2011. The present application claims priority from PCT International Patent Application No. PCT/US12/21621, which was filed on January 17, 2011. January 2012, entitled "Ballstent Device and Methods of Use," and also claims priority from Application 305. The present application also claims priority from PCT International Patent Application No. PCT/US12/00030, which was filed on 17th of January 2012, entitled "Blockstent Device and Methods of Use," and claims priority of Application 305. Each of the patent applications listed above is incorporated herein by reference in their entirety. FIELD OF THIS DISCLOSURE
[002] The present disclosure relates to devices and systems, including an expandable body and a delivery catheter for the treatment of saccular aneurysm of the vascular system or the obstruction of blood vessel segments, where the expandable body ultimately, remains in the blood vessel segment or aneurysm in an expanded state. In addition, the present disclosure relates to components for, and methods of, attaching the expandable body to the delivery catheter, as well as components and methods for separating the expanded body from the delivery catheter, such that the expanded body remains in place at an expanded state while the delivery catheter is removed from the patient's body. FIELD OF THIS DISCLOSURE
[003] An aneurysm is an abnormal outward bulge of a blood vessel that can occur anywhere in the body. This bulge weakens the blood vessel wall, making it susceptible to rupture, which results in bleeding or bleeding. Aneurysms are common in the arterial circulation of the brain, where they are known as cerebral aneurysms. When brain aneurysms rupture, this often leads to a hemorrhagic stroke and sometimes brain damage and death. Brain aneurysms are a common condition, affecting an estimated 2% of the adult population. Approximately 90% of brain aneurysms are saccular with a rounded, pouch-shaped shape. Invasive surgery remains one of the mainstays in its treatment, with surgery that involves opening the skull and sealing off the aneurysms by placing a small surgical clip on the outside of the neck, thus limiting blood flow to the aneurysm sac.
[004] Alternatively, minimally invasive, catheter-based endovascular treatments have been developed in which a series of small metal coils are used to fill the aneurysm sac, effectively stabilizing it. In order to treat a blood vessel or aneurysm with coils, a physician inserts a catheter into a lumen of the vascular system and maneuvers the tip of the catheter into the sac of the aneurysm. With the tip of the catheter in place, the physician passes small coils through the catheter into the lumen of the vessel or cavity of the aneurysm. Although effective, coiling of cerebral saccular aneurysms has disadvantages. First, coil placement is difficult to control, often resulting in coil protrusion in the main vessel or coil migration to unwanted locations. Second, coils only partially fill the aneurysm sac. Thrombus and scar tissue accumulation is necessary to seal the aneurysm, a process that takes weeks to occur and is sometimes incomplete, often resulting in aneurysm rupture or recanalization and reducing the effectiveness of coils in treating aneurysm rupture acute with subarachnoid hemorrhage. Incomplete filling of saccular aneurysms with coils is especially common in the neck region of saccular aneurysms, where coil density can be low and blood flow rates can be high. Third, coils are often needed to treat the aneurysm, resulting in high costs and long treatment times. Fourth, coils are susceptible to compression, further exposing the aneurysm neck and leading to substantial rates of aneurysm recurrence.
[005] More recently, traditional tubular stents have been adapted for the treatment of brain aneurysms. Stents are placed in delivery devices and positioned in the main vessel adjacent to the aneurysm. The stents are then expanded into the main vessel with the delivery device, followed by removal of the delivery device. The expanded metal stent acts to seal the aneurysm neck and keep blood flow out of the aneurysm sac to promote aneurysm thrombosis. Although effective, the use of these "flow-bypassing" stents has disadvantages. First, stents can cover and divert blood flow away from important arterial branches adjacent to the aneurysm, sometimes resulting in ischemia and stroke. Second, stents are a source of thrombus and the formation of intimal hyperplasia in the main vessel, which can result in narrowing of the main vessel lumen, ischemia, and effusion.
[006] In other clinical situations, patients may benefit from obstruction of certain segments of the vein or artery through endovascular means. Clinical settings where endovascular vessel obstruction is beneficial include reducing bleeding from an injured vessel, reducing blood flow to tumors, and redirecting the blood path in the vascular system for other purposes. Alternatively, minimally invasive, catheter-based endovascular treatments have been developed to occlude blood vessel segments. Endovascular medical devices for occluding blood vessels include balloon catheters in which the balloon can be inflated to fill the lumen of a segment of blood vessel and withdrawn from the catheter. There are two main disadvantages to using detachable balloon catheters for blood vessel obstruction. First, balloons are made of polymers that generally resist fabric modality. This limits the attachment of devices where they are placed. Second, the balloons are configured with elastic walls that are expanded with pressurization and valves designed to maintain that pressure after detachment. Unfortunately, there is a substantial rate of balloon and valve failure, resulting in deflation. Without tissue modality, balloon deflation can lead to balloon migration and obstruction of off-target vessel segments.
[007] Medical endovascular devices for occluding blood vessels include metal coils that are used to fill a portion of the lumen of a blood vessel segment to induce thrombosis and occlusion of the blood vessel segment. There are several major drawbacks to using metal coils for blood vessel obstruction. First, numerous coils are often needed to occlude the blood vessel segment, resulting in higher costs and longer treatment times. Second, coil placement is difficult to control, often resulting in coil placement in off-target vessel segments. Third, coils only partially fill the blood vessel. The accumulation of thrombus and scar tissue is necessary to occlude blood vessels, a process that takes weeks to occur and is sometimes incomplete, often resulting in incomplete obstruction or recanalization and failed treatment.
More recently, endovascular medical devices for blood vessel obstruction have been developed that include basket structures that are used to fill a portion of the lumen of a blood vessel segment to induce thrombosis and obstruction of the blood vessel segment. Although only a single basket structure is generally needed to occlude a segment of blood vessel, and the devices are generally easier to control, these devices only partially fill the blood vessel and require the accumulation of thrombus and scar tissue to occlude the blood vessel. . As with coils, this process takes weeks to occur and is sometimes incomplete, often resulting in incomplete obstruction or recanalization and failed treatment.
[009] Therefore, there is still a need for medical devices, systems and methods for the treatment of saccular aneurysms, including brain aneurysms, that result in a more effective and complete saccular aneurysm seal that is more durable and permanent. It is also desired to have medical devices, systems and methods that seal aneurysm sacs faster. Finally, it is desired to have medical devices, systems and methods that can be performed more easily and in less time, with a lower risk of complications and a lower cost, when compared to existing treatments.
[0010] There is also still a need for catheter-based medical devices, systems and methods for the obstruction of segments of blood vessels that are simple to perform, result in complete, rapid and controlled obstruction, have a low risk of recanalization, device migration or other complications and can be purchased at a reasonable cost. SUMMARY OF THIS DISCLOSURE
Disclosed in this document are medical systems and devices for the treatment of saccular aneurysm using an expandable body or structure. Also disclosed are medical systems and devices for obstructing or blocking segments of blood vessels, including arteries, veins and other vascular conduits of the vascular system, using an expandable body or structure. The expandable body can be configured for use as a balloon, ballstent, or blockstent. The terms expandable body, expandable structure, expandable balloon, ballstent, and blockstent, as used herein, refer to an expandable body having a single-layer or multi-layer construction, and where the expandable body may first be introduced into a non-expandable state. expanded into a patient using a delivery device, secondly, negotiated in the unexpanded state through the patient's cardiovascular system to a target treatment site (ie, implantation site), third, expanded into the treatment site from target to an expanded state and, fourth, detached from the delivery device to remain in the patient's body in an expanded configuration at the target treatment site. Also disclosed in this document are methods of manufacturing and using medical systems and medical devices.
[0012] The medical system disclosed in this document may be to fill a biological space of a patient. Such a medical system includes a single lobulated expandable metal body (eg, a ballstent or blockstent) and the delivery device. Filling a biological space includes filling at least a portion of a lumen of a ruptured or unruptured aneurysm or a lumen of a segment of blood vessel, including arteries and veins.
[0013] The single lobulated expandable metal body includes a distal region, a proximal region generally opposite the distal region and an intermediate region transitioning from the distal region to the proximal region. A central axis extends proximally-distally between the proximal and distal region of the single lobulated expandable metal body. A wall of the single lobulated expandable metal body generally extends continuously through the intermediate region distal to the proximal region to define an outer surface of the expandable body and an inner surface of the expandable body. The interior surface defines an interior volume of the expandable body, wherein the expandable body is configured to expand from a configuration (i.e. collapsed or non-expanded) deliverable to an expanded configuration.
[0014] The delivery device has a longitudinally extending body that includes a proximal and a distal end generally opposite the proximal end. The distal end of the delivery device is operably coupled to the proximal region of the expandable body. In one embodiment, when the expandable body is in the deliverable configuration, the wall assumes a pleated configuration having a plurality of pleats bent clockwise to the central axis, or alternatively counterclockwise to the central axis to form a bent region of the expandable body. Conversely, when the expandable body is in the expanded configuration, the plurality of pleats is not folded and the pleated configuration substantially ceases to exist.
[0015] In one embodiment, the medical system includes an electrolysis system having an electrical circuit partially compatible with the delivery device and configured to decouple a proximal region of the expandable body from a distal end of the electrolysis delivery device. In other embodiments, the medical system includes an electrical system that has an electrical circuit partially compatible with the delivery device to supply electrical power to a polymer link coupled to the proximal region of the expandable body and the delivery device. The electrical energy supplied heats the link, causing the link to release. The electrical system can also heat the polymer coupling by passing an electrical current through a resistive heating element or wire adjacent to the polymer coupling.
[0016] Methods to fill a patient's biological space are also disclosed in this document. One method includes providing a single lobed metal expandable body configured to expand from a configuration of the deliverable product to an expanded configuration. The expandable body is delivered into the patient's biological space in a deliverable configuration through a delivery device that has a distal end operably coupled to a proximal region of the expandable body. A fluid medium can be delivered to the interior volume of the expandable body through the delivery device to make the expandable body assume the expanded configuration. After expansion, the expandable body is decoupled from the delivery device.
[0017] In one embodiment, the method includes an electrolysis system having an electrical circuit partially compatible with the delivery device and configured to decouple a proximal region of the expandable body from a distal end of the delivery device by electrolysis. In another embodiment, the method includes using an electrical system that has an electrical circuit partially compatible with the delivery device to supply electrical energy to a polymer link coupled to the proximal region of the expandable body and the delivery device. The electrical energy supplied heats the link, causing the link to release. The electrical system can also be configured to heat the polymer coupling by passing an electrical current through a resistive heating element or wire adjacent to the polymer coupling.
[0018] Methods for fabricating a system to fill a patient's biological space are also disclosed in this document. One method includes fabricating a single lobulated expandable metal body that has a distal region, a proximal region generally opposite the distal region, and an intermediate region transitioning from the distal region to the proximal region. A central axis extends proximally-distally between the proximal and distal region of the single lobulated expandable metal body. A wall of the single lobulated expandable metal body generally extends continuously through the intermediate region distal to the proximal region to define an outer surface of the expandable body and an inner surface of the expandable body. The interior surface defines an expandable interior volume of the body.
The methods also include a delivery device having a longitudinally extending body that includes a proximal and a distal end generally opposite the proximal end, operably coupling the distal end of the delivery device to the proximal region of the expandable body. . Fabrication methods also include forming the expandable body wall into a pleated configuration. The pleated configuration includes a plurality of pleats bent clockwise to the central axis, or alternatively counterclockwise to the central axis to form a bent region of the expandable body.
[0020] Another method of manufacturing a system for filling a patient's biological space includes attaching a stainless steel ring to a proximal end of a sacrificial mandrel, depositing a metal layer on the sacrificial mandrel and at least a portion of the steel ring stainless steel and eliminating the sacrificial mandrel to leave behind the metallic layer in the form of a hollow body, which is shaped like the sacrificial mandrel. The stainless steel ring is therefore joined to and extending from a proximal region of the hollow body.
[0021] The method may include applying an electrically insulating material to an outer surface and an inner surface of the hollow body and an outer surface of the stainless steel ring and creating an anode by processing a portion of the outer surface of the region of the neck so that it is composed of stainless steel ring free of electrical insulation material. The method further includes coupling the stainless steel ring to a distal end of a delivery device and electrically coupling an electrolysis system to the potential anode via a conduction path that travels through the delivery device.
[0022] In the various embodiments of the systems and methods described above, the walls of the expandable body may include at least one metal layer, with a thickness ranging between approximately 5 µm and 50 µm. In one example, the metallic layer of the proximal, distal and intermediate regions may include gold or platinum. The expandable body wall may also include an inner layer of a non-metallic coating that extends over an inner surface of the metal layer and an outer layer of a non-metallic coating that extends over the outer surface of the metal layer. Non-metallic coatings can be an electrically insulating material including, for example, Parylene. For an example, the inner and outer layer of Parylene can coat the metallic layer with gold or platinum.
[0023] The surface of the metal layer may include rounded, stony or granular surface structures that have a surface height of approximately 0.1 µm to approximately 10 µm. The outer surface of the metal layer can include generally tubular protrusions. In one embodiment, some of the usually tubular bulges are branched. In another embodiment, some are joined at both ends to the metal layer to form rim shapes.
[0024] The metallic layer of the expandable body can be produced by electroforming in a mandrel, where optionally all or a part of the mandrel is sacrificial. Chuck parts can be formed from sacrificial aluminum components as well as non-sacrificial steel or stainless steel components. The mandrel may have a polished coating with no more than approximately 0.1 micron between the peak and valley of rough surface characteristics. Alternatively, the mandrel may have a pleated outer surface that generally replicates a pleated configuration of the expandable body that is intermediate in shape between the deliverable configuration and the expanded configuration. A stainless steel non-sacrificial mandrel component may include a gold or platinum surface that extends over at least a portion of an inner surface or an outer surface of an outer stainless steel layer of the non-sacrificial mandrel component.
[0025] In various embodiments, the expandable body may undergo one or more annealing processes. The expandable body can be annealed before or after being folded into the deliverable configuration. Furthermore, the expandable body can undergo an annealing process while comprising a non-metallic coating.
[0026] The wall of the expandable body may include pores that can extend completely through the thickness of the wall, from the interior to the exterior surface. Pores range from 1 micron to 500 microns in diameter. Thus, the expandable body can be inflated by a fluid supply device in fluid communication with the interior volume of the expandable body through the delivery device. The fluid supply device is configured to provide a flow rate of flow of flow to the interior volume that exceeds an exhaust flow rate of fluid from a plurality of pores at a fluid delivery pressure.
[0027] When in delivery configuration, the bent region of the expandable body can define a wire receiving channel. When in delivery configuration, the bent region of the expandable body can define a wire receive channel. Each crease includes a line of groove extending proximally-distally and radially from the central axis and each crease is separated from any immediately adjacent crease by an intervening ditch that extends proximally-distally such that the pleated configuration has an alternating furrow-ditch arrangement. When folded, each pleat is folded over an immediately adjacent pleat in a clockwise direction relative to the center axis, or in a counterclockwise direction relative to the center axis. In one embodiment, no part of the delivery device is found within the folded region of the expandable body. In another embodiment, the bent region of the expandable body may define a channel for receiving a guidewire.
[0028] In various embodiments, the expandable body is inflatable so that the expanded configuration is achieved. The expandable body is inflated by delivering a fluid medium to the interior volume of the expandable body. The fluid medium typically includes a liquid or gas. During expansion, the pressure within various modalities of the expandable body is three atmospheres. Other suitable pressures include two atmospheres and one atmosphere or less.
[0029] During inflation, the pleated configuration and the plurality of expandable body pleats that are present in the deliverable configuration are substantially eliminated. When expanded, the expandable body has sufficient strength to remain in the expanded configuration within a biological space after separation from the delivery device.
[0030] The expandable metal body and the delivery device are configured to allow the interior volume of the expandable body, optionally, to be at least partially filled with a solid or semi-solid support structure. Support structures include metallic or polymeric coils or wires, metallic or polymeric expandable structures, granules, balls, microspheres, a bioresorbable material or combinations thereof. In one embodiment, solid or semi-solid material or non-derived limbs from the patient are not required in the interior volume of the expandable body to make the expandable body take on or maintain the expanded configuration after separation from the expandable body and the delivery device.
[0031] When the expandable body is in the expanded configuration, the expandable body has a general shape that is a sphere or an oblong shape. In a specific modality where the expandable body must serve as a ballstent, the intermediate, proximal, and distal regions combine to form a generally spherical shape. In another particular modality where the expandable body must serve as a blockstent, the intermediate region is generally cylindrical and the proximal and distal regions are generally hemispherical.
[0032] The expandable body may include a neck that extends proximally outward from the proximal region to operably engage the distal end of a delivery device. In one embodiment, the expandable body and neck are both formed entirely from a malleable metal such as gold or platinum. In another embodiment, at least a portion of the neck includes stainless steel, while the remainder of the expandable body includes a malleable metal such as gold or platinum. The delivery device can be operably coupled to the neck portion of the proximal region of the expandable body via an elastic sleeve. The elastic sleeve can be formed from ChronoPrene, silicone or PEBAX®. A PEBAX® sleeve can have a durometer ranging from 25 to 80 Shore D. The delivery device can be attached to the expandable body by a friction fit. Also, a vacuum may be present in the catheter. The expanded expandable body and the delivery device can be separated by pulling the delivery device from the expandable body. The delivery device includes a longitudinally extending body, which may have a hydrophilic or lubricious coating. This coating can also be present on the expandable body. The longitudinally extending distal segment of the body is operably coupled to a proximal region of the expandable body. For example, the longitudinally extending distal end of the body may be received at the neck in the proximal region of the expandable body such that the outer surface of the longitudinally extending distal segment of the body is in contact with an inner surface of the expandable body neck. In another example, the longitudinally extending distal segment of the body ends near a proximal end of a ring-shaped region of exposed metal in the neck of the expandable body.
[0033] The various systems and methods may include or use an electrolysis system configured to supply a constant voltage, constant current or a square wave voltage to the exposed metallic surface at the neck to detach the expandable body. Separation takes place in an exposed or uncoated, ring-shaped, collar-shaped metal surface region formed of stainless steel or gold and exposed by, for example, laser etching. During electrolysis, the exposed or uncoated, ring-shaped metal surface region of the neck acts as an anode. When delivering a square wave voltage, the anode voltage is modulated based on a comparison between the anode voltage and the voltage of a reference electrode, supported in the delivery device or resident externally to the delivery device, such as with a needle or electrode pad residing on or within the patient.
[0034] A method of manufacturing the expandable body includes: a) providing a sacrificial mandrel comprising a pleated outer surface; b) depositing a layer of metal on the sacrificial mandrel; c) removing the sacrificial mandrel and leaving behind the metallic layer in the form of a hollow pleated body; d) coating with a non-metallic material an inner surface and an outer surface of the metal layer of the hollow pleated body; e) bending the pleated hollow body to further increase the extent to which the pleated hollow body is pleated, the fold comprising folding over a plurality of pleats clockwise relative to a central axis of the pleated hollow body, or anti- clockwise in relation to the central axis.
[0035] The part of the electrolysis system supported in the delivery device includes one or more conductors embedded in the wall of the catheter that act as the two electrical conductors for the electrical system and as structural reinforcement for the wall of the catheter. Conductors are wires, cables, or other electrical conductors that can be routed through the catheter wall in a spiral, braided, or straight-line configuration. One of the conductors is in electrical communication with an expandable body part that can function as an anode, such as in or near a ring-shaped region of the neck that has an exposed metal surface, while another of the conductors is in electrical communication. with a frame supported on the delivery device that can function as a cathode, such as a platinum metal ring. In one modality, one of the conductors is in electrical communication with a structure supported on the delivery device that can function as a reference electrode. DESCRIPTION OF FIGS.
[0036] FIGS. 1A-H are side and end views of the expandable body modalities of the medical device.
[0037] FIG. 2 is a plan view of the delivery catheter modality of the medical device.
[0038] FIGS. 3A-C are plan views of a medical device modality.
[0039] FIGS. 4A-E are views of an embodiment of the medical device illustrating a sequence of steps associated with delivery of the expandable body to an aneurysm and implantation.
[0040] FIGS. 4F-J are views of an embodiment of the medical device located in a vessel lumen and illustrating a sequence of steps associated with blocking or obstructing the lumen of a vessel segment.
[0041] FIGS. 5A-H are side and end views of the expandable body modalities of the medical device.
[0042] FIG. 6 is a plan view of an embodiment of the medical device delivery catheter.
[0043] FIGS. 7A-C are plan views of one modality of the medical device.
[0044] FIGS. 8A-E are views of a medical device modality illustrating a sequence of steps associated with delivery of the expandable body to an aneurysm and implantation.
[0045] FIGS. 8F-J are views of an embodiment of the medical device located in a vessel lumen and illustrating a sequence of steps associated with blocking or obstructing the lumen of a vessel segment.
[0046] FIGS. 9A-D are cross-sectional hemispheric views taken along a diameter of expandable body modalities.
[0047] FIG. 9E is a longitudinal section of the expandable body supported on a distal end of a delivery catheter, where the expandable body is spherical and can be employed as a modality of a ballstent.
[0048] FIG. 9F is a partial longitudinal section through the ballstent wall of FIG. 9 AND.
[0049] FIG. 9G is a longitudinal section of the expandable body supported on a distal end of a delivery catheter, where the expandable body is cylindrical with hemispherical ends and can be employed as a modality of a ballstent or blockstent.
[0050] FIG. 9H is a partial longitudinal section through the wall of the expandable body of FIG. 9G.
[0051] FIG. 9I is a longitudinal section of the expandable body supported on a distal end of a delivery catheter, where the expandable body is spherical and can be employed as a modality of a ballstent.
[0052] FIG. 9J is a partial longitudinal section through the ballstent wall of FIG. 9I.
[0053] FIG. 9K is a longitudinal section of the expandable body supported on a distal end of a delivery catheter, where the expandable body is cylindrical with hemispherical ends and can be employed as a modality of a ballstent or blockstent.
[0054] FIG. 9L is a partial longitudinal section through the wall of the expandable body of FIG. 9K.
[0055] FIGS. 10A-B are plan views of ballstent and blockstent, respectively, after insertion of an internal support structure.
[0056] FIGS. 11A-B are plan views of ballstent and blockstent modalities, respectively, in which the shape of the expanded body is being changed by the application of an external force using a balloon catheter.
[0057] FIGS. 12A-E are plan views of umballstent and blockstent modalities with a porous surface layer, facilitating tissue ingrowth into an aneurysm.
[0058] FIGS. 12F-I are plan views of umballstent and blockstent modalities with outer surface projections for anchoring the expanded body to surrounding tissues.
[0059] FIG. 13 is a plan view of a ballstent embodiment that has an elastomer joint.
[0060] FIG. 14A is a perspective view of an embodiment of an expandable body as compressed against a delivery catheter.
[0061] FIG. 14B is a perspective view of an embodiment of a compressed expandable body.
[0062] FIG. 14C is a perspective view of an embodiment of a compressed expandable body that defines an off-center channel.
[0063] FIG. 14D is a perspective view of an embodiment of a compressed expandable body.
[0064] FIGS. 15A-D are photographs depicting an exemplary form of folding and compressing an expandable body.
[0065] FIGS. 16A-B are cross-sections of catheter modalities of medical device delivery.
[0066] FIG. 17A is a plan view of an embodiment of the medical device with a lumen configured to accept a guide catheter rather than a guidewire.
[0067] FIG. 17B is a cross section of the device as taken along section line A-A in FIG. 17A.
[0068] FIG. 18 depicts a cross-sectional hemispheric view taken along a diameter of an expandable body modality and a portion of the delivery catheter.
[0069] FIG. 19 is a plan view of a component and a method for detaching an expandable body from a delivery catheter.
[0070] FIG. 20 is a plan view of a component and a method for detaching an expandable body from a delivery catheter.
[0071] FIG. 21A is a plan view of a component and a method for detaching an expandable body from a delivery catheter.
[0072] FIGS. 21B-C are cross sections taken along cut line B-B in FIG. 21A.
[0073] FIG. 22 is a plan view of a component and a method for detaching an expandable body from a delivery catheter.
[0074] FIGS. 23A-B are perspective views of partial cross-sections of an embodiment of the medical device in which the expandable body is attached to the delivery catheter, in which FIG. 23A depicts a compressed expandable body and FIG. 23B depicts an expanded expandable body.
[0075] FIGS. 24A-B are a perspective view and a longitudinal cross-sectional view, respectively, of modalities of the medical device delivery catheter where the delivery catheter has been advanced through the lumen of a guide catheter.
[0076] FIG. 25A is a perspective view of a partial cross-section of an embodiment of the medical device in which the expandable body neck is attached to the delivery catheter, an elastomeric sleeve supports the expandable body neck for the delivery catheter, and the expandable body is expanded.
[0077] FIG. 25B is a partial cross-sectional perspective view of an embodiment of the medical device in which the expandable body neck is attached to the delivery catheter with an elastomeric sleeve.
[0078] FIGS. 25C-D are plan views of an expandable body connected to a delivery catheter with an elastomeric sleeve.
[0079] FIGS. 26A-B are a perspective view and plan view, respectively, of an embodiment of the medical device in which the expandable body is attached to the delivery catheter with an adhesive that can be heated with a resistive heating element.
[0080] FIGS. 27A-B are plan view of an aneurysm filled by two ballstents and a blood vessel filled by two blocktents, respectively.
[0081] FIG. 28 is a perspective view of an arrangement for inflating or deflating an expandable body.
[0082] FIG. 29A is a plan view of an embodiment of the medical device in which the expandable body is attached to the delivery catheter with an adhesive and separated from the delivery catheter by electrolysis from a portion of the expandable body neck.
[0083] FIGS. 29B-F are cross-sectional and plan views of several delivery catheters.
[0084] FIG. 29G is a plan view of a catheter supporting one or more electrode rings.
[0085] FIGS. 29H-I are perspective and partial cross-sectional views of an expandable body attached to a delivery device.
[0086] FIG. 30A is a table providing exemplary dimensions for expandable body modalities when spherical in shape. Dimensions are provided by way of example and not limitation.
[0087] FIG. 30B is a table providing exemplary dimensions for delivery catheter, guidewire, and expandable body modalities when in the form of a blockstent having an intermediate cylindrical portion and hemispherical ends. Dimensions are provided by way of example and not limitation.
[0088] FIG. 31A illustrates various dimensions for an expandable body having a cylindrical middle portion and hemispherical ends.
[0089] FIGS. 31B-C illustrate various dimensions for a neck region of an expandable body.
[0090] FIG. 31D depicts various shapes for expandable bodies when in the form having an intermediate cylindrical part and hemispherical ends.
[0091] FIGS. 32A-C depict a sequence for electroforming an expandable body on a mandrel.
[0092] FIG. 33 depicts an embodiment of a mandrel for electroforming an expandable metallic body.
[0093] FIG. 34 depicts an embodiment of a mandrel for electroforming an expandable metallic body.
[0094] FIG. 35 is a partial cross section of an expandable metallic body produced by electroforming.
[0095] FIGS. 36A-D are photographs of various modalities of mandrel models and metallic expandable bodies formed there.
[0096] FIG. 36E shows an outer surface of an expandable metal body according to a modality.
[0097] FIGS. 37A-B respectively depict coatings on an outer surface and inner surface of an expandable metal body in the spherical shape of a ballstent.
[0098] FIGS. 37C-D respectively depict coatings on an outer surface and inner surface of an expandable metal body in the shape of a ballstent.
[0099] FIGS. 37E-H are multiple plan views and cross-sections depicting an exposed metal surface region in which the expandable metal body is removed from the delivery catheter by electrolysis.
[00100] FIGS. 38A-B are plan views of modalities of the ballstent medical device and the blockstent medical device, respectively.
[00101] FIG. 39 is a cross-sectional view of a hub for use with a ballstent or blockstent medical device, where detachment from the expanded body is accomplished by passing an electrical current to the medical device.
[00102] FIG. 40 is a top and side plan view of a handheld controller for use with the ballstent or blockstent medical device where detachment from the expandable body is accomplished by passing an electrical current to the medical device.
[00103] FIGS. 41A-C depict an expandable body folding and packaging tool.
[00104] FIGS. 42A-C depict a pin grommet assembly for use with an expandable body packaging and folding tool.
[00105] FIGS. 43A-B depict a metal ballstent in various stages of folding and packaging.
[00106] FIGS. 44A-B depict another tool for folding an expandable body.
[00107] FIG. 44C is a partial cross-sectional view of another tool for folding an expandable body.
[00108] FIGS. 45-47 are flowcharts illustrating the steps of manufacturing the expandable body, a delivery catheter and a medical kit containing a medical device, respectively. DETAILED DESCRIPTION
[00109] The present disclosure relates to a medical device, including a delivery device and an expandable structure or expandable body which may be referred to as a "ballstent" or a "blockstent", depending on the application in which the expandable body is used. The terms expandable body, expandable structure, expandable balloon, ballstent, and blockstent can generally be used interchangeably. Particular modalities of the expandable body may be referred to as a ballstent or blockstent according to the structure and/or use of the body.
[00110] The expandable body is a device similar to a stent, with thin walls, which can be expanded to a semi-rigid shape that can remain in the body for an extended period. Specifically, the expandable body, when acting as a ballstent, is configured for use in filling and sealing saccular aneurysms of blood vessels, especially cerebral saccular aneurysms and ruptured aneurysms. The expandable body, when acting as a blockstent, is configured for use in blocking or obstructing the lumen of segments of arteries, veins, and other biological conduits.
[00111] The delivery device is configured to deliver the ballstent to an aneurysm and to provide a path, through the lumen of a hollow cylindrical limb or lumen, for a fluid medium to move within the ballstent's void in an expanding manner. it and fill at least part of the volume of the aneurysm sac. Likewise, the delivery catheter can be configured to deliver a blockstent to a blood vessel segment and to provide a path, through a cylindrical limb or lumen, for fluid to move into the central void of the blockstent to expand and expand it. fill at least a portion of the lumen of the blood vessel segment. Expanding the expandable body, as used herein, can refer to the partial or complete expansion of the body using a fluid (ie, a liquid, gas, gel, or combination thereof) or a solid (ie, a solid body, a lattice, granular particles etc., or a combination thereof).
[00112] The expandable body can be formed by depositing a layer of metal onto a mandrel using an electroforming process. During the electroforming process, a metal ring, such as stainless steel or a gold ring, can be incorporated into the metal layer to create a collar for the expandable body. The mandrel may be a sacrificial mandrel which can be removed from the expandable body after electroforming to produce a hollow metallic expandable body.
[00113] The expandable hollow metallic body undergoes one or more annealing processes. The inner and outer surfaces of the expandable metallic body may be coated with a non-metallic material such as a polymer or an electrically insulating material. The expandable metallic body may be annealed before and after the expandable coated metallic body has been forced into a deliverable (ie, collapsed or non-expanded) folded or pleated configuration.
[00114] The expandable metal body can be folded into a deliverable configuration for insertion into a segment of blood vessel or aneurysm. When folded into the deliverable configuration, the expandable metal body is formed from a pleated configuration, having a number of pleats, which can be wrapped around a central axis of the expandable metal body.
[00115] When used to fill an aneurysm, the delivery device and an attached ballstent are advanced into the lumen of the aneurysm sac. Likewise, when used to occlude a blood vessel or other biological conduit, the delivery device and an attached blockstent are advanced into the lumen of the vessel or conduit. The delivery device can also deliver a liquid, solid or a combination thereof, into the interior void space of the expandable body to expand the body into the lumen of the vessel segment or sac of the aneurysm and to help maintain expansion of the expanded body. The expanded body may be detached from the delivery device by one or more of a variety of arrangements and methods, including mechanical, electrical, thermal, chemical, hydraulic or sonic methods and arrangements.
[00116] The medical device can be used as part of various medical systems, methods and kits. These medical systems, methods, and kits can be used to treat saccular arterial aneurysms, such as a cerebral saccular aneurysm, and to occlude a blood vessel or other biological conduit, such as an arterial duct, bronchus, pancreatic duct, bile duct, ureter, and tube. Fallopian. Alternatively, these medical systems, methods and kits can be used to treat a variety of medical conditions. THE EXPANDABLE BODY
[00117] In various embodiments, an expandable body configured for saccular cerebral aneurysm obstruction is generally referred to as a ballstent and may be spherical, oblong, or cylindrical in shape with rounded ends. In various embodiments, an expandable body configured to occlude the lumen of blood vessel segments is commonly referred to as a blockstent and may have an oblong or cylindrical shape.
[00118] A ballstent 100 is shown in FIG. 1A in an expanded state. This embodiment has an outer proximal neck 116 that defines an opening 112 for the passage of fluids, liquids, gases, gels or solids within the void space of the ballstent. Another embodiment of the spherical ballstent 100 is shown in FIG. 1B in an expanded state. This embodiment has an inner proximal neck 116 that defines an opening 112 for the passage of fluids, liquids, gases, gels or solids within the void space of the ballstent. Other embodiments of the expandable body, i.e., a blockstent 150 are shown in FIGs. 1C-1F, wherein the blockstent 150 is cylindrical with substantially planar opposite ends and has an outer proximal neck 116 (FIG. 1C) or an inner proximal neck 116 (FIG. 1D). FIGS. 1E-1H depict expandable bodies that can be used as 100 ballstents or 150 blockstents with external or internal proximal necks 116.
[00119] Another spherical modality of ballstent 100 is shown in FIG. 5A in an expanded state. This embodiment has an outer proximal neck 116 that defines an opening 112 for the passage of fluids, liquids, gases, gels or solids within the void space of the ballstent. This embodiment also has an outer distal neck 118 that defines an opening 114 for passage of a guidewire 302. Another spherical embodiment of ballstent 100 is shown in FIG. 5B in an expanded state. This embodiment has an inner proximal neck 116 that defines an opening 112 for the passage of fluids, liquids, gases, gels or solids within the void space of the ballstent. In addition, this embodiment has an internal distal neck 118 that defines an opening 114 for passage of a guidewire 302. In other embodiments, the ballstent can be constructed without a neck; such that the ballstent has at least one opening 112 or 114 without any wall structures that protrude away from or into the ballstent. FIGS. 5E and 5H depict expandable bodies that can be used as 100 ballstents or 150 blockstents with external or internal proximal necks 116.
[00120] Finally, the expandable metallic bodies disclosed in this document can have a variety of configurations and any of the configurations can be employed for a variety of uses, including obstruction of aneurysms and segments of biological conduits, including arteries and veins. Generally speaking, some settings can lend themselves more easily or effectively to one application or another. For example, the spherical expandable bodies 100 of FIGs. 1A-B and 5A-B may be advantageous when acting as a ballstent to fill the lumen (or empty space) of a saccular aneurysm, and the elongated expandable bodies 150 of FIGs. 1C-F and 5C-F may be advantageous when acting as a blockstent to occlude the lumen of a segment of a biological conduit.
[00121] The expandable metal body, such as the 100 ballstents or blockstents of FIGs. 1A-F and 5A-F, can be composed of a single continuous layer or wall 102, as indicated in FIG. 9A. Wall 102 includes a material, preferably a metal that is biocompatible and ductile, that can form a thin-walled construction and can assume a variety of shapes upon expansion. By way of example and not limitation, the metal may be selected from the group consisting of gold, platinum, silver, nickel, titanium, vanadium, aluminum, tantalum, zirconium, chromium, silver, magnesium, niobium, scandium, cobalt, palladium , manganese, molybdenum, and their respective alloys and combinations. Preferred metals include gold, platinum and silver, their alloys and combinations. Expandable bodies can also be made of alternative materials that can be formed into thin-walled structures that are sufficiently rigid or semi-rigid to tolerate compression and expansion and can maintain an expanded state in vivo. Alternative materials include polymers or plastics that are reinforced with metal braids or coils and other materials with similar properties. The materials forming wall 102 and wall thickness are selected such that the expandable body 100 or 150 has sufficient rigidity to remain in an expanded state in vivo under typical physiological conditions after expansion and separation of the delivery catheter, even where the pressure in and out of the central void or space 108 is the same or similar.
[00122] It is desirable that the materials used that form and support the expandable body 100 or 150 have sufficient mechanical properties of ductility, malleability and plasticity to be compressed or folded without tearing and later expanded without breaking. In general, ductility is a measure of a material's ability to deform without breaking, while the malleability of the material determines the ease of deformation without breaking when the metal is subjected to forces or pressure. Ductility and malleability influence the plasticity of the material, which generally refers to a property of the material that allows it to undergo a permanent change in shape without breakage or breakage. As such, the expandable bodies can be composed of any biocompatible materials having sufficient ductility, malleability and plasticity to undergo one or more compressions, folding processes and expansions.
[00123] The central layer 122 of wall 102 has an inner surface 106 and outer surface 124 that define a wall thickness 120. In particular, for FIGs. 9A and 9B, the distance between inner surface 106 and outer surface 124 is the overall wall thickness 120 of wall 102. Preferably, central layer 122 of wall 102 has a thickness 120 of from approximately 3 µm to about 50 µm and preferably it is approximately 10 µm thick. Wall thickness 120 can be uniform. For example, wall 102 can have a uniform thickness of 3 µm, 5 µm, 10 µm, 15 µm, 20 µm, 30 µm, 40 µm or 50 µm. Alternatively, the thickness of wall 102 at different locations may vary in thickness. Alternatively, expandable body 100 or 150 may be composed of a single porous layer or wall 122, as indicated in FIG. 9B, with pores or microperforations 1300 where at least some or all of the microperforations extend from inner surface 106 to outer surface 124. For this embodiment, wall 102 may be of uniform thickness or of varying thickness. During expansion of the ballstent 100 in this embodiment, the fluid medium can travel under pressure from the void or space 108, through the wall 102, and leave the ballstent on the outer surface 124. Preferably, for this embodiment, the microperforations 1300 can range from 1 µm - 500 µm in diameter.
[00124] The expandable body 100 or 150 includes a central wall or layer 122, optionally with an outer wall or layer 104, and optionally with an inner wall or layer 214, as indicated in FIG. 9C. As mentioned, the construction of the central layer or wall 122 and the layers 104 and 214 can be uniform, porous, or combinations thereof. In one embodiment of ballstent 100 used to treat the aneurysm, wall 102 includes a plurality of microperforations 1300 that extend completely through thickness 120 of wall 102.
[00125] In a construction, the central layer or wall 122 is continuous and formed from gold. Optionally, for this preferred construction, an outer layer 104 formed of porous gold can be added. Optionally, an inner layer 214 formed from Parylene™ can be present. Optionally, an outer layer 104 formed from Parylene™ can be present. In certain modalities where electrolysis is used to separate the expanded expandable body 100 or 150 from the delivery catheter, certain parts of the ballstent or blockstent (such as the neck or body) are coated with an insulator or polymer, such as Parileno™. These parts include the outer surface, the inner surface, or both the inner and outer surfaces, while a portion of the neck or body remains uncoated or uninsulated. In this case, the uncoated or uninsulated part of the wall is dissolved (eroded) by passing an electrical current to the uncoated or uninsulated region of the wall during electrolysis. In certain embodiments, uncoated or uninsulated parts of the wall are created by masking during the coating process. In other embodiments, the coating or insulation is removed by the uncoated or uninsulated parts of the wall, such as through etching or ablation, such as with laser ablation or laser etching. THE OUTSIDE EXPANDABLE BODY
[00126] As discussed, expandable body 100 or 150 may have one or more additional layer(s) or coating 104 on outer surface 124 of central layer 122, as indicated in FIG. 9C. Wall 102 and any additional outer layers define an outer surface 110 which, when expanded, contacts the inner wall of the blood vessel or aneurysm. The outer layer 104 can be of a uniform or varying thickness, preferably between about 1 µm and about 59 µm. In one embodiment, the outer layer 124 has a thickness between 0.1 µm and 10 µm. In a specific embodiment, the outer layer 124 has a thickness of about 1 µm.
[00127] The outer layer 124 can be formed from polymers, elastomers, latex or metals. The outer layer 124 may be an electrical insulator, and in a preferred embodiment, the outer layer 124 is formed of a coating of Parylene™. The outer shell or layer 104 of the expandable body 100 or 150 may be porous and contain a plurality of pores 200, as shown in FIGs. 9C and 9D. Alternatively, outer layer 104 can be smooth, with limited porosity or projections. For example, the outer layer 104 can be a polished metal surface. In one embodiment, parts of outer layer 104 may be smooth, while other parts may be porous or contain projections. In one embodiment, surface variations can include a pattern. FIG. 36E depicts outer surface structures 110 after electroforming. As shown, the outer surface 110 of wall 102 may have rounded, stony or granular structures. In various embodiments, rounded, stony or granular surface structures have a height of approximately 0.1 µm to about 10 µm.
[00128] When configured as a porous or spongy layer, the outer layer 104 may contain (or be configured to contain) solutions that include pharmaceutical drugs, pharmacologically active substance molecules or pharmaceutical compositions within pores 200. As such, solutions such as drugs pharmaceuticals, molecules of pharmacologically active substances or pharmaceutical compositions can be delivered to the treatment site. Drugs, pharmacologically active substance molecules or pharmaceutical compositions that promote thrombosis, stimulate cell proliferation or extracellular matrix production, or tissue growth, are examples of agents that can be placed in the pores 200 of the outer layer 104. Pharmaceutical drugs, molecules of pharmacologically active substances or pharmaceutical compositions are incorporated into the pores 200 of the outer wall or layer 104 before positioning the expandable body 100 or 150 in the desired location. The drug compositions can be delivered to the pores 200 via capillary action or overflow. Pores 200 range from about 0.01 µm to about 500 µm in diameter. Pore diameters for each expandable body can vary according to the specific drugs, pharmacologically active molecules, or pharmaceutical compositions that are to be incorporated and the desired rate of release in vivo. By way of example and not limitation, the expandable body 100 or 150 may have a porous outer layer 104 where the pore diameter averages from 0.01 µm to about 0.05 µm, to about 0.05 µm to about 0.5 µm, 0.5 µm to about 5 µm, about 5 µm to about 25 µm, about 25 µm to about 500 µm, about 0.05 µm to about 500 µm, or about from 0.01 µm to about 500 µm.
[00129] Pharmaceutical drugs, pharmacologically active molecules, or pharmaceutical compositions may include thrombin, platelet-derived growth factor, Ethiodol®, Sotradecol® or combinations thereof. Other pharmaceutical compounds and compositions that promote thrombosis, stimulate cell proliferation, stimulate extracellular matrix synthesis, or tissue growth in the porous outer wall of the expandable body 100 or 150 may also be used. Such drugs or pharmaceutical compositions can include molecules to promote cell proliferation, extracellular matrix production, or tissue growth, such that the expanded expandable body 100 or 150 will become more firmly attached to tissue at the site of treatment. Dosages and the manner in which pharmaceutical drugs, pharmacologically active molecules or pharmaceutical compositions are incorporated into wall 102 or outer layer 104 are a matter of choice, depending on the treatment performed. Other compounds can be used to promote blood clotting or thrombosis around the expandable body. For expandable body 100 or 150 modalities with a porous layer 104, over time, the ballstent or blockstent continues to expand within the expanded body, eventually becoming apposed to the surrounding tissue.
[00130] As can be understood from FIGs. 12A-D, the outer surface 110 of the expandable body 100 or 150 may also include one or more projections (which may generally be tubular or have other configurations) that may increase the strength of apposition of the expanded body to adjacent tissue and thus reduce the risk of movement or migration. The projections can range in length from about 0.01 µm to about 167 µm. Some projections may have a branched construction, while others may be joined at both ends to outer surface 110 to form rim shapes. In some modalities, the projections are rigid or semi-rigid. In other embodiments, the projections are flexible and hair-like, and may further include globular ends, similar to the protrusions on the surface of the gecko's paw. The projections can be attached to the expandable body 100 or 150 after forming. Alternatively, or additionally, the projections can be incorporated into the expandable body during electroforming.
[00131] Projections are features designed to hold the expandable body 100 or 150 in place once it has been expanded into the lumen of a blood vessel segment or aneurysm sac. These resources can be biological or physical or a combination of these. In one embodiment, the outer surface 110 of expandable body 100 or 150 can be coated with molecules that can bind to adjacent thrombus or tissue. These molecules can be attached to the expandable body 100 or 150 through a variety of methods, including chemical bonds such as hydrogen or covalent bonds. Alternatively, these molecules can be fixed through encapsulation of the porous layer or encapsulation of the various projections. Representative molecules that can be affixed to the wall of ballstent 100 or blockstent 150 include fibrin and molecules that can bind fibrin through covalent and non-covalent binding. With such a liner, the expandable body 100 or 150 can be anchored in the fibrin-rich clot that forms between the aneurysm wall and ballstent 100, or between the wall of a blood vessel segment and blockstent 150.
[00132] In another embodiment, the ballstent 100 may comprise an outer porous layer or wall 104 or a wall with external projections to promote thrombus formation on the outer surface 110 or pores 200 and promote cell proliferation, extracellular matrix production or tissue growth on or around wall 102 of ballstent 100 such that ballstent 100 will, over time, become more tightly attached to tissue on the adjacent wall of the aneurysm.
[00133] As shown in FIGS. 12A-D, central layer 122 and outer porous layer 104 of ballstent 100 placed in aneurysm 700 can be configured to promote thrombus formation 1206 in the outer layer. Thrombus may be composed of red blood cells 1208, platelets 1210, and fibrin 1212. Over time, thrombus 1206 may be partially absorbed into outer layer 104 as new endothelial cells 1214 form over the thrombus. The new endothelial cells can form a connective tissue seal 1216 through the opening of the aneurysm 700. In addition to sealing the opening of the aneurysm 700, the connective tissue 1216 from the wall 704 of the aneurysm can grow to the porous outer layer 104 of the ballstent 100 to make the ballstent adheres to the wall of the aneurysm as indicated in FIG. 12E.
[00134] In other embodiments, the projections may be generally tubular, straight, curved, hook-shaped or configured as threaded hooks 1800 as shown in FIGS. 12F-G. The projections can improve the fixation of blockstent 150 within a blood vessel, as illustrated in FIGS. 12H-I. In another embodiment, the outer surface 124 or 110 of the expandable body 100 or 150 further comprises one or more projections therefrom that can be used to anchor the expandable body 100 or 150 to surrounding tissue, specifically to the wall of a saccular aneurysm or a biological conduit such as an artery or vein, and keep the body expandable in the desired location. In a macroscopic form, the projections can be composed of nitinol or any other suitable biocompatible material.
[00135] FIG. 12G depicts a 100 expanded ballstent that is anchored to the 704 wall of the 700 aneurysm. The size and shape of the projections can be selected based on the condition being treated and can be designed and sized to provide sufficient anchoring support without causing excessive damage to the aneurysm wall. aneurysm or surrounding tissue. Alternatively, microscopic filaments or projections can be used to anchor the ballstent. For some modalities, these microscopic projections range in length from 0.01 µm to approximately 57 µm and can be straight or branched. In various embodiments, both ends of one or more of the projections can be attached to the outer surface 110 of the ballstent 100 and/or the outer surface 216 of the wall 102 to form a rim. Similarly, Fig. 12H depicts an expanded blockstent 150 with threaded hooks 1800, while FIG. 12I depicts an expanded blockstent 150 that is anchored to the wall 1802 of an 1804 blood vessel. THE INTERIOR OF THE EXPANDABLE BODY
[00136] In some embodiments, the expandable body 100 or 150 may include an additional liner or layer 214 on the inner surface 106 of the central layer 122, as shown in FIGS. 9D, 9F, 9H, 9J and 9L. The inner layer can be made of the same material as the core layer, or it can be made of different materials. The inner layer can be formed from gold, platinum, silver, alloys or combinations thereof. The additional layer 214 on the inner surface 106 of the central layer 122 of the expandable body 100 or 150 may also be formed of a polymer, plastic, latex, rubber, woven or mesh fiber material, metal, or other material, or combinations thereof. . Preferably, inner layer 214 is an elastomeric coating that is adhered to inner surface 106 of central layer 122. Inner layer 214 can be of a variety of thicknesses, preferably ranging from 0.1 µm to about 59 µm. In one embodiment, inner layer 124 has a thickness between about 0.1 µm and about 10 µm. The total thickness of wall 102, including central layer 122, outer layer 104 and inner layer 214 is preferably between about 2 µm and about 50 µm, regardless of whether the wall contains one, two, three or more layers. Inner layer 214 can be composed of polymers, latex or elastomers. In a preferred embodiment, inner layer 214 is composed of Parylene™. Inner layer 214 also adds mechanical properties (such as strength) to wall 102. In addition, inner layer 214 optionally can form a seal that prevents leakage of a fluid medium from expandable body 100 or 150, if central layer 122 contains a defect or hole. The central layer 122 and any additional layers define an interior surface 106 or 218, respectively, such that when the ballstent or blockstent is expanded, with a fluid, liquid, gas or solid, a central void or space 108 is defined. As shown in FIG. 9D, the distance between the inner surface 218 and the outer surface 110 is the overall wall thickness 120 of the wall 102. THE EXPANDABLE BODY COLLE(S) AND OPENING(S)
[00137] As illustrated in Figs. 1A-H and Figs. 5A-H, ballstent 100 and blockstent 150 have one or more apertures 112 and 114 defined by wall 102 or by one or more collars 116 and 118. In various modalities, ballstent or blockstent has one or more apertures 112 and 114 defined by necks 116 or 118 (see FIGS. 1A, 1C, 1E, 1G, 5A, 5C, 5E and 5G) or one or more openings 112 and 114, but not having necks 116 or 118 (see FIGS. 1B, 1D, 1F , 1H, 5B, 5D, 5F and 5H). In all embodiments, a fluid medium can enter opening 112 and move into the empty center or space 108 defined by interior surface 106 or 218, thereby expanding the expandable body. In various embodiments, one or both of the necks 116 and 118 may extend outside their respective end region of ballstent 100 and blockstent 150, as shown in FIGS. 1A, 1C, 1E, 1G, 5A, 5C, 5E and 5G. Alternatively, one or both of the collars 116 and 118 may extend inwardly from their respective end region and toward the interior void 108, as illustrated in FIGS. 1B, 1D, 1F, 1H, 5B, 5D, 5F and 5H. The proximal necks 116 can be used to secure the expandable body 100 or 150 to the delivery catheter and can function to separate the ballstent or blockstent from the delivery catheter. In various embodiments, necks 116 and 118 and wall 102 can be formed of different metals. For example, in one embodiment, the neck(s) 116 and 118 and the wall 102 may be formed of gold. In various embodiments, collars 116 and 118 can comprise stainless steel and wall 102 can be formed of gold, platinum, or other malleable metal. Necks 116 and 118 may include various metals, such as stainless steel and another metal such as gold or platinum, including embodiments in which various regions of expandable bodies 100 and 150 are distinct in their metal content and embodiments in which the different metals are formed in layers in the different regions.
[00138] In addition, the necks 116 and 118 can be designed and sized such that the opening 112 or 114 can be closed or partially closed before, during or after separation of the expanded body from the delivery catheter. One or more openings 112 or 114 may remain open. Optionally, before, during, or after separation, the necks 116 and 118 can be folded, secured, or closed to form a seal. Necks 116 and 118 have a length N1 as shown in FIGS. 31A and 37E, ranging between about 0.5 mm and about 20 mm, preferably a length between about 0.5 mm and 5 mm. In one embodiment, the neck length N1 is approximately 1.27 mm ±. 08 mm.
[00139] The necks 116 and 118 have an outside diameter N2 and an inside diameter N3 which define the openings 112 and 114, respectively. The outside diameter N2 is in a range between about 0.25 mm and about 2 mm and the inside diameter N3 is in a range between about 0.24 mm and about 1.95 mm, as indicated in FIG. 37F. In one embodiment, the collar N2 outer diameter is approximately 0.99 mm ± 0.01 mm and the collar N3 inner diameter is about 0.89 mm ± 0.01 mm.
[00140] The thickness of the walls of one or both of the 116 and 118 necks may be the same as the main body of the ballstent or the blockstent or may be thinner or thicker than the wall of the main body. Preferably, one or both of the necks 116 and 118 has a wall thickness N4 between approximately 3.0 µm and about 60.0 µm, as indicated in FIG. 37H, which is a closer view of region B of FIG. 37F. In a given modality, the neck has a thickness of approximately 50.0 μm. In an embodiment of ballstent 100, where the neck(s) 116 and 118 extend into the central void 108 as indicated in FIGs. 1B and 5B, the outer surface 110 of the expanded ballstent retains a more rounded surface contour to increase the strength of the expanded ballstent and to reduce the risk of damage to the aneurysm wall or adjacent tissue during placement of the ballstent.
[00141] One or both of the necks 116 or 118 may be coated or insulated on the inner wall, outer wall, or both. In some embodiments, a strip of conductive material, including an uncoated or uninsulated section of a weld, or part of the ballstent or blockstent itself, is left exposed, uncoated, or uninsulated, or further exposed after coating to form a exposed metal surface in the form of a ring or conductive materials that can be subjected to electrolysis to achieve separation between the expanded expandable body and the distal end of the delivery device. For example, as can be understood from FIGs. 9E, 9G, 9I, 9K, 35 and 37A-37D, in one embodiment, at least a portion of an inner surface of the neck metal layer of the expandable metal body is electrically insulated based on having an outer surface of a distal portion of the delivery device, extending along the inner surface of the metal layer of the neck of the expandable metal body. For the inner surface of the neck 116, a proximal edge of the exposed ring-shaped metal surface may be defined by a distal edge of the delivery device in the region of the neck and a distal edge of the exposed ring-shaped metal surface may be defined by a boundary of the inner insulation layer in the neck region. For the outer surface of the neck 116, both the proximal and distal boundaries of the exposed ring-shaped metal surface may be defined by a boundary of the outer insulating layer in the region of the neck. In such an embodiment, the distal end of the delivery device distally may terminate near a proximal edge of the exposed ring-shaped metal surface of the neck. As indicated in FIG. 29A, a lead wire may be coupled to electrical contact with the uncoated or uninsulated portion of the weld, or to the expandable body 100 or 150 to allow the uncoated or uninsulated portion to be dissolved (corroded) or removed through electrolysis.
[00142] In other embodiments, both collars 116 and 118 may be incised to create a number of circumferential perforations 2406, as shown in FIG. 22. The perforations can be broken to disengage the expandable body from the delivery device, as explained in more detail below in relation to methods for disengaging an expandable body 100 or 150. SHAPES AND DIMENSIONS OF THE EXPANDABLE BODY.
[00143] FIGS. 9E-9F and 9I-9J illustrate a ballstent 100 and catheter 220 that can be used to deliver the ballstent. The ballstent 100 includes a distal region 202 that includes the distal end 204 of the ballstent. Adjacent to distal region 202 is an intermediate region 206 where the ballstent transitions from distal region 202 to a proximal region 208 that includes a proximal end 210 of the ballstent. The proximal region 208 is generally opposite the distal region 202. A central axis 212 extends proximally-distally between the proximal region 208 and the distal region 202. The ballstent wall 102 extends in a general continuous fashion across the intermediate region 206, from distal region 202 to proximal region 208. Ballstent 100 is in the form of a single lobulated expandable metallic body.
[00144] In one embodiment, when ballstent 100 is expanded, the intermediate 206, proximal 208, and distal 202 regions combine to form a generally spherical shape. In various modalities, the dimensions of ballstents 100 are selected based on the size and shape of the saccular aneurysm being treated. Preferred shapes of ballstent 100 include round, oblong, and irregular. The diameter of the expanded round ballstent 100 ranges from about 2 mm to about 30 mm and preferably has an expanded diameter ranging from about 2 mm to about 20 mm. The expanded length of oblong ballstents preferably ranges from about 2 mm to about 30 mm. The ballstent 100 can have an expanded volume ranging from about 0.001 cc to about 65 cc. In preferred embodiments, the expanded diameter of spherical ballstent 100 ranges from about 2 mm to about 10 mm, while the reference expanded volume ranges from about 0.004 cc to about 40 cc. In preferred embodiments, the expanded length of the oblong ballstent 100 ranges from about 2 mm to about 30 mm. By way of example and not limitation, FIG. 30A provides exemplary dimensions for a modality of the 100 spherical ballstent.
[00145] FIGS. 9G-9H and 9K-9L illustrate a 150 blockstent and 220 catheter that can be used to deliver the blockstent. In such an embodiment, blockstent 150 includes a generally cylindrical intermediate region 206, a generally hemispherical proximal region 208, and a generally hemispherical distal region 208. In the present embodiment, the intermediate region 206 may have a radius R1 that is equal to the radius R2. of proximal region 208 and distal region 208, as indicated in FIG. 31A. In various embodiments, catheter 220 is typically coupled to proximal region 208 of the expandable body.
[00146] In other embodiments, one or more parts of the wall of the expandable body 102 may be thicker than the remaining parts of the wall. By way of example and not limitation, the wall in the middle of the expandable body body may be thicker or thinner than the wall in the proximal and distal parts of the expandable body, or the wall of a neck may be thicker or thicker. thin than the main body of the expandable body. In various embodiments, wall thickness 120, as shown in FIGS. 9A-D, can be sized relative to the total diameter of the expandable body to avoid unwanted increases in wall tension with increasing diameter. In various embodiments of the expandable body 100 or 150, a balance must be struck between a wall thickness 120 that is thin enough to allow for the various different compressed shapes of the delivery configuration and to allow expansion of the expandable body at lower and lower pressures. a wall thickness that is thick enough to resist compression upon delivery and peeling. Therefore, the average wall thickness 120 is preferably in a range between approximately 10.0 µm and approximately 50.0 µm. By way of example and not limitation, the wall thickness 120 for an expandable body 100 or 150 with an expanded diameter of about 4.0 mm may be approximately 10.0 µm, while the wall thickness for an expandable body with an expanded diameter of about 10.0 mm can be approximately 25.0 µm.
[00147] As shown in FIG. 31A, blockstent 150 can have a generally cylindrical shape with rounded or hemispherical ends. In other embodiments, blockstent 150 may have a generally cylindrical shape with flat or flat ends, as shown in FIGS. 9H and 9K, such that the total length of the blockstent is approximately equal to the length of the intermediate region 206. The blockstent 150 is in the form of a single lobulated expandable metal body.
[00148] The near-right angle formed between the intermediate region 206 and the distal end 204 and between the intermediate region 206 and the proximal end 210 can create a concentration of stresses that can affect the overall structural strength of the blockstent. To reduce stress concentration, the intersections 205 and 207 of the intermediate region 206 with the distal and proximal ends 204 and 210, respectively, have a radius R3 (See FIG. 31A). As R3 increases, the stress concentration at intersections 205 and 207 is reduced. On the other hand, if R3 is too large, subsequent changes to the geometry of the distal and proximal hemispherical ends 202 and 208, respectively, can compromise the structural strength of the blockstent. Therefore, an ideal configuration of blockstent 150 includes intersections 205 and 207, having a radius R3 that is limited to less than about 10-20% of the radius R2 (See FIG. 31A) of the distal and proximal hemispheric ends 202 and 208.
[00149] In various embodiments, blockstent 150 has an expanded diameter ranging from about 2 mm to about 30 mm. Assuming no change in wall thickness 120, the wall tension of expandable body 100 or 150 will increase as radius R1 (See FIG. 31A) of intermediate region 206 increases. Therefore, in some embodiments, the diameter of blockstent 150 is limited by the ultimate tensile strength of the material (eg, gold) used to form the blockstent and the pressure required to expand the compressed blockstent. As can be understood from FIGs 31A, blockstent 150 can have an expanded length L1 of between about 2 mm to about 120 mm. Preferably, the length is from about 5mm to about 60mm, and in a particular embodiment the expanded length L1 is approximately 40mm ± 0.03mm and the length L2 of the intermediate region 206 may be approximately 24mm ± 0.03 mm. FIG. 31D depicts a variety of 150A-D oblong blockstents representative of various modalities.
The stress concentration between the neck 116 and the proximal end 208 of the expandable body 100 or 150 can be reduced or compensated for by increasing the radius R4 between the neck and the proximal end, as shown in FIGS. 31B-C. For example, the stress experienced by wall 102 in FIG. 31B with a radius of R4 is greater than the voltage experienced by the wall in FIG. 31C with a radius of R4', where R4' is greater than R4. In addition, stress can be concentrated at the point where the neck 116 transitions to the proximal end wall 208 of the expandable body 100 or 150 due to a metal ring incorporated in the neck 116 during formation of the expandable body. This stress concentration can be alleviated by reducing the overall wall thickness N4 of neck 116. By way of example and not limitation, neck 116 shown in FIG. 31B can have an N4 wall thickness of approximately 25.0 µm, while the neck indicated in FIG. 31C can have an N4' wall thickness of approximately 12.5 µm. EXPANSION OF THE EXPANDABLE BODY
[00151] The central void or space 108 of expandable body 100 or 150 may be filled with gels, solids, fluids or combinations thereof to expand or inflate expandable body 100 or 150. The terms expand, inflate, and their shapes may be used interchangeably to refer to the action of changing the expandable body from the delivery configuration to an expanded or at least partially expanded configuration. A fluid medium is a substance having particles that easily move and change their relative position without mass separation. Fluid media that can be used to expand expandable body 100 or 150 include gases, liquids, gels and combinations thereof. By way of example and not limitation, the fluid medium may be water, a saline solution, a radiographic contrast solution or a mixture thereof. In one embodiment, the fluid medium can further include a solution or suspension of a drug, pharmacologically active molecules or a pharmaceutical preparation.
[00152] In various embodiments, the shape and multilayer construction of the expandable body 100 or 150 allows the expandable body to remain in an inflated or expanded configuration without the use of any non-patient-derived support structures. For example, the fluid medium used to inflate the expandable body 100 or 150 and, optionally, the patient's blood, will fill the interior void 108 and make the ballstent or blockstent remain in an expanded configuration. In addition, patient-derived support structures, including but not limited to blood clots and tissue ingrowths, can support and maintain the structural integrity of the expanded ballstent 100 or blockstent 150.
[00153] In one embodiment, microperforations 1300 also help maintain the structural integrity of the expandable body 100 or 150 when treating an aneurysm, by allowing fluid to pass through the wall 102 of the expandable body, thus maintaining a balance of pressure between the interior void 108 and the exterior environment of the expandable body. Microperforations 1300 can also help maintain the structural integrity of the expandable body 100 or 150 when treating an aneurysm, allowing tissue growth to pass through the wall 102 of the expandable body, thus maintaining a firm attachment between the expandable body and the adjacent tissue. Such microperforations may be advantageous in some embodiments of ballstent 100. Conversely, in some embodiments of blockstent 150, microperforations 1300 may be disadvantageous as allowing fluid components of blood to pass through the 102 wall of the blockstent may prevent blockstent 150 from completely occluding the desired blood vessel or conduit.
[00154] In another embodiment, the shape of an expanded expandable body 100 or 150 is maintained by placing solid structures of material or support in the central void space or space 108. Examples of such solid material include metal or polymeric wires or coils, structures metal or polymeric support solids, bioresorbable materials, radially expandable materials, granules, particles, spheres, microspheres. In certain embodiments, these solid materials can also be used to help expand expandable body 100 or 150. In other embodiments, these solid materials are added after expansion. In one embodiment, as shown in FIG. 10A, aneurysm 700 within blood vessel 1202 is filled with a ballstent 100 containing at least one expandable coil or wire 1204. In another embodiment, as shown in FIG. 10B, lumen 1202 of blood vessel segment 720 is filled with a blockstent 150 containing at least one expandable coil or wire 1204. In one aspect, expandable body 100 or 150 can be expanded by expandable coil or wire 1204 only. In other aspects, the expandable body 100 or 150 can be expanded by a fluid medium, and solid materials can be added later to provide support to maintain the expanded shape of the expandable body, or vice versa. Other suitable solid biocompatible materials can also be used. The solid fill members can function as a framework to ensure the structural integrity of the expandable body 100 or 150. For example, coil 1204 can promote the structural integrity of the expandable body 100 or 150 and reduce the compression of the expandable body 100 or 150. In one embodiment, solid material can be designed and manufactured to be compatible with an expandable body of a particular size or shape and can be packaged as part of the medical device for use with the packaged expandable body.
[00155] In the event that the expandable body 100 or 150 is not properly sized or positioned for the desired treatment, the expandable body may be intentionally retracted and recaptured. In one embodiment, where the expandable body 100 or 150 is still attached to the delivery catheter, negative pressure can be generated within the delivery catheter to aid in the retraction of the expandable body. In this mode, the expandable body 100 or 150 will be retracted due to the vacuum pressure alone.
[00156] In other embodiments, additional efforts are required to retract the expandable body 100 or 150 after deployment due to the inherently stable geometry of the expandable body. Additionally, structural features can be incorporated into the expandable body 100 or 150 to facilitate intentional collapse. For example, a series of vertical grooves can be created in expandable body 100 or 150 during the electroforming process to create geometric stress concentrations that encourage recoil under sufficient vacuum pressure. Another example is to coat the expandable body 100 or 150 with a thick polymer coating and remove most of the thick polymer coating by laser etching to leave a series of "ribs" along the outer surface 110 of the expandable body 100 or 150. The ribs can be formed laterally or longitudinally around the expandable body 100 or 150.
[00157] In other embodiments, one or more tools designed to retract the expandable body 100 or 150 may be used. In one example, an elongated tubular retract tool having a number of outwardly biased or slanted "fingers" may be inserted into a guide catheter. The fingers are retracted inward when the recoil tool is inserted into the guide catheter and over the delivery catheter. When the recoil tool exits the distal end of the guide catheter, the fingers snap radially outward and surround the expandable body 100 or 150. The recoil tool is retracted back into the guide catheter so that the fingers engage and compress and deflate the expandable body 100 or 150. A vacuum may also be applied throughout the process to encourage retraction of the expandable body 100 or 150. THE EXPANDABLE BODY IN USE
[00158] Advantageously, as illustrated in FIG. 11A, ballstent 100 can be delivered to lumen 701 of a saccular aneurysm 700, expanded, and then detached from delivery catheter 300, such that the delivery catheter can be removed while the expanded ballstent remains in place, filling a portion, substantially all, or the entire lumen of the aneurysm in an expanded state. The expanded ballstent 100 will normally conform to the shape of the saccular aneurysm cavity in which it is placed. Expanded ballstent 100 can also be molded with external force, such as a physical force applied by the inflated balloon portion 1102 of an adjacent balloon catheter 1100, as indicated in FIG. 11A. With precise positioning and molding, the ballstent 100 can be positioned in such a way that the 701 aneurysm lumen or cavity is completely or substantially filled and sealed, and furthermore with nothing of the ballstent, or a minimal amount of ballstent, to extend to the lumen of the vessel of origin 1202 from which the aneurysm formed. In another embodiment, expanded blockstent 150 may also be molded with external force, such as a physical force applied by the inflated balloon portion 1102 of an adjacent balloon catheter 1100, as indicated in FIG. 11B.
[00159] In a treatment modality of a saccular aneurysm, multiple shapes of expanded ballstent are acceptable as needed to treat saccular aneurysms of various shapes, including circular, oblong, and irregular, contact that the shape is usually rounded and the expanded ballstent includes a single lobe. Regardless of the shape formed, when a ballstent is expanded into the lumen or cavity 701 of a 700 aneurysm sac, in one modality, the ballstent is designed to conform, at least partially, to the shape of the cavity.
[00160] Research suggests that the presence of an intact endothelium correlates with the expansion of the lumen of blood vessels and aneurysms in certain clinical situations. In these environments, endothelial cells sense changes in the lumen of blood vessels or aneurysms and stimulate biological processes that lead to an increase in cellular and enzymatic activity in the wall of blood vessel segments or aneurysms associated with changes in cellular and extracellular wall components and expansion or lumen enlargement. Research has also shown that endothelial cells require blood flowing across their luminal surface to remain healthy and viable. Therefore, a medical device, system or method that could reduce or eliminate blood flowing over the luminal surface of endothelial cells lining a blood vessel segment or aneurysm may thus reduce endothelial cell viability, endothelial cell biochemical signaling, and increases in cellular and enzymatic activities associated with either aneurysm expansion or blood vessel or aneurysm enlargement, which is an important goal in the prevention or treatment of aneurysms. Therefore, in certain modalities, ballstent 100 is fully expanded to treat a saccular aneurysm. In addition to the physical nature of filling and blocking the effect of the expanded ballstent in the aneurysm sac, this treatment also reduces endothelial viability in the aneurysm sac. In other modalities, the ballstent 100 does not need to be fully expanded to treat a saccular aneurysm, but it can successfully seal the aneurysm or reduce endothelial cell viability while partially expanded. In all modalities, the ballstent remains in an expanded state (partially or completely) after detachment of the delivery catheter. An expanded state refers to at least partial distension of the ballstent 100, such as at least 20%, 50%, 75% or 90% and up to 100% of the maximum ballstent volume.
[00161] In many modalities, blockstent 150 does not need to be fully expanded to occlude a blood vessel segment. For example, blockstent 150 can be partially expanded, or it can be fully expanded. In all modalities, the ballstent remains in an expanded state (partially or completely) after detachment of the delivery catheter. An expanded state refers to at least partial distension of blockstent 150, such as at least 10%, 20%, 50%, 75%, or 90%, and up to 100% of the maximum blockstent volume. FORMING THE EXPANDABLE BODY
[00162] In an exemplary method of forming the expandable body 100 or 150, the central layer 122 of the wall 102 of ballstent 100 or blockstent 150 can be formed by vapor deposition, in which vapors from one or more polymers, pure metals, or Metal alloys are condensed on top of a substrate or mold (eg mandrel). The mold can be removed to provide an empty shell formed of pure metal or metal alloy.
[00163] In a preferred embodiment, the central layer 122 of wall 102 is formed by electroforming or electroplating a metal casing onto a removable mold or mold (eg, mandrel). For example, as shown in Figs. 32A-C, a 3200 multipart chuck for electroforming the expandable body 100 or 150 is shown in partial cross section. The 3200 mandrel includes a 3202 steel base and 3204 formwork that is removable from the base. Preferably, Form 3204 is composed of a rigid material, including, but not limited to, aluminum or stainless steel. Although shown as a sphere, other embodiments of the form 3204 may be of other shapes, including, but not limited to, the shape of a partially pleated or partially folded body 3204 which results in an expandable body 100 or 150 with a configuration intermediate to the configuration. deliverable (i.e., fully collapsed or pleated and folded) and the fully expanded configuration, such as a partially pleated mandrel 3204 being depicted in FIG. 33. In addition, the protrusions as shown in FIGS. 12F-I, can be adapted to Form 3204 such that protrusions are formed during the galvanizing or electroforming process. The form 3204 may be spherical, as shown in FIGS. 32A-B and 34 to generate an expandable spherical body 100 or 150. The form 3204 may be a cylindrical body with hemispherical ends to generate similarly shaped expandable bodies 100. In various embodiments, the mandrel 3200 or at least the removable form 3204 is sacrificial, such that it is consumed during the process of forming the expandable body 100 or 150.
[00164] To form an expandable metal body, the form 3204 is removed from the base 3202. A portion of the form 3204 can be threaded so that it can surround a threaded spindle 3206 that extends from the base 3202. 3204 is detached from base 3202, a metal ring 3208 is positioned on threaded spindle 3206. In one embodiment, as shown in FIG. 34, lead screw 3206 includes a shoulder 3212 that has a larger diameter than lead screw 3206 such that metal ring 3208 can seat in a desired position.
[00165] Ring metal 3208 is a non-sacrifical component of Chuck 3200. In one embodiment, ring metal 3208 is any biocompatible metal that is reactive to electrolysis. For example, the metallic ring 3208 can be composed of gold, stainless steel 316L or stainless steel 304. Preferably, the metallic ring composed of stainless steel 304, since stainless steel 304 has a lower nickel content than stainless steel 316L and will minimize the risk of cytotoxicity during electrolysis. In some embodiments, 304 stainless steel is preferred as it has a corrosion potential (approximately 0.18V - 0.38V) less than the hydrolysis potential of water (approximately 0.82V). Therefore, electrolysis with 304 stainless steel can be performed under more controlled conditions with more repeatable results than electrolysis performed with 316L stainless steel or gold, whose corrosion potentials (approximately 0.98 V - 1.18 V and approximately 0.7 V - 0.9 V , respectively) exceed the hydrolysis potential of water.
[00166] In various embodiments, the 3208 metallic ring is between approximately 0.025 inches and approximately 0.150 inches in length, with a wall that is between approximately 25.4 µm and approximately 254.0 µm thick. In one embodiment, the 3208 metallic ring is 0.05 inches long. A gold plating or plating optionally can be applied to at least a portion 3210 of the metallic ring 3208 to encourage the deposition of gold that will be used to form an expandable body of gold. Likewise, a plating or coating composed of another metal, including but not limited to platinum, can be used to encourage the deposition of the other metal. As such, the metallic ring 3208 will be integrated with the expandable body 100 or 150 and will form a part of the neck 116 of the expandable body.
[00167] Once the metal ring 3208 and the form 3204 are positioned on the threaded spindle 3206, the chuck 3200 is placed in an electrolytic bath (not shown) containing metal ions, such as gold, where the gold ions are deposited on the formwork and at least a part of the metallic ring 3208. In particular, the mandrel 3200 is positioned such that the expandable body 100 or 150 is electroformed over the formwork 3204 and the metallic ring portion 3208 with the gold flash, thereby connecting the metal ring to expandable body. Preferably, the remainder of the metallic ring 3208 is not gold plated.
[00168] In various embodiments and as can be understood from FIGS. 9A-D, the wall thickness 120 of ballstent 102 can be controlled by varying the electroforming process. For example, by adjusting the duration of the electroforming process, walls of greater or lesser thickness can be formed. Likewise, wall thickness 120 can be differentiated at certain locations by applying one or more masks to the 3200 chuck. In addition, the location of the 3200 chuck relative to the anode in the solution bath also affects the wall thickness. For example, an internal feature in the neck of the expandable body 100 or 150 may have a thinner wall than the rounded spherical portion of the expandable body. The expandable body 100 or 150 may be intentionally formed with a thinner and therefore weaker neck region that can be cut to separate the expandable body from the neck 116, including a neck that includes the metal ring 3208. additionally, a stress concentration ring in the form of a line or strip may be defined on the neck or proximal portion 208 of the expandable body 100 or 150, more specifically, a ring-shaped region of exposed metal (e.g., part of stainless steel ring 3208) or a gold portion of collar 116 to help facilitate separation of the delivery tool from the expandable body in the ring-shaped region of the exposed metal. Such a line of stress concentration can be formed into the ring-shaped region of the exposed metal by laser etching, various mechanical operations such as sawing or sanding, or by electrolysis.
[00169] After the formation of the expandable body 100 or 150 and the formwork 3204 are removed from the base of the mandrel 3202, where the formwork member is removed to leave only the metallic ring 3208 and the expandable body, shown in a partial cross section in the FIG. 35. In one embodiment, aluminum shape member 3204 is removed by neck 116 by chemical and/or thermal leaching. In another embodiment, a hole is drilled in aluminum form 3204 by collar 116 by mechanical operations such as, but not limited to, drilling with an auger drill. The hole can be used to accelerate and regulate the chemical leaching or etching process to remove the 3204 aluminum formwork from the expandable body 100 or 150. Preferably, combinations of mechanical, chemical and thermal methods are used to ensure that all constituents of the form 3204 are removed. It is desirable to completely remove the form 3204 from the expandable body 100 or 150 to ensure sufficient plasticity or malleability of the expandable body and to minimize any toxic effects after implantation, as may be the case specifically when the expandable body is composed of residual aluminum.
[00170] To reduce the presence of regions of stress concentrations or surface variations of the expandable body 100 or 150 and eliminate the transfer of concentric machine marks from the 3204 formwork, the 3200 chuck, and in particular the formwork, can be polished or cut before electroforming the expandable body. An unpolished formwork 3204 and a resulting expandable gold body 100 or 150 are shown in FIGS. 36A and 36B, respectively. Otherwise, a polished form 3204 with a faceted finish and the resulting expandable gold body 100 or 150 is shown in FIGS. 36C and 36D, respectively. In one embodiment, polishing form 3204 reduces the distance between major and minor points of surface imperfections or features to approximately 0.1 µm or less.
[00171] Once the formwork 3204 is removed from the expandable body 100 or 150, the expandable body can undergo an annealing process to improve the flexibility of the expandable body. In one embodiment, the expandable body is heated to about 300°C for approximately 1 hour and then immediately cooled in a bath of distilled water to room temperature. In other embodiments, expandable body 100 or 150 is bent or otherwise deformed after a first annealing process and subjected to one or more additional annealing processes. In other embodiments, expandable body 100 or 150 is bent or otherwise deformed and subjected to one or more annealing processes.
[00172] The exterior and interior surfaces of expandable body 100 or 150 can be cleaned to remove all remaining contaminants from the manufacture. For example, in one modality, the expandable body 100 or 150 is placed in an ultrasonic cleaner that contains an isopropyl alcohol bath for approximately 10 minutes. The expandable body 100 or 150 is then removed from the bath and injected with distilled water to remove any contaminants remaining within the expandable body. Optionally, expandable body 100 or 150 can be dried in a vacuum oven maintained at approximately 90°C.
[00173] As shown in FIGS. 37A and 37B, the outer surface 110 of ballstent 100, the inner surface 106, or both, are coated with a polymer such as Parylene™ or an acrylic polymer. The polymer can be added by incorporating a preformed material in the desired orientation, by vapor deposition, or other methods. In some embodiments, at least a portion of collar 116 or inner surface 3304 of metal ring 3208 is uncoated. In one embodiment, ballstent 100 can be annealed, as described above, at least once after application of the non-metallic coating. FIGS. 37C and 37D show a similarly coated blockstent 150.
[00174] In expandable body embodiments 100 or 150 where the wall 102 is composed of a material that is highly non-reactive during electrolysis, such as platinum, the interior and exterior of the neck 116 can be coated, while the remaining surfaces are not coated. Likewise, in some embodiments where the expandable body 100 or 150 will be detached by an operation other than electrolysis, only the inner surface 106 can be coated with the non-metallic coating.
[00175] In some embodiments, after coating, a portion of the polymer coating is removed from the outer surface 3300 to expose the metal surface in a band or ring configuration, as shown in FIGS. 37E-H. In other embodiments the exposed metal surface can be formed by masking this region before coating and then removing the masking material. Electrolysis can be used to separate the expanded expandable body from the remainder of the neck 3300 and the delivery catheter in the region comprising the exposed metal surface. The width W of the detachment site (ie, the exposed metal surface in a band or ring configuration) 3302 can be in a range between about 0.1 mm and about 0.4 mm. Release site W may be located anywhere along length N1 of collar 116. In some embodiments W may be located in the region of collar formed by metal ring 3208. In one embodiment, the exposed strip of release site 3302 it has a width W of 0.25 mm ± 0.03 mm and is located at a length N5 of approximately 0.51 mm ± 0.03 mm from the end of the collar 116. The metal strip can be exposed by any suitable method, including , but not limited to laser engraving or laser ablation. In other embodiments, the metal strip of release site 3302 may be exposed before or after the folding or compression of expandable body 100 or 150. By way of example and not limitation, in one embodiment, the metal exposed in region 3302 is gold, while in other embodiments the exposed metal is stainless steel.
[00176] In various embodiments, the wall 102 of the expandable body 100 or 150 is perforated to create a plurality of microperforations 1300, as indicated in FIG. 9B. By way of example and not limitation, microperforations 1300 can be created by laser by drilling into wall 102. Microperforations 1300 or pores can range from about 1 µm to about 500 µm in diameter and can extend completely through the wall thickness 1022 from the interior void 108 to the exterior surface 110. Alternatively, an expandable microperforated body 100 or 150 can be formed during the electroforming process, such as with the use of a masking pattern.
[00177] After perforation, the surfaces of the expandable body 110 and 106 can be coated with a polymer that does not completely cover the microperforations 1300, thus leaving channels between the inner and outer surfaces. Alternatively, the expandable body 100 or 150 can be laser drilled after coating. Microperforations 1300 allow fluid exchange between the interior void 108 of the expandable body 100 or 150 and the environment outside the expandable body.
[00178] In various embodiments, the outer layer 104 can be formed on the outside of the central layer 122 of the expandable body 100 or 150 by additional electroplating or electroforming, by vapor deposition, or by sputtering, where the material is corroded from a target (eg, an alloy of metal or metal) and then deposited onto a substrate (eg, a mandrel or mold), forming a thin layer on the substrate. Likewise, an inner layer 214 can be formed within the central layer 122 of expandable body 100 or 150 by further electroplating or electroforming, or by vapor deposition, or by sputtering.
[00179] In various embodiments, an additional polymer coating is applied to the expandable body 100 or 150 to adjust the strength and flexibility characteristics of the wall 102. For example, the additional reinforcing polymer can be applied via dip, rotation, or coating. spray, or through specialized deposition processes for the specific polymer. The additional coating can be Parylene, biocompatible polyurethanes, PTFE and silicone, among others. In one embodiment, this coating may be capped at the neck 116 of expandable body 100 or 150 using a mechanical or chemical model. In various modalities, detailed designs and geometries can be laser engraved into the reinforcement coating to further optimize wall properties with the bending geometry. In addition, removing the reinforcing liner in regions where it is not needed would also remove unnecessary material from the final diameter of the collected and packed expandable body 100 or 150.
The wall 102 of the main body of the expandable body 100 or 150 may be formed by methods other than those of the neck 116. The central layer 122 of the expandable body 100 or 150 may be formed by methods other than those of the outer layer or coating 104 or of the inner layer or liner 214. In various other embodiments, expandable body 100 or 150 can be formed by manipulating and securing one or more sheets of metal in the desired configuration to form wall 102 and/or outer layer 104. These two-dimensional sheets can further include rubber, plastic, polymers, woven or mesh fiber materials or other materials, or combinations thereof. By way of example and not limitation, one or more two-dimensional sheets of a metal can be bent into an expandable body shape and welded, glued or bonded. Likewise, two-dimensional sheets of material can be manipulated and secured to form outer layer 104 or inner layer 214. THE DELIVERY DEVICE
[00181] The expandable body 100 or 150 is advanced and positioned within the human body by an elongated portion of the medical device known as the "delivery device" or "delivery catheter". In one embodiment, a delivery device is an elongated surgical instrument that defines at least one lumen, or potential lumen. The delivery device has a proximal and a distal end and is sized to deliver fluid medium from a fluid medium source at the proximal end of the device to the central void or space 108 of expandable body 100 or 150, which is connected to the distal end. of the delivery device. In addition, any medical device or component of a medical device that can position the expandable body 100 or 150 at a desired location in the vascular system, such as the lumen of a saccular aneurysm or the lumen of a target blood vessel, will facilitate expansion of the body. expandable body and thus facilitate separation of the expandable body from the delivery device, is generally acceptable as a delivery device. Typically, the delivery device is a "catheter (a delivery catheter"). Preferably, the delivery catheter can be any flexible catheter, hollow wire, detachable core wire, or combinations thereof, suitable for accessing sites with the vascular system, including delivery catheters 300 and 400, shown in FIGS. 2 and 6. The delivery device can also be any other type of catheter, hollow wire, or removable core wire, or alternatively a needle or scalpel, a stylet, or combinations thereof, suitable for accessing sites within the vascular system, or in other biological conduits. In various embodiments, the delivery device is a 300 or 400 catheter that can carry a compressed expandable body attached 100 or 150 to the lumen of a saccular aneurysm or the lumen of a target blood vessel. Preferably, the delivery device or delivery catheter extends only to the expandable body neck 100 or 150, such that no part or component of the delivery device, including but not limited to a guidewire or an obturator, if extends to the interior void 108 of the expandable body.
[00182] A catheter is a tubular, flexible and elongated medical device configured for insertion into bodily compartments, including blood vessels, to allow the injection or withdrawal of fluids, among other functions. Catheters are usually formed from polymers or plastics and optionally even include the metal, as in a coil or braid configuration for reinforcement. Catheters can be configured to enable attachment to expandable bodies 100 or 150, facilitate delivery of the compressed expandable bodies to the lumen of an aneurysm sac or lumen of a target blood vessel or other biological conduit, facilitate expansion of the compressed expandable bodies and separate from expanded expandable bodies. In some embodiments, delivery catheter 300 or 400 can be configured to pass through the vascular system with the expandable body attached 100 or 150 in a compacted form, as shown in FIGS. 3A and 7A. After expansion, the expandable body 100 or 150 is separated from the delivery catheter 300, thus allowing the expandable expandable body to remain in place while the delivery catheter is removed from the body. In this way, delivery catheters are similar to balloon catheters for angioplasty, which are configured to allow attachment to traditional tubular stents to facilitate the delivery of compressed traditional tubular stents to the lumen of a specific segment of a blood vessel or other biological conduit , allow expansion of compressed traditional tube stents, and separate from expanded traditional tube stents.
[00183] The delivery catheter 300 and 400 is composed of a biocompatible material. By way of example and not limitation, delivery catheter 300 and 400 and several of its components may be formed from silicone rubber, natural rubber, polyvinyl chlorides, polyurethane, copolyester polymers, thermoplastic rubbers, silicone-polycarbonate copolymers , polyethylene ethyl vinyl acetate copolymers, woven polyester fibers or combinations thereof. In one embodiment, the wall of delivery catheter 300 and 400 may be reinforced with a metal, such as stainless steel braided or coiled or nitinol, to improve control and reduce kink formation of delivery catheter 300 and 400 during use. . Suitable metals for delivery catheter reinforcement include stainless steel and nitinol.
[00184] As shown in FIG. 2, 3A-B, 6, 7A-B and 16A-B, delivery catheter 300 and 400 will have a hollow, or potentially hollow, cylindrical member that defines a lumen to allow passage of a fluid medium from the proximal end of the catheter. delivery to the distal end of the delivery catheter and into the central void 108 of the expandable body. Delivery catheter 300 or 400 is designed and sized in such a way that it can be inserted into the body to deliver the expandable compressed body 100 or 150 to a desired location, facilitate expansion of the expandable body, and facilitate separation of the expandable expandable body from the delivery catheter. When a 400 single-lumen delivery catheter is used, the compressed expandable body can be positioned in the lumen of a saccular aneurysm or target blood vessel lumen after being advanced through a separate larger guide catheter that is positioned with its distal end in or near of the aneurysm or target location within the target blood vessel. Once in the aneurysm sac lumen or target blood vessel lumen and outside the guide catheter, the compressed expandable body 100 or 150 can be expanded and then the expanded expandable body and delivery catheter can be separated, and the delivery catheter and the guide catheter can be removed from the body while the expandable, expanded body remains in place. The hollow, or potentially hollow, cylindrical member 306 of delivery catheter 400 has a wall thickness ranging from about 0.05 mm to about 0.25 mm. Preferably, the hollow cylindrical member 306 has a wall thickness ranging from about 0.1 mm to about 0.2 mm. The lumen 312 defined by the hollow cylindrical member 306 for the purpose of allowing the passage of a fluid medium into the central void or space of the expandable body 108 has a diameter ranging from about 0.4 mm to about 1.0 mm. The proximal end of the hollow cylindrical member 306 includes a port or hub 3408 for communicating with a source of pressurized fluid medium, such as a syringe 314 or a pump (not shown) containing, for example, water, saline, or a contrast solution. radiographic. Fluid media for expansion of the expandable body is received within delivery catheter 300 or 400 through hub or port 3408. SINGLE-LUMEN CATHETERS
[00185] FIG. 2 shows a longitudinal view of a single lumen embodiment of the delivery catheter portion 400 of the medical device 500 and FIG. 16A depicts a cross-section of the single-lumen catheter. As shown in Figs. 4A-E, for the single lumen modality, delivery catheter 300 moves through the lumen of an 800 guide catheter to deliver compressed ballstent 100 to lumen 701 of a saccular aneurysm 700. For this single lumen modality, the delivery catheter 400 does not include a hollow cylindrical member that defines a lumen that is sized to allow passage of a guide member, or guidewire.
[00186] The dimensions of the 300 or 400 delivery catheter are a matter of design choice, depending on the size of the aneurysm that is to be treated and the location of the aneurysm in the vascular system. The distance between the aneurysm to be treated and the site of insertion of the medical device into the vascular system will determine, in part, the length of delivery catheter 300 or 400. Delivery catheter lengths range from about 5 cm to about 300 cm, with preferred ranges between about 75 cm and about 225 cm. The smallest diameter of a blood vessel segment in the path between the site of insertion of the medical device into the vascular system and the aneurysm to be treated will, in part, determine the diameter of the delivery catheter. Delivery catheter diameters range between 2 Fr and 7 Fr, with preferred ranges between 2 Fr and 5 Fr. Similarly, when obstructing a blood vessel, as illustrated in FIGS. 4F-J, the smallest diameter of a blood vessel segment in the path between the medical device insertion site in the vascular system and the blood vessel to be treated will determine, in part, the diameter of the delivery catheter. Thus, delivery catheter diameters for delivery of a 150 blockstent range between 2 Fr and 12 Fr, with preferred variations between 2 Fr and 5 Fr.
[00187] FIGS. 3A-C show longitudinal views of a single lumen embodiment of the delivery catheter portion of medical device 500. FIG. 3A shows a longitudinal view of a single lumen embodiment of medical device 500 with ballstent 100 in compressed form. FIG. 3B shows a longitudinal view of a single lumen embodiment of medical device 500 with ballstent 100 in a compressed form, while FIG. 3C depicts the medical device with blockstent 150 in an expanded form.
[00188] In some embodiments, the proximal end of delivery catheter 400 is configured with a hub 3408 that can facilitate a Luer-LokTM connection or Luer-SlipTM connection to connect a source of fluid media, such as a syringe 314, to lumen 312 of a hollow cylindrical member configured to transmit fluid medium from the proximal end of the catheter to the central void or expandable body space 100 or 150. As shown in FIG. 28, lumen 312 of a delivery catheter 400 is connected to a source of fluid medium, such as syringe 314, through a female Luer fitting 2802. A tap 2804 or flow switch may be positioned between the source of fluid medium. and delivery catheter 400 to allow greater control over the movement of the fluid medium into and out of the delivery catheter.
[00189] As shown in FIGS. 3A-B and 4A-E, in a medical device embodiment 500, delivery catheter 400 advances attached compressed ballstent 100 through the lumen of a larger guide catheter 800, beyond the distal end of the guide catheter, into lumen 701 of the 700 aneurysm bag. After the 100 compressed ballstent has been placed into the 701 lumen of the 700 aneurysm bag, a removable wire or obturator 404 is removed from the delivery catheter. Removable wire or plug 404 may include a handle 408 or other device to facilitate insertion and removal. Then, a source of fluid media, such as syringe 314, can be connected to hub 3408 and fluid media can be moved from syringe 314 to the central void or space 108 of ballstent 100, resulting in expansion of the ballstent within the lumen. 701 from aneurysm bag 700 and fill at least a portion of the aneurysm bag. Fluid media such as water, saline, radiographic contrast agent solutions or drug solutions such as thrombin can be used to expand compressed ballstent 100. As shown in FIG. 4E, after ballstent 100 is expanded, delivery catheter 400 and ballstent 100 are separated and delivery catheter and guide catheter 800 are removed, leaving the expanded ballstent in lumen 701 of aneurysm bag 700. A variety of methods and devices can be used to separate the delivery catheter from the ballstent 100. In one modality as indicated in FIGS. 2, 3A and 3B, delivery catheter 400 comprises an electrolysis wire 320 or the insulated lead wire. For this modality, after ballstent 100 is expanded, a DC current. It is applied to electrolysis wire 320 or insulated conductor to dissolve a portion of solder 316 between ballstent 100 and delivery catheter 400, or alternatively to dissolve a portion of ballstent 100 by electrolysis. Once the solder 316 is dissolved or corroded, or alternatively a portion of the ballstent 100 is dissolved or corroded, the delivery catheter 400 is separated from the ballstent and the delivery catheter and guide catheter 800 are removed.
[00190] A similar method can be used to occlude a blood vessel with a 150 blockstent. As shown in Figs. 3A, 3C, and 4F-J, in a medical device embodiment 500, delivery catheter 400 advances attached compressed blockstent 150 through the lumen of a larger guide catheter 800, beyond the distal end of the guide catheter, into lumen 721 of the target blood vessel segment 720. After the compressed blockstent 150 has been placed into lumen 721 of the target blood vessel segment 720, the removable wire or obturator 404 is withdrawn from the delivery catheter. Removable wire or plug 404 may include a handle 408 or other device to facilitate insertion and removal. Then, a source of fluid media, such as syringe 314, can be connected to hub 3408 and fluid media can be moved from syringe 314 to the central void or space 108 of blockstent 150, resulting in expansion of the blockstent within the lumen. 721 of the blood vessel segment 720 and blood vessel filling. As shown in FIG. 4J, after blockstent 150 is expanded, delivery catheter 400 and blockstent 150 are separated, and delivery catheter and guide catheter 800 are removed, leaving the expanded blockstent in lumen 721 of blood vessel segment 720. A variety of methods and devices can be used to separate the delivery catheter from the blockstent 150. In one modality, as indicated in FIGS. 2, 3A and 3C, delivery catheter 400 comprises an electrolysis wire 320 or an insulated lead wire. For this modality, after blockstent 150 is expanded, a DC current is applied to electrolysis wire 320 or insulated conductor to dissolve a portion of solder 316 between blockstent 150 and delivery catheter 400, or alternatively to dissolve a part of blockstent 150. Once the 316 solder is dissolved, or alternatively a portion of the blockstent 150 is dissolved or corroded, the delivery catheter 400 is separated from the blockstent and the delivery catheter and guide catheter 800 are removed. SINGLE LUMEN CATHETERS
[00191] In various embodiments as illustrated in FIGS. 29B-C, a 1000 single-lumen catheter has a 1002 coil reinforced wall consisting of one, two, or three electrical conductors (eg, wires, cables, etc.) to provide conductive paths to perform electrolysis, as explained in more detail. below. In one embodiment, the outer surface 1004 of wall 1002 is composed of polyamide and has a hydrophilic or lubricious coating, while the conductive paths include 0.001 inch x 0.003 inch 304V 1006 stainless steel coils. The 1006 conductive coils can be configured in an array of one, two, or three conductors 1008 as shown in FIGS. 29B-C and FIGS. 29D-F, as discussed below, with regard to performing electrolysis. Coil 1006 conductors and any other conductors can be straight, stranded, or coiled. The conductive path defined by the 1006 conductive coils can be coated with an insulating polymer such as Parylene™, while the 1012 inner lumen can be lined with a PTFE compound.
[00192] In certain embodiments, a modified infusion wire with a removable core can be used as a single-lumen delivery catheter. An infusion wire is a modified guide wire in which the solid metal core can be removed to leave a lumen that can be used to inject fluid media. An infusion wire with a removable core can be modified such that an expandable body 100 or 150 can be attached to the distal end and expand through the wire lumen after removal of the core wire.
[00193] In some embodiments, all or part of the interior and exterior surfaces of the delivery device may be further coated with a hydrophilic or lubricious coating. In other embodiments, all or a portion of the expandable body 100 or 150 may also be coated with a hydrophilic or lubricious coating. DOUBLE LUMEN CATHETERS
[00194] As shown in FIG. 6 and FIG. 16B, delivery catheter 300 may include a hollow cylindrical additional member that defines a second lumen 324 for receiving a guide member, such as a guidewire 302, to assist in guiding the ballstent component 100 of the medical device to the desired location, such as can be understood from FIGS. 7A-B and 8A-E. This second lumen 324 is generally adjacent and parallel to the first lumen 312. As shown in FIG. 6 and FIG. 16B the delivery catheter may be a dual-lumen catheter, with a lumen 312 configured to allow passage of fluid media from a fluid media source at the proximal end of the delivery catheter to the central void or space 108 of the ballstent at the distal end. of the delivery catheter, and the other lumen 324 configured to accept a guide member, such as a guidewire 302, to facilitate advancement and positioning of the medical device in the vascular system. As shown in FIG. 16B, delivery catheter 300 includes two hollow cylindrical members, each with a lumen, where the hollow cylindrical members 304 or 306 have a wall thickness of from about 0.05 mm to about 0.25 mm. Preferably, the hollow cylindrical member 304 or 306 has a wall thickness ranging from about 0.1 mm to about 0.2 mm. The lumen defined by hollow cylindrical member 304 for accepting a guidewire 302 has a diameter ranging from about 0.25 mm to about 0.5 mm. The lumen diameter for passing fluid medium to the ballstent 100 and the lumen diameter for accepting a guide member 324 can be similarly sized. Alternatively, the lumen diameter for the passage of fluid medium to the ballstent may be larger or smaller than the lumen diameter for accepting a guiding member such as a 302 guidewire.
[00195] For a delivery catheter with two lumens, the first and second hollow cylindrical members can be sized in the same way. Alternatively, the second hollow cylindrical member may have a larger diameter to accept the guiding member, or a smaller diameter. The proximal end of the second hollow cylindrical member 304 is coupled to the hub 3408. The hub 3408 facilitates insertion of the guide wire 302 into the second hollow cylindrical member 304. As can be understood from FIGs. 6, 7A-B, 8A-E and 16B, guidewire 302 is fed through second hollow cylindrical member 304 and extended outwardly from the distal end of delivery catheter 300. In this embodiment, delivery catheter 300 is advanced over guidewire 302 until compressed ballstent 100 is positioned in the lumen of a saccular aneurysm. Once the compressed ballstent 100 is in the desired position, the ballstent 100 is expanded by fluid media supplied to the first hollow cylindrical member 306 by syringe 314 connected to the ballstent expansion hub 3408. Fluid media such as water, saline, solutions of radiographic contrast agents or drug solutions such as thrombin can be used to expand the compressed ballstent. Guidewire 302 preferably is an angiographic wire of sufficient length for the distal tip of the guidewire to reach the aneurysm and a proximal end extending outward from the point of entry into the vascular system. In some embodiments, guidewire 302 has a straight or angled distal end, while in other embodiments guidewire 302 has a curved J-shaped distal tip, typically constructed from a memory metal alloy. of shape or a braided metal that causes the tip to return to the J-shape after any applied stress is removed. The materials and dimensions of the guidewire 302 can be selected based on the diameter, length and tortuosity of the blood vessels being traversed. Typically, guidewire 302 can be composed of any suitable biocompatible materials and has an outer diameter ranging from about 0.3mm to about 0.95mm.
[00196] FIGS. 7A-C show longitudinal views of a dual lumen embodiment of the delivery catheter portion 300 of medical device 500. FIG. 7A shows a longitudinal view of a dual lumen embodiment of medical device 500 with expandable body 100 or 150 in a compressed form, while FIG. 7B shows a longitudinal view of a dual lumen embodiment of medical device 500 with ballstent 100 in an expanded form. FIG. 7C depicts the medical device with blockstent 150 in an expanded form. Delivery catheter 300 is used to advance ballstent 100 over a guidewire 302 and into the lumen of the aneurysm sac. Delivery catheter 300 is also used to deliver a fluid, liquid, gas, solid, or a combination thereof, to expand ballstent 100 into lumen 701 of aneurysm bag 700. In one embodiment, a 320 electrolysis wire or a wire insulated conductor is connected or electrically coupled to a solder that joins the ballstent or blockstent with the delivery catheter. In another embodiment, an electrolysis wire 320 or an insulated lead wire is connected or electrically coupled to a portion of the ballstent 100 on an exposed metal surface 3302.
[00197] As shown in FIGS. 6, 7A-B and 8A-E, in a medical device 500 mode, the delivery catheter 300 advances the attached compressed ballstent 100 over the guidewire 302 and into the lumen 701 of the aneurysm bag 700. Compressed ballstent 100 was placed in lumen 701 of aneurysm sac 700, guidewire 302 is removed. Then wire or plug 404 is withdrawn from delivery catheter 300. Wire or plug 404 may include a tag 408 or other device to facilitate insertion and removal. Then, a fluid medium source, such as syringe 314, is connected to hub 3408 and fluid medium is moved from syringe 314 to the central void or space 108 of ballstent 100, resulting in expansion of the ballstent within until it fills. at least a portion of the aneurysm sac lumen 701. As shown in FIG. 8E, after ballstent 100 is expanded, delivery catheter 300 and ballstent 100 are separated and the delivery catheter is removed, leaving expanded ballstent 100 in lumen 701 of aneurysm bag 700. In one modality, a wire of electrolysis 320 or an insulated lead wire is connected or electrically coupled to a solder that joins the ballstent 100 with the delivery catheter, or to an exposed metal surface 3302 of the ballstent. For this modality, after ballstent 100 is expanded, a DC current. It is applied to electrolysis wire 320 or insulated conductor to dissolve or corrode a portion of solder 316 between ballstent 100 and delivery catheter 300, or alternatively to dissolve or corrode exposed metallic surface 3302 of ballstent 100 by electrolysis. Once solder 316 is dissolved or corroded, or alternatively the exposed metallic surface portion of ballstent 100 is dissolved or corroded, delivery catheter 300 is separated from ballstent 100 and delivery catheter 100 and guide catheter 800 are removed .
[00198] A similar method can be used to occlude a blood vessel with a 150 blockstent. As shown in Figs. 6, 7A, 7C, and 8F-J, delivery catheter 300 advances attached compressed blockstent 150 over a guidewire 302 and into lumen 721 of blood vessel segment 720. After compressed blockstent 150 has been placed in lumen 721 from the target blood vessel segment 720, the guidewire 302 is removed. Then wire or plug 404 is withdrawn from delivery catheter 300. Wire or plug 404 may include a tag 408 or other device to facilitate insertion and removal. Then, a source of fluid media, such as syringe 314, is connected to hub 3408 and fluid media is moved from syringe 314 to the central void or space 108 of blockstent 150, resulting in blockstent expansion until it fills a part of the lumen of blood vessel 721. As shown in FIG. 8J, after blockstent 150 is expanded, delivery catheter 300 and blockstent 150 are separated and the delivery catheter is removed, leaving blockstent 150 expanded within lumen 721 of blood vessel segment 720. In one modality, the delivery catheter comprises an electrolysis wire or an insulated lead wire that is connected or electrically coupled to a solder that joins the blockstent 150 with the delivery catheter, or to an exposed metal surface 3302 of the blockstent. For this modality, after blockstent 150 is expanded, a DC current is applied to electrolysis wire 320 or insulated conductor to dissolve or corrode a portion of solder 316 between blockstent 150 and delivery catheter 300, or alternatively to dissolve or corrode the exposed metal surface 3302 of blockstent 150. Once the 316 solder is dissolved or corroded, or alternatively the exposed metal surface portion of blockstent 150 is dissolved or corroded, the delivery catheter 300 is separated from the blockstent 150 and the delivery catheter 150 and guide catheter 800 are removed. GUIDANCE MEMBERS
[00199] As shown in FIGS. 8A-E, for a modality using a dual-lumen catheter, delivery catheter 300 moves over a guide member or guidewire 302 to deliver compressed ballstent 100 to lumen 701 of a saccular aneurysm 700. Examples of a guide member include a flexible guidewire. Guide wire 302 may include metal in the form of a flexible wire, coil or slender rod. For example, the basic angiography guidewire consists of a fixed solid metal core covered by a metal spring coil. In other situations, a delivery catheter is advanced over a needle or scalpel. Guidewire 302 occupies a lumen in the delivery catheter, with that lumen defined by the tubular portion of the delivery catheter. Once in place, the guidewire 302 can be removed to allow injection or withdrawal of a fluid medium.
[00200] As shown in FIGS. 17A-B, in another embodiment, the medical device delivery catheter may be configured with a lumen that can accept a guide catheter 800 as a guide member. With this configuration, the medical device can be advanced in a tri-axial configuration, with the medical device 500 advanced over a guide catheter 800, which is advanced over a guidewire. In certain embodiments, the proximal hub of the guide catheter may be removed to allow the lumen of the hollow cylindrical member 304 of the delivery catheter 300 of the medical device 500 to accept the guide catheter 800. In certain cases, this modality of the medical device may result in better control over the delivery of the expandable compressed body to the target vein aneurysm or lumen and better traceability of the expandable compressed body 100 or 150 as it is advanced to the desired location. As shown, in one aspect, the hollow cylindrical member 304 of delivery catheter 300 may be annular in shape and fully surround delivery catheter 800, while in other aspects, delivery catheter may involve 60%, 70%, 80% , 90% or more of the circumference of the guidance catheter. MEDICAL BALLSTENT AND BLOCKSTENT CATHETER DEVICES
[00201] FIG. 38A depicts an embodiment of a 3400A ballstent catheter medical device. As shown, the 3400A Ballstent Catheter medical device includes a 3402 delivery catheter configured in a 3404 distal end to couple to the ballstent 100. The 3406 proximal end of the 3402 delivery catheter attaches to a 3408 hub that allows for electrical communication and fluid with ballstent 100 through the catheter. A 314 syringe can be used to deliver a fluid medium to the ballstent 100. The 3400A device also includes a 3422 electrical connector to establish electrical communication from a 3418 power source to the ballstent 100.
[00202] FIG. 38B depicts one embodiment of a 3400B blockstent catheter medical device. As shown, the 3400B medical device includes a 3402 delivery catheter configured in a 3404 distal end for coupling with blockstent 150. The 3406 proximal end of the 3402 delivery catheter couples to a hub that allows for electrical and fluid communication with the blockstent 150, through the catheter. A syringe 314 can be used to deliver a fluid medium to the blockstent 150. The 3400B device also includes an electrical connector 3422 to establish electrical communication from a power source (not shown) to the blockstent 150.
[00203] A cross-sectional view of hub 3408 is shown in FIG. 39. The 3408 hub includes a 3410 first connection port that is configured with a taper fit or Luer hub that can facilitate a Luer-LokTM type connection or Luer-SlipTM type connection to connect a source of fluid media such as a syringe 314, to the lumen 312 of a hollow cylindrical member of the delivery catheter 3402 configured to transmit fluid medium from the proximal end of the delivery catheter to the central void or space 108 of expandable body 100 or 150. Optionally, the first connection port 3410 is also configured to wrap around a 404 shutter wire or a 302 guide wire.
[00204] Second connection port 3414 is configured to allow electrical communication with catheter 3402. For example, electrolysis of one or more wires 320 in electrical communication with electrodes mounted on catheter 3402 and/or ballstent 100 may extend through a channel 3416 from hub 3408 to second connection port 3414. Alternatively, one or more resistive wires may extend through channel 3416 from hub 3408 to second connection port 3414. A power supply or electricity source, such as a controller laptop 3418 shown in FIGS. 38A and 40, can communicate with wire 320 to perform various functions, including, but not limited to, electrolysis or heating of a heat sensitive material.
[00205] In a preferred embodiment, the second connection port 3414 is connected to a threaded nut 3420, such that an electrical terminal 3422 can be attached to the nut and the hub 3408. The electrical terminal 3422 is in electrical communication with one or more lead wires and configured to receive an electrical connector from an external power source, such as the 3418 handheld controller. By way of example and not limitation, the 3424 electrical connector may be a 3.5mm audio jack. Other electrical connectors can also be used.
[00206] As shown in FIG. 40, handheld controller 3418 can be connected to electrical terminal 3422 via a jack 3424 to deliver an electrical current through catheter 3402 to detach expandable body 100 or 150. For example, in one embodiment, catheter 3402 includes a lead coil 1006 which can be arranged in an array of one, two or three conductors 1007, 1008 and 1010, respectively, as shown in FIGS. 29C and 29E and 29F. The various conductor arrangements 1008 and 1010 provide reinforcing force and a conductive path along the length of catheter 3402. Portable controller 3418 provides a potential current or voltage to electrodes 1014, 1016, and optionally 1026, extending through the catheter. 3402 to detach the expandable body 100 or 150 by electrolysis or thermal detachment as explained below. In one embodiment, the handheld controller 3418 includes a body 3426, a power source such as a battery, one or more push buttons 3428, and one or more indicators 3430 to indicate controller status, detachment of expandable body 100 or 150, and the status of the power supply, such as the battery. FOLD THE EXPANDABLE BODY
[00207] In order to facilitate the advancement of the expandable body through the vascular system, some embodiments of the expandable body 100 or 150 comprise two or more metallic parts 1900A-B that are joined by a flexible joint 1902, as indicated in FIG. 13. In certain embodiments, this flexible joint can comprise a variety of materials that are flexible and biocompatible, including various polymers or elastomers. The 1902 assembly allows for better maneuverability and greater traceability as the expandable compressed body is advanced to the desired location. In other embodiments, expandable body 100 or 150 can include three or more metallic or rigid portions that are joined by two or more flexible hinges.
[00208] In order to facilitate the advancement of the expandable body through the vascular system, the expandable body 100 or 150 can be compressed into various shapes and dimensions. Optionally, this compression can include various shapes and patterns of folding or pleating. For example, one or more pleats can be made on the expandable body 100 or 150 and then the pleats can be wrapped in a cylindrical shape. Alternatively, the expandable body 100 or 150 can be flattened into a planar shape and then rolled into a cylindrical shape. Alternatively, the expandable body 100 or 150 can be compressed into a compact spherical shape. Furthermore, the expandable body parts 100 or 150 can be twisted during compression. In certain cases, the expandable body may be compressed around delivery catheter 300, as in FIG. 7A. In other cases, the expandable body can be compressed around the plug 404, as in FIG. 3A. In other embodiments, the expandable body 100 or 150 can be compressed into itself without a central catheter or obturator.
[00209] In FIG. 14A, expandable body 100 or 150 has been pleated, folded, and wrapped around hollow cylindrical member 304 of delivery catheter 300. In FIG. 14B, the expandable body 100 or 150 has been pleated, folded and wrapped around the delivery catheter. In another embodiment, the expandable body 100 or 150 is folded into folds, then the folds of the folded expandable body are wrapped around the hollow cylindrical member 304 of the delivery catheter 300, and the expandable body is compressed against the delivery catheter, as indicated in FIG. 14C. In another embodiment, the expandable body 100 or 150 is folded into pleats, then the pleated pleats of the expandable folded body are wrapped around the removable wire or plug 404, and then the expandable body is pressed against the removable wire or plug 404. in another embodiment, the expandable body 100 or 150 is folded into pleats, and then the pleated pleats are rolled into a generally cylindrical shape without a removable wire or obturator or catheter acting as a central point of attachment, as indicated in FIG. 14D.
[00210] In various embodiments, the expandable body 100 or 150 is attached to the delivery catheter 300, 400, then the pleats are formed, and then the pleated folds are enveloped and compressed against the delivery catheter 300, or the obturator 404. in another embodiment, expandable body 100 or 150 is first folded to form pleats and then attached to delivery catheter 300, 400, and then the pleated folds are enveloped and compressed against the outer surface of delivery catheter 300, or obturator 404. In another embodiment, the expandable body 100 or 150 can be folded and compacted into a variety of shapes, in a manner similar to Japanese origami, as shown in FIGS. 15A-D.
[00211] The expandable body 100 or 150 can be folded to form one or more pleats, which can be further folded, rolled and compressed, similar to the folding of non-compliant expandable bodies of angioplasty. In various other embodiments, the pleated expandable body is folded and compressed to fit the end of a flexible guidewire and travel within a hollow cylindrical member of a separate catheter. Expandable body 100 or 150 can be folded and compacted with any suitable arrangements and methods. It is desired that the expandable body 100 or 150 have regular pleats. EXPANDABLE BODY FOLDING TOOL
[00212] In one embodiment, the expandable body 100 or 150 can be folded using a folding tool 3500 as shown in FIGS. 41A-C. The folding tool 3500 is configured to form pleats within the expandable body 100 or 150 and wrap around the expandable body to further minimize the cross-sectional area of the expandable body in recoil. The 3500 folding tool includes a 3502 folding mount and a 3504 removable vise clamp mount.
The collapsible mount 3502 includes a base 3506 defining a centrally positioned opening 3508 for receiving the vise clamp assembly 3504. The centrally positioned opening 3508 is threaded such that the vise clamp assembly can be secured to the base 3506. On top of base 3506, an annular folding mold 3510 is positioned coaxially with aperture 3508. Annular folding mold 3510 is slidably coupled to base 3506 such that annular folding mold can rotate about central axis 3512.
[00214] The annular folding mold 3510 includes an annular smooth ring 3514 having an outer diameter D1, an inner diameter D2 and a plurality of projections 3516 extending diagonally away from the inner surface 3518 of the annular ring towards the axis 3512 and nearly converge on the axis at a height H above the annular ring. Distal end 3520 of each projection 3516 defines a vertically oriented blade 3522 having a height h and extending radially inward a distance d toward axis 3512. In one embodiment, the blade of thickness 3522 thins along. d as you approach axis 3512, in another embodiment, the blade has a uniform thickness. In one embodiment, the projections 3516 are flexible and integrated with the ring 3514, or alternatively, mechanically coupled to the ring.
The annular ring 3514 is held against the base 3506 by a cover plate 3524. The cover plate 3524 is mechanically coupled by fasteners 3526 to the base 3506 and one or more standoffs 3528. The cover plate 3524 defines a central cavity first 3530 having a diameter D3 and a second central cavity 3532 that is coaxial with the first central opening and has a diameter D4 smaller than D3. The diameter D3 of the first central cavity 3530 is greater than the outer diameter D1 of the annular ring 3514, such that the annular ring can rotate within the first central cavity. Diameter D4 is larger than the inner diameter D2 of the annular ring, 3514, but smaller than the outer diameter D1, such that the cover plate 3524 can hold the annular folding mold 3510 against the base 3506, but still allow rotation of the Annular folding mold 3510.
[00216] Cover plate 3524 also includes at least one arcuate channel 3534 that receives a screw (not shown) coupled to the annular ring 3514 and a thumbscrew 3536 such that the screw can be used to rotate the bending mold. annular 3510. Cover plate 3524 also defines one or more apertures 3538 for receiving one or more compression ring slide shafts 3540. The slide shafts 3540 are slidably coupled to a compression ring slope 3542 that engages with the mold of annular fold 3510. In one embodiment, return springs 3544 are coupled to the slide shafts 3540 and the compression ring slope 3542 to apply a bias force that returns the compression ring slope to a standard position.
[00217] Compression ring slope 3542 defines an annular opening 3544 that mate with projections 3516 of annular folding mold 3510. Compression ring slope 3542 also defines a screw hole 3546 for receiving a screwdriver 3548 with a bulge 3550, through an optional bushing nut 3552. Rotation of the screwdriver 3548 causes the slide of the compression ring 3542 to translate along the slope axes of the compression ring 3540. For example, rotation of the screwdriver 3548 can cause the slide of compression ring 3542 to translate along the slope axes of compression ring 3540 toward base 3506. As compression ring slope axes 3540 move toward base 3506, the annular aperture 3544 engages with projections 3516 causing each blade 3522 to translate radially inwardly toward shaft 3512 and an expandable body 100 or 150 held by removable vise clamp 3504.
[00218] Referring now to Figs. 42A-C, the removable vise collet assembly 3504 includes a collet 3554 compacting a compression tube 3556 and a center pin 3558 received within the compression tube. In one embodiment, the compression tube 3556 can compress and hold the neck 116 of an expandable body 100 or 150 that is placed on the center pin 3558. In one embodiment, a viscous elastomeric material (not shown) is placed around the neck. to protect the collar against the clamping surfaces of the 3554 vise collet. The 3554 vise collet is held against a 3560 collet piston by a 3562 collet piston. The 3560 collet piston also receives a 3564 piston stop and one or more anti-rotation pins 3566 that prevent unwanted rotation of piston stop and caliper 3554, which prevents rotation of compression tube 3556 and center pin 3558. caliper piston 3560 mates with a piston spring 3568 within a base 3570, where the piston spring allows longitudinal translation of the 3560 collet piston.
[00219] By way of example and not limitation, an expandable body 100 or 150 to be folded can be coupled to the removable vise clamp assembly 3504 by placing the central pin 3558 inside the collar 116 and positioning the compression tube 3556 to attach to the outer surface of the neck. The collet assembly 3504 is mounted so that the collet 3554 compresses the compression tube 3556 against the collar 116 and the center pin 3558. The collet assembly 3504 is then attached to the collapsible assembly 3502.
[00220] Screw screw 3548 is rotated to translate the slide of compression ring 3542 along the axes of slope of compression ring 3540 toward base 3506. As slope of compression ring 3542 moves toward the base 3506, annular aperture 3544 engages with projections 3516 causing each blade 3522 to translate radially inwardly and engage with expandable body 100 or 150. Each blade 3522 deforms expandable body to form a plurality of pleats 3600, as shown in FIGS. 43A-B. Each crease 3600 includes a crest line 3602 extending proximal-distal and radially outward from axis 3512. Each crease is separated from any immediately adjacent crease by an interposed runner 3604 extending proximal-distal.
[00221] After the plurality of pleats 3600 are formed, the compression ring slope 3542 is raised slightly, causing each blade 3522 to partially disengage from the expandable body 100 or 150 held in the removable vise clamp assembly 3504. Annular folding mold 3510 is rotated about axis 3512 by translation of screw and a thumbscrew 3536 along at least one arcuate channel 3534. In one embodiment, rotation of annular folding mold 3510 bends each pleat 3600 of the plurality of pleats over an immediately adjacent pleat 3600 clockwise to center axis 3512 or, alternatively, counterclockwise.
[00222] FIGS. 43A-B are, respectively, lateral and axial end views of the expandable body 100 or 150 in a progressive series of stages of being picked up, folded and packed. From an inflated configuration denoted as 3800, the expandable body 100 or 150 is simultaneously compressed and folded by the folding tool 3500 as denoted as 3802-3806. Once the pleats 3600 are fully formed, as indicated at 3806, the folding tool 3500 can be used to rotate the formed pleats 3600 and wrap the pleats over the expandable body 100 or 150 in a fully compressed delivery configuration, indicated as 3808. Preferably, as can be understood from FIGs. 9E, 9G and 14B, the expandable body 100 or 150 is wrapped around itself and not a delivery device. More specifically, delivery device 220 only extends to expandable body neck 100 or 150; no part of the delivery device 220 extends over the bent region of the expandable body. In other words, the delivery device only extends to the neck of the expandable body 100 or 150, but does not extend to the volume 108 of the expandable part of the expandable body. In such an embodiment and as can be understood from FIGS. 14B-C, the bent region of the expandable portion of the expandable body may define a central channel 1400A or an off-centre channel 1400B that may accept a guidewire or other delivery device. Alternatively, as can be understood from FIG. 14D, the bent region cannot receive a guidewire or other delivery device and therefore does not define a channel. In other embodiments, as can be understood from FIG. 14A, the expandable body is wrapped around a distal region of the delivery device.
[00223] The expandable body 100 or 150 is preferably bent such that a distal end portion 202 of the expandable body extends distally away from the interior void space of the expandable body, and a proximal end portion 208 of the expandable body extends proximally to away from the inner empty space 108 of the expandable body. In other embodiments, the expandable body 100 or 150 may be folded such that the distal end portion 202 is folded proximally inward towards the interior void 108, and the proximal end portion may also be folded distally inward towards the interior void. .
[00224] FIGS. 44A-B depict an alternative embodiment of the bending tool 3500. In this embodiment, the compression ring slope 3700 is an annular ring that is manually pushed against a non-rotating annular bendable mold 3702. rotated to rotate the expandable body 100 or 150 after forming the plurality of pleats 3600 to effect folding of the pleats clockwise or counterclockwise.
[00225] FIG. 44C is a partial cross-sectional view of an expandable body 100 or 150 within the folding tool 3500. In one embodiment, the expandable body 100 or 150 is partially or completely expanded prior to folding. The collet assembly 3504 can be in fluid communication with one or more air lines or pressurized liquid 3572 such that a fluid medium or gas can be delivered to the expandable body 100 or 150 through the hollow center pin 3558. The pressurized air line 3572 extends from the clamp assembly 3504 to a low pressure inflation device such as an air pump or an endoflator (not shown) or, alternatively, a fluid source such as a syringe 314. In one embodiment, a low pressure check valve 3574 is configured in line with pressurized air line 3572. In another embodiment, pressurized air line 3572 is split and connected to the low pressure inflation device and a separate low pressure check valve 3574. In one embodiment, the check valve 3574 may be configured to crack or otherwise release air under a specific internal air pressure to allow air to escape from the check valve and prevent inflation too much of the expandable body 100 or 150 during folding.
[00226] After the expandable body 100 or 150 is mounted to the gripper assembly 3504, the gripper assembly holds the neck of the expanded body neck 116 tightly around the center pin 3558 to form an airtight seal with the pressurized air line 3572. Approximately 1-5 psi of positive pressure is delivered to the 3572 air line to the expandable body 100 or 150. As the 3510 folding mold attaches to the expandable body 100 or 150, the gradually decreasing internal volume of the expandable body increases. internal pressure on him. The pressure build-up is mitigated by check valve 3574, such that the internal pressure within the expandable body is constant while being bent. Maintaining a constant positive pressure inside the expandable body 100 or 150 prevents the expandable body from collapsing in areas without direct contact with the bendable mold 3510. This allows for a smoother, more regular recoil of the expandable body 100 or 150. ATTACH AND DETACH THE EXPANDABLE BODY
[00227] The expandable body 100 or 150 can be attached to, or coupled to, the delivery catheter in a variety of ways. For example, the expandable body 100 or 150 can be affixed to the delivery catheter by a friction fit, using an adhesive or glue, by soldering, by joining or joining components, or by applying a compressive force of a fastener, ring, elastomer sleeve or wrap, or compression balloon. Various methods and devices can be used to separate the expandable, expandable body from the delivery catheter. By way of example and not limitation, these methods and devices can be broadly classified as physical or mechanical, electrical, thermal, chemical, hydraulic and sonic. MECHANICAL FIXATION BY FRICTION
[00228] In one embodiment, a physical or mechanical connection is made between an expandable body and a delivery catheter, wherein the mating parts are configured to fit tightly and remain together by friction. Upon expansion of the expandable body, the physician slides the distal end of the delivery catheter out of the expandable body neck to effect separation, a process that can be facilitated by moving a guide catheter 800 forward to confine the expanded expandable body 100 or 150 prior to removal of the delivery catheter, as indicated in FIG. 23B. In one embodiment, as shown in FIG. 18, neck 1600 of expandable body 100 or 150 engages distal end 1706 of core wire or plug 404 by friction. As shown in Figs. 18, 23A-B and 24A-B, the distal portion 1706 of the core wire or obturator 404 of the delivery catheter 400 has a smaller diameter than the more proximal portion 1707. In other embodiments, the distal portion 1706 of the core wire or obturator 404 of delivery catheter 400 has the same diameter as the most proximal portion 1707. After the compressed expandable body 100 or 150 is positioned in the lumen of a saccular aneurysm, the core wire or obturator 404 is removed. fluid media path through lumen 312 of delivery catheter 400 and into the central void or space 108 of expandable body 100 or 150. Once obturator 404 is removed, a fluid media source 314 can be connected to hub 3408 and the fluid medium can be injected into the void 108 of the expandable body 100 or 150 until it is expanded. After expandable body 100 or 150 is expanded, the distal end of guide catheter 800 is advanced forward against the wall of expandable expandable body 100 or 150 and the distal end of delivery catheter 400 is withdrawn from expandable body neck 1600 to separate the delivery catheter from the expanded expandable body, allowing the delivery catheter to be removed, leaving the expanded expandable body in the lumen of the saccular aneurysm or lumen of the target vessel segment. In this way, guide catheter 800 functions as a buttress against the outer surface of expandable body 100 or 150, while the expanded expandable body is separated from the delivery catheter.
[00229] Alternatively, the delivery catheter and expandable body can be separated by other physical methods. In another embodiment, as shown in FIG. 25A, a mechanical attachment is made between an expandable body and a delivery catheter where an outer neck 116 on expandable body 100 or 150 is configured to fit tightly around the distal end of hollow cylindrical member 306 of delivery catheter 400. A sleeve Elastic or wrap 1302 is connected to distal end 1304 of hollow cylindrical member 306 of delivery catheter 400 and extended through at least a portion of outer neck 116 of expandable body 100 or 150 to hold the neck of expandable body against the distal end of the member. hollow cylindrical body 306 of delivery catheter 400. Once the expandable body is expanded into the lumen of the saccular aneurysm or the lumen of the target vessel segment, the expandable expandable body 100 or 150 is separated from the distal end of the hollow cylindrical member 306 of the catheter delivery 400 using guide catheter 800, similar to the above, to support the expandable body while the distal end of hollow cylindrical member 306 of the catheter enters. ga 400 is pulled away from the expanded expandable body. MECHANICAL FIXATION BY AN ELASTOMERAL SLEEVE
[00230] As shown in FIGS. 25B-D, an elastomer sleeve or wrap 1302 compressively or frictionally coupled around the distal end 1304 of the delivery device 306. To couple the expandable body 100 or 150 to the delivery device, according to one embodiment, the elastomer sleeve 1302 is rolled away from the distal end 1304 of the delivery device 306, the neck 116 of the expandable body is slid over the distal end of the delivery device 306, and the elastomer sleeve is rolled toward the distal end of the delivery device and compresses around the outer surface 3300 of the neck of the expandable body. The expandable body neck 116 is then held between the distal end of the delivery device 306 and the elastomer sleeve 1302.
[00231] In a preferred embodiment, shown in FIGS. 25A-B, the delivery device 306 does not extend into the interior void 108 of the expandable body 100 or 150, such that the expandable body can be retracted, folded and/or folded back on itself. Elastomer sleeve 1302 holds expandable body 100 or 150 secured to delivery device 306 during positioning, inflation, and release. In one embodiment, elastomer sleeve 1302 holds neck 116 of expandable body 100 or 150 secured to delivery device 306 as electrolysis is performed on exposed strip 3302. In another embodiment, expandable body 100 or 150 may be detached from the device. 306 by pulling the delivery device away from the expandable body 100 or 150 after expansion.
[00232] Elastomer sleeve 1302 may have an inside diameter ranging from 0.025 inches to 0.04 inches, with thickness ranging from 0.002 inches to 0.01 inches. In a preferred embodiment, elastomer sleeve 1302 has an internal diameter of approximately 0.028 inches with a wall thickness of approximately 0.008 inches. The 1302 elastomer sleeve may be any suitable biocompatible elastomer, including but not limited to ChronoPreneTM manufactured by AdvanSource Biomaterials of Wilmington, MA or Polyether Block amide (PEBA), better known under the trade name PEBAX®, manufactured by Arkema of Colombes, France. In a preferred embodiment, the 1302 elastomer sleeve is comprised of a 2533 or 25 Shore D PEBAX ® durometer.
[00233] In one embodiment, shown in FIG. 25D, elastomer sleeve 1302 can be fabricated to include a variety of ribs 1306. Ribs 1306 provide structural support for sleeve 1302. The ribs also allow elastomer sleeve 1302 to stretch laterally, in a direction perpendicular to the ribs, as indicated by 1308. In the present embodiment, the elastomer sleeve 1302 does not stretch longitudinally in line with the ribs 1306. MECHANICAL DETACHMENT ARRANGEMENTS
[00234] In various other embodiments, the expandable body 100 or 150 is attached to the distal end of the hollow cylindrical member 306 of the delivery catheter 400 with an adhesive, glue or solder. In these embodiments, the expandable body 100 or 150 is separated from the delivery catheter 400 by one or more mechanical methods. The expanded expandable body 100 or 150 can be separated from the delivery device by a variety of mechanical methods that cut, tear, or otherwise physically degrade a portion of the expandable body to separate the remainder of the expandable body from the delivery catheter 400.
[00235] As shown in FIG. 19, in one embodiment, a thin, flexible hoop of material 2200 can be positioned to surround the outside of the outer neck of the expandable body 2202. The hoop material can be formed from various thin, strong and flexible materials such as wire, strand of polymer, filament, ribbon, thread or loop. Upon expansion of the expandable body, the collar may be pulled toward the proximal end of the delivery catheter 2204 to cut the neck 2202 of the expandable body 100 or 150 and separate the expandable expandable body from the delivery catheter. Preferably, the collar is pulled through a lumen of the delivery catheter sized to accept the collar as it is pulled back. In another embodiment (not shown), a thin, flexible hoop of material (in certain embodiments representing a hoop loop or modified hoop loop) can be advanced through a second catheter until the hoop is placed around the outside of the proximal portion. of the outer neck of an expandable, expandable body. The collar can be placed against the neck and withdrawn towards the second catheter to cut neck 116 from the expandable body 100 or 150 and separate the expandable body from the delivery catheter.
[00236] In another embodiment, as shown in FIG. 20, a distal end 2500 of a thin hoop of material (such as a strand, polymer wire, filament, thread or loop) is affixed to a hoop on the neck of the expandable body 2202, while the proximal end 2506 of the hoop material extends up to the proximal end of delivery catheter 2204. Upon expansion of the expandable body 100 or 150, the hoop of material is pulled toward the proximal end of delivery catheter 2204, which cuts a neck portion 2202 away from the expandable body. 100 or 150 to separate the expandable, expandable body from the delivery catheter.
[00237] In another embodiment, as shown in FIGS. 21A-C, neck 2202 of expandable body 100 or 150 may be cut by one or more blades 2302A-D. In the present embodiment, a cutting insert 2304 is advanced over the delivery catheter 2204. The cutting insert 2304 has a cutting region 2308 that includes the blades 2302A-D. When the expanded expandable body 100 or 150 is to be detached from the delivery catheter, the cutting device 2304 is positioned such that the neck 2202 is within the cutting region 2308. The blades 2302A-D can then be actuated to cut the neck 2202. By way of example and not limitation, blades 2302A-D may be actuated by rotation of the cutting device, insertion of a wire, retraction of a wire, or other appropriate methods. FIGS. 21B-C are transverse views along line B-B of the cutting region before (FIG. 21B) and during blade actuation (FIG. 21C).
[00238] In another embodiment, shown in FIG. 22, neck 2202 of expandable body 100 or 150 may define a plurality of circumferential perforations 2406. Perforations 2406 are torn as delivery catheter 2204 is pulled away from expandable body 100 or 150.
[00239] In another embodiment, a ring structure is attached to the distal end of the delivery catheter, while a second ring structure is attached to the proximal end of the expandable body, with a coupling of the two rings attaching the expandable body to the delivery catheter . After expansion of the expandable body, rings can be uncoupled, resulting in separation of the expandable expandable body 100 or 150 and the delivery catheter. Unlocking the rings can be performed by a spring clamp or other similar methods in order to release the expandable body.
[00240] In other embodiments, hydraulic methods can be used to stop the expandable, expandable body 100 or 150 of the catheter delivery device. In one embodiment, the expandable body 100 or 150 separates the delivery catheter after the fluid medium is injected through a lumen to trigger a mechanical articulation between the expandable body 100 or 150 and the delivery catheter, resulting in separation from the expanded body. expandable 100 or 150 and the delivery catheter. DETACHMENT BY ELECTROLYSIS
[00241] A method for using electrolysis to withdraw the expandable body 100 or 150 can be performed using the one, two, or three electrically-conducting single-lumen 1000 catheters, as shown in FIGS. 29B-F. The arrangement of one or two conductors 1007 and 1008, respectively, can be used to perform constant current electrolysis. The three-conductor arrangement 1010 can be used to perform constant voltage electrolysis or electrolysis using a square wave voltage potential. In any of these embodiments, electrical conductors can be composed of any biocompatible conductive material, including platinum, stainless steel, gold, or silver and their alloys. In one example, the electrical conductors could be a platinum-iridium alloy.
[00242] When using the one or two electrical conductor arrangement 1008 to perform constant current electrolysis, there is less control over the voltage potential at the anode or working electrode 1014. As such, the voltage potential for the working electrode 1014 increases until the current and potential flux to the working electrode 1014 is sufficient to cause oxidation of ions in the bloodstream at the working electrode. For example, the current can break down H2O molecules in the bloodstream to form H+ ions and electronegative O2 molecules. The O2 molecules then bond with the exposed gold at the site of detachment from an expandable body of 100 or 150 gold and dissolve the exposed gold strip. The polymer coating on the expandable body 100 or 150 is a dielectric that prevents H+ ion and O2 molecules from reacting with the coated portions of the expandable body.
[00243] In one embodiment, approximately 0.01 to 5.0 mA of constant current is provided between the anode or working electrode 1014 and a cathode or ground electrode 1016 electrically coupled to one or more 1028 conductive cathode rings connected to the catheter 1000 , as indicated in FIG. 29G. Another embodiment of the two electrical conductor arrangement 1008 is shown in FIGS. 29H-I. In the present embodiment, the proximal end 1018 of a thermoset polymer segment 1020 is attached to a distal end 1022 of the catheter 1000, while the distal end 1024 of the thermoset polymer segment is attached to the metallic ring 3208 formed on the neck 116 of the expandable body 100 or 150. The working electrode 1014, in a partial cross-section of the thermoset polymer segment 1020, as indicated in FIG. 29H, is incorporated within polymer segment 1020 and bonded to anode metal ring 3208. In one aspect, working anode or electrode 1014 can be bonded directly to metal ring 3208 using a silver or any other suitable adhesive.
[00244] In another embodiment, the three-conductor 1010 arrangement can be used to provide more control and selectivity in the voltage potential of the working electrode 1014. In addition to the working electrode 1014 and 1016 the ground electrode, the three-conductor arrangement electrical 1010 includes a reference electrode 1026 and a potentiostat (not shown) which are used to monitor and control the voltage potential of the working electrode relative to the reference electrode. In various embodiments, reference electrode 1026 is preferably made of silver, silver, or platinum chloride.
[00245] By way of example and not limitation, the three-conductor arrangement 1010 can be used to detach the expandable body 100 or 150 using a constant current, a constant voltage, or an alternating square wave potential voltage. Anode or working electrode 1014 is modulated based on a comparison between the voltage of the working electrode and the voltage of the reference electrode 1026, which in the present embodiment is supported on the delivery catheter. In one mode, the potentiostat is configured to supply a voltage in the range between approximately +0.5V and +1.5V at working electrode 1014 relative to reference electrode 1026.
[00246] In various embodiments, electrical current travels from the cathode ring 1028 that is supported on the delivery catheter 1000 to a location outside the patient's body by a conductive electrode 1016 embedded in the wall of the delivery catheter. Electrode 1016 also provides structural reinforcement to the wall of delivery catheter 1000.
[00247] In another embodiment, the expandable body 100 or 150 and the delivery catheter 300 may be accompanied by one or more non-insulated solders 316, or an adhesive 318, as indicated in FIG. 29A. An electrolysis electrical conductor 320, which may be in the form of a wire or cable that depends on the electrical insulating material surrounding the catheter wall and/or a dedicated electrical insulating jacket of the electrical conductor itself for electrical isolation, extends along of the length of the delivery catheter from the proximal end of the delivery catheter 400 to the distal end of the delivery catheter. The proximal end of electrical conductor 320 is electrically coupled to a power source or source of electrical current 3100 outside the patient's body. The 3100 power source is also in electrical communication with a 3106 needle or adhesive electrode on the patient's skin which acts as a cathode for the electrolysis process. The distal end of the electrolysis electrical conductor 320 is coupled to the proximal portion of the expandable body 100 or 150, also attached to the distal portion of the delivery catheter. The expandable body 150 or 100 is acting as an anode for electrolysis. In this way, the electrolysis electrical conductor 320 is in electrical communication with the portion 3102 of the expandable body which is not electrically insulated and which is not connected to the delivery catheter. In various embodiments, the electrolysis electrical conductor 320 may be within the wall of the delivery catheter 300 as indicated in FIG. 29A, along the outer surface of the delivery catheter, or within a lumen of the delivery catheter.
[00248] In some embodiments, the electrolysis electrical conductor 320 is insulated, wherein a proximal portion 3102 of the expandable body 100 or 150 is not insulated, which is similar to the detachment site 3302. In some embodiments, the electrical conductor of electrolysis 320 and the remainder of the expandable body 100 or 150 and 116 are insulated, while a proximal portion 3102 of the expandable body is not insulated. In other embodiments, the neck 116 of the expandable body 100 or 150 is composed of metal that can easily undergo electrolysis (such as stainless steel or gold) wherein the remainder of the expandable body is composed of a metal that does not readily undergo electrolysis, such as platinum. For this embodiment, the platinum portion of the expandable body 100 or 150 need not be insulated. An electrical current or charge is applied to the electrolysis electrical conductor 320 after the expandable body 100 or 150 is expanded. Current is applied in an amount and for a time sufficient to dissolve at least a portion of the uninsulated portion 3102 of the expandable body 100 or 150, resulting in separation of the delivery catheter from the expandable body, leaving the expandable body expanded in the desired position while delivery catheter 300 is removed.
[00249] An electrical current is applied to the electrolysis electrical conductor 320 after the expandable body 100 or 150 is expanded. Current is applied in an amount and for a time sufficient to dissolve at least a portion of the solder and separate the delivery catheter from the expandable body 100 or 150, leaving the expandable body in the desired position while the delivery catheter 300 is removed. In another embodiment, current is applied in an amount and for a time sufficient to dissolve at least a portion of the expandable body and separate the delivery catheter from the expandable body 100 or 150, leaving the expandable body in the desired position while the delivery catheter delivery is removed. In one modality the current is a direct current (DC) while in another modality the current is an alternating current (AC).
[00250] Normally, during constant current electrolysis, gas bubbles formed as a by-product of electrolysis tend to form an insulating barrier at the release site. The gas bubble barrier in combination with an aggregation of non-ionic blood constituents (fats, proteins and amino acids, among others) at the detachment site tends to increase the impedance at the detachment site and increase the time required for detachment, as the electrolysis rate is decreased. Likewise, blood may start to clot at the 3302 detachment site further preventing detachment processes.
[00251] Electrolysis preferably is performed when the expandable body 100 or 150 is positioned such that the detachment site 3302 is within a constant flow of ionic blood constituents. For example, when ballstent 100 is positioned to fill an aneurysm, the detachment site 3302 is positioned such that the detachment site protrudes into adjacent blood vessels or close to adjacent blood vessels. While close to the adjacent vessel or adjacent vessel, the 3302 detachment site is exposed to a constant flow of ionic blood constituents that aid in the electrolysis process to withdraw the ballstent 100. The constant blood flow also minimizes the incidence of clotting. blood at the detachment site 3302 during electrolysis, thus potentially reducing the time required to separate the expanded expandable body 100 or 150 and the delivery catheter.
[00252] In another embodiment, voltage-controlled electrolysis is performed using an alternating square-wave potential voltage. By way of example and not limitation, the potential at the anode or working electrode 1014 alternates between approximately +0.5V and approximately +0.8V, relative to the reference electrode 1026, at a frequency in a range between 0.1 Hz and 10 Hz. In one aspect, the rate at which the voltage potential of the anode or working electrode 1014 varies can be configured to allow for the removal of oxides that form on the surface of the anode or working electrode and any aggregation of protein that can graduate. In this embodiment, oxides are removed during the period of lower voltage "depassivation" while aggregated proteins are removed during the higher voltage period of "passivation or hydrolysis". The removal of protein oxides and aggregates is promoted by voltage cycling. Therefore, the use of an alternating square-wave potential voltage or the use of square-wave voltage pulses can allow for shorter and more consistent detachment times.
[00253] In various embodiments, the voltage ranges used to perform voltage-controlled electrolysis may vary in response to the composition of the material at the 3302 shedding site and the reference electrode. For example, if the 3302 detachment site is composed of gold and the reference electrode 1026 is composed of platinum, then the voltage at the gold anode can alternate between approximately +0.6V and approximately +1.4V with respect to reference electrode at about 1 Hz. On the other hand, the voltage potential at the release site 3302 stainless steel composite 304 can alternate between approximately +0.1v and approximately +0.4V relative to the 1026a platinum reference electrode at about 1 Hz. In one mode, the 3302 drop-out is 316L stainless steel. In this mode, electrolysis is performed such that the potential in the 316L stainless steel anode alternates between approximately +0.7V and approximately +1.2V relative to the 1026 reference platinum electrode at approximately 1 Hz. desirable for the low voltage of the square wave alternating voltage potential to be below the hydrolysis potential of water. DETACHMENT BY THERMAL OPERATION
[00254] In another embodiment, as shown in FIGS. 26A-B, a mechanical attachment is made between an expandable body and a delivery catheter, in which a portion of the expandable body is attached to the distal portion of the delivery catheter using a connector link 2700. Connector link 2700 may be a adhesive, a metal (eg, gold foil), a polymer, a polymer binding agent, or other material that reacts to heating (such as with a low melt temperature binding agent) when applied between the hollow cylindrical member 306 of delivery catheter 400 and the expandable body. Connector link 2700 may also be a ring or tube of temperature-sensitive material (e.g., gold foil, a polymer, or other binding agent) that connects expandable body 100 or 150 to the delivery catheter. By way of example and not limitation, polymer connecting links may be composed of hydrogel polymers, polyurethane, polyethylene terephthalate, polyethylene, high density polyethylene, polyetherethylketone, polyphenylenesulfide, polyolefin, polyolefin elastomers, polyamide, polypropylene, Hytrel ®, vinyl ethylene alcohol (EVA), fully aromatic polyester polymers including liquid crystal polymers (LCP) such as Vectran, and combinations thereof.
[00255] Upon expansion of the expandable body 100 or 150, an electrical current is passed through the resistance heating element 2702 in electrical communication with an electrical conductor (eg wire or cable) 2704, resulting in heating or heating of the sensitive material to heat that forms connector link 2700. As connector link 2700 is heated, expandable body 100 or 150 may be separated from delivery catheter 306 by one or more methods. For example, heating the connecting link 2700 can cause the link to reach its liquid transition temperature, thus causing the link to reflux and separating the link. In another example, heating the connecting link can weaken the link, changing the strength of the material. Therefore, if the link 2700 is under elastic load, the increase in temperature will weaken the link until it fails under the load. In yet another example, heating the connecting link 2700 can cause the link to deform and undergo a significant dimensional change. If the connecting link 2700 is heated to only a specific point, the link may undergo an unsymmetrical modification in geometry, thus allowing the transition between a "closed" configuration and an "open" configuration.
[00256] In another embodiment, the connecting link 2700 may be a collar or other connecting structure made of a shape memory metal alloy, including but not limited to nitinol, or a shape memory polymer (SMP). In this embodiment, connecting link 2700 is coupled to collar 116 of expandable body 100 or 150. Resistance heating element 2702 is then wrapped around the collar to heat and reshape the collar, which returns to an originally open configuration, thereby releasing the expandable body 100 or 150 from the catheter. DETACHMENT BY CHEMICAL OPERATION
[00257] In another embodiment, a mechanical fixation is made between an expandable body 100 or 150 and a delivery catheter, in which a portion of the expandable body is attached to the distal portion of the delivery catheter using one or more connections that are sensitive to chemical dissolution. The binding medium can be composed in such a way that the binding medium dissolves when contacted by a solution with a high concentration of salt, an acid, a base or a specific chemical substance. By way of example and not limitation, a cap or other protective device may be removed from the region where the expandable body 100 or 150 joins the delivery catheter to expose the attachment means. Also by way of example and not limitation, injection or infusion of a solution with a high concentration of salt, an acid, a base or a specific chemical for the binding region, after expansion of the expandable body 100 or 150 in the locality desired, can result in dissolution of the connection means and separation from the expanded expandable body and the delivery catheter. DETACHMENT BY SOUND OPERATION
[00258] In another embodiment, a mechanical fixation is made between an expandable body 100 or 150 and a delivery catheter, in which a portion of the expandable body is attached to the distal portion of the delivery catheter using one or more adhesives, glues, connections or solders that are sensitive to sonic waves. In this embodiment, the link between the expandable body 100 or 150 and the delivery catheter is broken by sound waves, such as focusing on pulsed ultrasound waves, resulting in separation of the delivery catheter and the expanded expandable body. SEALING THE DETACHED EXPANDABLE BODY
[00259] In one embodiment, the wall opening 112 of the expandable expanded body 100 or 150 is left open at the end of the procedure. In other embodiments, the expandable expanded body wall opening 100 or 150 is closed before the end of the procedure. By way of example and not limitation, opening 112 may be sealed by applying an external force with inflation of the balloon portion 1102 of a balloon catheter 1100 adjacent the expandable body 100 or 150, as indicated in FIG. 11. Alternatively, an opening can be sealed by placing a collar of flexible material around the outer surface of the expandable body neck 100 or 150 prior to separation of the expanded expandable body and delivery catheter. In this method, the material hoop may comprise a metallic strand, polymer braid, filament, thread, thread or loop. EXPANDABLE BODY RADIOPAQUE MARKING
[00260] According to any of the methods where the expandable body 100 or 150 is separated from the delivery catheter, one or more radiopaque markers may be incorporated into the appropriate parts of the delivery catheter or expandable body to aid in the positioning of the expandable body, expansion of the expandable body, separation of the expandable expanded body from the delivery catheter, and removal of the delivery catheter after separation. For example, a radiopaque marker dot or band can be incorporated into the medical device to identify the location where separation is intended or designed to occur. In addition, the radiopaque material can be incorporated into ballstent 100 or ballstent 150. Additionally, a radiopaque marker band or dot can be incorporated into the distal end of the delivery catheter so that the tip of the delivery catheter can be viewed under fluoroscopy while pulling the delivery catheter away from the expandable body 100 or 150. A radiopaque marker dot or band may also be placed over the release components as required. The radiopaque marker can be composed of various radiodense materials, including, but not limited to, a metal band, a metal dot or line, or a barium dot or line.
[00261] In several modalities, a saccular aneurysm or a blood vessel can be visualized using a radiopaque stain. The radiopaque dye can be injected prior to introducing the 100 ballstent or 150 ballstent and can be used to confirm the appropriate size and position for the compressed or expanded ballstent 100 or expanded ballstent 150. EXPANDABLE BODY MEDICAL KIT
[00262] In various embodiments, a medical kit can be provided for treating a patient with the medical device. The medical kit may include medical device 500, a guidewire 302, one or more guide catheters 800, one or more expandable body support structures, and methods for separating the expanded expandable body 100 or 150 from the delivery catheter 300 or 400 , including separate medical devices for separation, (such as a power source and controller to perform electrolysis or heat a thermally sensitive bonding structure that joins the expandable member 100 or 150 and the delivery device). The medical kit may also include instructions for its use. Instructions for use may be provided on the medical kit packaging in the form of a label. Instructions for use can be provided in any tangible medium (eg paper, CD, DVD, etc.) either separately from the medical kit or contained within the medical kit packaging. Instructions for use can be provided via an electronic data feed or via Internet instructions.
[00263] The 3400A medical device can be used as part of various medical systems, methods and kits. These medical systems, methods and kits can be used to treat saccular arterial aneurysms, such as a cerebral saccular aneurysm. Alternatively, these medical systems, methods and kits can be used to treat a variety of medical conditions. In one modality, medical systems, methods and kits can be used to occlude biological conduits in patients in need thereof, the biological conduits including arteries, veins, vascular structures, ducts, airways, bile ducts, pancreatic ducts, enterocutaneous fistulas, ureters , fallopian tubes and urethra, among others. The medical kit includes the medical device and instructions for use. The medical kit may also contain additional components for performing a variety of treatments using the medical device 500. EXEMPLARY METHODS FOR THE MANUFACTURING OF A MEDICAL KIT
[00264] FIGS. 45-47 are flowcharts of methods for fabricating the expandable body 100 or 150, a delivery catheter 1000, and a medical kit. In one embodiment, a 4000 method for manufacturing the expandable body 100 or 150 includes forming the expandable body into a mandrel in step 4002 and coating the expandable body in step 4004. In step 4006, the release site and the sites where the wires conductors are connected to the expandable body 100 or 150 are exposed. The expandable body 100 or 150 is then annealed, folded, wrapped, and annealed again in steps 4008-4012.
[00265] A 4100 method for fabricating or otherwise preparing an existing delivery catheter is provided. At step 4102, a 3402 coil reinforced catheter is obtained and the outer coating is removed from the catheter to expose a portion of the electrical conductors of the coil at step 4104. At step 4106 a portion of the exposed electrical conductors is unwrapped, a cathode ring 1028 is attached to catheter 1000 at step 4108 and the exposed electrical conductors are then covered with an insulating material at step 4110. The attachment sites of catheter 3402 are masked, and the catheter is coated with a hydrophilic or lubricious coating at steps 4112 and 4114. One end of catheter 3402 is configured for coupling with a source of fluid and, optionally, a source of electrical current. By way of example and not limitation, catheter 1000 may be connected to a hub which may further include a Luer fitting.
[00266] The anode and cathode electrical conductors 1014 and 1016 are connected to electrical extension conductors, which are then covered in insulating jackets in steps 4118 and 4120. In steps 4122 and 4124, the extension electrical conductors are soldered to an electrical outlet , such as electrical terminal 3422, and the soldered joint is covered with a heat shrink insulating jacket.
[00267] As shown in FIG. 47, method 4200 for assembling medical device 3400A and a medical kit includes connecting expandable body 100 or 150 to catheter 3402 at step 4202. At step 4204, electrical conductor anode 1014 is connected to expandable body 100 or 150 and the conductive surfaces exposed are further isolated at step 4206. Once assembled, the 3400A device is tested at step 4208 and packaged in a medical kit at step 4210. EXEMPLARY METHODS OF USE OF THE EXPANDABLE BODY
A typical method for using the 3400A medical device to treat a saccular aneurysm includes accessing a human's vascular system with a needle, passing a guide member, or guidewire 302 into the vessel, optionally placing a vascular sheath, advancing the medical device composed of a 100 compressed ballstent and a 300 or 400 delivery catheter, and advancing it until the compressed ballstent lies in the 701 lumen of a 700 aneurysm bag. Then the 100 ballstent is expanded by passing a fluid, liquid, gas, or solid material, or combinations thereof, through the delivery catheter and into the central void or space 108 of the ballstent. The delivery catheter and expanded ballstent 100 are then separated and the delivery catheter is removed from the body, while the expanded ballstent remains in place within lumen 701 of aneurysm bag 700. Position of ballstent 100 during and after the procedure can be monitored by any suitable method, including fluoroscopy, computed tomography, resonance and ultrasound, including intravascular ultrasound
[00269] Two or more ballstents 100A-B can be used in combination to fill the lumen or void 701 of aneurysm sac 700, as illustrated in FIG. 27A, while two or more blocktents 150 can be used in combination to fill the lumen or void 721 of blood vessel segment 720, as illustrated in FIG. 27B. In addition, a second, third, or additional 100 or 150 expandable bodies may be required to fill the remaining portion of the blood vessel segment or aneurysm sac not filled by the first ballstent 100A or first blockstent 150A, respectively.
[00270] In various modalities of ballstent 100, the shape of a ballstent that has been expanded into the lumen of a saccular aneurysm is determined, in part, by the shape of the ballstent formed. For example, in some modalities, ballstent 100 is manufactured in a round, oblong, irregular, or non-spherical orientation to match the cavity contours for a particular saccular aneurysm 700. The expanded shape is also determined by the size and shape of the lumen of the saccular aneurysm. The expanded shape can also be determined by applying an external force, such as inflating the balloon portion of a balloon catheter adjacent to the expanded balltent 100. In certain embodiments of the methods, the balloon portion 1102 of a balloon catheter 1100 is inflated in the blood vessel lumen of origin 1202 adjacent to the expanded ballstent 100 in the aneurysm sac lumen, thus pushing the wall 1104 of the ballstent 100 toward the aneurysm, as indicated in FIG. 11A. In other embodiments, the ballstent 100 is fabricated in a round, oblong, irregular, or non-spherical orientation to match cavity contours for a particular saccular aneurysm 700.
[00271] In all modalities, the expanded shape of ballstent 100 is determined by the following factors: 1) the manufactured shape of ballstent 100; 2) the degree of expansion of ballstent; 3) the size and shape of aneurysm 700; and 4) the effect of any external force applied to the ballstent after expansion. By way of example and not limitation, the size and shape of the manufactured ballstent 100 can be determined by taking measurements of the 700 aneurysm. pattern. Other methods of measuring the aneurysm can also be used.
[00272] In another modality, the position, size and shape of the expanded ballstent 100 can be manipulated while positioned within the aneurysm 700. In the present modality, it is not necessary to determine the precise contours of the aneurysm 700 before inserting the ballstent 100. The ballstent 100 is shaped by the degree of expansion of the ballstent and the application of external forces. For example, an external force can be applied by inflating the balloon portion of a balloon catheter adjacent to the expanded ballstent 100, or by tools inserted through or around delivery catheter 400 or guide catheter 800. In other embodiments, the Ballstent 100 can be molded in one step before or after the step of separating the expanded ballstent from the delivery catheter 400.
[00273] In various embodiments, ballstent 100 is designed so that the outer surface 110 or 124 of the expanded ballstent 100 makes contact with a substantial portion of the inner surface 704 of the aneurysm 700, as shown in FIGS. 4A-E and 8A-E. In one embodiment, the outer surface 110 or 124 of the ballstent 100 makes contact with at least 50%, 75%, 90% or more of the inner surface 704 of the aneurysm 700, including up to 100%. In modalities, the expanded ballstent 100 is designed to fill the lumen of the 701 aneurysm sac. In one modality, the outer surface 110 or 124 of the ballstent 100 fills at least 50%, 75%, 90% of the 701 lumen volume of the aneurysm 700, including up to 100%.
[00274] In various modalities of blockstent 150, the shape of the blockstent that has been expanded into the lumen of a segment blood vessel is determined, in part, by the shape of the blockstent formed. For example, in some embodiments, blockstent 150 is manufactured in a cylindrical, oblong, irregular, or non-spherical orientation to match the contours of the lumen, void, or cavity for a specific 720 blood vessel segment or biological conduit segment. The expanded shape is also determined by the size and shape of the lumen, void or cavity of the blood vessel segment, or biological conduit segment. The expanded shape can also be determined by applying an external force, such as inflating the balloon portion of a balloon catheter adjacent to the expanded balltent 150. In certain embodiments of the methods, the balloon portion 1102 of a balloon catheter 1100 is inflated in the blood vessel lumen of origin 1202 adjacent to the expanded blockstent 150 in the blood vessel lumen or biological conduit, thereby pushing the wall 1104 of blockstent 100 away from the balloon portion of the balloon catheter, as indicated in FIG. 11B. In some embodiments, blockstent 150 is fabricated in a non-spherical orientation to match the contours of the lumen, void, or cavity for a specific blood vessel segment 720 or biological conduit segment.
[00275] In all modalities, the expanded shape of blockstent 150 is determined by the following factors: 1) the fabricated shape of the blockstent; 2) the degree of expansion of blockstent; 3) the size and shape of the lumen, void or cavity of the blood vessel segment, or biological conduit segment; and 4) the effect of any application of external force on blockstent after expansion. By way of example and not limitation, the size and shape of manufactured blockstent 150 may be determined by measurements of the lumen, void, or cavity to be filled. Measurements can be made using medical imaging, including two-dimensional and three-dimensional reconstructions and standard distance reference markers. Other methods of measuring the lumen, void or cavity can also be used.
[00276] In another embodiment, the position, size and shape of the expanded blockstent 150 can be manipulated and configured or changed from in vivo or even in situ when positioned within the blood vessel segment 720 or biological conduit. In this embodiment, it is not necessary to determine the precise contours of the lumen, void, or cavity to be filled before inserting the blockstent 150. The blockstent 150 is shaped by the degree of expansion of the blockstent and the application of internal or external forces. For example, an external force can be applied by inflating the balloon portion of a balloon catheter adjacent to expanded blockstent 100, or by tools inserted through or around delivery catheter 400 or guide catheter 800. In other embodiments, the blockstent 150 can be molded in one step before or after the step of separating the expanded blockstent from the 400 delivery catheter.
[00277] In various embodiments, blockstent 150 is designed so that the outer surface 110 of the blockstent makes contact with a substantial portion of the inner surface 704 of the blood vessel segment 720, as shown in FIGS. 4F-J and 8F-E. In one embodiment, the outer surface 110 of blockstent 150 makes contact with at least 50%, 75%, 90% or more of the inner surface 724 of the blood vessel segment 720, including up to 100%. In modalities, the 150 expanded ballstent is designed to fill the 721 lumen of the 720 blood vessel segment. In one modality, the 150 expanded blockstent fills at least 50%, 75%, 90% or more of the volume of the 721 lumen of the blood vessel segment. blood vessel 720, including up to 100%.
[00278] In all modalities, ballstent 100 and blockstents 150 are designed to keep their shapes expanded. As such, expanded bodies are not designed for or intended for compression or flattening into disc-like structures, before or after separation from the delivery catheter.AN EXEMPLARY METHOD OF TREATMENT USING THE EXPANDABLE BODY
[00279] By way of example and not limitation, as can be understood from FIGS. 2, 3A-B, and 4A-E, a first method of using device 500 or 3400A to treat a patient may include the steps of examining a patient and collecting diagnostic medical images to identify a saccular aneurysm. The vascular system can be accessed using any suitable method, including accessing an artery using the Seldinger technique. A guidewire 302 is inserted into the vascular system. Then a guide catheter 800 is inserted into the vascular system and advanced into or near the lumen of the saccular aneurysm. The position and luminal dimensions of the saccular aneurysm are then visualized by an intra-arterial injection of radiographic contrast solution under fluoroscopy. Guidewire 302 is removed and medical device 500 or 3400A is then inserted through guide catheter 800 until compressed ballstent 100 is advanced into lumen 701 of aneurysm 700. Ballstent 100 is then expanded into lumen 701 of aneurysm 700 A radiographic contrast solution can be injected into the source vessel 1202 of aneurysm 700 to confirm that the size of the expanded ballstent 100 is appropriate and that it is correctly positioned in the aneurysm. Once proper placement and sizing of the expanded ballstent 100 has been confirmed, the expanded ballstent is separated from the delivery catheter 400 by any of the methods disclosed in this document, and the delivery catheter is removed. The expanded ballstent 100 is left in the patient, where subsequent examination can be conducted to determine if further treatment is needed. The expanded ballstent 100 is left in patient functions to prevent bleeding or expansion of the aneurysm, and as such it alleviates future medical problems that the patient could experience if aneurysm 700 had not been treated.
[00280] By way of example and not limitation, as can be understood from FIGS. 6, 7A-B and 8A-E, a second method of using device 500 or 3400A to treat a patient may include the steps of examining a patient and collecting diagnostic medical images to identify a saccular aneurysm. The vascular system can be accessed using any suitable method, including accessing an artery using the Seldinger technique. A guidewire 302 is inserted into the vascular system. Then a guide catheter 800 is inserted into the vascular system and advanced with a guide wire 302 until the guide wire 302 is positioned in or near the lumen of the saccular aneurysm. The position and luminal dimensions of the saccular aneurysm are then visualized by an intra-arterial injection of radiographic contrast solution under fluoroscopy. Guide catheter 800 is removed and medical device 500 or 3400A is then inserted over guide wire 302 until compressed ballstent 100 is advanced into lumen 701 of aneurysm 700. Guide wire 302 is removed. The 100 ballstent is then expanded into lumen 701 of aneurysm 700. A radiographic contrast solution can be injected into the source vessel 1202 of aneurysm 700 to confirm that the size of the expanded ballstent 100 is appropriate and that it is correctly positioned in the aneurysm. Once proper placement and sizing of the expanded ballstent 100 has been confirmed, the expanded ballstent is separated from the delivery catheter 300 by any of the methods disclosed in this document, and the delivery catheter is removed. The expanded ballstent 100 is left in the patient, where subsequent examination can be conducted to determine if further treatment is needed. The expanded ballstent 100 is left in patient functions to prevent bleeding or expansion of the aneurysm, and as such it alleviates future medical problems that the patient could experience if aneurysm 700 had not been treated.
[00281] In another modality, the ballstent 100 can be rapidly deployed during an emergency. In particular, the ballstent 100 can be rapidly implanted to treat a ruptured cerebral aneurysm, thus eliminating the need to open the patient's skull prior to treating such an aneurysm. AN EXEMPLARY METHOD OF TREATMENT OF A PATIENT WITH CEREBRAL ANEURISM
[00282] A hypothetical method for using the 500 or 3400A medical device to treat a patient with a cerebral saccular aneurysm might start with one or more pre-surgical consultations, where a number of tests can be performed. Tests can include blood tests, urine tests, electrocardiograms and imaging tests including a CT scan, an MRI of the head and a cerebral angiogram, among others. From diagnostic imaging tests, images and measurements of the aneurysm can be obtained demonstrating the position, size and shape of the aneurysm. Consultations can take place several days before, or on the same day, the procedure is performed.
[00283] On the day of the procedure, the patient is prepared for the procedure and local anesthesia is usually given. The patient's groin is then aseptically prepared and wrapped. A doctor then accesses a femoral artery in the patient with a micropuncture set. A 0.035" 302 soft tip guidewire is retrogradely inserted into the femoral artery. A 6Fr vascular sheath is placed. A 5Fr diagnostic catheter is advanced over the guidewire until the tip of the 5Fr diagnostic catheter is in the lumen of the femoral artery. cerebral saccular aneurysm, where it can act as an 800 guide catheter. While the physician is positioning the 800 guide catheter, a surgical assistant prepares the ballstent 100 portion of the medical device by wetting the outer porous layer 104 of the ballstent with a solution containing thrombin. The 500 or 3400A medical device is advanced through the 800 guide catheter and positioned in the 701 lumen of the 700 aneurysm bag. The tip of the 800 guide catheter is pulled back, exposing the compressed ballstent 100. After the compressed ballstent 100 is in the desired position , the compressed ballstent is expanded by injecting a saline solution through the 312 lumen of the 300 or 400 delivery catheter and into the central void 108 of the ballstent until the ballstent is ex pandir to fill at least part of the aneurysm. The physician obtains an angiogram of aneurysm 700 and artery of origin 1202 by injecting radiographic contrast material to confirm that expanded ballstent 100 is correctly positioned within lumen 701 of saccular aneurysm 700 and fills the aneurysm properly. The physician then connects the proximal end of an electrolysis wire 320 or the insulated lead wire to a DC power source and applies a current to the electrolysis or insulated lead wires that are electrically connected to the neck 116 of the ballstent 100 in quantity and for a time. sufficient to bring about dissolution of a portion of the neck or proximal body 208 of the ballstent that is uncoated and uninsulated, resulting in separation between the expanded ballstent and the delivery catheter. The physician obtains an angiogram of aneurysm 700 and artery of origin 1202 by injecting radiographic contrast material to confirm that expanded ballstent 100 is correctly positioned within the lumen of the saccular aneurysm and fills the aneurysm properly. The physician removes delivery catheter 400 and guide catheter 800. The physician advances a balloon catheter 1100 over guidewire 302 until balloon 1102 is adjacent to expanded ballstent 100. Balloon 1102 portion of balloon catheter 1100 is then inflated with a saline solution until it fills the lumen of the artery of origin 1202 and flattens and pushes the wall 1104 of the expanded ballstent 100 toward the aneurysm 700. The doctor takes another angiogram of the aneurysm 700 and the artery of origin 1202 to confirm that the expanded ballstent 100 is correctly positioned within the lumen of the saccular aneurysm and adequately fills the aneurysm, and that the lumen of the source artery 1202 is free of obstruction. The physician removes the 1100 balloon catheter, the 302 guidewire, and the sheath and achieves hemostasis from the femoral artery puncture with compression. The patient is then transported to a recovery room. During and after recovery, the physician periodically monitors the patient, as well as the position of the ballstent 100 and the completeness of the aneurysm seal 700.
[00284] It will be appreciated that the devices and methods of the present invention are capable of being incorporated in the form of a variety of modalities, only a few of which have been illustrated and described above. The disclosures in this document may be incorporated in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive and the scope of the present invention is therefore indicated by the appended claims and not by the above description. All changes and variations that fall within the meaning and equivalence range of the claims must be contained within their scope.

权利要求:
Claims (29)
[0001]
1. System for occluding the lumen of blood vessel segments in a patient, characterized in that it comprises: a) a single lobulated expandable metal body (100, 150) comprising: a distal region (202); a proximal region (208) generally opposite the distal region (202); an intermediate region (206) transitioning from the distal region (202) to the proximal region (208); a central shaft (212) extending proximal-distal between the proximal region (208) and the distal region (202); and a wall (102) extending generally continuously through the intermediate region (206) from the distal region (202) to the proximal region (208) to define an outer surface (124) of the expandable body (100, 150) and a inner surface (106, 218) of the expandable body (100, 150), the inner surface (10, 218) defining a central gap (108) of the expandable body (100, 150), wherein the expandable body (100, 150) is configured to expand from a deliverable delivery configuration to an expanded configuration; b) a delivery catheter (300, 400) comprising: a longitudinally extending body comprising a proximal end and a distal end generally opposite the proximal end, the distal end of the delivery catheter (300, 400) being operatively coupled to the proximal (208) region of the expandable body (100, 150); c) wherein, when the expandable body (100, 150) is in the configuration manageable, the wall (1 02) adopts a pleated configuration comprising a plurality of pleats (3600) bent in a clockwise direction to the central axis (212), or in a counterclockwise direction to the central axis (212) to form a the bent region of the expandable body (100, 150), d) wherein the delivery catheter (300, 400) includes a hollow cylindrical member defining a lumen (312) to permit the passage of a fluid medium from the proximal end of the catheter. delivery (300, 400) to the distal end of the delivery catheter (300, 400) and into the central lacuna (108) of the expandable body (100, 150); proximal end of the delivery catheter (300, 400) into the central gap (108) of the expandable body (100, 150) can result in expansion of the expandable body (100, 150);f) where, when the expandable body ( 100, 150) is in the expanded configuration, the plurality of pleats (3600) does not is folded; g) wherein, when the expandable body (100, 150) is in the expanded configuration, the expandable body (100, 150) has sufficient strength to maintain it in the expanded configuration in vivo under typical physiological conditions within the segment lumen of blood cases after disengagement catheter separation (300, 400) in which a pressure inside and outside the central lacuna (108) is the same or similar; and h) in which no solid or semi-solid material or member, not derived from the patient, is needed in the central gap (108) of the expandable body (100, 150) to at least assist in making the expandable body (100 , 150) adopt or maintain the expanded configuration after separation from the expandable body (100, 150) expanded in the delivery catheter (300, 400).
[0002]
2. System according to claim 1, characterized in that the wall (102) of the expandable body (100, 150) has a wall thickness (120) between 5 micrometers and 50 micrometers.
[0003]
3. System according to claim 2, characterized in that the wall (102) of the expandable body (100, 150) comprises at least one layer (122, 104, 214), wherein the at least one layer ( 122, 104, 214) is a metallic layer.
[0004]
4. System according to claim 3, characterized in that the metallic layer comprises gold.
[0005]
5. System according to claim 4, characterized in that an outer surface (110) of the metallic layer comprises a rounded, rough or granular surface structure.
[0006]
6. System according to claim 5, characterized in that the rounded, rough or granular surface structures have a surface height of 0.1 micrometers to 10 micrometers.
[0007]
7. System according to claim 6, characterized in that at least a portion of the wall (102) of the expandable body (100, 150) comprises an inner layer (214) and an outer layer (104).
[0008]
8. System according to claim 7, characterized in that the inner layer (214) is non-metallic.
[0009]
9. System according to claim 8, characterized in that the inner layer (214) is a polymer.
[0010]
10. System according to claim 9, characterized in that the inner layer (214) has a thickness between 0.1 micrometers and 10 micrometers.
[0011]
11. System according to claim 10, characterized in that when the expandable body (100, 150) is in the expanded configuration, the expandable body (100, 150) expanded comprises a general shape that is generally spherical.
[0012]
12. System according to claim 11, characterized in that the expandable body (100, 150) has an expanded diameter between 2 mm and 30 mm.
[0013]
13. System according to claim 10, characterized in that when the expandable body (100, 150) is in the expanded configuration, the expandable body (100, 150) expanded comprises a general shape that is generally cylindrical or oblong .
[0014]
14. System according to claim 10, characterized in that when the expandable body (100, 150) is in the expanded configuration, the expandable body (100, 150) assumes a shape in which the intermediate region (206) it is generally cylindrical and the proximal (208) and distal (202) region are both generally hemispherical.
[0015]
15. System according to claim 14, characterized in that the expandable body (100, 150) has an expanded diameter between 2 mm and 30 mm.
[0016]
16. System according to claim 15, characterized in that the expandable body (100, 150) has an expanded length between 5 mm and 60 mm.
[0017]
17. System according to claim 16, characterized in that the delivery catheter (3.00, 400) comprises two lumens, with a lumen (312) configured to allow the passage of fluid medium from a medium source fluid (314) at the proximal end of the delivery catheter (300, 400) to the central lacuna (108) of the expandable body (100, 150), and the other lumen (324) configured to accept a guide member such as a guide wire (302).
[0018]
18. System according to claim 1, characterized in that the expandable metallic body further comprises: a) a proximal neck (116).
[0019]
19. System according to claim 1, characterized in that the expandable metal body (100, 150) further comprises: a) a proximal neck (116); and b) a distal neck (118).
[0020]
20. System according to claim 18, characterized in that the expandable body (100, 150) is attached to the administration catheter (300, 400) using an adhesive, glue, solder or solder.
[0021]
21. System according to claim 1, characterized in that the expandable body (100, 150) is attached to the administration catheter (300, 400) by a friction fit.
[0022]
22. System according to claim 19 or 20, characterized in that the proximal neck (116) or the distal neck (118) of the expandable body (100, 150) is attached to the administration catheter (300, 400) .
[0023]
23. System according to claim 22, characterized in that at least a portion of the wall (102) of the expandable body (100, 150) comprises an inner layer (214) and an outer layer (104), and in that the inner layer (214) of at least a portion of the neck (116, 118) affixed to the delivery catheter (300, 400) comprises stainless steel and the outer layer (104) comprises gold.
[0024]
24. The system of claim 23, characterized in that a portion of the outer layer (104) is absent in a ring-shaped region of the proximal neck (116) to form an exposed metal surface or structure in shape. of ring.
[0025]
25. System according to claim 24, characterized in that the surface or exposed metal structure in ring shape comprises stainless steel.
[0026]
26. System according to claim 25, characterized in that it further comprises an electrolysis system comprising an electrical circuit in which a portion of the electrical circuit is supported on the delivery catheter (300, 400) and configured to cause the separating the expandable body (100, 150) from the distal end of the delivery catheter (300, 400).
[0027]
27. System according to claim 26, characterized in that it comprises one or more conductors incorporated in a wall of the administration catheter (300, 400) which acts as both electrical conductors for the electrical system and structural reinforcement for the administration catheter wall (300, 400).
[0028]
28. System according to claim 1, characterized in that the expandable body (100, 150) expanded and the administration catheter (300, 400) can be separated by pulling the administration catheter (300, 400) and the expandable body (100, 150) expanded.
[0029]
29. System according to claim 5 or 28, characterized in that the expandable body (100, 150) comprises two necks (116, 118) and a first opening in a neck of the expandable body (100, 150) is It is sealed after separating the expandable body (100, 150) from the delivery catheter (300, 400) while a second opening in a second neck remains open.

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US11090176B2|2021-08-17|

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AU2012207387A1|2013-07-18|

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KR101925815B1|2018-12-06|

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JP2014506809A|2014-03-20|

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WO2012099909A2|2012-07-26|

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CN110464402A|2019-11-19|

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RU2013138347A|2015-02-27|

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IL271003D0|2020-01-30|

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IL227440A|2019-01-31|

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法律状态:
2018-07-10| B25A| Requested transfer of rights approved|Owner name: METACTIVE MEDICAL, INC. (US) |

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2018-12-11| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2019-11-05| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2020-11-03| B06A| Patent application procedure suspended [chapter 6.1 patent gazette]|

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2021-04-06| B25D| Requested change of name of applicant approved|Owner name: ARTIO MEDICAL, INC. (US) |

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2021-04-20| B25G| Requested change of headquarter approved|Owner name: ARTIO MEDICAL, INC. (US) |

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2021-06-08| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2021-08-24| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 17/07/2012, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US201161433305P| true| 2011-01-17|2011-01-17|

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PCT/US2012/000030|WO2012099704A2|2011-01-17|2012-01-17|Blockstent device and methods of use|

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USPCT/US2012/021621|2012-01-17|

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USPCT/US2012/000030|2012-01-17|

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USPCT/US2012/021620|2012-01-17|

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PCT/US2012/021621|WO2012099910A2|2011-01-17|2012-01-17|Ballstent device and methods of use|

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PCT/US2012/047072|WO2013109309A1|2012-01-17|2012-07-17|Expandable body device and method of use|

---