Double wire dilator and lumen systems

Description

1 / 17 “DOUBLE-WIRE DILATOR AND LUMEN SYSTEMS” RELATED ORDERS

[001] This application claims priority over U.S. Provisional Application No. 63 / 629,947, filed March 24, 2023, entitled “Dilator and Dual Wire Lumen Systems,” and U.S. Utility Application No. 18 / 612,628, filed March 21, 2024, entitled “Dilator and Dual Wire Lumen Systems,” each of which is hereby incorporated by reference in its entirety. TECHNICAL FIELD

[002] This application relates to stent prostheses, guide wires, catheters and methods of using them. BRIEF DESCRIPTION OF THE VARIOUS VIEWS OF THE DRAWINGS

[003] The embodiments disclosed in this document will become more fully apparent from the following description and the appended claims, in combination with the accompanying drawings. The drawings represent only typical embodiments, embodiments which will be described with specificity and further detail in connection with the drawings in which:

[004] Figure 1 illustrates a branched stent prosthesis with a guidewire according to the modalities in this document.

[005] Figure 2A illustrates a 200 double-wire lumen system with a first configuration 201a within a 100 branched stent prosthesis, according to the embodiments in this document, Figure 2B illustrates the 200 double-wire lumen system with a second configuration 201b within the 100 branched stent prosthesis, according to the embodiments in this document. Petition 870250085714, dated 09 / 23 / 2025, p. 8 / 40 2 / 17

[006] Figure 2C illustrates the double wire lumen system 200 with a third configuration 201 c within the branched stent prosthesis 100, according to the embodiments in this document.

[007] Figure 3 illustrates a branched stent prosthesis implanted within a branched implant site, according to the embodiments in this document.

[008] Figure 4 illustrates a branched stent prosthesis and a double-wire lumen system that includes a guide sheath, according to the embodiments in this document.

[009] Figure 5 illustrates a method in accordance with the modalities disclosed in this document. DETAILED DESCRIPTION

[010] Dilating systems and / or double-wire lumen systems can be configured to deliver a guidewire from one branch of a branched stent prosthesis implanted inside a patient's body to another branch. Such systems can be configured to be advanced from an insertion site external to an anatomical system to a stent prosthesis internal to the anatomical system. A double-wire lumen system can be implanted from an insertion site on a branched stent prosthesis. Such systems can be configured to deliver a guidewire with the aid of another guidewire.

[011] Stent prostheses can be implanted in various lumens of the body for a variety of purposes. Stent prostheses can be implanted, for example, in the arterial system for a variety of therapeutic purposes, including the treatment of occlusions within the lumens of that anatomical system. The present disclosure may be applicable to stent prostheses designed for the central venous system, peripheral vascular system, system Petition 870250085714, dated 09 / 23 / 2025, page 9 / 40 3 / 17 of aneurysm of the abdominal aorta, bronchial system, esophageal system, biliary system or any other system of the human body. Furthermore, the present disclosure may be equally applicable to other prostheses, such as grafts.

[012] Figure 1 illustrates a branched stent prosthesis 100 with a guidewire 102 according to the embodiments in this document. In the illustrated embodiment, the branched stent prosthesis 100 is partially composed of a wire or laser-cut stent 106. In some embodiments, the wire or laser-cut stent 106 is configured to be expandable to an implanted position as illustrated from an unexpanded / unimplanted configuration (e.g., by inflating one or more balloons from within the branched stent prosthesis 100) after the branched stent prosthesis 100 is delivered to a desired location. The wire or laser-cut stent 106 can be formed from any suitable material, such as nickel-titanium alloy, stainless steel, cobalt-chromium, platinum, polymers, etc. The 106 wire or laser-cut stent can have a zigzag pattern, a wavy pattern, or any other suitable pattern.A wire or laser-cut stent 106 can be pre-formed or formed according to a tubular body 104. The material, pattern, and wire diameter of a wire or laser-cut stent 106 that is a wire stent, or the wall thickness and frame width of a wire or laser-cut stent 106 that is a laser-cut stent, can be configured to provide chronic outward-directed radial force and resistance to an inward-directed radial force. For a non-self-expanding design, the implanted wire or laser-cut stent 106 can be configured to provide radial stiffness and radial strength to resist a local or inward-directed radial force. Petition 870250085714, dated 09 / 23 / 2025, page 10 / 40 4 / 17

[013] The branched stent prosthesis also includes the tubular body 104. The tubular body 104 can be formed from a variety of materials and / or layers of materials, including biocompatible materials that are resistant to fluid passage through a wall of the tubular body 104. For example, the tubular body 104 can be formed from polyethylene terephthalate, polyurethane, silicone rubber, nylon, fluoropolymer, polyester, etc. The wall thickness can vary from about 0.025 mm to about 0.5 mm.

[014] In certain embodiments, the wall of the tubular body 104 may be impermeable to tissue cell growth and / or tissue cell migration through the wall, for example, to prevent or inhibit stenosis of the tubular body 104. Additionally or alternatively, in some embodiments, the wall of the tubular body 104 may be fluid impermeable, so that fluid is prevented from leaking from the interior of the branched stent prosthesis 100 to the exterior of the branched stent prosthesis 100 and to the surrounding tissue. In some embodiments, an inner surface of the wall may include serially deposited polytetrafluoroethylene (PTFE) fibers to resist fibrin deposition and platelet adhesion to the surfaces.

[015] Note that, in the embodiments presented in this document, stent prostheses are illustrated as having tubular bodies (such as tubular body 104 in Figure 1). However, it should be understood that branched expandable stent prostheses that use a scaffold, frame or wire stent without a tubular body are within the scope of the disclosure.

[016] As illustrated in this document, the branched stent prosthesis 100 can be for implantation in a branched implant site within a body having a trunk, a first branch and a second branch. Thus, the branched stent prosthesis 100 includes a trunk portion 108, a first branched portion 110 and a second branched portion. Petition 870250085714, dated 09 / 23 / 2025, page 11 / 40 5 / 17 112. The trunk portion 108, the first branched portion 110, and the second branched portion 112 are joined (i.e., meet) at an intersection. For implantation of the branched stent prosthesis 100 at the branched implantation site, the trunk portion 108 of the branched stent prosthesis 100 is used in the trunk of the branched implantation site, the first branched portion 110 is implanted in the first branch of the branched implantation site, and the second branched portion 112 is implanted in the second branch of the branched implantation site.

[017] The guidewire 102 extends between the first branched portion 110 and the second branched portion 112. In other words, the guidewire 102 passes through the second branched portion 110 and out of the second branched portion 112 and can be configured to extend beyond the first branched portion 110 and the second branched portion 112. The guidewire 102 can be positioned inside the branched stent prosthesis 100 before or during the implantation of the branched stent prosthesis 100 to assist in the implantation of the branched stent prosthesis 100 at the branched implantation site. As such, the 102 guidewire can extend back through a branch of the branched implant site and go up to / through an insertion site, through which a practitioner has delivered the branched stent prosthesis into the body (e.g., using one or more delivery systems, such as a catheter delivery system in some modalities).In some modalities, the guidewire may be called a floss wire, since it passes from one branch to another and can extend from the branched stent prosthesis 100 to reach corresponding locations on each side of the vasculature. The guidewire 102 may also be called a branch guidewire due to its location.

[018] The 102 guidewire can be configured to exit from the opposite branch of the branched implant site so that a length of the 102 guidewire is Petition 870250085714, dated 09 / 23 / 2025, p. 12 / 40 6 / 17 extends to / through an incision, so that the practitioner can access the guidewire 102 from two separate and distinct locations in the body (subsequently providing access to the second branched portion 112 and the first branched portion 110 of the branched stent prosthesis 100). In some embodiments, this allows the practitioner to implant one or more systems along either end of the guidewire 102 in the branched stent prosthesis 100.

[019] The 100 branched stent prosthesis can be implanted within a branched implant site within the body (e.g., within a body vascular system). For example, the vascular system can be an aortic / iliac bifurcation. In some embodiments, the 100 branched stent prosthesis can be implanted within any branched implant site that includes a first branched portion, a second branched portion, and a trunk portion.

[020] Figure 2A illustrates a double-wire lumen system 200 with a first configuration 201a within a branched stent prosthesis 100, according to the embodiments in this document. The double-wire lumen system 200 includes a dilator 214 and a guidewire 216. In some embodiments, the double-wire lumen system additionally includes the guidewire 102. The guidewire 216 is located within the dilator 214 and extends parallel to the dilator 214 within the first branched portion 110 of the branched stent prosthesis 100. The dilator 214 includes an orifice 218, and a distal end of the dilator 214 has an opening 220 through which the dilator 214 can be advanced and / or retracted along the guidewire 102.

[021] The orifice 218 is an opening (for example, a hole, cutout, slit, incision or the like) within a side wall of the dilator 214 that is large enough to allow the guide wire 216 to pass through. Petition 870250085714, dated 09 / 23 / 2025, p. 13 / 40 7 / 17 Orifice 218 may be located adjacent to the distal end of dilator 214 proximal to the distal tip of dilator 214. In particular, orifice 218 may be located closer to the distal end of dilator 214 than to a proximal end of dilator 214. As detailed below, orifice 218 may be displaced proximally from the distal tip of dilator 214 such that orifice 218 is aligned with a trunk portion of a stent graft when the distal tip of dilator 214 is partially disposed in a second leg of a stent graft and the proximal portion of dilator 214 is disposed in a first leg of a stent graft.

[022] In some embodiments, one or more edges of the orifice may be indicated by various means, such as with radiopaque (or radiodense) markers (e.g., a substance that is opaque to X-rays or similar electromagnetic radiation), such as radiopaque markers 222a and 222b, as shown in Figure 2. The radiopaque markers may be indicated as spots, rings, bands, etc. around the orifice 218. The radiopaque markers allow the position of the orifice 218 to be tracked during a procedure. In some embodiments, the dilator 214 may include a radiopacifier to enhance visualization and tracking of the dilator 214 and / or the orifice 218 during implantation. In some embodiments, the distal end of the dilator 214 may include a radiopaque marker instead of the orifice 218, and a distance between the distal end and the orifice 218 is known so as to allow tracking of the location of the orifice 218.In some other modalities, there may be radiopaque markers at the distal end of the dilator 214, around the orifice 218 and / or at other locations along the dilator 214. Petition 870250085714, dated 09 / 23 / 2025, p. 14 / 40 8 / 17

[023] As depicted in Figures 2A-2C, the 200 double-wire lumen system can be configured to be advanced through bends and / or curves within the 100 branched stent prosthesis. The 200 double-wire lumen system can be inserted through the first branched portion 110 of the 100 branched stent prosthesis. Within the first branched portion 110, the guidewire 102 and guidewire 216 are located within the dilator 214, and a distal end of the guidewire can be positioned at a similar distance from the distal end of the dilator 214 as the orifice 218. In the depicted configuration 201a (e.g., before the dilator 214 is advanced through bends and / or curves within the 100 branched stent prosthesis), the guidewire 216 is fully enclosed within the dilator 214. The distal end of the dilator 214 and the distal end of guidewire 216 are advanced along guidewire 102, which is stationary.The dilator 214 and the guidewire 216 are directed along the guidewire 102 towards the intersection between the trunk portion 208, the first branched portion 110 and the second branched portion of the branched stent prosthesis 100.

[024] Figure 2B illustrates the double-wire lumen system 200 with a second configuration 201b within the branched stent prosthesis 100, according to the embodiments in this document. At or near the intersection, the distal end of the dilator 214 is advanced (e.g., bent as a result of being guided by the guidewire 102) toward the second branched portion 112 while a distal end of the guidewire 216 is advanced (e.g., guided) through the orifice 218 and along the trunk portion 108, so that the dilator 214 and guidewire 216 no longer move parallel to each other. In other words, the dilator 214 and guidewire 216 split toward the second branched portion 112 and the trunk portion 108, respectively. The guidewire 216 can be advanced toward the trunk portion. Petition 870250085714, dated 09 / 23 / 2025, p. 15 / 40 9 / 17 108 by means of a professional manipulating a proximal end of the guidewire 216. Advancement of the guidewire 216 can occur when the orifice 218 is directed so that it opens towards the trunk portion 108. The guidewire 216 can be advanced when it is determined that the orifice 218 is directed into the trunk portion 108, for example, by means of the radiopaque markers 222a and 222b. It should be noted that, within the first branched portion 110, the proximal portions of the dilator 214 and the guidewire 216 remain parallel, and the corresponding portion of the guidewire 216 remains located within the dilator 214.

[025] Figure 2C illustrates the double wire lumen system 200 with a third configuration 201 c within the branched stent prosthesis 100, according to the embodiments in this document. Once the dilator 214 and the guidewire 216 are separated at the intersection, the dilator 214 can be held stationary while the guidewire 216 can continue to be advanced through the orifice 218 and upward through the trunk portion 108 of the branched stent prosthesis 100, so that a practitioner can reach the distal end of the guidewire 216 through the trunk portion 108 (e.g., through an incision, opening, or similar in the body that provides access to portion 108 through a branched implant site trunk). The guidewire 216 can continue to be advanced upward and along the trunk portion 108 until the distal end reaches a desired location.

[026] Once the guidewire 216 is positioned at the desired location, the dilator 214 can be retracted along the guidewire 102 back through the first branched portion 110 of the branched stent prosthesis 100. The dilator 214 is retracted in such a way that there is little or no translational dependence between the dilator 214 and the guidewire 216, so that the guidewire 216 remains in place extending between the first branched portion 110 and the Petition 870250085714, dated 09 / 23 / 2025, p. 16 / 40 10 / 17 portion of trunk 208, while the dilator 214 is fully extracted. In some embodiments, this can be achieved by constructing the dilator 214 from a sufficiently malleable or flexible material, compared to constructing the guide wire 216 from a more rigid material. In other embodiments, this can be achieved by constructing the dilator 214 and the guide wire 216 from the same material, but such that they have different durometers. The dilator 214 and / or the guide wire 216 can be constructed from a material such as polypropylene, polyethylene, nylon, Pebax or similar. The dilator 214 and the guide wire 216 can be constructed to have an appropriate flexibility or rigidity (e.g., durometer) relative to the particular material (e.g., the malleability of the structure can be varied even without changing the material).

[027] Figure 3 illustrates a branched stent prosthesis 100 implanted within a branched implant site 300, according to the embodiments in this document. When the branched stent prosthesis 100 is implanted within the branched implant site 300, it can provide stent in / through the branched implant site within the anatomical system in which it is implanted.

[028] The branched implant site 300 may be a portion of an anatomical system that includes a trunk 308, a first branch 310, and a second branch 312 that are in mutual fluid communication. The branched stent prosthesis 100 is implanted so that the trunk portion 108 is located within the trunk 308, the first branched portion 110 is located within the first branch 310, and the second branched portion 112 is located within the second branch 312 of the branched stent prosthesis 100 and the branched implant site 300, respectively. In some Petition 870250085714, dated 09 / 23 / 2025, page 17 / 40 In the 11 / 17 modalities, the implant site for branched 300 is the aortoiliac bifurcation in the arterial system.

[029] In some embodiments, the branched stent prosthesis 100, once implanted, provides an appropriate channel for the desired fluid flow through the branched implant site 300. It may be that the region around the branched implant site 300 is diseased, deformed and / or damaged, and that implantation of the expandable branched stent prosthesis 100 in the manner illustrated may correct and / or improve the existing problems.

[030] As illustrated, the branched implant site 300 of Figure 3 is used within an anatomical system that is a cardiovascular system. However, it should be noted that although the examples in this document describe (and the figures in this document illustrate) the implantation of expandable branched stent prostheses and double-wire lumen systems within cardiovascular systems, the cardiovascular anatomical context is given by way of example and not by way of limitation.It will be understood that implantation systems analogous to those described in relation to the disclosure herein may be used to implant double-wire lumen systems within appropriate branched stent prostheses with / at branched implant sites of other anatomical systems, and that the corresponding methods for using these implantation systems to implant the corresponding double-wire lumen systems that are analogous to the methods described herein may be used in those other anatomical contexts.

[031] Figure 4 illustrates a branched stent prosthesis 100 and a double-wire lumen system 400 that includes a guide sheath 420, according to the embodiments in this document. The double-wire lumen system 400 may be similar to the double-wire lumen system 200, as observed by similar reference numbers, except that, in addition to the dilator 214 and the wire Petition 870250085714, dated 09 / 23 / 2025, page 18 / 40 12 / 17 guide 216, the 400-wire dual lumen system additionally includes a guide 420 sheath.

[032] In some embodiments, the guide sheath 420 can be implemented to encircle or house the dilator 214, the guide wire 216, and a portion of the guide wire 102 until the distal end of the dilator 214 reaches the interior of the first branched portion 110 of the branched stent prosthesis 100. The guide sheath 420 can be configured to carry the dilator 214 and the guide wire 216 from an insertion site that connects an exterior of a body to a branch (e.g., the branch 310 as illustrated in Figure 3) and to a corresponding branched portion (e.g., the first branched portion 110 of the branched stent prosthesis 100) along the guide wire 102. The guide sheath 420 can be configured to prevent the double-lumen wire system 400 from becoming trapped during placement.Once the dilator 214 has been positioned at the desired location (e.g., deep within the first branched portion 110 of the branched stent prosthesis 100), the guide sheath 420 can be retracted back along the double-wire lumen system 400 and the guide wire 102 and out of the first branched portion 110.

[033] Figure 5 illustrates a method 500 according to the embodiments disclosed in this document. The method 500 involves inserting, through a first branched portion of a branched stent prosthesis, a dilator system into the branched stent prosthesis, wherein the branched stent prosthesis comprises the first branched portion, a second branched portion and a trunk portion, wherein the dilator system comprises a dilator and a first guidewire (block 502). The trunk portion, the first branched portion and the second branched portion may be the trunk portion 108, the first branched portion 110 and the second branched portion 112 of the branched stent prosthesis 100 of Figures 1-4, or they may be other portions Petition 870250085714, dated 09 / 23 / 2025, page 19 / 40 13 / 17 suitable from other branched stent prostheses. The dilator system can be the 200-wire double lumen system of Figure 2, the 400-wire double lumen system of Figure 4, or any other suitable system.

[034] Method 500 additionally includes directing the dilator system toward an intersection between the first branched portion, the second branched portion, and the trunk portion of the branched stent prosthesis (block 504).

[035] Method 500 additionally involves advancing a distal end of the dilator toward the second branched portion of the branched stent prosthesis (block 506).

[036] Method 500 additionally involves advancing, at the intersection, a distal end of the first guidewire along the trunk portion of the branched stent prosthesis through a hole disposed in a lateral wall of the dilator (block 508). The hole may be located at the distal end of the dilator. In this sense, the hole may be located close to an actual distal endpoint of the dilator, so that there is a finite distance between the endpoint and the location of the hole. In some embodiments, the first guidewire is configured to exit the dilator through the hole and be advanced into the trunk portion of the branched stent prosthesis while the dilator is directed toward the second branched portion of the branched stent prosthesis.

[037] Method 500 additionally includes retracting the dilator through the first branched portion of the branched stent prosthesis (block 510). The dilator can be configured to be retracted through the first branched portion of the branched stent prosthesis, along the second guidewire, and independently of the first guidewire. In other words, the first guidewire is left in place when the dilator is retracted. In some embodiments, the dilator is configured to produce minimal disturbance to the first guidewire when Petition 870250085714, dated 09 / 23 / 2025, p. 20 / 40 14 / 17 as it is retracted. In some modalities, the second guide wire may be a flexible wire.

[038] In some embodiments, method 500 may additionally include passing the dilator system along a second guidewire that extends between the first branched portion and the second branched portion of the branched stent prosthesis. The second guidewire may be guidewire 102 of Figures 1-4, or it may be another wire that passes between the first and second branched portions of the branched stent prosthesis. For example, in one embodiment, the second guidewire may be a wire that is positioned within the branched stent prosthesis during or before implanting the branched stent prosthesis at a branched implantation site. In other embodiments, the second guidewire may be a wire that is positioned within the branched stent prosthesis after it has been implanted, for example, as part of another procedure that a practitioner would perform. A portion of the second guidewire is disposed within the dilator.

[039] In some embodiments, the dilator system further comprises a guide sheath housing the dilator, the first guide wire and a portion of the second guide wire, wherein method 500 further comprises advancing the guide sheath within the first branched portion along the second guide wire towards the intersection to advance the dilator and the first guide wire along the second guide wire.

[040] In some embodiments, the 500 method is performed on a branched stent prosthesis that is already implanted in a branched implantation site. Thus, the 500 method further comprises delivering the branched stent prosthesis into a branched implantation site comprising a trunk, a first branch, and a second branch. In some embodiments, the branched implantation site is located within a Petition 870250085714, dated 09 / 23 / 2025, p. 21 / 40 15 / 17 vascular system of a body, such as an aortoiliac bifurcation in an arterial system.

[041] Although the dilators described in this document include a single orifice, in some embodiments, a dilator may have more than one orifice. In some embodiments, the multiple orifices may be located at different locations around the lateral wall (e.g., they are aligned in a ring pattern), but each is equidistant from the distal endpoint of the dilator. In other embodiments, the multiple orifices may be located along a single line on the lateral wall of the dilator, but each is at a different distance from the distal endpoint of the dilator. In other embodiments, the multiple orifices may each be located at a different point both around and along the dilator.Such configurations can be used to reduce restrictions related to the process of advancing and directing the first guidewire from a first branched portion of a branched stent prosthesis to a trunk portion of the branched stent prosthesis.

[042] Although the examples represented in this document refer to the installation or implantation of a guidewire from a first branched portion to a trunk portion of a branched stent prosthesis, in other embodiments, any methods described are applicable to the implantation of a guidewire between any two branches (between the first branched portion, the second branched portion and the trunk portion) by advancing the dilator system along a second guidewire that extends between two other branches (between the first branched portion, the second branched portion and the trunk portion).

[043] All methods disclosed in this document comprise one or more steps or actions to perform the described method. Petition 870250085714, dated 09 / 23 / 2025, page 22 / 40 16 / 17 The steps and / or actions of the method can be interchanged. In other words, unless a specific order of steps or actions is required for the proper operation of the method, the order and / or use of specific steps and / or actions can be modified.

[044] References to approximations are made throughout this descriptive report, such as by the use of the term “substantially”. For each of these references, it should be understood that, in some embodiments, the value, feature or characteristic may be specified without approximation. For example, when qualifiers such as “about” and “substantially” are used, these terms include within their scope the qualified words in the absence of their qualifiers. For example, when the term “substantially perpendicular” is cited with respect to a feature, it is understood that in other embodiments, the feature may have a precisely perpendicular configuration.

[045] Similarly, in the above description of embodiments, several features are sometimes grouped into a single embodiment, figure, or description thereof, for the purpose of expediting disclosure. This method of disclosure, however, should not be interpreted as reflecting an intention that any claim requires more features than those expressly cited in that claim. Instead, as the following claims reflect, the inventive aspects reside in a combination of fewer than all the features of any previously disclosed embodiment.

[046] The claims that follow this written disclosure are expressly incorporated herein into this written disclosure, with each claim representing in itself a separate embodiment. This disclosure includes all permutations of the independent claims with their dependent claims. Furthermore, embodiments Petition 870250085714, dated 09 / 23 / 2025, page 23 / 40 17 / 17 additional claims capable of deriving from the independent and dependent claims that follow are also expressly incorporated into this written description.

[047] Without further elaboration, it is believed that a person skilled in the art can use the foregoing description to utilize the invention to its fullest extent. The claims and embodiments disclosed herein should be interpreted as merely illustrative and exemplary, and not as a limitation of the scope of this disclosure in any way. It will be evident to those of ordinary skill in the art, with the aid of this disclosure, that alterations can be made to the details of the embodiments described above without departing from the underlying principles of the disclosure herein. In other words, various modifications and improvements of the embodiments specifically disclosed in the description above are within the scope of the appended claims. Furthermore, the order of the steps or actions of the methods disclosed herein can be altered by those skilled in the art without departing from the scope of this disclosure.In other words, unless a specific order of steps or actions is required for the proper operation of the embodiment, the order or use of specific steps or actions may be modified. The scope of the invention is therefore defined by the following claims and their equivalents. Petition 870250085714, dated 09 / 23 / 2025, page 24 / 40

Claims

1 / 3 CLAIMS 1. System CHARACTERIZED in that it comprises: a branched stent prosthesis having a first branched portion, a second branched portion and a trunk portion; a dilator comprising an orifice disposed in a lateral wall of the dilator; and a first guidewire configured to be advanced through the first branched portion and out of the trunk portion of the branched stent prosthesis through the dilator orifice.

2. System according to claim 1, CHARACTERIZED in that the orifice is disposed at a distal end of the dilator.

3. System, according to any one of claims 1 and 2, CHARACTERIZED in that it further comprises: a second guidewire extending between the first branched portion and the second branched portion of the branched stent prosthesis; and a guide sheath housing the dilator, the first guidewire and a portion of the second guidewire, the guide sheath for advancing the dilator and the first guidewire along the second guidewire within the first branched portion of the branched stent prosthesis.

4. System according to claim 3, CHARACTERIZED in that the dilator and the first guidewire are advanced along the second guidewire towards an intersection between the first branched portion, the second branched portion, and the trunk portion of the branched stent prosthesis to direct the dilator towards the second branched portion of the branched stent prosthesis and to direct the first guidewire along the trunk portion of the branched stent prosthesis. Petition 870250085714, dated 09 / 23 / 2025, pp. 38 / 40 2 / 3 5. System, according to any one of claims 1 to 4, CHARACTERIZED in that the dilator is configured to be retracted through the first branched portion of the branched stent prosthesis.

6. System, according to any one of claims 1 to 5, CHARACTERIZED in that it further comprises a balloon disposed within the branched stent prosthesis to expand the branched stent prosthesis.

7. System, according to any one of claims 1 to 6, CHARACTERIZED in that the branched stent prosthesis is arranged in a branched implantation site within a body's vascular system.

8. System for use with a branched stent prosthesis having a first branched portion, a second branched portion and a trunk portion joined at an intersection, the system being CHARACTERIZED in that it comprises: a dilator comprising an orifice within a lateral wall of the dilator; a first guidewire disposed within the dilator; and a second guidewire, wherein a portion of the second guidewire is disposed within the guide sheath.

9. System according to claim 8, CHARACTERIZED in that it further comprises a guide sheath configured to carry the first guide wire and the dilator along the second guide wire of the first branched portion of the branched stent prosthesis towards the intersection, wherein the first guide wire, the second guide wire and the dilator are arranged within the guide sheath.

10. System, according to any of claims 8 and 9, CHARACTERIZED in that the second guide wire extends between the first branched portion and the second branched portion of the branched stent prosthesis.

11. System, according to any one of claims 8 to 10, CHARACTERIZED in that at the intersection, the first guide wire is configured to exit the dilator through the orifice and be advanced into the trunk portion of the branched stent prosthesis and the dilator is directed to the second branched portion of the branched stent prosthesis.

12. System, according to any one of claims 8 to 11, CHARACTERIZED in that the dilator is configured to be retracted through the first branched portion of the branched stent prosthesis independently of the first guidewire.

13. System, according to any one of claims 8 to 12, CHARACTERIZED in that the orifice is disposed at a distal end of the dilator. Petition 870250085714, dated 09 / 23 / 2025, p. 40 / 40

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