Thrombus aspiration system and related methods

Abstract

A system for blood clot removal can include a first tube, a second tube slidable within the first tube, and a self-expanding receptacle having a membrane and positioned at least partially within the second tube. When a proximal portion of the second tube and the receptacle are positioned within a distal end of the first tube and the second tube is moved proximally relative to the receptacle until a distal end of the second tube is positioned proximally of a proximal end of the receptacle, the proximal portion of the receptacle can radially expand and contact the distal end of the first tube, and a distal portion of the receptacle can radially expand such that it has an inner diameter that is at least 10% greater than an inner diameter of the first tube.

Description

[0001] Cross-references to related applications

[0002] This application claims priority to U.S. Provisional Application No. 61 / 09,258, filed on October 13, 2020, entitled “Thrombus Aspiration System and Related Methods,” the contents of which are incorporated herein by reference in their entirety. Technical Field

[0003] The present invention generally relates to systems for thrombus removal, and more specifically to systems suitable for removing thrombi via aspiration. Background Technology

[0004] A blood clot (also known as a thrombus) can block blood flow through a blood vessel, causing tissues to lose blood and oxygen and resulting in damage. Blood clots are a major cause of stroke and require timely treatment to reduce the risk of long-term disability and death.

[0005] Thrombectomy is a common procedure used to treat stroke. In thrombectomy, a guiding catheter is inserted into the patient's vascular system in the groin and advanced toward the thrombus. A stent retrieval device can then be passed through the guiding catheter and engaged with the thrombus to capture it; once the thrombus is captured, the stent retrieval device and catheter can be removed to restore blood flow to the brain. Alternatively, a small-bore aspiration catheter can be passed through the guiding catheter, and when the distal end of the small-bore aspiration catheter is at the thrombus, a vacuum can be applied at the proximal end of the catheter, forcing the thrombus against the opening of the aspiration catheter to remove it. Over the past decade, thrombectomy has improved stroke treatment success rates, with approximately 85% of procedures achieving recanalization.

[0006] However, the inventors have recognized many challenges that hinder successful recanalization in all thrombectomy procedures. For example, blood flow to the thrombus can impede its removal. While attempts have been made to address this issue using a balloon-guided catheter that blocks blood flow to the thrombus in the internal carotid artery (ICA), other vessels can continue to supply blood to the neurovascular system, thus continuing to impede thrombus removal.

[0007] Furthermore, thrombi include (1) white thrombi primarily composed of platelets and (2) red thrombi primarily composed of erythrocytes. These different thrombus components produce different mechanical properties; white thrombi tend to have higher Young's modulus and tensile strength, while red thrombi tend to have lower Young's modulus and tensile strength. Therefore, stent retrieval devices can easily achieve mechanical engagement with red thrombi for thrombus removal, but may not be able to capture white thrombi, which are more difficult to capture than red thrombi.

[0008] When a vacuum is applied, even if the stent retrieval device cannot mechanically engage the thrombus, the aspiration catheter can maintain thrombus retention at its ostium. However, aspiration catheters also present challenges. Because the aspiration catheter must be able to access the vascular system where the thrombus resides (typically the ICA or middle cerebral artery (MCA) – e.g., its MI segment), aspiration catheters for stroke are often relatively narrow, with a diameter less than 50% of the vessel diameter. Such narrow aspiration catheters may fail to aspirate thrombi that have crossed the vessel and triggered the stroke. Therefore, thrombus removal is usually achieved by retracting the aspiration catheter (with most of the thrombus located outside its lumen) rather than by allowing a vacuum source to pass through the lumen and aspirate the thrombus. During catheter withdrawal, there is a risk of exposed thrombi dislodging, which could lead to recanalization failure.

[0009] Some researchers have improved aspiration success rates by using larger diameter aspiration catheters. These catheters are designed to reach the target vascular system regardless of their size. For example, while aspiration catheters typically have an inner diameter of 0.066", Microvention has developed the SOFIA with an inner diameter of 0.070" and access to the MCA. TM Plus catheters, and Perfuze Ltd. is developing the Millipede CIS catheter with an inner diameter of 0.088". While these aspiration catheters have a larger luminal cross-sectional area and therefore can generate greater suction during aspiration, they may still be unable to take up thrombi that are typically about twice the size in diameter (e.g., about 0.157").

[0010] Another aspiration method includes advancing a self-expanding stent disposed within a small diameter sheath to the thrombus and expanding the distal portion of the stent out of the sheath such that the distal portion of the stent radially expands against the artery wall. In this manner, the stent can capture the thrombus through its expanded mouth. One embodiment of such a device is the ANCD Advanced Thrombectomy System by Anaconda Biomed S.L. While such devices can have an expanded mouth through which the thrombus can easily pass, their stents narrow at their proximal portion down to a diameter that is less than the diameter of the sheath to which the stent is attached. For example, the stent of the ANCD Advanced Thrombectomy System narrows down to an inner diameter of 0.043". This constriction can hinder the capture of the thrombus through the sheath during aspiration.

[0011] Accordingly, there is a need in the art for thrombectomy systems that can better capture thrombus to increase the likelihood of successful recanalization. SUMMARY

[0012] The present system addresses this need in the art with a first tube, a second tube slidable within the first tube, and a self-expanding receptacle positioned at least partially within the second tube. The first tube can have a relatively large internal lateral dimension (e.g., at least about 0.090") and can be inserted into a patient's vasculature at the groin and advanced to or before the patient's ICA. The receptacle and the second tube (both narrower than the first tube) can pass through and beyond the distal end of the first tube to reach a thrombus in the patient's neurovasculature. The receptacle can then be pushed distally (e.g., via a pusher or pusher coil connected thereto) and / or the second tube can be pulled proximally such that the distal portion of the receptacle advances beyond the distal end of the second tube and radially expands to contact the artery wall. In contrast to current systems, the second tube can be withdrawn from the first tube to allow the proximal portion of the receptacle to radially expand to the inner wall of the first tube. Thus, the proximal portion of the receptacle (despite being narrower than its distal portion that expands) can have a larger internal lateral dimension (e.g., at least about 0.071") than the internal lateral dimension of self-expanding stents used in current thrombectomy systems.

[0013] With the larger throat, the receptacle can more easily capture and pass the thrombus to the first tube when vacuum is applied at the proximal end of the first tube, allowing the vacuum source to draw the thrombus through the lumen of the first tube to remove the thrombus. The narrow transition between the distal portion and the proximal portion of the receptacle can facilitate the capture of the thrombus into the first tube, which can not occur in aspiration catheters that do not include a receptacle with a distal portion that expands against the artery wall, such as the SOFIA Plus or the Millipede CIS. TM

[0014] ​To further facilitate thrombus uptake, the first tube can have a radially expandable distal end such that the proximal portion of the receiver expands the radially expandable distal end when expanded to the inner wall of the first tube. With this expansion, the inner lateral dimension of the proximal portion of the receiver can be at least as large (e.g., at least about 0.090") as the inner lateral dimension of the first tube at a proximal location of the distal end of the first tube, creating a throat that is even more conducive to thrombus uptake.

[0015] In this manner, the second tube and receiver can have a narrow profile during insertion to facilitate access to a thrombus disposed at a location that a larger diameter first tube can not easily access, and the receiver can expand at both its distal end and proximal end to a larger blood vessel and first tube wall, respectively, for aspiration, such that removal of the thrombus through the first tube can be achieved.

[0016] Some systems for removing blood clots include a first tube, a second tube, and a self-expanding receiver. In some systems, the second tube is slidable within the first tube. In some systems, the self-expanding receiver is positioned at least partially within the second tube. In some systems, the receiver is radially expandable. In some such systems, when a proximal portion of the second tube and receiver is positioned within a distal end of the first tube and the second tube is moved proximally relative to the receiver until a distal end of the second tube is positioned proximally of a proximal end of the receiver, the proximal portion of the receiver radially expands and contacts the distal end of the first tube, and a distal portion of the receiver radially expands such that an inner diameter of the receiver is greater than an inner diameter of the first tube, optionally at least 10% greater than the inner diameter of the first tube. In some systems, the receiver includes a transition portion that narrows between the distal portion of the receiver and the proximal portion of the receiver.

[0017] Some systems include a multi-port adapter having a first port, a second port, and a third port. In some systems, the first tube has a proximal fitting and the first port is configured to couple with the proximal fitting of the first tube. In some systems, the second port is configured to seal around a cylindrical structure positioned therethrough. In some systems, the third port has a luer lock.

[0018] Some systems include a vacuum source. In some systems, the vacuum source is couplable with the luer lock of the third port of the multi-port adapter.

[0019] Some systems include a guidewire that is positionable within an inner lumen of the second tube and movable relative to the second tube.

[0020] Some methods for removing blood clots include: advancing a first tube through the patient's vascular system and advancing a second tube through the first tube until the proximal portion of a receiver is positioned within the distal end of the first tube, in which a self-expanding receiver is positioned in a restricted orientation. Some methods include moving the second tube proximally relative to the receiver at least until the distal end of the second tube is proximal to the proximal end of the receiver, the distal portion of the receiver expands and contacts a blood vessel, and the proximal portion of the receiver contacts the distal end of the first tube. In some such methods, the contact between the distal portion of the receiver and the blood vessel is sufficient to obstruct blood flow in the vessel. Some methods include applying a vacuum to the first tube. In some methods, applying a vacuum aspirates the blood clot into the receiver. Some methods include aspirating the clot through the receiver into the first tube and withdrawing the receiver back into the first tube. Some methods include withdrawing the first tube, receiver, and blood clot from the patient.

[0021] In some embodiments, the distal end of the first tube is radially expandable. In some such embodiments, upon contact with the radially expandable distal end of the first tube, the proximal portion of the receiver is capable of radially expanding the radially expandable distal end, optionally such that the proximal portion of the self-expanding receiver includes an inner diameter at least as large as the inner diameter of the first tube at a proximal location of the radially expandable distal end. In some methods, the proximal portion of the receiver causes this radial expansion of the distal end of the first tube.

[0022] In some embodiments, the self-expanding receiver has a membrane. In some embodiments, the membrane comprises polytetrafluoroethylene. In some embodiments, the membrane comprises urethane. In some embodiments, the receiver comprises a strut. In some embodiments, the receiver comprises nitinol (a nickel-titanium intermetallic compound). In some embodiments, the receiver has radiopaque markers located within 1 mm or less of the distal end of the receiver, and / or radiopaque markers located within 1 mm or less of the proximal end of the receiver.

[0023] In some embodiments, the system includes a pusher. Some methods include applying pressure to the receiver via the pusher during at least some movement. In some embodiments, the pusher includes a pusher wire connected to the receiver. In some embodiments, the pusher is positionable within a second tube and is sized to contact the proximal end of the receiver within the second tube. In some embodiments, the pusher is not connected to the receiver. In some such embodiments, the method includes retracting the pusher.

[0024] The term "coupled" is defined as connected, although not necessarily directly, and not necessarily mechanically; two items that are "coupled" can be unitary with each other. The terms "a" and "an" are defined as one or more unless this disclosure or the context clearly indicates otherwise. The term "substantially" is defined as largely but not necessarily wholly that which is specified, and includes the specified content; for example, substantially 90 degrees includes 90 degrees, and substantially parallel includes parallel as understood by one of ordinary skill in the art. In any embodiment disclosed, the terms "substantially" and "about" can be replaced with the specified "within [a percentage] of," where the percentage includes 0.1%, 1%, 5%, and 10%.

[0025] The terms "comprise," "comprises," and "comprising," "have," "has," and "having," and "include," "includes," and "including," are open-ended linking verbs. As a result, a product or process that "comprises," "has," or "includes" one or more steps, elements, or features possesses those one or more steps, elements, or features, but is not limited to possessing only those one or more steps, elements, or features.

[0026] Any embodiment of any of the products, systems and methods can make use of one or more elements and / or features of the products, systems and methods described herein. Any embodiment of any of the products, systems and methods can be used in combination with one or more embodiments of another of the products, systems and methods described herein.

[0027] Further, a device or system configured in a certain way is configured at least in that way, but can also be configured in ways different from that specifically described.

[0028] One or more features of an embodiment can apply to other embodiments even if it is not described or shown, unless the nature of the disclosure or the embodiment clearly dictates otherwise.

[0029] Some details associated with the above-described embodiments and other embodiments are described below. BRIEF DESCRIPTION OF DRAWINGS

[0030] The following drawings are presented by way of example and not limitation. For brevity and clarity, each feature of a given structure is not always marked in every drawing in which the structure appears. Identical reference numerals do not necessarily refer to the same structure throughout different parts of the drawings. Conversely, similar reference numerals can be used to refer to similar or analogous features or structures, not necessarily the same.

[0031] FIG. 1A is a side view of one of the present systems for removing a thrombus, including a first tube, a second tube slidable within the first tube, and a self-expanding receptacle connected with a pusher wire.

[0032] FIG. 1B depicts the system of FIG. 1A with the second tube disposed within the first tube and the receptacle compressed and disposed within the second tube.

[0033] FIG. 2A is a cross-sectional view of the first tube taken along line 2A-2A of FIG. 1A

[0034] FIG. 2B is a cross-sectional view of the second tube taken along line 2B-2B of FIG. 1B

[0035] FIG. 2C is a cross-sectional view of the receptacle taken along line 2C-2C of FIG. 1A

[0036] FIG. 3A is a partial cross-sectional view of the system of FIG. 1B FIG. 1A

[0037] FIG. 3B is a cross-sectional view of the system of FIG. 3A FIG. 1A

[0038] FIG. 4A is a partial cross-sectional view of the system of FIG. 1A

[0039] FIG. 4B is a cross-sectional view of the system of FIG. 4A FIG. 1A

[0040] FIG. 5A is​​​​​​​​​​FIG. 1A partial cross-sectional view of the system of FIG. 1 in the second deployed configuration, wherein the second tube is removed from the first tube such that the proximal portion of the receiver expands to and contacts the inner wall of the first tube.

[0041] FIG. 5B is a cross-sectional view of the system of FIG. 1 taken along line 5B-5B. FIG. 5A FIG. 1A

[0042] FIG. 6A is a partial cross-sectional view of a second embodiment of the present system that is substantially the same as the system of FIG. 1 (except that FIG. 1A the first tube of the system of FIG. 1 has a radially expandable distal end that can be expanded by the proximal portion of the receiver when the system is in the second deployed configuration. FIG. 6A

[0043] FIG. 6B is a cross-sectional view of the system of FIG. 1 taken along line 6B-6B. FIG. 6A

[0044] FIG. 7 is a side view of a receiver suitable for use with some of the present systems that include a membrane, struts, and radiopaque markers.

[0045] FIG. 8A is a partial cross-sectional view of a third embodiment of the present system that is substantially the same as the system of FIG. 1 (except that FIG. 1A the pusher of the system of FIG. 1 is a coil that is not connected to the receiver. FIG. 8A

[0046] FIG. 8B is a partial cross-sectional view of the system of FIG. 1 with the pusher coil of the first tube removed. FIG. 8A

[0047] is a side view of a multi-port adapter having a first port configured to couple to a proximal fitting of a first tube, a second port configured to seal around a cylindrical structure passing therethrough, and a third port configured to couple to a vacuum source. FIG. 9A

[0048] is a side view of a first tube having a proximal fitting that can be attached to the first port of the multi-port adapter of FIG. 1. FIG. 9B FIG. 9A

[0049] FIG. 9C ​​​​​​​A side view of a first tube, a second tube, a receiver, and a vacuum source having a proximal accessory attached to a first port of a multiport adapter, the second tube being configured to pass through a second port of the multiport adapter and within the first tube, the receiver being partially disposed within the second tube in an unfolded position, and the vacuum source including a syringe attached to a third port of the multiport adapter.

[0050] FIG. 10 Depicting and FIG. 9C The system shown is basically similar to the system shown, except that... FIG. 10 The vacuum source in this is a vacuum pump, not a syringe.

[0051] FIG. 11A The image depicts the vascular system of a patient with a thrombus located in the M1 segment of the middle cerebral artery, the guidewire extending to the thrombus, and the guidewire extending to the base of the internal carotid artery. FIG. 1A The first tube of the system.

[0052] FIG. 11B Depicting FIG. 11A The vascular system, in which FIG. 1A The system's second tube is placed inside the first tube and extends beyond the first tube to reach the thrombus.

[0053] FIG. 12A To set FIG. 11A Vascular system FIG. 1A A partial cross-sectional view of the system, in which the system is in an insertion configuration such that the distal ends of the second tube and the receiver are located at the thrombus.

[0054] FIG. 12B To set FIG. 11A Vascular system FIG. 1A A partial cross-sectional view of the system, wherein the system is in a first deployed configuration such that the distal end of the receiver is positioned at the thrombus and expands into the vessel wall.

[0055] FIG. 12C To set FIG. 11A Vascular system FIG. 1A A partial cross-sectional view of the system, wherein the system is in a second deployed configuration, in which the second tube is retracted from the first tube, such that the proximal portion of the receiver contacts the inner wall of the first tube.

[0056] FIG. 12D To set FIG. 11A Vascular system FIG. 1A A partial cross-sectional view of the system, wherein, in the second deployed configuration, a vacuum is applied to the first tube, causing the thrombus to move within the receiver and to the transition section of the receiver.

[0057] FIG. 12E To set FIG. 11A Vascular systemFIG. 1A A partial cross-sectional view of the system, wherein a thrombus is drawn into a proximal portion of the receptacle within the first tube when vacuum is applied to the first tube.

[0058] FIG. 12F To set within FIG. 11A the vasculature FIG. 1A A partial cross-sectional view of the system, wherein a thrombus is drawn into the lumen of the first tube when vacuum is applied to the first tube.

[0059] FIG. 12F An experiment depicting an attempt to draw a white thrombus model through a 1.5 mm diameter catheter is depicted. As shown, the model thrombus was unable to be drawn through the catheter mouthpiece.

[0060] FIG. 11A An experiment depicting drawing a white thrombus model through a funnel attached to the distal end of a 1.5 mm diameter catheter is depicted. As shown, the model thrombus was able to pass through the 1.0 mm diameter throat of the funnel.

[0061] FIG. 1A An experiment demonstrating deployment of a self-expanding receptacle from a catheter using a pusher is depicted.

[0062] FIG. 12F An experiment demonstrating deployment of a self-expanding receptacle from a 4F sheath set within a 6F sheath such that a proximal portion of the receptacle expands to the inner wall of the 6F sheath and a distal portion of the receptacle expands to a 0.157" diameter tube is depicted.

[0063] FIG. 11A An experiment depicting drawing a model thrombus in a 6 mm diameter tube through a self-expanding receptacle deployed from an 8F catheter is depicted. DETAILED DESCRIPTION

[0064] Referring to FIG. 1A and FIG. 12F , a first embodiment of the present system 10 for removing a thrombus is shown, the system including a first tube 14, a second tube 18, and a self-expanding receptacle 22. For example, the first tube 14 and the second tube 18 can each include a catheter or sheath defining a lumen extending between a proximal end (e.g., 62a, 66a) and a distal end (e.g., 62b, 66b) thereof. As FIG. 11A shown, the second tube 18 can be disposed within the lumen of the first tube 14. The receptacle 22 can be compressed from its expanded state (as shown in FIG. 1) and positioned at least partially within the lumen of the second tube 18. FIG. 1A FIG. 12F

[0065] ​​The first tube 14, the second tube 18, and the self-expanding receiver 22 can be sized such that the system 10 can access and remove a thrombus from a patient's neurovascular system, such as in an ICA or MCA (e.g., in the Ml segment thereof). See also FIG. 11A The first tube 14 and the second tube 18 can each have an inner lateral dimension (e.g., diameter) 30a, 34a and an outer lateral dimension (e.g., diameter) 30b, 34b, respectively. The inner lateral dimension 30a of the first tube 14 can be greater than or equal to any of 0.070", 0.075", 0.080", 0.085", 0.090", 0.095", or 0.100", or between any two of these (e.g., at least 0.085" or at least about 0.090"), and its outer lateral dimension 30b can be greater than or equal to any of 0.080", 0.085", 0.090", 0.095", 0.100", 0.105, or 0.110", or between any two of these (e.g., at least 0.100") (e.g., the first tube can be an 8F catheter or a 6F sheath). Each dimension provided herein in English units can be converted to the corresponding metric units by rounding to the nearest millimeter. With such lateral dimensions, the first tube 14 can have sufficient flexibility to facilitate access to the ICA, while having a relatively large inner lateral dimension 30a to facilitate aspiration, as described in further detail below. To travel up from an insertion point at the patient's groin to the ICA, the length 42 of the first tube 14 can be greater than or equal to any of 70 cm, 80 cm, 90 cm, 100 cm, 110 cm, 120 cm, or 130 cm, or between any two of these (e.g., at least 90 cm).

[0066] The external lateral dimension 34b of the second tube 18 may be smaller than the internal lateral dimension 30a of the first tube 14, such that the second tube is a slidable vessel within the first tube and enters a narrower vessel into the patient's neurovascular system, such as in the ICA or MCA (e.g., the M1 segment). For example, the external lateral dimension 34b of the second tube 18 may be less than or equal to any one of 0.095", 0.090", 0.085", 0.080", 0.075", 0.070", or 0.065", or between any two of them (e.g., less than 0.085), and the internal lateral dimension 34a of the second tube may be less than or equal to any one of 0.090", 0.085", 0.080", 0.075", 0.070", 0.065", or 0.060", or between any two of them (e.g., less than 0.080) (e.g., the second tube may be a 6F catheter or a 4F sheath). Additionally, the length 46 of the second tube 18 may be longer than the length 42 of the first tube 14, allowing the second tube to advance beyond the distal end 62b of the first tube to reach the thrombus. For example, the length 46 may be greater than or equal to any one of 90 cm, 100 cm, 110 cm, 120 cm, 130 cm, 140 cm, or 150 cm, or in any two of these ranges (e.g., at least 110 cm).

[0067] like FIG. 1A As shown, when receiver 22 is in its expanded state, the receiver may have an internal lateral dimension (e.g., diameter) 38a and an external lateral dimension (e.g., diameter) 38b, the internal and external lateral dimensions of which are greater than the internal and external lateral dimensions of the first tube 14 and the second tube 18. For example, when fully expanded, the internal lateral dimension 38a of receiver 22 may be at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 100%, or 200% larger than the internal lateral dimension 30a of the first tube 14, such as greater than or equal to any one of 0.100", 0.125", 0.150", 0.175", 0.200", 0.225", or 0.250", or between any two of them (e.g., diameter). The receiver 22 may be greater than or equal to any one of 0.150", 0.175", 0.200", 0.225", 0.275", or 0.300", or in any two of them (e.g., at least 0.175"). If sized, the receiver 22 may expand radially to contact the vessel walls in the patient's neurovascular system, thereby facilitating thrombus uptake, as described in further detail below.

[0068] For further reference FIG. 12F and FIG. 11A, while the receiver 22 is wider than the first tube 14 and the second tube 18 when in its expanded state, the receiver can be compressed and at least partially positioned within the second tube such that the receiver can be advanced through the first tube and easily delivered to the thrombus using the second tube. While in the second tube 18, the receiver 22 can be in contact with the inner wall of the second tube such that the compressed outer lateral dimension of the receiver is equal to the inner lateral dimension 34a of the second tube. The receiver 22 can also have a first compressed inner lateral dimension 58a that is less than the uncompressed inner lateral dimension 38a thereof, such as the first compressed inner lateral dimension being less than or equal to any of 80%, 70%, 60%, 50%, 40%, or 30% of the uncompressed inner lateral dimension, or between any two of these.

[0069] The receiver 22 can have a length 50 that is shorter than the length 42 of the first tube 14 and the length 46 of the second tube 18, which allows the receiver to extend from the distal end 82 of the first tube to the thrombus in the neurovascular system of the patient. For example, the length 50 can be greater than or equal to any of 9 cm, 10 cm, 11 cm, 12 cm, 13 cm, 14 cm, 15 cm, 16 cm, 17 cm, 18 cm, 19 cm, 20 cm, 21 cm, 22 cm, 23 cm, 24 cm, or 25 cm, or between any two of these. To allow the receiver 22 to be manipulated while the receiver is disposed within the patient (e.g., for deployment from outside the second tube 18), the system 10 can include a pusher 26 that can be connected to the proximal end 70a of the receiver. The length 50 of the receiver 22 and the length 54 of the pusher 26 can both be longer than the length 42 of the first tube 14 and the length 46 of the second tube 18 such that, with the receiver disposed at or at least partially beyond the distal end 62b of the first tube, the pusher extends from the proximal end 62a of the first tube and the proximal end 66a of the second tube FIG. 1A ). For example, the length 54 of the pusher 26 can be greater than or equal to any of 80 cm, 90 cm, 100 cm, 110 cm, 120 cm, 130 cm, or 140 cm, or between any two of these.

[0070] Reference is made to FIG. 12F and FIG. 11ATo allow the receiver 22 to deploy for thrombus uptake, the receiver may be slidable relative to the second tube 18. In this way, the receiver 22 may be pushed distally (e.g., by applying pressure with the pusher 26) and / or the second tube 18 may be pulled proximally (e.g., from its proximal end 66a outside the patient's body), such that the distal end 70b of the receiver is positioned distal to the distal end 62b of the first tube 14 and the distal end 66b of the second tube 18. When the receiver 22 deploys, the distal portion 74b of the receiver may expand radially, increasing the internal lateral dimension of the receiver to the maximum uncompressed internal lateral dimension 38a of the receiver, thereby facilitating the receiver's ability to uptake the thrombus. The expanded distal portion 74b may engage with the patient's vessel wall, thereby blocking flow to the thrombus to facilitate its removal. The proximal end 70a of receiver 22 can be held proximal to the distal end 62b of the first tube 14, such that the proximal portion 74a of receiver remains compressed, and the transition portion 78 of receiver narrows from the expanded distal portion 74b of receiver to its compressed proximal portion.

[0071] like FIG. 1A and FIG. 12F As shown, the second tube 18 is disposed within the first tube 14 such that the second tube contacts the proximal portion 74a of the receiver 22 and thus compresses the proximal portion of the receiver 22. The proximal portion 74a of the receiver 22 therefore has an internal lateral dimension equal to the first compression internal lateral dimension 58a. However, further reference... FIG. 11A and FIG. 1A The second tube 18 can be pulled proximally relative to the receiver 22 and thus retracted from the first tube 14, such that the proximal portion 74a of the receiver (e.g., included at its proximal end 70a) can expand radially to the inner wall of the distal end of the first tube. Therefore, the proximal portion 74a of the receiver 22 can have a second compressed internal lateral dimension 58b that is larger than the first compressed internal lateral dimension 58a, such as being at least 10%, 20%, 30%, 40%, 50%, or 60% larger (e.g., at least 40%) than the first compressed internal lateral dimension. For example, the second compressed internal lateral dimension 58b can be greater than or equal to any one of 0.055", 0.060", 0.065", 0.070", 0.075", 0.080", or 0.085", or between any two of them (e.g., at least 0.065" or at least about 0.071"). Optionally, the second compressed internal lateral dimension is at least 40%, 50%, 60%, or 70% of the uncompressed lateral dimension 38a of the receiver 22. When a vacuum is applied at the proximal end of the first tube, the expandability of the proximal portion 74a of the receiver 22 can facilitate thrombus uptake into the first tube 14 and thus promote a higher recanalization success rate than current expandable stent systems (which have narrower laryngeal obstruction for uptake).

[0072] The proximal portion 74a of the receiver 22 can engage and thereby form a seal with the distal end 82 of the first tube 14 to impede blood flow into the interior lumen of the first tube 14 when a vacuum is applied at the proximal end 62a of the first tube. This engagement can also be sufficient to allow withdrawal of the receiver 22 as the first tube 14 is withdrawn from the vasculature of the patient. This engagement can be achieved via frictional and / or fastening components coupled to the proximal portion 74a of the receiver 22 and the distal end 82 of the first tube 14. For example, the proximal portion 74a of the receiver 22 can be configured to exert a pressure on the distal end 82 of the first tube 14 that is greater than or equal to any of 40 kPa, 50 kPa, 60 kPa, 70 kPa, 80 kPa, 90 kPa, 100 kPa, or 110 kPa, or between any two of these (e.g., between 50 kPa and 100 kPa); this pressure can create a seal between the receiver and the first tube to impede blood flow at the interface between them, and create sufficient friction to maintain the connection between them as the receiver and first tube are withdrawn from the vasculature of the patient.

[0073] Further reference is made to FIG. 12F and FIG. 11A In some embodiments, the distal end 82 of the first tube 14 is radially expandable. In such embodiments, the proximal portion 74a of the receiver 22 can cause the distal end 82 of the first tube 14 to radially expand when it comes into contact with the distal end and thereby exert pressure on the distal end. After expanding the distal end 82, the proximal portion 74a of the receiver 22 can have a third compressed inner lateral dimension 58c that is greater than the second compressed inner lateral dimension 58b. As shown, the proximal portion 74a of the receiver 22 can exert sufficient force on the distal end 82 such that the third compressed inner lateral dimension 58c is at least as large as the inner lateral dimension 30a of the first tube 14 at a proximal location of the distal end, such as greater than or equal to any of 100%, 105%, 110%, 115%, or 120% of the inner lateral dimension 30a, or between any two of these. For example, the third compressed inner lateral dimension 58c can be greater than or equal to any of 0.070", 0.075", 0.080", 0.085", 0.090", 0.095", or 0.100", or between any two of these (e.g., at least 0.085" or at least about 0.090"), and / or can be at least 50%, 60%, 70%, or 80% of the uncompressed lateral dimension 38a of the receiver 22. This additional expandability can further facilitate the uptake of thrombus by the receiver 22 and the first tube 14 by creating a larger throat.

[0074] The receiver 22 can have any suitable structure that produces the expandability described above and allows the receiver to obstruct flow between the portions of the patient's blood vessel proximal and distal to the receiver. With reference to FIG. 1A For example, the receiver 22 can include a membrane 86 that defines its outer surface. The membrane 86 can be liquid impermeable such that when the distal portion 74b of the receiver expands and contacts the blood vessel wall, the receiver 22 can obstruct blood flow to the thrombus, but allow fluid communication between the thrombus and the first tube 14 for aspiration. Suitable materials for the membrane 86 include polymers such as polytetrafluoroethylene (PTFE) and urethane. PTFE, for example, advantageously exhibits low friction with other surfaces and thus facilitates insertion and deployment of the receiver 22.

[0075] To facilitate its expandability, the receiver 22 can include struts 90. The struts 90 can be configured to facilitate radial expansion of the receiver 22 when the receiver is radially compressed. For example, the struts 90 can include nitinol (i.e., an alloy including nickel and titanium) that is super-elastic such that the struts can return to their original shape upon release of mechanical loads applied thereon. The coupling between the struts 90 and the membrane 86 can be achieved in various ways. As one example, the receiver 22 can include a second membrane (e.g., including the same material as the membrane 86, such as PTFE and / or urethane) that defines the inner wall of the receiver and is adhered to the membrane 86 such that the struts 90 are disposed between the two membranes. Such a membrane configuration can facilitate a stronger membrane-strut connection, particularly when the membrane 86 includes PTFE and the struts 90 include nitinol (as is preferred for the struts configuration). This is because the adhesion between the membranes holding the struts 90 therebetween can be stronger than the bond between PTFE and nitinol. However, the struts 90 can be adhered to the inner wall of the membrane 86 without a second membrane disposed on the other side thereof: while such a structure can not be as strong as the dual membrane configuration, it can produce sufficient strength to withstand the forces exerted on the receiver 22 during the aspiration process.

[0076] In other embodiments, the receiver 22 can have a braided configuration in which braided wires (e.g., including nitinol) are attached to the membrane 86. In some such embodiments, the braided wires can be encapsulated by the membrane 86, which preferably includes urethane for the braided configuration.

[0077] The receiver 22 can also include one or more radiopaque markers 94. The radiopaque markers 94 can inhibit X-rays from passing therethrough, and thus can be observed via fluoroscopy when the receiver 22 is disposed within a patient. For example, each radiopaque marker 94 can include tantalum or platinum. The radiopaque markers 94 can thereby assist a physician in determining the location of the receiver 22 in the vasculature of a patient during insertion and deployment of the receiver 22. At least one radiopaque marker 94 can be disposed closer to the proximal end 70a than to the distal end 70b of the receiver 22, such as within a distance 98b of the distal end, the distance being less than or equal to any of 5 mm, 4 mm, 3 mm, 2 mm, 1 mm, or 0.5 mm, or between any two of these (e.g., less than or equal to 1 mm). Such a distally positioned radiopaque marker 94 can assist a physician in determining the location of the receiver 22 relative to a thrombus, so that the receiver can be positioned proximate the thrombus for sufficient engagement for aspiration. Additionally or alternatively, at least one radiopaque marker 94 can be disposed closer to the proximal end 70a than to the distal end 70b of the receiver 22, such as within a distance 98a of the proximal end, the distance being less than or equal to any of 5 mm, 4 mm, 3 mm, 2 mm, 1 mm, or 0.5 mm, or between any two of these (e.g., less than or equal to 1 mm). Such a proximally positioned radiopaque marker 94 in combination with a distally positioned radiopaque marker can allow a physician to determine the length of the receiver 22 as it is deployed. In some embodiments, components of the receiver 22 spanning the receiver length 50 (e.g., the struts 90, collectively) can be radiopaque, such that at least a portion thereof is visible via fluoroscopy along the length of the receiver.

[0078] As noted above, the pusher 26 can be connected to the receiver 22 so that the receiver can be advanced toward a thrombus. Such a pusher 26 can include a pusher wire including, for example, stainless steel, such as wire conventionally used for a guidewire. A suitable wire for the pusher 26 is that used in the CHIKAI black 18 neurovascular guidewire available from Asahi Intecc Co., Ltd. However, turning to FIG. 12F and FIG. 11AIn other embodiments, the pusher need not be connected to the receiver, but can instead be positionable within the second tube 18 and sized to contact the proximal end 70a of the receiver 22. For example, the pusher 26 can comprise a coil (rather than a wire) of any length described above for the length of the pusher, such that the distal end of the pusher can reach the receiver 22 at the distal end of the second tube 18, while the proximal end of the pusher can enter from outside the first and second tubes 14, 18 and can have an outer lateral dimension that is less than the inner lateral dimension 34a of the second tube, but large enough to engage the proximal end 70a of the receiver. Thus, the unconnected pusher 26 can be advanced through the second tube 18 to push and thereby deploy the receiver 22 FIG. 1A ). Once the receiver 22 is deployed, the pusher 26 can be withdrawn from the patient ( FIG. 12F ), such that the entire cross-section of the lumen of the first tube 14 proximal of the receiver 22 can be used for thrombus uptake.

[0079] Referring to FIG. 11A , the system 10 can include a multi-port adapter 102 that can facilitate advancing the second tube 18 and the receiver 22 through the first tube 14 and can be coupled to a vacuum source 114 for aspiration. As shown, the multi-port adapter 102 can include at least three ports 106a-106c FIG. 1A ) for aspiration. The first port 106a can be configured to couple to the proximal fitting 110 of the first tube 14 FIG. 12F and FIG. 11A ), such that the lumen of the multi-port adapter 102 is in fluid communication with the lumen of the first tube. The second port 106b can be configured to allow the second tube 18 to pass through the proximal fitting 110 of the first tube into the lumen of the multi-port adapter 102 and through the lumen of the first tube 14 FIG. 1A ) when the proximal fitting 110 of the first tube is coupled with the first port 106a. In this way, the second tube 18 and the receiver 22 can be advanced to a thrombus in the neurovasculature of a patient, as described above. Additionally, the second tube 18 can be withdrawn from the first tube 14 through the second port 106b during deployment of the receiver 22.

[0080] For aspiration, the multi-port adapter 102 can include a third port 106c that can be coupled to the vacuum source 114 FIG. 12F). The third port 106c can have a luer lock for implementing such a vacuum source connection. When the vacuum source 114 is coupled to the third port 106c, it can be in fluid communication with the internal lumen of the multi-port adapter 102, and thus the internal lumen of the first tube 14. Accordingly, the vacuum source 114 can apply a vacuum to the first tube 14 by reducing the pressure at the third port 106c, thereby drawing a thrombus into the receiver 22 and through the first tube. To facilitate effective application of the vacuum and mitigate leakage of blood from the multi-port adapter 102, the second port 106b can be closed during aspiration such that fluid cannot flow therethrough. For example, the second port 106b can be configured to seal around a cylindrical structure positioned therethrough (e.g., can include a Tuohy-Borst adapter) such that if the pusher 26 is connected to the receiver 22 and remains in the first tube 14 during aspiration, the second port can form a seal around the pusher after the second tube 18 is withdrawn.

[0081] The vacuum source 114 of the system 10 can include any suitable device by which a vacuum can be applied to the proximal end 62a of the first tube 14 to draw a thrombus into the deployed receiver 22 and through the first tube for removal of the thrombus. For example, as shown, the vacuum source 114 can include a syringe, which optionally has a barrel configured to hold any of greater than or equal to 40 mL, 50 mL, 60 mL, 70 mL, or 80 mL of fluid, or between any two of these. During aspiration, a relatively small negative pressure differential that the syringe can create between the proximal end 64a of the first tube 14 and the distal end 70b of the receiver 22 can be sufficient to ingest and remove a thrombus, at least in part due to the relatively large cross-sectional area of the mouth and throat of the receiver 22. For example, such a pressure differential can be less than or equal to any of 180 mmHg, 160 mmHg, 140 mmHg, 120 mmHg, or 100 mmHg, or between any two of these.

[0082] With reference to FIG. 11A In other embodiments, the vacuum source 114 can include a vacuum pump, which can include a pumping unit 118 (e.g., having a motor) and a container 122 in fluid communication with the pumping unit such that the pumping unit can draw a vacuum on the container. The container 122, in turn, can be coupled to the third port 106c of the multi-port adapter 102 via a tube 126 such that the pumping unit 118 is in fluid communication with the proximal end 62a of the first tube 14 and thus can apply a vacuum at the proximal end 62a of the first tube 14 via the container, which can receive fluid drawn from the vasculature of the patient during aspiration. The pumping unit 118 can be configured to control the pressure at the proximal end 62a of the first tube 14 (e.g., with a regulator 130) to create a sufficient pressure differential for removal of a thrombus.

[0083] Any of the systems in the present disclosure can be included in a kit. In such a kit, the self-expanding receiver 22 can already be at least partially positioned within the second tube 18, such that the receiver is ready for insertion into a patient, allowing for rapid treatment.

[0084] Turning to FIG. 1A and FIG. 12F Some methods of the present disclosure to remove a thrombus (e.g., 138) (e.g., a red thrombus or a white thrombus) include advancing a first tube (e.g., 14) (e.g., any of those described above) through a vasculature of a patient (e.g., 134) FIG. 11A As described above, the first tube can be inserted into the vasculature of the patient at the groin and advanced up to the ICA (e.g., 142), such as within 5 cm, 4 cm, 3 cm, or 1 cm of the ICA. The system 10 optionally includes a guidewire 150 that can be advanced to the thrombus prior to insertion of the first tube, such that the first tube can be threaded through the guidewire, facilitating advancement of the first tube through the vasculature of the patient.

[0085] With the first tube disposed in the vasculature of the patient, some methods include advancing a second tube (e.g., 18) (e.g., any of those described above) through the first tube FIG. 1A The second tube can be advanced such that a distal end (e.g., 66b) of the second tube is positioned distal to a distal end (e.g., 62b) of the first tube in the ICA or MCA (e.g., a Ml segment thereof). In this manner, the distal end of the second tube can be positioned proximate to the thrombus, such as within 5 cm, 4 cm, 3 cm, 2 cm, or 1 cm of the thrombus. The proximal end (e.g., 66a) of the second tube can remain outside of the patient while the second tube is advanced through the first tube, such that the proximal end can be used by a physician.

[0086] With reference to FIG. 12F In some methods, a self-expanding receiver (e.g., 22) (e.g., any of those described above) can also be advanced to the thrombus. For example, the self-expanding receiver can be positioned in the second tube (e.g., in a distal portion thereof) in a constrained orientation, such that the receiver is advanced with the second tube. In such a method, the second tube can be advanced until a proximal portion (e.g., 74a) of the receiver is positioned within a distal end portion (e.g., 82) of the first tube. Alternatively, after the second tube is advanced through the first tube such that a distal end of the second tube is in the ICA or MCA, the receiver can be pushed through the second tube (e.g., with a pusher 26, which can include any of those described above) until a proximal portion of the receiver is positioned in a distal portion of the first tube.

[0087] To deploy the receiver, some methods include moving the second tube proximally relative to the receiverFIG. 11A and FIG. 1A ), such as by pulling a proximal portion of the second tube. During at least some of the movement (e.g., while a portion of the receiver is disposed in the second tube), pressure can be applied to the receiver by the pusher, facilitating unsheathing of the receiver. The second tube can be moved such that the distal end of the second tube is positioned proximal to the distal end of the receiver, allowing the distal portion of the receiver (e.g., 74b) to radially expand and contact the vessel lumen. The maximum uncompressed outer lateral dimension of the receiver can be greater than the inner lateral dimension (e.g., diameter) of the vessel, such that the expanded distal portion can exert sufficient pressure on the vessel to occlude blood flow therein. For example, the distal portion of the receiver can exert a pressure on the vessel wall that is greater than or equal to any of 40 kPa, 50 kPa, 60 kPa, 70 kPa, 80 kPa, 90 kPa, 100 kPa, or 110 kPa, or between any two of these (e.g., between 50 kPa and 100 kPa).

[0088] The movement of the second tube can be performed at least until the distal end of the second tube is located proximal to the proximal end of the receiver. With the receiver unsheathed from the second tube, the proximal portion of the receiver can radially expand and contact the distal end portion of the first tube FIG. 12F ). As explained above, this allows the throat of the receiver to have a greater inner lateral dimension to facilitate aspiration. If the distal end portion of the first tube is radially expandable as described above, the proximal portion of the receiver can radially expand the radially expandable distal end portion such that the proximal portion of the receiver has an inner lateral dimension (e.g., 58c) that is at least as great as the inner lateral dimension of the first tube at the proximal location of the distal end portion of the first tube. When deployed, the receiver can include a transition portion (e.g., 78) that narrows between the expanded distal portion of the receiver and the proximal portion of the receiver disposed within the second tube.

[0089] During deployment, the pusher can be utilized to adjust the position of the receiver relative to the thrombus. For example, exerting pressure on the receiver via the pusher can advance the receiver such that the distal end portion of the receiver contacts the thrombus, which can facilitate aspiration of the thrombus. As described above, the pusher need not be connected to the receiver; with such a configuration, some methods include withdrawing the pusher from the patient to allow a greater portion of the cross-section of the first tube to be used for aspiration.

[0090] Referring to FIG. 11A , some methods include applying a vacuum to the first tube (e.g., in any of the ways described above, such as with a syringe or vacuum pump). As a result, the pressure at the proximal end of the first tube can be reduced, creating a negative pressure differential between the distal end of the receiver and the proximal end of the first tube that can cause the thrombus to aspirate into the receiver FIG. 1A). This uptake can easily occur because the distal portion of the receiver expands against the vessel wall. Additionally, and with reference to FIG. 12F and FIG. 11A , application of the vacuum can draw the thrombus through the receiver and into the first tube. As shown, the narrow transition section of the receiver and the radially expanded proximal portion facilitate deformation and compression of the thrombus so that it can enter the first tube. This uptake can occur even if the thrombus is a white thrombus that is more resistant to compression than a red thrombus. The vacuum can continue to draw the uptaken thrombus into the first tube and out of the proximal end of the first tube. If a vacuum pump is used for the drawing, recanalization can be confirmed when the pump pressure changes. In some methods, the receiver can be withdrawn into the first tube (e.g., by pulling a proximal portion of a pusher disposed outside the patient’s body if the pusher is connected to the receiver) and the first tube can be withdrawn from the patient’s vasculature.

[0091] In some procedures, even with a relatively large receiver throat, the thrombus can not be drawn into the first tube when the vacuum is applied. When this occurs, to remove the thrombus, the first tube and receiver can be withdrawn from the patient with the thrombus disposed in the receiver. Alternatively, the receiver can be withdrawn into the first tube (e.g., with a pusher) when the vacuum is applied to the first tube, which can allow the thrombus to be uptaken into the first tube for removal.

[0092] EMBODIMENTS

[0093] The present application will be described in greater detail by way of specific embodiments. The following embodiments are exemplary and are not intended to limit the present application in any way. One skilled in the art will readily recognize a variety of noncritical parameters that can be changed or modified to yield essentially the same results.

[0094] EMBODIMENT 1

[0095] With reference to FIG. 1A and FIG. 12F , the uptake of a model white thrombus into a catheter during drawing was evaluated with and without a narrow receiver (or funnel). In both experiments, the catheter through which a vacuum was drawn had a diameter of 1.5 mm. In the experiment using a funnel, the funnel was reduced in diameter to 1.0 mm. As shown in FIG. 11A , without the funnel, the model white thrombus was drawn into the mouth of the catheter but could not pass through it. However, as shown in FIG. 1A , even though the 1.0 mm diameter of the throat was smaller than the diameter of the catheter that could not uptake the thrombus, the model white thrombus could pass through the funnel and exit the throat. This illustrates how the gradual tapering of the funnel facilitated thrombus uptake.

[0096] EMBODIMENT 2

[0097] Referring to FIG. 12F , an exemplary receiver (e.g., 22) is shown that includes struts and a membrane that is deployed from a sheath with a pusher (e.g., 26). As shown, as the pusher is advanced forward, the receiver exits the sheath and radially expands FIG. 11A and FIG. 1A ). The pusher is then withdrawn FIG. 12F .

[0098] Example 3

[0099] Referring to FIG. 11A , an exemplary system is shown in which a first tube (e.g., 14) is a 6F sheath with a 0.090" inner diameter, a second tube (e.g., 18) is a 4F sheath with a 0.070" inner diameter, and a self-expanding receiver (e.g., 22) includes struts and a membrane. To simulate insertion into the Ml segment of an MCA, the system is inserted into a tube having a 0.157" inner diameter in which the 4F sheath is disposed in and extends past the distal end of the 6F sheath, and the receiver is compressed and disposed in the 4F sheath. A pusher (e.g., 26) is used to hold the receiver in place as the 4F sheath is retracted FIG. 1A ). As the 4F sheath is retracted from the 6F sheath, the receiver radially expands such that the distal portion of the receiver engages the inner wall of the 0.157" diameter tube and the proximal portion of the receiver engages the inner wall of the 6F sheath with a narrowed transition therebetween FIG. 12F .

[0100] Example 4

[0101] Referring to FIG. 11A , an aspiration experiment was performed using a self-expanding receiver (e.g., 22) deployed from an 8F catheter such that the distal portion of the catheter radially expanded to the inner wall of a 6mm diameter tube and the proximal portion radially expanded to the inner wall of the 8F catheter. A model thrombus (e.g., 138) was positioned in the 6mm diameter tube distal to the receiver FIG. 1A ). A vacuum was applied at the proximal end of the 8F catheter, drawing the model thrombus toward the receiver FIG. 12F and FIG. 11A ). The model thrombus was able to pass through the throat of the receiver and through the 8F catheter FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A FIG. 12F FIG. 11A FIG. 1A .

[0102] The above specification and examples provide a complete description of the structure and use of illustrative embodiments. Although certain implementations have been described above with a certain degree of particularity, one skilled in the art could make numerous alterations to the disclosed implementations without departing from the scope of the present disclosure. As such, the various illustrative embodiments of products, systems and methods are not intended to be limited to the particular form set forth herein, but include all modifications and equivalents falling within the scope of the claims. Accordingly, the products, systems and methods are to be construed as including all alternatives falling within the scope of the appended claims, and any embodiments falling within the scope of the claims are to be construed as falling within the scope of the present disclosure. For example, elements can be omitted or combined as a unitary structure, and / or connections can be substituted. Further, aspects of any of the examples described above can be combined with aspects of any of the other examples described to form further examples having comparable or different properties and / or functions and addressing the same or different problems. Similarly, it will be understood that the benefits and advantages described above can relate to one embodiment or can relate to several embodiments.

[0103] The claims are not intended to include, and should not be interpreted to include, a limitation that the apparatus or steps be performed in a particular order, unless the claims explicitly state otherwise. The claims are not intended to include, and should not be interpreted to include, a limitation that the apparatus or steps be performed in a particular order, unless the claims explicitly state otherwise.

Claims

1. A system for removing blood clots, the system comprising: a first tube; a second tube slidable within the first tube; and a self-expanding receiver having a membrane and positioned at least partially within the second tube, wherein the receiver is radially expandable such that when a proximal portion of the second tube and the receiver are positioned within a distal end of the first tube, and the second tube is moved proximally relative to the receiver until a distal end of the second tube is positioned proximally of a proximal end of the receiver: a proximal portion of the receiver radially expands and contacts the distal end of the first tube; and a distal portion of the receiver radially expands such that an inner diameter of the receiver is at least 10% greater than an inner diameter of the first tube; a distal end of the first tube is radially expandable; and the proximal portion of the receiver is capable of radially expanding the radially expandable distal end when in contact with the radially expandable distal end of the first tube such that the proximal portion of the self-expanding receiver comprises an inner diameter at least as great as an inner diameter of the first tube at a proximal location of the radially expandable distal end; the proximal portion of the receiver, when in contact with the distal end of the first tube, radially expands the distal end and thereby exerts pressure on the distal end, and the proximal portion of the receiver engages with the distal end of the first tube and thereby forms a seal when a vacuum is applied at a proximal end of the first tube.

2. The system of claim 1, further comprising a pusher wire coupled to the receiver.

3. The system of claim 1, further comprising a pusher positionable within the second tube and sized to contact the proximal end of the receiver within the second tube. the receiver comprises struts.

4. The system of claim 1, wherein, the receiver comprises nitinol.

5. The system of claim 1, wherein, the membrane comprises polytetrafluoroethylene.

6. The system of claim 1, wherein, the membrane comprises urethane.

7. The system of claim 1, wherein, the receiver has a radiopaque marker positioned within 1 millimeter or less of a distal end of the receiver.

8. The system of claim 1, wherein, the receiver has a radiopaque marker within 1 millimeter or less of the proximal end of the receiver.

9. The system of claim 1, wherein, 10. The system of claim 1, further comprising a guidewire positionable within a lumen of the second tube and movable relative to the second tube.

11. The system of claim 1, wherein: the first tube has a proximal fitting; and the system further comprises a multi-port adapter comprising: a first port configured to couple to the proximal fitting of the first tube; a second port configured to seal around a cylindrical structure positioned through the second port; and a third port having a luer lock.

12. The system of claim 11, further comprising a vacuum source couplable to the luer lock. the vacuum source comprises a pump.

13. The system of claim 12, wherein, ​

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