Dual-branch ascending aorta stent graft system

Abstract

A primary stent graft (22) is provided that includes an internal support channel (120) disposed within a generally tubular primary fluid flow guide (28). A distal channel fluid flow guide end opening (127B) of the channel fluid flow guide (128) faces radially inward when the inner support channel (120) is in a collapsed state. The distal channel fluid flow guide end opening (127B) at least partially distally faces within the primary fluid flow guide (28) when the internal support channel (120) is in an expanded condition and the primary stent graft (22) is in a radially expanded deployed condition. The elongate members (160A, 160B) are removably positioned to sequentially pass through: (a) a proximal primary fluid flow guide end opening (27A), (b) a longitudinal portion (142) of a primary fluid flow lumen (29) of the primary stent graft fluid flow guide (28), (c) a distal channel fluid flow guide end opening (127B), and (d) a primary fluid flow guide lateral opening (30) to the outside of the primary fluid flow lumen (29). Other embodiments are also described.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims priority to U.S. Provisional Application No. 63 / 406,955, filed on September 15, 2022, which is assigned to the assignee of the present application and is incorporated herein by reference. Technical Field

[0003] The present application relates generally to prostheses and surgical methods and, in particular, to tubular prostheses including endovascular stent grafts and surgical techniques for using the prostheses to maintain patency of body passages such as blood vessels and to treat aneurysms, dissections, aortic ulcers, and intramural hematomas of arterial walls. Background Art

[0004] Endovascular prostheses are sometimes used to treat acute aortic syndromes, which include aortic aneurysms, aortic dissections, aortic ulcers (e.g., penetrating aortic ulcers (PAU), and intramural hematomas (IMH). This treatment involves implanting a stent or stent-graft within the diseased vessel to bypass the abnormality. Aneurysms are cysts that form from the dilation of the artery wall. Aneurysms may be congenital, but are usually caused by disease or, occasionally, trauma. Aortic aneurysms that usually form between the renal arteries and the iliac arteries are called abdominal aortic aneurysms ("AAA"). Other aneurysms occur in the aorta, such as thoracic aortic aneurysms ("TAA"), which may occur in one or more of the descending aorta, ascending aorta, and aortic arch.

[0005] Endovascular aneurysm repair (EVAR) has transformed the practice of treating aortic aneurysms from an open surgical approach to a much less invasive surgical approach.The first step of endovascular intervention typically requires the introduction of a delivery system into the patient's vascular system.

[0006] WO 2014 / 108895 by Shalev et al. describes an intravascular system including an intravascular implant and a delivery tool. The implant is configured to present a radially compressed delivery state and a radially expanded deployment state. The delivery tool includes: a proximal main delivery catheter having a distal portion, in which the implant is disposed when in a radially compressed delivery state; and a distal constraint assembly, which includes a constraint assembly tubular shaft disposed at the distal end of the proximal main delivery catheter. The distal constraint assembly is configured to present an engaged state and a disengaged state, in which the distal constraint assembly prevents the implant from being displaced proximally relative to the distal constraint assembly, and in the disengaged state, the distal constraint assembly allows the implant to be displaced proximally relative to the distal constraint assembly. Other embodiments are also described.

[0007] Hamer et al., U.S. Patent 8,267,988, describes a kind of expandable prosthetic device and the delivery method that allows multiple guide wires to be initially placed in the selected target site.Prosthesis comprises main body device.This main body device has a separate side branch guide wire cavity, and this side branch guide wire cavity passes through the main body device and passes through the side opening in the main body device.When the main body device is advanced, the side opening is self-guided (self-guided by the side branch guide wire) and self-aligned to the side branch vessel mouth.The main body device is then deployed, so that the side branch guide wire is left in place.Then, the side branch device is advanced through the main body device along the side branch guide wire, passes through the side wall opening and enters into the natural side branch blood vessel.The side branch device can then be deployed to engage the main body device and the natural side branch blood vessel.

[0008] U.S. Patent 8,672,989 to Schreck et al. describes an endoluminal prosthesis system that can be deployed in an area of ​​a patient's vascular system having one or more branch vessels, the endoluminal prosthesis system having a main graft body having a first opening in a wall portion of the main graft body and a preloaded guidewire positioned within the main graft body and advanced through the first opening. One or more branch grafts can be attached to the main graft body to cover one or more openings in the main graft body. Summary of the invention

[0009] In some embodiments of the present application, a method is provided, the method comprising intravascularly introducing a vascular implant into a patient's vascular system through a vascular access site located downstream of a first branch of an aortic arch. Thereafter, advancing the vascular implant through the first branch to the aortic arch. Thereafter, advancing the vascular implant from the aortic arch at least partially into a second branch of the aortic arch. Thereafter, deploying the vascular implant at least partially in the second branch.

[0010] In some embodiments of the present application, a guidewire is deployed between (i) a first vascular access site downstream of a first branch of the aortic arch and (ii) a second vascular access site downstream of a second branch of the aortic arch, such that the guidewire is partially positioned within the first branch, partially positioned within the aortic arch, and partially positioned within the second branch. A vascular implant is advanced over the guidewire and deployed within the vascular system.

[0011] In some embodiments of the present application, a stent graft system includes a main stent graft and an elongated member. The main stent graft is configured to present a radially compressed delivery state and a radially expanded deployment state. The main stent graft includes a flexible main stent graft stent member and a substantially tubular main fluid flow guide, which is firmly attached to at least a portion of the main stent graft stent member and covers at least a portion of the main stent graft stent member. The main fluid flow guide is shaped to define a proximal main fluid flow guide end opening and a distal main fluid flow guide end opening, a main fluid flow cavity between the proximal main fluid flow guide end opening and the distal main fluid flow guide end opening, and a main fluid flow guide lateral opening. The main stent graft also includes an internal support channel, which is configured to present an expanded state and a telescoping state, and is disposed in the main fluid flow guide. The internal support channel includes a substantially tubular channel fluid flow guide, which is shaped to define a proximal channel fluid flow end opening and a distal channel fluid flow end opening. The internal support channel defines a channel lumen between the proximal channel fluid flow end opening and the distal channel fluid flow end opening when the internal support channel is in the expanded state.

[0012] The distal channel fluid flow guide end opening faces radially inward when the inner support channel is in the telescoping state. The distal channel fluid flow guide end opening faces distally at least partially within the main fluid flow guide when the inner support channel is in the expanded state and the main stent-graft is in the radially expanded deployed state.

[0013] The proximal channel fluid flow end opening is sealingly coupled to the periphery of the main fluid flow guide lateral opening, so that when the internal support channel is in an expanded state, the channel cavity is in fluid communication with the external fluid of the main fluid flow guide via the main fluid flow guide lateral opening. The outer surface of the internal support channel is coupled to the inner surface of the main fluid flow guide, so that the internal support channel extends distally from the main fluid flow guide lateral opening beside the inner surface of the main fluid flow guide. Optionally, the internal support channel is also coupled to portions of the main stent-graft stent component.

[0014] The elongated member is removably positioned to sequentially pass through: (a) the proximal main fluid flow guide end opening, (b) the longitudinal portion of the main fluid flow lumen, (c) the distal channel fluid flow guide end opening, and (d) the main fluid flow guide lateral opening to the exterior of the main fluid flow lumen. The internal support channel is configured to automatically transition to an expanded state when not constrained in a telescoping state by the main stent graft and not constrained in a telescoping state by the elongated member.

[0015] For some applications, the elongated member includes an auxiliary guidewire tube shaped to define an auxiliary guidewire lumen for inserting an auxiliary guidewire through the auxiliary guidewire lumen. For other applications, the elongated member includes an auxiliary guidewire.

[0016] Therefore, according to inventive concept 1 of the present invention, a stent graft system is provided, the stent graft system comprising:

[0017] (i) a main stent-graft configured to assume a radially compressed delivery state and a radially expanded deployed state, and comprising:

[0018] A flexible main stent graft stent component and a generally tubular main fluid flow guide, the main fluid flow guide: (a) securely attached to and covering at least a portion of the main stent graft stent component, and (b) shaped to define a proximal main fluid flow guide end opening and a distal main fluid flow guide end opening, a main fluid flow cavity between the proximal main fluid flow guide end opening and the distal main fluid flow guide end opening, and a main fluid flow guide lateral opening; and an internal support channel, the internal support channel: (a) configured to present an expanded state and a telescoping state, (b) disposed within the main fluid flow guide, and (c) including a generally tubular channel fluid flow guide, the channel fluid flow guide being shaped to define (1) a proximal channel fluid flow end opening and a distal channel fluid flow end opening, and being shaped to (2) when the internal support channel is in an expanded state, a proximal channel fluid flow end opening is provided at the distal channel fluid flow end opening.

[0019] The port and the distal channel fluid flow end opening define a channel cavity, wherein:

[0020] (A) when the internal support channel is in the telescoping state, the distal channel fluid flow guide end opening faces radially inward, and

[0021] (B) the distal channel fluid flow guide end opening faces at least partially distally within the main fluid flow guide when the inner support channel is in the expanded state and the main stent-graft is in the radially expanded deployed state,

[0022] wherein the proximal channel fluid flow end opening is sealingly connected to the periphery of the lateral opening of the main fluid flow guide, so that when the internal support channel is in an expanded state, the channel cavity is in fluid communication with the external fluid of the main fluid flow guide via the lateral opening of the main fluid flow guide; and

[0023] (ii) an elongated member removably positioned to pass through, in order: (a) a proximal main fluid flow guide end opening, (b) a longitudinal portion of the main fluid flow chamber, (c) a distal channel fluid flow guide end opening, and (d) a main fluid flow guide lateral opening to the exterior of the main fluid flow chamber,

[0024] Wherein, the inner support channel is configured to automatically transition to an expanded state when not constrained in a telescoping state by the main stent graft and not constrained in a telescoping state by the elongated member.

[0025] Inventive concept 2. The stent graft system according to inventive concept 1, which is used together with an auxiliary guidewire, wherein the elongated member comprises an auxiliary guidewire tube shaped to define an auxiliary guidewire lumen for inserting the auxiliary guidewire through the auxiliary guidewire lumen.

[0026] Inventive concept 3. A stent graft system according to Inventive concept 2,

[0027] Wherein, the longitudinal portion of the auxiliary guide wire tube includes: (a) a first longitudinal sub-portion, the first longitudinal sub-portion extending between the proximal main fluid flow guide end opening and the main fluid flow guide lateral opening via the distal channel fluid flow guide end opening; and (b) a second longitudinal sub-portion, the second longitudinal sub-portion extending from the main fluid flow guide lateral opening to the outside of the main fluid flow cavity and having a length of 1 cm measured from the main fluid flow guide lateral opening to the distal end of the second longitudinal sub-portion, and

[0028] Wherein, the longitudinal portion of the auxiliary guidewire tube is neither folded nor kinked when the distal end of the second longitudinal sub-portion remains in contact with the outer surface of the main stent-graft while the main stent-graft is in the radially compressed delivery state.

[0029] Inventive concept 4. The stent graft system according to Inventive concept 2,

[0030] Wherein, the longitudinal portion of the auxiliary guide wire tube includes: (a) a first longitudinal sub-portion, the first longitudinal sub-portion extending between the proximal main fluid flow guide end opening and the main fluid flow guide lateral opening via the distal channel fluid flow guide end opening; and (b) a second longitudinal sub-portion, the second longitudinal sub-portion extending from the main fluid flow guide lateral opening to the outside of the main fluid flow cavity and having a length of 1 cm measured from the main fluid flow guide lateral opening to the distal end of the second longitudinal sub-portion, and

[0031] wherein the longitudinal portion defines a directional path from the proximal main fluid flow guide end opening to the distal end of the second longitudinal subportion when the distal end of the second longitudinal subportion remains in contact with the outer surface of the main stent-graft while the main stent-graft is in a radially compressed delivery state, and the directional path does not include any proximally directed portion.

[0032] Inventive concept 5. The stent graft system according to Inventive concept 2,

[0033] Wherein, the longitudinal portion of the auxiliary guide wire tube includes: (a) a first longitudinal sub-portion, the first longitudinal sub-portion extending between the proximal main fluid flow guide end opening and the main fluid flow guide lateral opening via the distal channel fluid flow guide end opening; and (b) a second longitudinal sub-portion, the second longitudinal sub-portion extending from the main fluid flow guide lateral opening to the outside of the main fluid flow cavity and having a length of 1 cm measured from the main fluid flow guide lateral opening to the distal end of the second longitudinal sub-portion, and

[0034] wherein the longitudinal portion of the auxiliary guidewire tube has a minimum radius of curvature of at least 0.15 cm at any location along the longitudinal portion when the distal end of the second longitudinal sub-portion remains in contact with the outer surface of the main stent-graft while the main stent-graft is in a radially compressed delivery state.

[0035] Inventive Concept 6. The stent graft system according to Inventive Concept 5, wherein the minimum radius of curvature is at least 1 cm.

[0036] Inventive Concept 7. The stent graft system according to Inventive Concept 2, wherein the main stent graft is configured such that the auxiliary guidewire tube can be removed from the internal support channel when the main stent graft is in the radially compressed delivery state.

[0037] Inventive Concept 8. The stent graft system of Inventive Concept 7, wherein the main stent graft is configured such that the auxiliary guidewire tube can be removed from the internal support channel while the main stent graft is in the radially compressed delivery state and the auxiliary guidewire is inserted through the auxiliary guidewire lumen.

[0038] Inventive Concept 9. The stent graft system according to Inventive Concept 1, wherein the distal channel fluid flow guide end opening is disposed distal to the main fluid flow guide lateral opening when the internal support channel is in an expanded state and the main stent graft is in a radially expanded deployed state.

[0039] Inventive concept 10. A stent graft system according to inventive concept 1, wherein the internal support channel is configured such that when the internal support channel is in a telescoping state, the proximal end point of the distal channel fluid flow guide end opening is disposed proximal to the distal end point of the main fluid flow guide lateral opening.

[0040] Inventive concept 11. The stent graft system according to inventive concept 1, wherein the internal support channel is configured such that the best fit plane defined by the distal channel fluid flow guide end opening automatically oscillates during the automatic conversion of the internal support channel from the telescoping state to the expanding state:

[0041] from at least partially radially inwardly facing distal channel fluid flow guide end opening,

[0042] To a distal channel fluid flow guide end opening at least partially facing the distal end.

[0043] Inventive concept 12. The stent graft system according to Inventive concept 1,

[0044] wherein the main stent graft stent component comprises struts, and

[0045] wherein an outer surface of the internal support channel is coupled to an inner surface of the primary fluid flow guide by coupling to one or more of the struts of the main stent-graft stent component such that the internal support channel extends distally from a lateral opening of the primary fluid flow guide alongside the inner surface of the primary fluid flow guide.

[0046] Inventive Concept 13. The stent graft system according to Inventive Concept 1, wherein the elongated member comprises an auxiliary guide wire.

[0047] Inventive concept 14. The stent graft system according to Inventive concept 13,

[0048] The longitudinal portion of the auxiliary guide wire includes: (a) a first longitudinal sub-portion, which extends between the proximal main fluid flow guide end opening and the main fluid flow guide lateral opening via the distal channel fluid flow guide end opening; and (b) a second longitudinal sub-portion, which extends from the main fluid flow guide lateral opening to the outside of the main fluid flow cavity and has a length of 1 cm measured from the main fluid flow guide lateral opening to the distal end of the second longitudinal sub-portion, and

[0049] Wherein, the longitudinal portion of the auxiliary guidewire is neither folded nor kinked when the distal end of the second longitudinal sub-portion remains in contact with the outer surface of the main stent-graft while the main stent-graft is in the radially compressed delivery state.

[0050] Inventive concept 15. The stent graft system according to Inventive concept 13,

[0051] The longitudinal portion of the auxiliary guide wire includes: (a) a first longitudinal sub-portion, which extends between the proximal main fluid flow guide end opening and the main fluid flow guide lateral opening via the distal channel fluid flow guide end opening; and (b) a second longitudinal sub-portion, which extends from the main fluid flow guide lateral opening to the outside of the main fluid flow cavity and has a length of 1 cm measured from the main fluid flow guide lateral opening to the distal end of the second longitudinal sub-portion, and

[0052] wherein the longitudinal portion defines a directional path from the proximal main fluid flow guide end opening to the distal end of the second longitudinal subportion when the distal end of the second longitudinal subportion remains in contact with the outer surface of the main stent-graft while the main stent-graft is in a radially compressed delivery state, and the directional path does not include any proximally directed portion.

[0053] Inventive concept 16. The stent graft system according to Inventive concept 13,

[0054] The longitudinal portion of the auxiliary guide wire includes: (a) a first longitudinal sub-portion, which extends between the proximal main fluid flow guide end opening and the main fluid flow guide lateral opening via the distal channel fluid flow guide end opening; and (b) a second longitudinal sub-portion, which extends from the main fluid flow guide lateral opening to the outside of the main fluid flow cavity and has a length of 1 cm measured from the main fluid flow guide lateral opening to the distal end of the second longitudinal sub-portion, and

[0055] wherein the longitudinal portion of the auxiliary guidewire has a minimum radius of curvature of at least 0.15 cm at any location along the longitudinal portion when the distal end of the second longitudinal subportion remains in contact with the outer surface of the main stent-graft while the main stent-graft is in a radially compressed delivery state.

[0056] Inventive concept 17. The stent graft system according to inventive concept 16, wherein the minimum radius of curvature is at least 1 cm.

[0057] Inventive Concept 18. The stent graft system according to any one of Inventive Concepts 1 to 17, wherein the internal support channel further comprises a flexible channel support member, the channel fluid flow guide being fixedly attached to the flexible channel support member.

[0058] Inventive concept 19. A stent graft system according to inventive concept 18, wherein the channel stent component includes one or more stent struts, the one or more stent struts being shaped to define a tongue-shaped stent strut that is securely attached to a portion of a periphery of the distal channel fluid flow guide end opening.

[0059] Inventive concept 20. The stent graft system according to inventive concept 19, wherein the tongue-shaped stent strut is configured such that the tip of the tongue-shaped stent strut automatically swings along a curved path from facing proximally to facing less proximally during the automatic transition of the internal support channel from the telescoping state to the expanding state.

[0060] Inventive concept 21. The stent graft system according to Inventive concept 19, wherein the smallest surface defined by the tongue-shaped stent struts faces:

[0061] The inner support passage at least partially faces the distal end when in the expanded state, and

[0062] The inner support passage at least partially faces radially inward when in the telescoping state.

[0063] Inventive Concept 22. The stent graft system according to Inventive Concept 21, wherein the tongue-shaped stent strut is configured such that the tongue-shaped stent strut automatically swings during the automatic conversion of the inner support channel to the expanded state:

[0064] from a minimum surface at least partially facing radially inwardly,

[0065] to a minimum surface at least partially facing the distal end.

[0066] Inventive concept 23. The stent graft system according to any one of Inventive concepts 1 to 17,

[0067] The stent graft system further comprises a main delivery catheter having a proximal catheter end and a distal catheter end,

[0068] wherein the main stent graft is removably disposed within the main delivery catheter such that the main delivery catheter constrains the main stent graft in a radially compressed delivery state, wherein the distal main fluid flow guide end opening faces the distal catheter end, thereby constraining the internal support passage in a telescoping state, and

[0069] wherein the elongated member is removably positioned to pass, in sequence, through: (a) a proximal main fluid flow guide end opening, (b) a longitudinal portion of the main fluid flow chamber, (c) a distal channel fluid flow guide end opening, (d) a main fluid flow guide lateral opening to the outside of the main fluid flow chamber within the main delivery catheter, and (e) a distal catheter end.

[0070] Inventive concept 24. A stent graft system according to inventive concept 23, wherein the longitudinal portion of the elongated member extends between the proximal main fluid flow guide end opening of the radially compressed main stent graft and the distal catheter end and has a minimum radius of curvature of at least 0.15 cm at any position along the longitudinal portion.

[0071] Inventive concept 25. The stent graft system according to inventive concept 24, wherein the minimum radius of curvature is at least 1 cm.

[0072] Inventive Concept 26. The stent graft system according to Inventive Concept 23, wherein the longitudinal portion of the elongate member extends between the proximal main fluid flow guide end opening of the radially compressed main stent graft and the distal conduit end and is neither folded nor kinked.

[0073] Inventive Concept 27. The stent graft system of Inventive Concept 23, wherein the longitudinal portion of the elongated member defines a directional path from the proximal main fluid flow guide end opening of the radially compressed main stent graft to the distal conduit end, and the directional path does not include any proximally directed portion.

[0074] According to inventive concept 28 of the present invention, a method is also provided, the method comprising:

[0075] A main stent-graft is provided, the main stent-graft being configured to assume a radially compressed delivery state and a radially expanded deployed state, and comprising:

[0076] a flexible main stent-graft stent component and a generally tubular main fluid flow guide that: (a) is securely attached to and covers at least a portion of the main stent-graft stent component, and (b) is shaped to define a proximal main fluid flow guide end opening and a distal main fluid flow guide end opening, a main fluid flow lumen between the proximal main fluid flow guide end opening and the distal main fluid flow guide end opening, and a main fluid flow guide lateral opening; and an inner A support channel, an internal support channel: (a) configured to assume an expanded state and a collapsed state, (b) disposed within a main fluid flow guide, (c) including a generally tubular channel fluid flow guide, the channel fluid flow guide being shaped to define (1) a proximal channel fluid flow guide end opening and a distal channel fluid flow guide end opening, and being shaped to (2) define a channel cavity between the proximal channel fluid flow guide end opening and the distal channel fluid flow guide end opening when the internal support channel is in the expanded state,

[0077] wherein the proximal channel fluid flow guide end opening is sealingly connected to the periphery of the lateral opening of the main fluid flow guide, so that when the internal support channel is in an expanded state, the channel cavity is in fluid communication with the outside of the main fluid flow guide via the lateral opening of the main fluid flow guide;

[0078] providing an elongated member that is removably positioned to sequentially pass through: (a) a proximal main fluid flow guide end opening, (b) a longitudinal portion of the main fluid flow chamber, (c) a distal channel fluid flow guide end opening, and (d) a main fluid flow guide lateral opening to the exterior of the main fluid flow chamber;

[0079] introducing the main stent-graft into the vasculature of a patient with: (a) the main stent-graft in a radially compressed delivery state, and (b) the inner support channel in a telescoping state wherein the distal channel fluid flow guide end opening faces radially inward; and

[0080] Thereafter, the main stent graft is converted to a radially expanded deployed state.

[0081] wherein the inner support channel is configured to automatically transition to an expanded state when not constrained in a telescoping state by the main stent graft and not constrained in a telescoping state by the elongated member, and

[0082] Wherein, when the internal support channel is in the expanded state, the distal channel fluid flow guide end opening at least partially faces the distal end within the main fluid flow guide.

[0083] Inventive concept 29. The method according to inventive concept 28,

[0084] wherein the elongated member is an auxiliary wire guide tube, and

[0085] The method further includes inserting an auxiliary guidewire through an auxiliary guidewire lumen of the auxiliary guidewire tube before introducing the main stent graft into the vascular system.

[0086] Inventive concept 30. The method according to inventive concept 29, further comprising, after the internal support channel is automatically switched to the expanded state, in which the distal channel fluid flow guide end opening at least partially faces the distal end within the main fluid flow guide:

[0087] The branch stent graft is advanced over the auxiliary guidewire (a) from a vascular access site through a distal main fluid flow guide end opening into the main stent graft, (b) into a distal channel fluid flow guide end opening, (c) through the channel fluid flow guide, and (d) out of the main fluid flow guide lateral opening through a proximal channel fluid flow end opening.

[0088] Inventive concept 31. The method according to inventive concept 29, further comprising, after inserting the auxiliary guidewire through the auxiliary guidewire lumen and before introducing the main stent graft into the vascular system:

[0089] When the main stent graft is in a radially compressed delivery state outside the patient's body, the auxiliary guidewire tube is removed from the internal support channel so that the auxiliary guidewire remains positioned to pass through, in sequence, (a) the proximal main fluid flow guide end opening, (b) the longitudinal portion of the main fluid flow lumen, (c) the distal channel fluid flow guide end opening, and (d) the main fluid flow guide lateral opening to the exterior of the main fluid flow lumen.

[0090] Inventive concept 32. The method according to inventive concept 29, wherein inserting the auxiliary guidewire through the auxiliary guidewire lumen comprises inserting the auxiliary guidewire through the auxiliary guidewire lumen when the main stent-graft is in a radially compressed delivery state.

[0091] Inventive concept 33. The method according to inventive concept 32, wherein inserting the auxiliary guidewire through the auxiliary guidewire lumen comprises inserting the auxiliary guidewire through the auxiliary guidewire lumen while the main stent-graft is located outside the patient's body.

[0092] Inventive concept 34. The method of inventive concept 28, wherein the distal channel fluid flow guide end opening is disposed distal to the main fluid flow guide lateral opening when the internal support channel is in the expanded state and the main stent graft is in the radially expanded deployed state.

[0093] Inventive concept 35. The method according to inventive concept 28,

[0094] wherein the elongated member is an auxiliary guide wire, and

[0095] The method further includes deploying an auxiliary guidewire between the two vascular access sites before introducing the main stent graft into the vascular system.

[0096] Inventive concept 36. The method according to inventive concept 35, further comprising, after the internal support channel is automatically switched to the expanded state, in which the distal channel fluid flow guide end opening at least partially faces the distal end within the main fluid flow guide:

[0097] The branch stent graft is advanced over the auxiliary guidewire (a) from a vascular access site through a distal main fluid flow guide end opening into the main stent graft, (b) into a distal channel fluid flow guide end opening, (c) through the channel fluid flow guide, and (d) out of the main fluid flow guide lateral opening through a proximal channel fluid flow end opening.

[0098] According to inventive concept 37 of the present invention, a method is further provided, the method comprising:

[0099] introducing the vascular implant intravascularly into the patient's vascular system through a vascular access site located downstream of a first branch of the aortic arch;

[0100] Thereafter, the vascular graft is advanced through the first branch to the aortic arch;

[0101] Thereafter, advancing the vascular implant at least partially from the aortic arch into a second branch of the aortic arch; and

[0102] Thereafter, the vascular implant is at least partially deployed in the second branch.

[0103] Inventive concept 38. The method according to inventive concept 37, wherein the first branch is a brachiocephalic artery, and wherein the second branch is selected from the group of branches comprising: a left common carotid artery (LCCA) and a left subclavian artery (LSA).

[0104] Inventive concept 39. The method according to inventive concept 37,

[0105] wherein the vascular access site is a first vascular access site,

[0106] wherein the method further comprises deploying a guidewire between the first vascular access site and a second vascular access site downstream of the second branch such that the guidewire is positioned partially within the first branch, partially within the aortic arch, and partially within the second branch, and

[0107] Wherein, advancing the vascular implant through the first branch to the aortic arch and at least partially from the aortic arch into the second branch comprises:

[0108] advancing the vascular graft over the guidewire through the first branch to the aortic arch; and

[0109] Thereafter, the vascular implant is advanced over the guidewire from the aortic arch at least partially into the second branch.

[0110] Inventive concept 40. The method according to inventive concept 37,

[0111] wherein intravascularly introducing the vascular implant into the vascular system comprises intravascularly introducing the vascular implant into the vascular system while the vascular implant is disposed in a radially compressed delivery state within a portion of a delivery catheter,

[0112] wherein advancing the vascular implant through the first branch to the aortic arch and at least partially from the aortic arch into the second branch comprises advancing a portion of a delivery catheter through the first branch to the aortic arch and at least partially from the aortic arch into the second branch, and

[0113] Wherein deploying the vascular implant at least partially in the second branch includes releasing the vascular implant from the portion of the delivery catheter such that the vascular implant transitions to a radially expanded deployed state at least partially in the second branch.

[0114] Inventive concept 41. The method of inventive concept 37, wherein the vascular implant comprises a stent graft comprising a flexible stent component and a generally tubular fluid flow guide securely attached to and covering at least a portion of the stent component.

[0115] Inventive concept 42. The method according to inventive concept 41,

[0116] wherein the stent graft is a branched stent graft, wherein the stent component is a branched stent graft stent component, and wherein the fluid flow guide is a branched stent graft fluid flow guide,

[0117] wherein the method further comprises, prior to advancing the vascular implant through the first branch into the aortic arch, deploying the main stent-graft at least partially in the aortic arch such that a main fluid flow guide lateral opening defined by a generally tubular main stent-graft fluid flow guide of the main stent-graft is oriented toward the second branch, the main stent-graft further comprising a flexible main stent-graft stent member, the main stent-graft fluid flow guide being securely attached to the main stent-graft stent member so as to cover at least a portion of the main stent-graft stent member,

[0118] wherein advancing the vascular graft through the first branch into the aortic arch comprises advancing the branch stent graft through the first branch into the main stent graft,

[0119] wherein advancing the vascular implant at least partially from the aortic arch into the second branch comprises advancing the branch stent graft from within the main stent graft through the main fluid flow guide lateral opening partially into the second branch, and

[0120] Wherein deploying the vascular graft at least partially in the second branch includes deploying the branch stent graft partially in the second branch outside the lateral opening of the main fluid flow guide and partially inside the main stent graft.

[0121] Inventive concept 43. The method according to inventive concept 41, wherein the aortic arch suffers from acute aortic syndrome.

[0122] Inventive concept 44. The method according to inventive concept 43, wherein the wall of the aortic arch suffers from an aneurysm.

[0123] Inventive concept 45. The method according to inventive concept 43, wherein the wall of the aortic arch suffers from dissection.

[0124] Inventive concept 46. The method according to inventive concept 43, wherein the wall of the aortic arch is afflicted with a penetrating aortic ulcer (PAU).

[0125] Inventive concept 47. The method according to inventive concept 43, wherein the wall of the aortic arch suffers from an intramural hematoma (IMH).

[0126] According to inventive concept 48 of the present invention, a method is additionally provided, the method comprising:

[0127] deploying a guidewire between (i) a first vascular access site downstream of a first branch of an aortic arch of the patient and (ii) a second vascular access site downstream of a second branch of the aortic arch such that the guidewire is positioned partially within the first branch, partially within the aortic arch, and partially within the second branch;

[0128] advancing the vascular implant over the guidewire; and

[0129] The vascular implant is deployed within the patient's vascular system.

[0130] Inventive concept 49. The method according to inventive concept 48, wherein the first branch is a brachiocephalic artery, and wherein the second branch is selected from the group of branches comprising: a left common carotid artery (LCCA) and a left subclavian artery (LSA).

[0131] Inventive concept 50. The method according to inventive concept 49, wherein the first vascular access site is located on the right axillary artery (RAA).

[0132] Inventive concept 51. The method according to inventive concept 49, wherein the second branch is the LCCA, and the second vascular access site is located on the LCCA.

[0133] Inventive concept 52. The method according to inventive concept 48, wherein deploying the guidewire between the first vascular access site and the second vascular access site such that the guidewire is positioned partially within the first branch, partially within the aortic arch, and partially within the second branch comprises:

[0134] The guidewire is deployed between (i) the second vascular access site and (ii) a third vascular access site downstream of the descending aorta such that:

[0135] (a) the guidewire is positioned partially within the second branch, partially within the aortic arch, and partially within the descending aorta,

[0136] (b) the first end portion of the guidewire emerges from the vascular system at the second vascular access site, and

[0137] (c) a second end portion of the guidewire opposite the first end portion emerges from the vascular system at a third vascular access site; and

[0138] looping the second end portion of the guidewire outside the patient's body by reinserting the second end portion of the guidewire into the vascular system through the third vascular access site; and

[0139] Thereafter, the second end portion of the guidewire is advanced through the descending aorta, through a portion of the aortic arch, through at least a portion of the first branch, and out of the first vascular access site such that the loop is drawn into the vascular system via the third vascular access site.

[0140] Inventive concept 53. The method according to inventive concept 52,

[0141] wherein the guidewire is an auxiliary guidewire, and wherein deploying the guidewire between the second vascular access site and the third vascular access site comprises deploying the auxiliary guidewire between the second vascular access site and the third vascular access site, and

[0142] Wherein, deploying the guidewire between the first vascular access site and the second vascular access site includes deploying the auxiliary guidewire between the first vascular access site and the second vascular access site in the following manner:

[0143] deploying a main guidewire between the first vascular access site and a third vascular access site such that (a) a first end portion of the main guidewire emerges from the vascular system at the first vascular access site, and (b) a second end portion of the main guidewire opposite the first end portion of the main guidewire emerges from the vascular system at the third vascular access site,

[0144] deploying a through-catheter over the main guidewire between the first vascular access site and the third vascular access site such that (a) a first end portion of the through-catheter emerges from the vascular system at the first vascular access site, and (b) a second end portion of the through-catheter opposite the first end portion of the through-catheter emerges from the vascular system at the third vascular access site,

[0145] Thereafter, the main guidewire is removed from the through-catheter, and

[0146] Thereafter, the second end portion of the auxiliary guidewire is advanced through the through-tube and out of the first vascular access site, such that the loop is pulled into the vascular system via the third vascular access site.

[0147] Inventive concept 54. The method according to inventive concept 53, wherein the method further comprises, after deploying the main guidewire between the first vascular access site and the third vascular access site and before deploying the through-catheter over the main guidewire and deploying the vascular implant within the vascular system:

[0148] A main stent-graft is deployed at least partially in the aortic arch over the main guidewire such that a main fluid flow guide lateral opening defined by a main stent-graft fluid flow guide of the main stent-graft is oriented toward the second branch, the main stent-graft further comprising a flexible main stent-graft stent component, the main stent-graft fluid flow guide being securely attached to the main stent-graft stent component so as to cover at least a portion of the main stent-graft stent component.

[0149] Inventive concept 55. The method according to inventive concept 54, wherein deploying the main stent graft comprises:

[0150] introducing the delivery catheter into the vascular system through the third vascular access site and advancing the delivery catheter over the primary guidewire and the secondary guidewire while the main stent-graft is disposed in a radially compressed delivery state within a portion of the delivery catheter; and

[0151] The main stent-graft is released from the portion of the delivery catheter such that the main stent-graft is at least partially converted to a radially expanded deployed state in the aortic arch.

[0152] Inventive concept 56. The method according to inventive concept 54,

[0153] wherein the vascular implant comprises a branch stent graft, the branch stent graft comprising a flexible branch stent graft stent component and a generally tubular branch stent graft fluid flow guide, the branch stent graft fluid flow guide securely attached to and covering at least a portion of the branch stent graft stent component,

[0154] wherein deploying the vascular implant within the patient's vascular system includes, after the main stent-graft is at least partially deployed in the aortic arch, advancing the branch stent-graft over the auxiliary guidewire from the first vascular access site into the main stent-graft, from within the main stent-graft and partially into the second branch through the lateral opening of the main fluid flow guide, such that the branch stent-graft is partially located in the second branch outside the lateral opening of the main fluid flow guide and partially located within the main stent-graft.

[0155] Inventive concept 57. The method according to inventive concept 48,

[0156] wherein advancing the vascular implant comprises advancing the vascular implant over the guidewire while the vascular implant is disposed in a radially compressed delivery state within a portion of a delivery catheter,

[0157] Therein, deploying the vascular implant within the vascular system includes releasing the vascular implant from a portion of the delivery catheter such that the vascular implant transitions to a radially expanded deployed state within the vascular system.

[0158] Inventive concept 58. The method of inventive concept 48, wherein the vascular implant comprises a stent graft comprising a flexible stent component and a generally tubular fluid flow guide securely attached to and covering at least a portion of the stent component.

[0159] Inventive concept 59. The method according to inventive concept 58, wherein the aortic arch suffers from acute aortic syndrome.

[0160] Inventive concept 60. The method according to Inventive concept 59, wherein the wall of the aortic arch suffers from an aneurysm.

[0161] Inventive concept 61. The method according to Inventive concept 59, wherein the wall of the aortic arch suffers from dissection.

[0162] Inventive concept 62. The method according to inventive concept 59, wherein the wall of the aortic arch is afflicted with a penetrating aortic ulcer (PAU).

[0163] Inventive concept 63. The method according to Inventive concept 59, wherein the wall of the aortic arch suffers from an intramural hematoma (IMH).

[0164] Inventive concept 64. The method of inventive concept 48, wherein advancing the vascular implant over the guidewire comprises advancing the vascular implant over the guidewire from the first vascular access site to the aortic arch, and from the aortic arch at least partially into the second branch.

[0165] Inventive concept 65. The method according to inventive concept 64,

[0166] wherein the vascular implant comprises a branch stent graft including a flexible branch stent graft stent component and a generally tubular branch stent graft fluid flow guide securely attached to and covering at least a portion of the branch stent graft stent component,

[0167] wherein the method further comprises, prior to deploying the vascular implant within the vascular system, deploying the main stent-graft at least partially in the aortic arch such that a main fluid flow guide lateral opening defined by a tubular main stent-graft fluid flow guide of the main stent-graft is oriented toward the second branch, the main stent-graft further comprising a flexible main stent-graft stent member, the main stent-graft fluid flow guide being securely attached to the main stent-graft stent member so as to cover at least a portion of the main stent-graft stent member,

[0168] wherein advancing the vascular implant over the guidewire from the first vascular access site to the aortic arch comprises advancing the branch stent graft from the first vascular access site into the main stent graft,

[0169] wherein advancing the vascular graft at least partially from the aortic arch into the second branch comprises advancing the branch stent graft partially over the guidewire from within the main stent graft through the main fluid flow guide lateral opening into the second branch, and

[0170] Therein, deploying the vascular implant within the vascular system includes deploying the branch stent graft partially in the secondary branch outside the lateral opening of the main fluid flow guide and partially inside the main stent graft.

[0171] The present invention will be more fully understood through the following detailed description of its embodiments in conjunction with the accompanying drawings, in which: BRIEF DESCRIPTION OF THE DRAWINGS

[0172] Figure 1A to Figure 1B is a schematic diagram of a vascular implant assembly in a disassembled state and an assembled state, respectively, according to an application of the present invention;

[0173] Figure 1C to Figure 1D The invention is used in a disassembled state and an assembled state respectively. Figure 1A to Figure 1B A schematic diagram of another configuration of a vascular implant assembly;

[0174] FIG. 2A to FIG. 2O is a schematic diagram of several stages of a method for deploying one or more vascular implants according to applications of the present invention;

[0175] Figure 3 According to the application of the present invention Figure 1A to Figure 1B Schematic diagram of alternative implantation of a vascular implant component in a vascular system;

[0176] FIG. 4A to FIG. 4C According to the application of the present invention Figure 1A to Figure 1B Schematic side views of the internal support channel of the main stent graft of the vascular implant assembly in an expanded state, a partially telescoped state and a telescoped state respectively;

[0177] FIG. 4D to FIG. 4F According to another application of the present invention Figure 1A to Figure 1B Schematic side views of the internal support channel of the main stent graft of the vascular implant assembly in an expanded state, a partially telescoped state and a telescoped state respectively;

[0178] Figure 5 A partially distal and partially side view of a device in an expanded state according to an application of the present invention FIG. 4A to FIG. 4C A schematic diagram of a flexible channel support member for an internal support channel;

[0179] FIG. 6A to FIG. 6C is a schematic diagram of several stages of a portion of a method for deploying a main stent graft and a branch stent graft in accordance with an application of the present invention; and

[0180] Figure 7 According to the application of the present invention Figure 1A to Figure 1B Schematic diagram of a configuration of a main stent-graft of a vascular implant assembly of FIG. 1 , the main stent-graft being disposed within a portion of a main delivery catheter in a radially compressed delivery state. DETAILED DESCRIPTION

[0181] Figure 1A to Figure 1B 2 is a schematic diagram of a vascular implant assembly 20 in a disassembled state and an assembled state according to an application of the present invention. The vascular implant assembly 20 generally includes a main stent graft 22 and a branch stent graft 24. Figure 1A to Figure 1B , both main stent-graft 22 and branch stent-graft 24 are shown in a radially expanded deployed state.

[0182] Figure 1C to Figure 1D 1 is a schematic diagram of another configuration of a vascular implant assembly according to the application of the present invention, in a disassembled state and an assembled state, respectively. Figure 1C to Figure 1D , both the main stent graft 22 and the branch stent graft 24 are shown in a radially expanded deployed state. Figure 1C to Figure 1D right Figure 1A to Figure 1B The configuration and Figure 1C to Figure 1D The differences between the configurations are described.

[0183] The main stent graft 22 generally includes a flexible main stent graft stent member 26 and a generally tubular fluid flow guide 28. The generally tubular fluid flow guide 28 is securely attached to the main stent graft stent member 26, such as by suturing or sewing, so as to cover at least a portion of the main stent graft stent member 26. The stent member can be attached to the inner surface and / or the outer surface of the fluid flow guide. Optionally, a portion of the stent struts of the stent member can be attached to (e.g., sutured to) the inner surface and another portion is attached to the outer surface. The main stent graft fluid flow guide 28 is shaped to define a proximal main fluid flow guide end opening 27A and a distal main fluid flow guide end opening 27B, a main fluid flow cavity 29 between the proximal main fluid flow guide end opening 27A and the distal main fluid flow guide end opening 27B, and a main fluid flow guide lateral opening 30.

[0184] For some applications, main stent-graft fluid flow guide 28 has one or more of the following dimensions when unconstrained (by deployment catheter, anatomical structures, or otherwise) in the radially expanded deployed state:

[0185] Length of at least 15 cm and not more than 30 cm and / or between 15 cm and 30 cm,

[0186] · a maximum diameter of at least 1 cm, no more than 5 cm and / or between 1 cm and 5 cm,

[0187] The area of ​​the lateral opening 30 is at least 0.5 cm 2 , not more than 2.1cm 2 and / or 0.5 cm 2 Up to 2.1cm 2 ,

[0188] The circumference of the lateral opening 30 is at least 2 cm, no more than 6.5 cm and / or between 2 cm and 6.5 cm,

[0189] The circumference of the proximal main fluid flow guide end opening 27A is at least 10 cm, no more than 15 cm and / or 10 cm to 15 cm, and / or

[0190] • The circumference of the distal primary fluid flow guide end opening 27B is at least 1.6 cm, no more than 4.5 cm and / or 1.6 cm to 4.5 cm.

[0191] The branch stent graft 24 generally includes a flexible branch stent graft stent member 32 and a generally tubular branch stent graft fluid flow guide 34. The branch stent graft fluid flow guide 34 is securely attached to the branch stent graft stent member 32, such as by suturing or sewing, so as to cover at least a portion of the branch stent graft stent member 32. The stent member can be attached to the inner surface and / or the outer surface of the fluid flow guide. Optionally, a portion of the stent struts of the stent member can be attached (e.g., sutured) to the inner surface and another portion to the outer surface. Further optionally, the branch stent graft fluid flow guide 34 includes two layers of graft that are bonded together - the branch stent graft stent member 32 is sandwiched between them - thereby encapsulating the branch stent graft stent member 32 in the graft material of the branch stent graft fluid flow guide 34. The branch stent graft 24 is configured to be disposed through the main fluid flow guide lateral opening 30 so as to form a blood-tight seal between the branch stent graft fluid flow guide 34 and the following:

[0192] The portion of the main stent-graft fluid flow guide 28 that defines the perimeter of the main fluid flow guide lateral opening 30, such as at Figure 1B as shown in, and / or

[0193] In applications where the main stent graft 22 includes an internal support channel 120, such as in Figure 1BAs shown in and as referred to below FIG. 4A to FIG. 4C , 4D to Figure 4F , Figure 5 , FIG. 6A to FIG. 6C as well as Figure 7 As described in detail, the interior supports the inner surface of the tubular passage fluid flow guide 128 of the passage 120 .

[0194] For some applications, main stent-graft 22 is configured to be positioned partially in descending aorta 66, partially in aortic arch 62, and partially in first branch 60 of aortic arch 62. For example, first branch 60 may be brachiocephalic artery (BCT) 64. As used in this application, including the claims and inventive concepts, a "branch" of the aortic arch means an artery that branches from the aortic arch, i.e., BCT 64, left common carotid artery (LCCA) 72, or left subclavian artery (LSA) 74. As used in this application, including the claims and inventive concepts, a "branch" of the aortic arch does not mean the mouth of the branch (i.e., the opening that branches from the aortic arch). Thus, "downstream" of a "branch" of the aortic arch means downstream along the branch artery, rather than downstream along the continuation of the aorta.

[0195] For some applications, branch stent graft 24 is configured to be positioned partially in a secondary branch 70 of aortic arch 62 and partially within main stent graft 22 within aortic arch 62. For example, secondary branch 70 may be LCCA 72 (as shown) or LSA 74 (as shown). Figure 3 , and described below).

[0196] For some applications, vascular implant assembly 20 also includes branch extension stent graft 36. Figure 1A to Figure 1B and Figure 1C to Figure 1D , branch-extension stent-graft 36 is shown in a radially expanded deployed state. Branch-extension stent-graft 36 generally includes a branch-extension stent-graft stent member 40 and a generally tubular branch-extension stent-graft fluid flow guide 38. Branch-extension stent-graft fluid flow guide 38 is securely attached to branch-extension stent-graft stent member 40 so as to cover at least a portion of branch-extension stent-graft stent member 40. For these applications, main stent-graft fluid flow guide 28 is shaped to define an extended lateral opening 42, and branch-extension stent-graft 36 is configured to be disposed through extended lateral opening 42 so as to form a blood-tight seal between main stent-graft fluid flow guide 28 and branch-extension stent-graft fluid flow guide 38, such as in Figure 1B and Figure 1DOptionally, main stent-graft fluid flow guide 28 may implement any of the features of the lateral tubes described in US Pat. No. 10,485,684 to Marmur et al., which is incorporated herein by reference.

[0197] Typically, the flexible stent members described herein are self-expandable (and biased toward a radially expanded deployed state), although they may alternatively be balloon expandable. Typically, each of the flexible stent members includes one or more stent struts, which may or may not be interconnected and may or may not be arranged as rings that are optionally axially separated from each other. In a configuration in which the stent struts are not interconnected, the stent struts are held together by a generally tubular fluid flow guide. For example, the flexible stent member may include a metal such as a superelastic metal alloy, a shape memory metal alloy, and / or nitinol; alternatively, the metal may include stainless steel.

[0198] Each of the generally tubular fluid flow guides may include at least one biocompatible substantially blood-impermeable fabric. The fabric may include, for example, polyester, polyethylene (e.g., polyethylene terephthalate), polymer film materials (e.g., polytetrafluoroethylene (PTFE), polypropylene, polyethylene, high-density polyethylene, polyurethane, polyolefin, ePTFE), polymer textile materials (e.g., woven polyethylene terephthalate (PET)), natural tissue grafts (e.g., saphenous vein or collagen), or combinations thereof.

[0199] FIG. 2A to FIG. 2O is a schematic diagram of several stages of a method for deploying one or more vascular implants according to applications of the present invention. For some applications, the method is used to treat an aortic arch 62 suffering from an acute aortic syndrome such as an aneurysm, dissection, penetrating aortic ulcer (PAU), and / or intramural hematoma (IMH). Although the method is illustrated as including the above referenced Figure 1A to Figure 1B The main stent graft 22 and branch stent graft 24 of the configuration of the vascular implant assembly 20 described above are deployed, but the method can also be alternatively used to deploy the main stent graft 22 and branch stent graft 24 of the configuration of the vascular implant assembly 20 described above. Figure 1C to Figure 1D The configuration of described vascular implant assembly 20 is deployed, perhaps is used for one or more other vascular implants such as one or more uncovered supports, one or more balloon catheters or one or more stent grafts except the stent graft of vascular implant assembly 20 are deployed.This method can include all steps in the step described hereinafter or only a subset of step and / or include but not limited to those additional steps described hereinafter.

[0200] like Figure 2A , a main guide wire 50A is deployed intravascularly (usually percutaneously) between a first vascular access site 52A and a third vascular access site 52C of a patient's vascular system 54, such that (a) a first end portion 56A of the main guide wire 50A passes out of the vascular system 54 at the first vascular access site 52A, and (b) a second end portion 58A of the main guide wire 50A opposite to the first end portion 56A of the main guide wire 50A passes out of the vascular system 54 at the third vascular access site 52C. The main guide wire 50A can be deployed using techniques known in the art for deploying through guide wires. The main guide wire 50A can be introduced into the vascular system and advanced within the vascular system in either direction (i.e., from the third vascular access site 52C to the first vascular access site 52A or from the first vascular access site 52A to the third vascular access site 52C).

[0201] Typically, first vascular access site 52A is located downstream of first branch 60 of aortic arch 62. For example, in applications where first branch 60 is BCT 64, first vascular access site 52A may be located on the right axillary artery (RAA), such as shown.

[0202] Typically, third vascular access site 52C is located downstream of descending aorta 66. For example, third vascular access site 52C may be located on the right femoral artery, as illustrated, or on the right iliac artery (routing not shown).

[0203] like Figure 2B , auxiliary guide wire 50B is deployed between second vascular access site 52B and third vascular access site 52C, so that (a) first end portion 56B of auxiliary guide wire 50B passes out from vascular system 54 at second vascular access site 52B, and (b) second end portion 58B of auxiliary guide wire 50B opposite to first end portion 56B of auxiliary guide wire 50B passes out from vascular system 54 at third vascular access site 52C. Auxiliary guide wire 50B can be deployed using techniques known in the art for deploying through guide wires. Auxiliary guide wire 50B can be introduced into the vascular system and advanced within the vascular system in either direction (i.e., from third vascular access site 52C to second vascular access site 52B or from second vascular access site 52B to third vascular access site 52C).

[0204] Typically, second vascular access site 52B is located downstream of second branch 70 of aortic arch 62. For example, in applications where second branch 70 is LCCA 72, second vascular access site 52B may be located directly on LCCA 72, or in applications where second branch 70 is LSA 74 (such as described below), second vascular access site 52B may be located downstream of second branch 70 of aortic arch 62. Figure 3), second vascular access site 52B may be located directly on LSA 74 or on one of its downstream branches (eg, left axilla or left arm).

[0205] For example, auxiliary guidewire 50B may be introduced through a catheter deployed between second vascular access site 52B (e.g., LCCA 72 or LSA 74) and third vascular access site 52C. Alternatively, auxiliary guidewire 50B may be introduced via second vascular access site 52B or third vascular access site 52C using an introducer or access sheath (with or without a catheter) and then captured to bring the end portion of auxiliary guidewire 50B to its target location in vascular system 54.

[0206] For some applications, refer to FIG. 6A to FIG. 6C The steps of the method described are performed in the following situations: (a) after deploying the main guide wire 50A and the auxiliary guide wire 50B, such as those described above with reference to Figure 2A and Figure 2B as described above, and (b) prior to deploying the main stent graft 22 over the main guide wire 50A, such as described below with reference to FIG. 2C to FIG. 2E as described.

[0207] As in FIG. 2C to FIG. 2E As shown in FIG. 1 , main stent graft 22 is at least partially deployed in aortic arch 62 over main guide wire 50A such that main fluid flow guide lateral opening 30 is oriented toward second branch 70 (as in FIG. 1 ). FIG. 2D to FIG. 2E For example, a delivery system may be provided that includes a main delivery catheter 80A and a main inner shaft 78 shaped to define a guidewire longitudinal lumen 79 (described below) through which the main guidewire 50A passes. FIG. 6A to FIG. 6C and Figure 7 ). Typically, the delivery system also includes a nose cone 86 as is known in the catheter art. For some applications, proper rotational alignment and / or axial orientation of the main fluid flow guide lateral opening 30 is achieved using fluoroscopy. For example, the main stent-graft 22 may include one or more radiopaque markers located near (e.g., on the periphery of) the main fluid flow guide lateral opening 30.

[0208] Typically, the main stent graft 22 is deployed by:

[0209] The main stent graft 22 is disposed within a portion of the main delivery catheter 80A and is constrained by the main delivery catheter 80A in a radially compressed delivery state (the main stent graft 22 is typically disposed radially between the main delivery catheter 80A and the main inner shaft 78 (in the Figure 2D , FIG. 6A to FIG. 6C and Figure 7 When the main delivery catheter 80A is introduced into the vascular system 54 through the third vascular access site 52C and the main delivery catheter 80A is advanced over the main guide wire 50A and the auxiliary guide wire 50B, as shown in Figure 2C shown in, and

[0210] Release main stent-graft 22 from the portion of main delivery catheter 80A so that main stent-graft 22 transitions at least partially within aortic arch 62 to a radially expanded deployed state, such as at FIG. 2D to FIG. 2E Typically, the main stent graft 22 is released from the main delivery catheter 80A by withdrawing the main delivery catheter proximally, such as in Figure 2D As shown in .

[0211] In a configuration in which the auxiliary guide wire 50B is removably pre-positioned to specifically pass through the proximal catheter end 83 and exit from the distal catheter end 82 in sequence, such as in FIG. 4D to FIG. 4F and Figure 7 As shown in FIG, during advancement of main delivery catheter 80A over main guidewire 50A and auxiliary guidewire 50B, main stent-graft 22 may slide distally over auxiliary guidewire 50B. Alternatively or additionally, main stent-graft 22 may remain axially stationary relative to auxiliary guidewire 50B, in which case auxiliary guidewire 50B may move with the delivery system and may be distally moved out of an auxiliary access sheath at a second vascular access site 52B (the auxiliary access sheath is used to introduce auxiliary guidewire 50B into the vascular system, as is known in the guidewire art).

[0212] Figure 2D The main stent graft 22 is shown partially released from the main delivery catheter, and Figure 2E The main stent graft is shown fully released from the main delivery catheter.

[0213] For some applications, such as FIG. 2C to FIG. 2E As shown in FIG, the most distal portion of main stent-graft 22 is deployed in first branch 60 of aortic arch 62. For example, first branch 60 may be BCT 64, such as shown. Alternatively, the most distal portion of main stent-graft 22 is deployed in aortic arch 62 (configuration not shown).

[0214] Usually, as in Figure 2C As shown in FIG. 1 , when the main delivery catheter 80A is advanced over the main guidewire 50A and the auxiliary guidewire 50B, both the main guidewire 50A and the auxiliary guidewire 50B pass through the distal catheter end 82 of the main delivery catheter 80A. Typically, the auxiliary guidewire 50B passes through the following:

[0215] Starting from the distal catheter tip 82 of the main delivery catheter 80A,

[0216] into the distal portion of the main delivery catheter 80A that is external to the main stent-graft 22,

[0217] through the lateral opening 30 of the main fluid flow guide,

[0218] · penetrate into the main stent graft 22, and

[0219] · out of the proximal primary fluid flow guide end opening 27A in the primary delivery conduit 80A,

[0220] For example, as hereinafter referred to FIG. 4A to FIG. 4C , FIG. 6A to FIG. 6C and Figure 7 Typically, the main guidewire 50A and the auxiliary guidewire 50B are also passed through the main delivery catheter 80A until they reach the outside of the patient's body (not shown).

[0221] As described above, in some configurations, main stent-graft fluid flow guide 28 is shaped to define extended lateral openings 42. In some of these configurations, main stent-graft 22 is deployed at least partially over main guidewire 50A in aortic arch 62 such that extended lateral openings 42 are disposed upstream in aortic arch 62 near the bifurcation of aortic arch 62 and BCT 64, oriented toward ascending aorta 84, such as in FIG. 2D to FIG. 2E As shown in .

[0222] As in Figure 2F As shown in FIG. 1 , a through catheter 90 is deployed on a main guide wire 50A between a first vascular access site 52A and a third vascular access site 52C such that (a) a first end portion 92A of the through catheter 90 passes out of the vascular system 54 at the first vascular access site 52A, and (b) a second end portion 92B of the through catheter 90 opposite to the first end portion 92A passes out of the vascular system 54 at the third vascular access site 52C.

[0223] As in Figure 2G As shown in FIG. 5 , the main guidewire 50A is removed (withdrawn) from the through catheter 90 , thereby leaving the through catheter 90 in place within the vascular system 54 .

[0224] As in Figure 2H As shown in FIG. 1 , the second end portion 58B of the auxiliary guidewire 50B is reinserted into the vascular system 54 through the third vascular access site 52C via the through-tube 90 so that the second end portion 58B of the auxiliary guidewire 50B forms a loop 94 outside the patient's body.

[0225] As in Fig.2IAs shown in FIG. 5 , the second end portion 58B of the auxiliary guidewire 50B is advanced through the through catheter 90 and out of the first vascular access site 52A.

[0226] As in Figure 2J As shown in FIG. 5 , through-tube 90 is removed from vascular system 54 via first vascular access site 52A.

[0227] As in Figure 2J and Figure 2K , loop 94 is pulled into vascular system 54 via third vascular access site 52C, typically by pulling second end portion 58B of auxiliary guidewire 50B out of first vascular access site 52A. Thus, auxiliary guidewire 50B is deployed between first vascular access site 52A and second vascular access site 52B such that:

[0228] The auxiliary guidewire 50B is partially positioned within the first branch 60, partially positioned within the aortic arch 62, and partially positioned within the second branch 70, and

[0229] Auxiliary guidewire 50B is positioned to pass between distal primary fluid flow guide end opening 27B and primary fluid flow guide lateral opening 30 via a portion of lumen 98 defined by main stent-graft 22 .

[0230] Optionally, execute Figure 2J and Figure 2K , namely, removing the through catheter 90 from the vascular system 54 while the second end portion 58B of the auxiliary guidewire 50B is pulled through the first vascular access site 52A.

[0231] like Figure 2L As shown in FIG. 4 , the branch extension stent graft 36 is deployed through the extended lateral opening 42 to form a blood-tight seal between the main stent graft fluid flow guide 28 and the branch extension stent graft fluid flow guide 38. Figure 2K Steps and Figure 2M The deployment of the branch-extend stent graft 36 is shown between the steps of FIG. 1 , but the branch-extend stent graft 36 may alternatively be deployed between the steps of FIG. Figure 2E Steps and Figure 2N Deploy at any point between the steps.

[0232] As in Figure 2M to Figure 2N, the branch stent graft 24 is deployed by advancing the branch stent graft 24 over the auxiliary guide wire 50B (a) from the first vascular access site 52A into the main stent graft 22, (b) from within the main stent graft 22, and (c) partially into the second branch 70 via the main fluid flow guide lateral opening 30. Thus, the branch stent graft 24 is partially located in the second branch 70 outside the main fluid flow guide lateral opening 30 and partially located inside the main stent graft 22, thereby forming a blood-tight seal between the main stent graft fluid flow guide 28 and the branch stent graft fluid flow guide 34. For example, the above-described delivery system may also include a branch delivery catheter 80B and a branch inner shaft (not shown) shaped to define a guidewire longitudinal lumen through which the auxiliary guide wire 50B passes.

[0233] For some applications, main stent-graft 22 includes internal support passage 120, such as described below with reference to FIG. 4A to FIG. 4C , FIG. 4D to FIG. 4F , Figure 5 , FIG. 6A to FIG. 6C and Figure 7 In these applications, at this stage of deployment, the distal channel fluid flow guide end opening 127B of the inner support channel 120 is at least partially facing distally within the main fluid flow guide 28 (e.g., partially facing distally and partially toward the central axis of the main fluid flow guide 28, such as shown). In applications where the stent graft system 110 includes an auxiliary guidewire tube 140, such as described below with reference to FIG. 4A to FIG. 4C and FIG. 6A to FIG. 6C As described, this orientation can facilitate insertion of auxiliary guide wire 50B into distal channel fluid flow guide end opening 127B, through internal support channel 120, and through main fluid flow guide lateral opening 30. After main stent graft 22 has been transitioned to the radially expanded deployed state, as in Figure 2C and Figure 2D As shown in the transition between the two, as described below, this orientation can also facilitate the advancement of the branch delivery catheter 80B along the path over the auxiliary guidewire 50B, such as described below with reference to Figure 2M and 2N as described.

[0234] Typically, when the branch stent graft 24 is disposed in a radially compressed delivery state within a portion of the branch delivery catheter 80B, the branch stent graft 24 is advanced over the auxiliary guide wire 50B, such as in Figure 2M Thereafter, the branch stent graft 24 is released from the portion of the branch delivery catheter 80B, so that the branch stent graft 24 is at least partially converted to a radially expanded deployed state in the second branch 70, such as in Figure 2NBranch stent graft 24 is typically released from branch delivery catheter 80B by withdrawing the branch delivery catheter proximally.

[0235] As in Fig.2O As shown in FIG. 5 , auxiliary guidewire 50B is removed from vascular system 54 via first vascular access site 52A or second vascular access site 52B, thereby implanting vascular graft assembly 20 (including main stent graft 22 , branch stent graft 24 , and branch extension stent graft 36 ) in vascular system 54 .

[0236] Now refer to Figure 3 , Figure 3 is a schematic diagram of an alternative implantation of a vascular implant assembly 20 in accordance with an application of the present invention in a vascular system 54. In this implantation, a branch stent graft 24 is partially positioned in an LSA 74. Although the above reference Figure 1A to Figure 1B The main stent graft 22 and branch stent graft 24 of the described configuration of the vascular implant assembly 20 illustrate this alternative implantation, but this alternative implantation may alternatively be used in conjunction with the above referenced Figure 1C to Figure 1D The configuration of vascular implant assembly 20 described is used together.

[0237] Reference Figure 2M to Figure 2O and Figure 3 In some applications of the present invention, a method is provided, comprising:

[0238] introducing intravascularly a vascular implant 100 into a vascular system 54 through a vascular access site 52 located downstream of a first branch 60 of an aortic arch 62; the vascular implant 100 may include a branched stent graft 24 or another vascular implant, such as a non-branched stent graft, an uncovered stent, or a balloon catheter, and / or the vascular access site 52 may be a first vascular access site 52A or another vascular access site;

[0239] Thereafter, the vascular implant 100 is advanced through the first branch 60 to the aortic arch 62, for example Figure 2M As shown in;

[0240] Thereafter, advancing the vascular implant 100 at least partially from the aortic arch 62 into the second branch 70 of the aortic arch 62; and

[0241] Thereafter, the vascular implant 100 is at least partially deployed in the second branch 70, for example Figure 2N As shown in .

[0242] For some applications where vascular access site 52 is first vascular access site 52A, the method further includes deploying guidewire 50 between first vascular access site 52A and second vascular access site 52B located downstream of second branch 70. Thus, the guidewire is partially positioned within first branch 60, partially within aortic arch 62, and partially within second branch 70, such as at Figure 2M Advancing the vascular implant 100 through the first branch 60 to the aortic arch 62 and at least partially from the aortic arch 62 into the second branch 70 includes:

[0243] Advancing vascular implant 100 over guidewire 50 through first branch 60 to aortic arch 62; and

[0244] Thereafter, the vascular implant 100 is advanced at least partially over the guide wire 50 from the aortic arch 62 into the second branch 70 .

[0245] For some of these applications where guidewire 50 is deployed between first vascular access site 52A and second vascular access site 52B, vascular implant 100 is intravascularly introduced into vascular system 54 while vascular implant 100 is disposed in a radially compressed delivery state within a portion of delivery catheter 80, such as branch delivery catheter 80B. Figure 2M 80 for the branched stent graft 24. The vascular implant 100 is advanced through the first branch 60 to the aortic arch 62 and at least partially into the second branch 70 from the aortic arch 62 by advancing the portion of the delivery catheter 80 through the first branch 60 to the aortic arch 62 and at least partially into the second branch 70 from the aortic arch 62. The vascular implant 100 is at least partially deployed in the second branch 70 by releasing the vascular implant 100 from the portion of the delivery catheter 80, so that the vascular implant 100 is at least partially transitioned to a radially expanded deployed state in the second branch 70.

[0246] Still refer to FIG. 2A to FIG. 2O and Figure 3 In some applications of the present invention, a method is provided, comprising:

[0247] Deploy guidewire 50 between (i) first vascular access site 52A downstream of first branch 60 of aortic arch 62 and (ii) second vascular access site 52B downstream of second branch 70 of aortic arch 62, such that guidewire 50 is partially positioned within first branch 60, partially positioned within aortic arch 62, and partially positioned within second branch 70, e.g., Figure 2K to Figure 2L As shown for the auxiliary guide wire 50B;

[0248] Advance the vascular implant 100 over the guide wire 50, e.g. Figure 2M as shown for branched stent graft 24; and

[0249] Deploy vascular implant 100 within a patient's vascular system, such as in Figure 2N This is shown for a branched stent graft 24 .

[0250] Vascular implant 100 may include branched stent graft 24 or another vascular implant, such as a non-branched stent graft, an uncovered stent, or a balloon catheter.

[0251] For some applications, deploying guidewire 50 between first vascular access site 52A and second vascular access site 52B such that guidewire 50 is partially positioned within first branch 60, partially positioned within aortic arch 62, and partially positioned within second branch 70 includes:

[0252] Deploy guidewire 50 between (i) second vascular access site 52B and (ii) third vascular access site 52C downstream of descending aorta 66, such as at Figure 2N As shown for auxiliary guide wire 50B,

[0253] The guidewire 50 is positioned partially within the second branch 70, partially within the aortic arch 62, and partially within the descending aorta 66,

[0254] The first end portion 56 of the guidewire 50 is passed out of the vascular system 54 at the second vascular access site 52B, and

[0255] The second end portion 58 of the guide wire 50 opposite to the first end portion 56 is at the third

[0256] The vascular access site 52C passes through the vascular system 54;

[0257] The second end portion 58 of the guidewire 50 is looped 94 outside the patient's body by reinserting the second end portion of the guidewire 50 through the third vascular access site 52C into the vascular system 54, such as at Figure 2H as shown for auxiliary guide wire 50B; and

[0258] Thereafter, second end portion 58 of guidewire 50 is advanced (a) through descending aorta 66, (b) through a portion of aortic arch 62, (c) through at least a portion of first branch 60, and (d) out of first vascular access site 52A such that loop 94 is drawn into vascular system 54 via third vascular access site 52C, e.g., at Figures 2I to 2K As shown for auxiliary guide wire 50B.

[0259] For some applications where guidewire 50 is auxiliary guidewire 50B, auxiliary guidewire 50B is deployed between first vascular access site 52A and second vascular access site 52B by deploying main guidewire 50A between first vascular access site 52A and third vascular access site 52C such that (a) first end portion 56A of main guidewire 50A passes through vascular system 54 at first vascular access site 52A, and (b) second end portion 58A of main guidewire 50A, opposite first end portion 56A of main guidewire 50A, passes through vascular system 54 at third vascular access site 52C, such as in Figure 2B Optionally, additionally perform the above reference Figure 2C to Figure 2J Some or all of the steps of the described method.

[0260] For some applications, vascular implant 100 is advanced over guidewire 50 while vascular implant 100 is disposed in a radially compressed delivery state within a portion of delivery catheter 80, such as branch delivery catheter 80B, such as in Figure 2M The vascular implant 100 is deployed in the vascular system 54 by releasing the vascular implant 100 from the portion of the delivery catheter 80 so that the vascular implant 100 is converted to a radially expanded deployment state in the vascular system 54, such as in Figure 2N This is shown for a branched stent graft 24 .

[0261] For some applications, vascular implant 100 is advanced over guidewire 50 from first vascular access site 52A to aortic arch 62 and from aortic arch 62 at least partially into second branch 70, such as in Figure 2M to Figure 2N Optionally, prior to deploying branch stent graft 24 within vascular system 54, main stent graft 22 is at least partially deployed in aortic arch 62 such that main fluid flow guide lateral opening 30 is oriented toward second branch 70, such as described above with reference to Figure 2M to Figure 2N as described.

[0262] Still refer to FIG. 2A to FIG. 2O and Figure 3 Optionally, the deployment techniques described herein are implemented in combination with one or more of the deployment techniques described in US Patent 8,945,203 to Shalev et al., which is incorporated herein by reference.

[0263] Refer again Figure 1A And also refer to FIG. 4A to FIG. 4C , FIG. 4A to FIG. 4C1 is a schematic side view of the internal support channel 120 of the main stent graft 22 according to the application of the present invention in an expanded state, a partially telescoped state, and a telescoped state. For example, the internal support channel 120 can be in a partially telescoped state during the transition from the expanded state to the telescoped state during manufacturing and / or in a partially telescoped state during the transition from the telescoped state to the expanded state during deployment, such as described below. Although FIG. 4A to FIG. 4C The diagram shows the Figure 1A to Figure 1B The main stent graft 22 and branch stent graft 24 of the vascular implant assembly 20 are described with reference to the drawings, but mutatis mutandis, with reference to FIG. 4A to FIG. 4C Many of the features described also apply to the Figure 1C to Figure 1D The configuration of vascular implant assembly 20 is described.

[0264] FIG. 4A to FIG. 4C Also shown, by way of example and not limitation, is a portion of a stent graft system 110 that includes a main stent graft, such as the stent graft described above with reference to FIG. Figures 1A to 3 A main stent graft 22 is described.

[0265] Also refer to Figure 5 , Figure 5 FIG. 1 is a schematic diagram of a flexible channel support member 126 of an internal support channel 120 in an expanded state, viewed from a partial distal end and partial side view, in accordance with an application of the present invention. Figure 5 The channel fluid flow guide 128 is not shown in FIG. 1 , although the channel fluid flow guide 128 actually exists. Figure 5 The flexible channel support member 126 shown in FIG. 1 may utilize the flexible channel support member 126 described above with reference to FIG. Figure 1A to Figure 1B The configuration of vascular implant assembly 20 described or referred to above is Figure 1C to Figure 1D The configuration of vascular implant assembly 20 described herein is achieved.

[0266] In these configurations, the internal support channel 120 is configured to assume an expanded state and a collapsed state, such as in FIG. 4A to FIG. 4C The internal support channel 120 is disposed within the main fluid flow guide 28. The internal support channel 120 includes a generally tubular channel fluid flow guide 128 shaped to define:

[0267] a proximal channel fluid flow end opening 127A and a distal channel fluid flow end opening 127B, and

[0268] When the internal support channel 120 is in an expanded state, such as Figure 4AAs shown in FIG. 1 , a channel lumen 129 is defined between the proximal channel fluid flow end opening 127A and the distal channel fluid flow end opening 127B.

[0269] The proximal channel fluid flow end opening 127A is sealingly connected to the periphery of the main fluid flow guide lateral opening 30, typically around the entire periphery of the lateral opening, so that when the internal support channel 120 is in an expanded state, the channel cavity 129 is connected to the external fluid of the main fluid flow guide 28 via the main fluid flow guide lateral opening 30.

[0270] For some applications, such as Figure 1C to Figure 1D As shown in FIG. 1 , the outer surface 131 of the inner support channel 120 (in Figure 1C and Figure 4A 133 of the main fluid flow guide 28 such that the internal support channel 120 extends distally from the main fluid flow guide lateral opening 30 beside the inner surface of the main fluid flow guide 28. Typically, in these applications, the tubular channel fluid flow guide 128 is coupled to the inner surface 133 of the main fluid flow guide 28, such as by coupling (e.g., coupling by sutures 137) to one or more struts of the main stent-graft stent component 26. (Sutures 137 are in addition to any other sutures (shown by way of example as being smaller than sutures 137) that couple the main fluid flow guide 28 itself to the struts of the main stent-graft stent component 26.)

[0271] As in Figure 4C As shown in FIG. 1 , when the internal support channel 120 is in the telescoping state, the distal channel fluid flow guide end opening 127B faces radially inward (ie, toward the central longitudinal axis 135 of the primary fluid flow guide 28 ).

[0272] As in Figure 4A , when inner support channel 120 is in the expanded state and main stent-graft 22 is in the radially expanded deployed state, distal channel fluid flow guide end opening 127B faces distally at least partially within main fluid flow guide 28 (optionally angled relative to central longitudinal axis 135 of main fluid flow guide 28, such as shown). Typically, when inner support channel 120 is in the expanded state and main stent-graft 22 is in the radially expanded deployed state, distal channel fluid flow guide end opening 127B is disposed distal to main fluid flow guide lateral opening 30.

[0273] In some applications of the present invention, the stent graft system 110 further includes an auxiliary guide wire tube 140, which is removably positioned to sequentially pass through:

[0274] Typically, the proximal catheter end 83,

[0275] The proximal main fluid flow guide end opening 27A,

[0276] the interior of the longitudinal portion 142 of the main fluid flow chamber 29,

[0277] Distal channel fluid flow guide end opening 127B,

[0278] · lateral opening 30 of the main fluid flow guide,

[0279] along the outside of the main fluid flow cavity 29, and

[0280] Typically, it is spaced apart from (eg, 0.5 cm to 2 cm apart, such as about 1 cm apart) or terminates at the same level as the distal catheter tip 82 .

[0281] In this configuration, the auxiliary guide wire tube 140 is an implementation of an elongated member 160A, which is removably positioned to pass through (a) the proximal main fluid flow guide end opening 27A, (b) the longitudinal portion 142 of the main fluid flow chamber 29, (c) the distal channel fluid flow guide end opening 127B, and (d) the main fluid flow guide lateral opening 30 to the outside of the main fluid flow chamber 29.

[0282] The auxiliary guidewire tube 140 is shaped to define an auxiliary guidewire lumen for inserting the auxiliary guidewire 50B through the auxiliary guidewire lumen, such as described below with reference to Figure 6B as described.

[0283] In this configuration, the auxiliary guidewire 50B typically has a diameter of 0.012 inches to 0.016 inches (0.305 mm to 0.406 mm), such as 0.014 inches (0.356 mm).

[0284] In this configuration, the internal support channel 120 is configured to automatically switch to the expanded state when:

[0285] · not constrained by main stent-graft 22 in a telescoping state, such as when at least a longitudinal portion of main stent-graft 22 located beside inner support passage 120 is in a radially expanded deployed state, such as when Figure 2D or when at least a longitudinal portion of the main stent graft 22 located beside the inner support channel 120 is converted to a radially expanded deployed state when the inner support channel 120 automatically converts to the expanded state, and

[0286] Not constrained by the auxiliary guide wire tube 140, such as (i) after the auxiliary guide wire tube 140 is removed, such as in the following reference Figure 6C As described, or (ii) where the auxiliary guide wire tube 140 is allowed to pass loosely through the internal support channel 120 (ie, the auxiliary guide wire tube 140 is not tensioned enough to constrain the internal support channel 120 in a telescoping state).

[0287] For some applications, main stent-graft 22 is configured such that auxiliary guidewire tube 140 can be removed from inner support passage 120 when main stent-graft 22 is in a radially compressed delivery state, such as described below with reference to Figure 6C In these applications, inner support channel 120 becomes free of auxiliary guidewire tube 140 before becoming free of main stent-graft 22.

[0288] Alternatively or additionally, for some applications, main stent-graft 22 is configured such that auxiliary guidewire tube 140 can be removed from internal support passage 120 when main stent-graft 22 is in the radially compressed delivery state and auxiliary guidewire 50B is inserted through the auxiliary guidewire lumen, such as described below with reference to Figure 6C as described.

[0289] For some applications, such as Figure 4C As shown in FIG. 1 , the longitudinal portion 144 of the auxiliary guide wire tube 140 includes:

[0290] a first longitudinal sub-portion 144A extending between the proximal main fluid flow guide end opening 27A and the main fluid flow guide lateral opening 30 via the distal channel fluid flow guide end opening 127B, and

[0291] A second longitudinal sub-portion 144B extending from the main fluid flow guide lateral opening 30 to the outside of the main fluid flow cavity 29 and having a length of 1 cm measured from the main fluid flow guide lateral opening 30 to the distal end 146 of the second longitudinal sub-portion 144B.

[0292] Typically, the auxiliary guidewire tube 140 also includes a distal portion that extends distally from the distal end 146 of the second longitudinal subsection 144B and extends out from the distal catheter end 82 of the main delivery catheter 80A.

[0293] For some applications, such as Figure 4C As shown in FIG. 1 , when distal end 146 of second longitudinal sub-portion 144B remains in contact with the outer surface of main stent-graft 22 (e.g., through main delivery catheter 80A) while main stent-graft 22 is in a radially compressed delivery state, longitudinal portion 144 of auxiliary guidewire tube 140:

[0294] is almost straight, i.e. has a minimum radius of curvature anywhere along the longitudinal portion 144, that is to say a minimum radius of curvature of at least 0.15 cm, such as at least 0.3 cm, at least 0.5 cm, at least 1 cm, at least 2 cm, at least 3 cm or at least 5 cm,

[0295] Unfolded,

[0296] · Not kinked,

[0297] · not folded or kinked, and / or

[0298] • defining a directional path 148 from the proximal primary fluid flow guide end opening 27A to the distal end 146 of the second longitudinal sub-portion 144B, and the directional path 148 does not include any proximally directed portion.

[0299] The above characteristics enable the auxiliary guidewire 50B to be inserted through the auxiliary guidewire lumen when the main stent graft 22 is in the radially compressed delivery state, such as described below with reference to Figure 6B as described.

[0300] For some applications, such as Figure 4C As shown in FIG. 1 , the internal support channel 120 is configured so that when the internal support channel 120 is in the telescoping state, the most proximal end point 150A of the distal channel fluid flow guide end opening 127B is disposed proximal to the most distal end point 150B of the main fluid flow guide lateral opening 30. The auxiliary guide wire tube 140 passes through a gap 151 defined between the most proximal end point 150A and the most distal end point 150B. (The gap 151 is defined by the axial overlap of the distal channel fluid flow guide end opening 127B and the main fluid flow guide lateral opening 30.)

[0301] For some applications, tongue-shaped stent struts 152 are folded proximally back onto themselves (e.g., during loading of main stent-graft 22 into main delivery catheter 80A prior to introduction of main stent-graft 22 into vascular system 54). Figure 4A and Figure 4C This folding can be facilitated by:

[0302] · Make the auxiliary guide wire tube 140 pass through the proximal main fluid flow guide end opening 27A, the interior of the longitudinal portion 142 of the main fluid flow chamber 29, the distal channel fluid flow guide end opening 127B, the main fluid flow guide lateral opening 30 and along the outside of the main fluid flow chamber 29, as shown in Figure 4A As shown in

[0303] · Before and during compression of the main stent graft 22 into the main delivery catheter 80A, tension is applied to the auxiliary guidewire tube 140; this tension primarily helps to fold the tongue-shaped stent struts 152 into the correct orientation (extending proximally) to compress the internal support channel 120; this tension also constrains the internal support channel 120 in a telescoping state.

[0304] Now refer to FIG. 4D to FIG. 4F , FIG. 4D to FIG. 4F 1 is a schematic side view of the internal support channel 120 of the main stent graft 22 according to another application of the present invention in an expanded state, a partially telescoping state, and a telescoping state. FIG. 4A to FIG. 4C Unlike the described configuration, stent graft system 110 does not include auxiliary guidewire tube 140. Instead, auxiliary guidewire 50B is removably pre-positioned to sequentially pass through:

[0305] Typically, the proximal catheter end 83,

[0306] The proximal main fluid flow guide end opening 27A,

[0307] the interior of the longitudinal portion 142 of the main fluid flow chamber 29,

[0308] Distal channel fluid flow guide end opening 127B,

[0309] · lateral opening 30 of the main fluid flow guide,

[0310] along the outside of the main fluid flow cavity 29, and

[0311] Typically, away from the distal catheter end 82 (eg, 150 cm to 500 cm away, such as 200 cm to 400 cm away).

[0312] In this configuration, the auxiliary guide wire 50B is an implementation of an elongated member 160B, which is removably positioned to pass through (a) the proximal main fluid flow guide end opening 27A, (b) the longitudinal portion 142 of the main fluid flow chamber 29, (c) the distal channel fluid flow guide end opening 127B and (d) the main fluid flow guide lateral opening 30 to the outside of the main fluid flow chamber 29.

[0313] In this configuration, the auxiliary guidewire 50B typically has a diameter of 0.016 inches to 0.02 inches (0.406 mm to 0.508 mm), such as 0.018 inches (0.457 mm).

[0314] In this configuration, the internal support channel 120 is configured to automatically switch to the expanded state when:

[0315] · not constrained by main stent-graft 22 in a telescoping state, such as when at least a longitudinal portion of main stent-graft 22 located beside inner support passage 120 is in a radially expanded deployed state, such as when Figure 2D or when at least a longitudinal portion of the main stent graft 22 located beside the inner support channel 120 is converted to a radially expanded deployed state when the inner support channel 120 automatically converts to the expanded state, and

[0316] Not constrained by the auxiliary guide wire 50B. Figure 2D , auxiliary guidewire 50B does not constrain internal support channel 120, even though auxiliary guidewire 50B is loosely passed through internal support channel 120. (Typically, auxiliary guidewire 50B constrains internal support channel 120 only during loading of main stent-graft 22 into main delivery catheter 80A, as described below.)

[0317] For some applications, such as Figure 4F As indicated in FIG. 1 , the longitudinal portion 144 of the auxiliary guide wire 50B:

[0318] a first longitudinal sub-portion 144A extending between the proximal main fluid flow guide end opening 27A and the main fluid flow guide lateral opening 30 via the distal channel fluid flow guide end opening 127B, and

[0319] A second longitudinal sub-portion 144B extending from the main fluid flow guide lateral opening 30 to the outside of the main fluid flow cavity 29 and having a length of 1 cm measured from the main fluid flow guide lateral opening 30 to the distal end 146 of the second longitudinal sub-portion 144B.

[0320] As described above, the auxiliary guidewire 50B also includes a distal portion extending distally from the distal end 146 of the second longitudinal sub-portion 144B and extending from the distal catheter end 82 of the main delivery catheter 80A.

[0321] For some applications, such as Figure 4F , when distal end 146 of second longitudinal sub-portion 144B remains in contact with the outer surface of main stent-graft 22 (e.g., through main delivery catheter 80A) while main stent-graft 22 is in a radially compressed delivery state, longitudinal portion 144 of auxiliary guidewire 50B:

[0322] is almost straight, i.e. has a minimum radius of curvature anywhere along the longitudinal portion 144, that is to say a minimum radius of curvature of at least 0.15 cm, such as at least 0.3 cm, at least 0.5 cm, at least 1 cm, at least 2 cm, at least 3 cm or at least 5 cm,

[0323] Unfolded,

[0324] · Not kinked,

[0325] · not folded or kinked, and / or

[0326] • defining a directional path 148 from the proximal primary fluid flow guide end opening 27A to the distal end 146 of the second longitudinal sub-portion 144B, and the directional path 148 does not include any proximally directed portion.

[0327] The above characteristics can prevent damage (such as kinking) to the auxiliary guidewire 50B when the main stent graft 22 is in the radially compressed delivery state, such as described above with reference to Figure 2C and refer to the following Figure 7 as described.

[0328] As mentioned above Figure 4C as described, and also as Figure 4F As shown in FIG. 1 , for some applications, the internal support channel 120 is configured such that when the internal support channel 120 is in the telescoping state, the proximal end point 150A of the distal channel fluid flow guide end opening 127B is disposed proximal to the distal end point 150B of the main fluid flow guide lateral opening 30. Figure 4F In the configuration shown in FIG. 1 , the auxiliary guide wire 50B passes through a gap 151 defined between the proximal end point 150A and the distal end point 150B. (The gap 151 is defined by the axial overlap of the distal channel fluid flow guide end opening 127B and the main fluid flow guide lateral opening 30.)

[0329] For some applications, tongue-shaped stent struts 152 are folded proximally back onto themselves (e.g., during loading of main stent-graft 22 into main delivery catheter 80A prior to introduction of main stent-graft 22 into vascular system 54). Figure 4D and Figure 4E This folding can be facilitated by:

[0330] The auxiliary guide wire 50B is passed through the proximal main fluid flow guide end opening 27A, the interior of the longitudinal portion 142 of the main fluid flow chamber 29, the distal channel fluid flow guide end opening 127B, the main fluid flow guide lateral opening 30 and along the exterior of the main fluid flow chamber 29, as shown in FIG. Figure 4D As shown in

[0331] · Before and during compression of the main stent graft 22 into the main delivery catheter 80A, tension is applied to the auxiliary guidewire 50B; this tension primarily helps to fold the tongue-shaped stent struts 152 into the correct orientation (extending proximally) to compress the internal support channel 120; this tension also constrains the internal support channel 120 in a telescoping state.

[0332] Now refer to FIG. 4A to FIG. 4C and FIG. 4D to FIG. 4F For some applications, the internal support channel 120 also includes a flexible channel support member 126 to which the channel fluid flow guide 128 is securely attached.

[0333] For some of these applications, the channel support member 126 includes one or more support struts shaped to define a tongue-shaped support strut 152. The tongue-shaped support strut 152, generally including its tip 154, is securely attached to a portion of the periphery of the distal channel fluid flow guide end opening 127B to help define the distal channel fluid flow guide end opening 127B.

[0334] Still refer to FIG. 4A to FIG. 4C and FIG. 4D to FIG. 4F For some applications, the smallest surface 156 defined by tongue-shaped support struts 152 faces:

[0335] When the inner support channel 120 is in the expanded state, at least partially facing the distal end, such as in Figure 4A and Figure 4D As shown in

[0336] When the inner support channel 120 is in the telescoping state, it at least partially faces radially inward (i.e., toward the central longitudinal axis 135), such as in Figure 4C and Figure 4F As shown in .

[0337] As used in this application, including the claims and inventive concepts, the "minimum surface" defined by the tongue-shaped support strut 152 is a mathematical surface bounded by the two sides and the tip of the tongue-shaped support strut 152, which has its area locally minimized according to the definition of a "minimum surface" known in the mathematical arts. It will be understood that the minimum surface is a mathematical structure, not a physical element of the internal support channel 120.

[0338] Still refer to FIG. 4A to FIG. 4C and FIG. 4D to FIG. 4F For some applications, the tongue-shaped support strut 152 is configured so that when the inner support channel 120 is moved from the telescoping state ( Figure 4C and Figure 4F ) automatically switches to the expanded state ( Figure 4A and Figure 4D During the step (shown in FIG), the tip 154 ​​of the tongue-shaped stent strut 152 automatically swings along the curved path 157 from facing the proximal end to facing less proximal end, such as partially facing the distal end.

[0339] Still refer to FIG. 4A to FIG. 4C and FIG. 4D to FIG. 4F For some applications, the tongue-shaped support strut 152 is configured so that when the inner support channel 120 is moved from the telescoping state ( Figure 4C and Figure 4F ) automatically switches to the expanded state ( Figure 4A and Figure 4D During the period shown in FIG. 1 , the tongue-shaped support strut 152 automatically swings:

[0340] from a minimum surface 156 that faces at least partially radially inwardly (ie, toward the central longitudinal axis 135),

[0341] • To a minimum surface 156 at least partially facing the distal end.

[0342] Still refer to FIG. 4A to FIG. 4C and FIG. 4D to FIG. 4F For some applications, the internal support channel 120 is configured so that when the internal support channel 120 is moved from the telescoping state ( Figure 4C and Figure 4F ) automatically switches to the expanded state ( Figure 4A and Figure 4D During the period shown in FIG. 1 , the best fit plane defined by the distal channel fluid flow guide end opening 127B automatically swings:

[0343] from a distal channel fluid flow guide end opening 127B that faces at least partially radially inward (ie, toward the central longitudinal axis 135),

[0344] • To a distal channel fluid flow guide end opening 127B that is at least partially facing the distal end.

[0345] Now refer to FIG. 6A to FIG. 6C , FIG. 6A to FIG. 6C is a schematic diagram of several stages of a portion of a method for deploying a main stent graft 22 and a branch stent graft 24 in accordance with an application of the present invention. FIG. 6A to FIG. 6C 8. Main stent graft 22 is shown disposed within a portion of main delivery catheter 80A in a radially compressed delivery state. (For clarity of illustration, main stent graft 22 is shown in FIG. FIG. 6A to FIG. 6C ) is shown slightly expanded, even though in practice the main stent-graft 22 is typically more radially compressed when in this delivery state.

[0346] In some applications, FIG. 6A to FIG. 6C The steps of the method illustrated in FIG. 5 are performed after (a) deploying the main guide wire 50A and the auxiliary guide wire 50B, such as in the above references, respectively. Figure 2A and Figure 2B as described above, and (b) performed prior to deploying the main stent graft 22 over the main guide wire 50A, such as described above with reference to FIG. 2C to FIG. 2E as described.

[0347] For some applications, such as Fig. 6A As shown in FIG. 1 , the stent graft system 110 also includes a main delivery catheter 80A, such as described above with reference to FIG. FIG. 2C to FIG. 2E Main stent graft 22 is removably disposed within main delivery catheter 80A in a radially compressed delivery state with distal main fluid flow guide end opening 27B facing distal catheter end 82 of main delivery catheter 80A and internal support channel 120 in a telescoping state.

[0348] As in Fig. 6A As shown in the figure, the auxiliary guide wire tube 140 is removably positioned to pass through, in sequence, (a) the proximal main fluid flow guide end opening 27A, (b) the longitudinal portion 142 of the main fluid flow chamber 29, (c) the distal channel fluid flow guide end opening 127B, (d) the main fluid flow guide lateral opening 30 to the outside of the main fluid flow chamber 29 within the main delivery catheter 80A, and (e) the distal catheter end 82.

[0349] For some applications, such as Fig. 6A As shown in FIG. 1 , the longitudinal portion 144 (at Figure 4C (in the middle mark):

[0350] extends between proximal main fluid flow guide end opening 27A of radially compressed main stent-graft 22 and distal catheter end 82 and is substantially straight, i.e., has a minimum radius of curvature anywhere along longitudinal portion 144, that is, a minimum radius of curvature of at least 0.15 cm, such as at least 0.3 cm, at least 0.5 cm, at least 1 cm, at least 2 cm, at least 3 cm, or at least 5 cm,

[0351] extends between the proximal main fluid flow guide end opening 27A of the radially compressed main stent-graft 22 and the distal catheter end 82 and is neither folded nor kinked, and / or

[0352] • defining a directional path from the proximal main fluid flow guide end opening 27A of the radially compressed main stent-graft 22 to the distal catheter end 82, and the directional path does not include any proximally directed portion.

[0353] As in Figure 6B As shown in the figure, the auxiliary guide wire 50B is inserted through the auxiliary guide wire lumen of the auxiliary guide wire tube 140, and the auxiliary guide wire 50B is positioned in a removable manner to pass through (a) the proximal main fluid flow guide end opening 27A, (b) the longitudinal portion 142 of the main fluid flow cavity 29, (c) the distal channel fluid flow guide end opening 127B and (d) the main fluid flow guide lateral opening 30 to the outside of the main fluid flow cavity 29.

[0354] Such insertion of auxiliary guidewire 50B is typically performed while main stent-graft 22 is in a radially compressed delivery state and main stent-graft 22 (and main delivery catheter 80A) is located outside the patient's body, such as in Figure 6B Typically, but not necessarily, the second end portion 58B of the auxiliary guidewire 50B (the second end portion 58B of the auxiliary guidewire 50B passes out of the vascular system 54 at the third vascular access site 52C) is inserted into the auxiliary guidewire lumen of the auxiliary guidewire tube 140.

[0355] Typically, the auxiliary guidewire 50B is advanced along (eg, through) the delivery system to a delivery handle of the delivery system.

[0356] In addition, similarly Figure 6B As shown in FIG. 1 , main guidewire 50A is typically inserted into guidewire longitudinal lumen 79 of main inner shaft 78 of the delivery system, also typically when main stent graft 22 (and main delivery catheter 80A) is outside the patient's body. Typically, but not necessarily, second end portion 58A of main guidewire 50A (second end portion 58A of main guidewire 50A emerges from vascular system 54 at third vascular access site 52C) is inserted into guidewire longitudinal lumen 79.

[0357] In some applications, such as Figure 6C , auxiliary guidewire tube 140 is removed from main stent graft 22 (and from main delivery catheter 80A, and from the delivery system altogether). As a result of this removal, auxiliary guidewire 50B remains positioned to pass, in sequence, through (a) proximal main fluid flow guide end opening 27A, (b) longitudinal portion 142 of main fluid flow lumen 29, (c) distal channel fluid flow guide end opening 127B, (d) main fluid flow guide lateral opening 30 to the exterior of main fluid flow lumen 29, and (e) and out of proximal catheter end 83 of main delivery catheter 80A (optionally into a handle of the delivery system (not shown)).

[0358] For some applications, such removal of auxiliary guidewire tube 140 from main stent-graft 22 is performed while main stent-graft 22 (and main delivery catheter 80A) is outside the patient's body, such as during Figure 6C Alternatively, the removal is performed after the main stent graft has been introduced into the vascular system 54, such as in Figure 2C As shown in .

[0359] This method is as mentioned above Figure 2C to Figure 2O The description continues with main stent-graft 22 introduced into vascular system 54 with (a) main stent-graft 22 in a radially compressed delivery state and (b) internal support channel 120 in a telescoping state in which distal channel fluid flow guide end opening 127B faces radially inwardly within main fluid flow lumen 29. Thereafter, main stent-graft 22 is transitioned to a radially expanded deployment state, as in Figure 2C and Figure 2D The conversion between Figure 2D As shown in FIG. 1 , the internal support channel 120 is configured to automatically switch to an expanded state when it is not constrained in a telescoping state by the main stent graft 22 and is not constrained in a telescoping state by the auxiliary guide wire tube 140. As described above, when the internal support channel is in the expanded state, the distal channel fluid flow guide end opening 127B at least partially faces the distal end within the main fluid flow guide 28. (As shown in FIG. 1 , the distal channel fluid flow guide end opening 127B at least partially faces the distal end within the main fluid flow guide 28.) Figure 2D As shown in FIG. 1 , the auxiliary guide wire 50B does not constrain the internal support channel 120, even though the auxiliary guide wire 50B loosely passes through the internal support channel 120. )

[0360] Likewise, FIG. 2D to FIG. 2O As shown in FIG. 1 , when the internal support channel 120 is in the expanded state, the distal channel fluid flow guide end opening 127B faces distally at least partially within the main fluid flow guide 28. As described above with reference to Figure 2M to Figure 2NAs described, branch stent graft 24 is deployed by advancing branch stent graft 24 over auxiliary guidewire 50B: (a) advancing branch stent graft 24 from first vascular access site 52A (via distal main fluid flow guide end opening 27B) into main stent graft 22, (b) advancing branch stent graft 24 from within main stent graft 22, and (c) advancing branch stent graft 24 partially into second branch 70 via main fluid flow guide lateral opening 30. Thus, branch stent graft 24 is partially located in second branch 70 outside main fluid flow guide lateral opening 30 and partially located inside main stent graft 22. To advance the branch stent graft 24 from within the main stent graft 22 and partially into the second branch 70, the branch stent graft 24 is (a) advanced from within the main stent graft 22 into the distal channel fluid flow guide end opening 127B of the channel fluid flow guide 128 of the internal support channel 120, (b) advanced through the channel fluid flow guide 128, and (c) exited from the main fluid flow guide lateral opening 30 via the proximal channel fluid flow end opening 127A. The insertion of the branch stent graft 24 from within the main stent graft 22 into the distal channel fluid flow guide end opening 127B of the channel fluid flow guide 128 is facilitated by having the distal channel fluid flow guide end opening 127B at least partially facing distally within the main fluid flow guide 28. Typically, during the above-described advancement of the branch stent graft 24, the branch stent graft 24 is disposed within a portion of the branch delivery catheter 80B in its radially compressed delivery state.

[0361] Now refer to Figure 7 , Figure 7 8 is a schematic diagram of a configuration of a main stent graft 22 according to an application of the present invention, the main stent graft 22 being disposed within a portion of a main delivery catheter 80A in a radially compressed delivery state. (For clarity of illustration, the main stent graft 22 is shown in FIG. 80A.) Figure 7 ) is shown slightly expanded, even though in practice the main stent-graft 22 is typically more radially compressed when in this delivery state.

[0362] In this configuration, the auxiliary guide wire 50B is removably pre-positioned to pass through, in sequence, (a) the proximal main fluid flow guide end opening 27A, (b) the longitudinal portion 142 of the main fluid flow chamber 29, (c) the distal channel fluid flow guide end opening 127B, (d) the main fluid flow guide lateral opening 30 to the exterior of the main fluid flow chamber 29, and (e) and exit from the proximal catheter end 83 of the main delivery catheter 80A (optionally into the handle of the delivery system (not shown)).

[0363] In embodiments, techniques and devices described in one or more of the following applications, which are incorporated herein by reference, are combined with the techniques and devices described herein:

[0364] Benary et al., U.S. Patent 8,317,856

[0365] Shalev et al., U.S. Patent 8,870,938

[0366] Shalev et al., U.S. Patent 8,945,203

[0367] Shalev et al., U.S. Patent 9,993,360

[0368] Shalev's U.S. Patent 9,668,892

[0369] Shalev’s U.S. Patent Application Publication 2016 / 0193029

[0370] Marmur et al., U.S. Patent 10,603,197

[0371] Marmur et al., U.S. Patent 10,485,684.

[0372] It will be appreciated by those skilled in the art that the present invention is not limited to what has been specifically shown and described above. On the contrary, the scope of the present invention includes both the combination and sub-combination of the various features described above, as well as variations and modifications not in the prior art that will occur to those skilled in the art when reading the foregoing description.

Claims

1. A stent graft system, comprising: (i) a main stent-graft configured to assume a radially compressed delivery state and a radially expanded deployed state, and comprising: a flexible main stent-graft stent component and a generally tubular primary fluid flow guide that: (a) is securely attached to and covers at least a portion of the main stent-graft stent component and (b) is shaped to define proximal and distal primary fluid flow guide end openings, a primary fluid flow lumen therebetween, and a primary fluid flow guide lateral opening; and An internal support channel, the internal support channel: (a) configured to assume an expanded state and a collapsed state, (b) disposed within the primary fluid flow guide, (c) comprising a generally tubular channel fluid flow guide, the channel fluid flow guide being shaped to define: (1) a proximal channel fluid flow end opening and a distal channel fluid flow end opening, and being shaped to (2) define a channel cavity between the proximal channel fluid flow end opening and the distal channel fluid flow end opening when the internal support channel is in the expanded state, wherein: (A) when the internal support channel is in the telescoping state, the distal channel fluid flow guide end opening faces radially inward, and (B) the distal channel fluid flow guide end opening faces at least partially distally within the main fluid flow guide when the internal support channel is in the expanded state and the main stent-graft is in the radially expanded deployed state, wherein the proximal channel fluid flow end opening is sealingly connected to the periphery of the lateral opening of the main fluid flow guide, so that when the internal support channel is in the expanded state, the channel cavity is in communication with the external fluid of the main fluid flow guide via the lateral opening of the main fluid flow guide; and (ii) an elongated member removably positioned to pass through, in order: (a) the proximal main fluid flow guide end opening, (b) a longitudinal portion of the main fluid flow chamber, (c) the distal channel fluid flow guide end opening, and (d) a lateral opening of the main fluid flow guide to the exterior of the main fluid flow chamber, Wherein the inner support channel is configured to automatically transition to the expanded state when not constrained by the main stent graft in the telescoping state and not constrained by the elongated member in the telescoping state.

2. The stent graft system according to claim 1, wherein the stent graft system is used together with an auxiliary guide wire, The elongated member includes an auxiliary guidewire tube shaped to define an auxiliary guidewire lumen for inserting the auxiliary guidewire therethrough.

3. The stent graft system according to claim 2, in, The longitudinal portion of the auxiliary guide wire tube includes: (a) a first longitudinal sub-portion, which extends between the proximal main fluid flow guide end opening and the main fluid flow guide lateral opening via the distal channel fluid flow guide end opening; and (b) a second longitudinal sub-portion, which extends from the main fluid flow guide lateral opening to the outside of the main fluid flow chamber and has a length of 1 cm measured from the main fluid flow guide lateral opening to the distal end of the second longitudinal sub-portion, and wherein the longitudinal portion of the auxiliary guidewire tube is neither folded nor kinked while the distal end of the second longitudinal sub-portion remains in contact with an outer surface of the main stent-graft while the main stent-graft is in the radially compressed delivery state.

4. The stent graft system according to claim 2, in, The longitudinal portion of the auxiliary guide wire tube includes: (a) a first longitudinal sub-portion, which extends between the proximal main fluid flow guide end opening and the main fluid flow guide lateral opening via the distal channel fluid flow guide end opening; and (b) a second longitudinal sub-portion, which extends from the main fluid flow guide lateral opening to the outside of the main fluid flow chamber and has a length of 1 cm measured from the main fluid flow guide lateral opening to the distal end of the second longitudinal sub-portion, and wherein, when the distal end of the second longitudinal subsection remains in contact with an outer surface of the main stent-graft while the main stent-graft is in the radially compressed delivery state, the longitudinal section defines a directional path from the proximal primary fluid flow guide end opening to the distal end of the second longitudinal subsection, and the directional path does not include any proximally directed portion.

5. The stent graft system according to claim 2, in, The longitudinal portion of the auxiliary guide wire tube includes: (a) a first longitudinal sub-portion, which extends between the proximal main fluid flow guide end opening and the main fluid flow guide lateral opening via the distal channel fluid flow guide end opening; and (b) a second longitudinal sub-portion, which extends from the main fluid flow guide lateral opening to the outside of the main fluid flow chamber and has a length of 1 cm measured from the main fluid flow guide lateral opening to the distal end of the second longitudinal sub-portion, and wherein the longitudinal portion of the auxiliary guidewire tube has a minimum radius of curvature of at least 0.15 cm at any position along the longitudinal portion when the distal end of the second longitudinal sub-portion remains in contact with the outer surface of the main stent-graft while the main stent-graft is in the radially compressed delivery state.

6. The stent graft system according to claim 5, wherein: The minimum radius of curvature is at least 1 cm.

7. The stent graft system according to claim 2, wherein: The main stent-graft is configured such that the auxiliary guidewire tube is removable from the internal support channel when the main stent-graft is in the radially compressed delivery state.

8. The stent graft system according to claim 7, wherein: The main stent-graft is configured such that the auxiliary guidewire tube is removable from the internal support channel while the main stent-graft is in the radially compressed delivery state and the auxiliary guidewire is inserted through the auxiliary guidewire lumen.

9. The stent graft system according to claim 1, wherein: The distal channel fluid flow guide end opening is disposed distal to the main fluid flow guide lateral opening when the internal support channel is in the expanded state and the main stent-graft is in the radially expanded deployed state.

10. The stent graft system according to claim 1, wherein: The internal support channel is configured such that when the internal support channel is in the telescoping state, the proximal end point of the distal channel fluid flow guide end opening is disposed proximal to the distal-most end point of the primary fluid flow guide lateral opening.

11. The stent graft system according to claim 1, wherein: The internal support channel is configured such that during the automatic conversion of the internal support channel from the telescoping state to the expanding state, the optimal fit plane defined by the distal channel fluid flow guide end opening automatically oscillates: From the distal channel fluid flow guide end opening that at least partially faces radially inward, to the distal channel fluid flow guide end opening that at least partially faces distally.

12. The stent graft system according to claim 1, in, The main stent-graft stent component includes struts, and wherein an outer surface of the internal support channel is coupled to an inner surface of the primary fluid flow guide by coupling to one or more of the struts of the main stent-graft stent component such that the internal support channel extends distally from a lateral opening of the primary fluid flow guide alongside the inner surface of the primary fluid flow guide.

13. The stent graft system of claim 1, wherein: The elongated member includes an auxiliary guide wire.

14. The stent graft system according to claim 13, in, The longitudinal portion of the auxiliary guide wire includes: (a) a first longitudinal sub-portion, which extends between the proximal main fluid flow guide end opening and the main fluid flow guide lateral opening via the distal channel fluid flow guide end opening; and (b) a second longitudinal sub-portion, which extends from the main fluid flow guide lateral opening to the outside of the main fluid flow cavity and has a length of 1 cm measured from the main fluid flow guide lateral opening to the distal end of the second longitudinal sub-portion, and wherein the longitudinal portion of the auxiliary guidewire is neither folded nor kinked while the distal end of the second longitudinal sub-portion remains in contact with an outer surface of the main stent-graft while the main stent-graft is in the radially compressed delivery state.

15. The stent graft system according to claim 13, in, The longitudinal portion of the auxiliary guide wire includes: (a) a first longitudinal sub-portion, which extends between the proximal main fluid flow guide end opening and the main fluid flow guide lateral opening via the distal channel fluid flow guide end opening; and (b) a second longitudinal sub-portion, which extends from the main fluid flow guide lateral opening to the outside of the main fluid flow cavity and has a length of 1 cm measured from the main fluid flow guide lateral opening to the distal end of the second longitudinal sub-portion, and wherein, when the distal end of the second longitudinal subsection remains in contact with an outer surface of the main stent-graft while the main stent-graft is in the radially compressed delivery state, the longitudinal section defines a directional path from the proximal primary fluid flow guide end opening to the distal end of the second longitudinal subsection, and the directional path does not include any proximally directed portion.

16. The stent graft system according to claim 13, in, The longitudinal portion of the auxiliary guide wire includes: (a) a first longitudinal sub-portion, which extends between the proximal main fluid flow guide end opening and the main fluid flow guide lateral opening via the distal channel fluid flow guide end opening; and (b) a second longitudinal sub-portion, which extends from the main fluid flow guide lateral opening to the outside of the main fluid flow cavity and has a length of 1 cm measured from the main fluid flow guide lateral opening to the distal end of the second longitudinal sub-portion, and wherein the longitudinal portion of the auxiliary guidewire has a minimum radius of curvature of at least 0.15 cm at any location along the longitudinal portion when the distal end of the second longitudinal sub-portion remains in contact with an outer surface of the main stent-graft while the main stent-graft is in the radially compressed delivery state.

17. The stent graft system of claim 16, wherein: The minimum radius of curvature is at least 1 cm.

18. The stent graft system according to any one of claims 1 to 17, wherein: The internal support channel also includes a flexible channel support member to which the channel fluid flow guide is fixedly attached.

19. The stent graft system of claim 18, wherein: The channel support member includes one or more support struts shaped to define a tongue-shaped support strut that is fixedly attached to a portion of a perimeter of the distal channel fluid flow guide end opening.

20. The stent graft system of claim 19, wherein: The tongue-shaped stent strut is configured such that a tip of the tongue-shaped stent strut automatically swings along a tortuous path from proximally facing to less proximally facing during the automatic transition of the internal support channel from the telescoping state to the expanded state.

21. The stent graft system of claim 19, wherein: The minimum surface defined by the tongue-shaped bracket strut faces: When the inner support passage is in the expanded state, the inner support passage at least partially faces the distal end, and The inner support passage at least partially faces radially inward when in the telescoping state.

22. The stent graft system of claim 21, wherein: The tongue-shaped stent strut is configured such that during the automatic transition of the inner support channel to the expanded state, the tongue-shaped stent strut automatically oscillates: from said smallest surface at least partially facing radially inwardly, to said smallest surface at least partially facing the distal end.

23. The stent graft system according to any one of claims 1 to 17, in, The stent graft system also includes a main delivery catheter having a proximal catheter end and a distal catheter end, wherein the main stent graft is removably disposed within the main delivery catheter such that the main delivery catheter constrains the main stent graft in the radially compressed delivery state, wherein the distal main fluid flow guide end opening faces the distal catheter end, thereby constraining the internal support passage in the telescoping state, and wherein the elongated member is removably positioned to pass, in sequence, through: (a) the proximal main fluid flow guide end opening, (b) the longitudinal portion of the main fluid flow chamber, (c) the distal channel fluid flow guide end opening, (d) the main fluid flow guide lateral opening to the outside of the main fluid flow chamber within the main delivery catheter, and (e) the distal catheter end.

24. The stent graft system of claim 23, wherein: The longitudinal portion of the elongate member extends between the proximal main fluid flow guide end opening of the radially compressed main stent-graft and the distal conduit end and has a minimum radius of curvature of at least 0.15 cm at any location along the longitudinal portion.

25. The stent graft system of claim 24, wherein: The minimum radius of curvature is at least 1 cm.

26. The stent graft system of claim 23, wherein: The longitudinal portion of the elongate member extends between the proximal main fluid flow guide end opening of the radially compressed main stent-graft and the distal conduit end and is neither folded nor kinked.

27. The stent graft system of claim 23, wherein: The longitudinal portion of the elongate member defines a directional path from the proximal main fluid flow guide end opening of the radially compressed main stent-graft to the distal conduit end, and the directional path does not include any proximally directed portion.

28. A method comprising: A main stent-graft is provided, the main stent-graft being configured to assume a radially compressed delivery state and a radially expanded deployed state, and comprising: a flexible main stent-graft stent component and a generally tubular primary fluid flow guide that: (a) is securely attached to and covers at least a portion of the main stent-graft stent component and (b) is shaped to define proximal and distal primary fluid flow guide end openings, a primary fluid flow lumen therebetween, and a primary fluid flow guide lateral opening; and an internal support channel, the internal support channel: (a) configured to assume an expanded state and a collapsed state, (b) disposed within the primary fluid flow guide, (c) including a generally tubular channel fluid flow guide, the channel fluid flow guide being shaped to define (1) a proximal channel fluid flow guide end opening and a distal channel fluid flow guide end opening, and being shaped to (2) define a channel cavity between the proximal channel fluid flow guide end opening and the distal channel fluid flow guide end opening when the internal support channel is in the expanded state, wherein the end opening of the proximal channel fluid flow guide is sealingly connected to the periphery of the lateral opening of the main fluid flow guide, so that when the internal support channel is in the expanded state, the channel cavity is in fluid communication with the outside of the main fluid flow guide via the lateral opening of the main fluid flow guide; providing an elongated member removably positioned to pass through, in order: (a) the proximal main fluid flow guide end opening, (b) a longitudinal portion of the main fluid flow chamber, (c) the distal channel fluid flow guide end opening, and (d) a lateral opening of the main fluid flow guide to the exterior of the main fluid flow chamber; introducing the main stent-graft into a patient's vasculature with: (a) the main stent-graft in the radially compressed delivery state, and (b) the internal support channel in the telescoping state, wherein the distal channel fluid flow guide end opening faces radially inward; and Thereafter, converting the main stent graft to the radially expanded deployed state, wherein the internal support channel is configured to automatically transition to the expanded state when not constrained by the main stent graft in the telescoping state and not constrained by the elongated member in the telescoping state, and wherein the distal channel fluid flow guide end opening at least partially faces distally within the main fluid flow guide when the internal support channel is in the expanded state.

29. A method comprising: introducing the vascular implant intravascularly into the patient's vascular system through a vascular access site located downstream of a first branch of the aortic arch; Thereafter, advancing the vascular implant through the first branch to the aortic arch; thereafter, advancing the vascular implant at least partially from the aortic arch into a second branch of the aortic arch; and Thereafter, the vascular implant is at least partially deployed in the second branch.

30. A method comprising: deploying a guidewire between (i) a first vascular access site downstream of a first branch of an aortic arch of the patient and (ii) a second vascular access site downstream of a second branch of the aortic arch such that the guidewire is positioned partially within the first branch, partially within the aortic arch, and partially within the second branch; advancing a vascular implant over the guidewire; as well as The vascular implant is deployed within the patient's vascular system.

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