Expandable luminal stents and methods of use

Abstract

To provide expandable luminal stents and methods of use.SOLUTION: A luminal stent comprises: a) a plurality of radially expandable stent components including proximal and distal ends and struts, where the struts are joined to each other at the respective opposite ends, the stent components being arranged in relative proximal and distal relationship to each other; and b) a plurality of bridges linking immediately proximal and distal radially expandable stent components to each other, thereby forming the luminal stent, where the axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a consequence of decrease in the number of bridges spanning the stent components, and the radial stiffness of the luminal stent decreases from the proximal end to the distal end with the distance from the proximal end of the luminal stent as a consequence of at least one of increase in the length of the struts of the stent components and decrease in the thickness of the struts of the stent components.SELECTED DRAWING: Figure 1-1

Description

[Technical field]

[0001] Related Applications This application claims priority to U.S. Provisional Patent Application No. 62 / 800,078, filed February 1, 2019, and entitled BALLOON EXPANDABLE COVERED BRIDGING STENT, which is incorporated by reference in its entirety.

[0002] The present invention relates to expandable luminal stents and methods of use. [Background technology]

[0003] 2. Background of the Invention Stents are often used to bridge a patient's arterial branches with a stent-graft prosthesis in treating aortic diseases such as aortic aneurysms. Known as "luminal stents" or "bridging stents," implantation typically involves directing such a stent in a collapsed state through fenestrations in a previously implanted stent-graft. Although luminal stents may be self-expanding, balloons are often used in combination with non-self-expanding luminal stents to accommodate each patient's unique anatomy. For example, the degree of expansion required may vary along the length of the luminal stent. Proper implantation may also require that the radial expansion force varies along the length of the luminal stent, such that additional force may be required to secure a balloon-expandable luminal stent at the fenestrations of a previously implanted stent-graft. In these cases, the first balloon and the balloon catheter to which it is mounted must often be withdrawn and replaced with a second balloon catheter having a larger diameter balloon than its predecessor. Removal and replacement of the balloon during surgery necessarily prolongs the procedure and can further traumatize the tissue.

[0004] Additionally, each patient's unique anatomy typically requires customization during implantation, regardless of luminal stent design, particularly the degree of expansion of the luminal stent from a collapsed position. More specifically, both radial and longitudinal stiffness may need to vary along the length of the branch stent graft, thereby necessitating great precision during implantation. [Prior art documents] [Patent documents]

[0005] [Patent Document 1] U.S. Patent No. 8,292,943 Summary of the Invention [Problem to be solved by the invention]

[0006] However, commonly available branched stent grafts are limited in radial stiffness and longitudinal flexibility and must therefore be carefully selected prior to or even during surgery to properly fit the fenestration of the implanted prosthesis and accommodate the patient's anatomy. Selecting the wrong luminal stent can be problematic and even disastrous in that once deployed, stents generally cannot be removed and replaced.

[0007] Therefore, a need exists for aortic repair systems and methods that overcome or minimize the above-mentioned problems. [Means for solving the problem]

[0008] Summary of the Invention FIELD OF THEINVENTION The present invention relates generally to luminal stents, and luminal stent assemblies and systems. The present invention also relates generally to methods of implanting luminal stents, and luminal stent assemblies and systems.

[0009] In one aspect, the present invention relates to a luminal stent including a plurality of radially expandable stent components, each having a proximal end and a distal end, where at least one of the stent components includes struts coupled to each other at their respective opposite ends thereby forming proximal and distal apices, and where the radially expandable stent components are aligned in a proximal and distal relationship relative to each other. A plurality of bridges connect the immediately proximal and distal radially expandable stent components to one another, thereby forming a luminal stent and defining a continuous lumen and proximal and distal ends of the luminal stent, wherein the axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decreasing number of bridges spanning, also referred to as "connecting", the radially expandable stent components with increasing distance from the proximal end of the luminal stent, and the radial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of at least one of an increasing strut length of the radially expandable stent components and a decreasing stent thickness of the radially expandable stent components with increasing distance from the proximal end of the luminal stent.

[0010] In another environment, the invention relates to a luminal stent and a luminal stent assembly including at least one of a luminal graft component and a polymeric coating on the luminal stent, the luminal stent including a plurality of radially expandable stent components, each radially expandable stent component having a proximal end and a distal end, at least one of the stents including struts, the struts including opposed ends and coupled to one another at their respective opposed ends thereby forming proximal and distal apices, and the radially expandable stent components aligned in a proximal and distal relationship relative to one another. A plurality of bridges of the luminal stent connect the immediately proximal and distal radially expandable stent components to one another, thereby forming a luminal stent and defining a continuous lumen at the proximal and distal ends of the luminal stent, where the axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decreasing number of bridges across the radially expandable stent components with increasing distance from the proximal end of the luminal stent, and the radial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of at least one of an increasing strut length of the radially expandable stent component and a decreasing stent thickness of the radially expandable stent component with increasing distance from the proximal end of the luminal stent. The luminal stent assembly further includes at least one of a luminal graft component and a polymeric coating on the luminal stent, thereby forming a luminal stent assembly.

[0011] In yet another aspect, the invention relates to a luminal stent assembly including a luminal stent and a balloon within the luminal stent when the luminal stent is in a collapsed position and having a larger diameter at one end and an opposite end when expanded. The luminal stent includes a plurality of radially expandable stent components, each radially expandable stent component having a proximal end and a distal end, at least one of the stent components including struts including opposed ends connected to each other at their respective opposite ends thereby forming proximal and distal apices. The radially expandable stent components are aligned in proximal and distal relationship relative to one another and have a plurality of bridges connecting the immediately proximal and distal radially expandable stent components to one another, where the axial stiffness of the luminal stent decreases from the proximal to distal end of the luminal stent as a result of a decreasing number of bridges across the radially expandable stent components with increasing distance from the proximal end of the luminal stent, and the radial stiffness of the luminal stent decreases from the proximal to distal end of the luminal stent as a result of at least one of an increasing strut length of the radially expandable stent components and a decreasing stent thickness of the radially expandable stent components with increasing distance from the proximal end of the luminal stent. The balloon is within the luminal stent when the luminal stent is in a collapsed state and has a larger diameter at one end than the opposite end when inflated.

[0012] In yet another aspect, the invention relates to a luminal stent assembly comprising at least one of a luminal stent, a luminal graft component, and a polymeric coating thereon, thereby forming a luminal stent assembly, where the luminal stent assembly has a proximal end and a distal end, and a balloon is within the luminal stent when the luminal stent is in a collapsed position and has a larger diameter at one end and an opposite end when inflated. The luminal stent comprises a plurality of radially expandable stent components, each radially expandable stent component having a proximal end and a distal end, at least one of the stent components comprising struts, the struts comprising opposed ends coupled to each other at their respective opposed ends, thereby forming proximal and distal apices. The radially expandable stent components are aligned in proximal and distal relationship relative to one another and have a plurality of bridges connecting the immediately proximal and distal radially expandable stent components to one another, where the axial stiffness of the luminal stent decreases from the proximal to distal end of the luminal stent as a result of a decreasing number of bridges across the radially expandable stent components with increasing distance from the proximal end of the luminal stent, and the radial stiffness of the luminal stent decreases from the proximal to distal end of the luminal stent as a result of at least one of an increasing strut length of the radially expandable stent components and a decreasing stent thickness of the radially expandable stent components with increasing distance from the proximal end of the luminal stent. The balloon is within the luminal stent when the luminal stent is in a collapsed state and has a larger diameter at one end than the opposite end when inflated.

[0013] In another aspect, the present invention relates to a stent graft system including a luminal stent assembly, the luminal stent assembly including a luminal stent having a plurality of radially expandable stent components, the radially expandable stent components extending from approximately an anterior end to an posterior end. a radially expandable stent component having a proximal end and a distal end, at least one of the stent components includes struts, where the struts include opposed ends and are connected to one another at their respective opposed ends thereby forming proximal and distal apices, the radially expandable stent components are aligned in a proximal and distal relationship relative to one another, a plurality of bridges connect the immediately proximal and distal radially expandable stent components to one another, an axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decreasing number of bridges across the radially expandable stent components with increasing distance from the proximal end of the luminal stent, and a radial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of at least one of an increasing length of the struts of the radially expandable stent components and a decreasing stent thickness of the radially expandable stent components with increasing distance from the proximal end of the luminal stent. A plurality of bridges connect the immediately proximal and distal radially expandable stent components to one another. At least one of the luminal graft component and the polymeric coating is on the luminal stent. The balloon is within the luminal stent when the luminal stent is in a collapsed position and has a larger diameter at one end and an opposite end when inflated.

[0014] In yet another aspect, the present invention relates to a luminal stent assembly including a luminal stent and at least one of a luminal graft component and a polymeric coating. The luminal stent includes a plurality of radially expandable stent components, each of which has a proximal end and a distal end, and at least one of the stent components includes struts, where the struts include opposing ends and are connected to each other at their respective opposing ends, thereby forming proximal and distal apices, and the radially expandable stent components nest relative to each other in a relative proximal and distal relationship. A plurality of bridges connect the immediately proximal and distal radially expandable stent components to each other at at least one of the respective proximal and respective distal apices, thereby forming the luminal stent and defining a continuous lumen, proximal and distal ends of the luminal stent. At least one of the luminal graft component and the polymeric coating is on the luminal stent, thereby forming a luminal stent assembly, where the luminal stent assembly has a proximal and distal end.

[0015] In yet another aspect, the present invention relates to a luminal stent assembly including at least one luminal stent, at least one of a luminal graft component and a polymeric coating, and at least one stent distal to the luminal stent. The luminal stent includes a plurality of radially expandable stent components, each of which has a proximal end and a distal end, and at least one of the stent components includes struts, where the struts include opposing ends and are connected to each other at their respective opposing ends, thereby forming proximal and distal apices, and the radially expandable stent components are in a relative proximal and distal relationship to each other. A plurality of bridges connect the immediately proximal and distal radially expandable stent components to each other, thereby forming the luminal stent, and defining a continuous lumen, proximal and distal ends of the luminal stent. At least one of the luminal graft component and the polymeric coating is on the luminal stent. At least one stent is distal to the luminal stent and coupled to the luminal stent by at least one of a luminal graft component and a polymeric coating, thereby forming a luminal stent assembly having a proximal end at the luminal stent and a distal end at a stent distal to the luminal stent, the axial stiffness of the luminal stent assembly decreasing from the proximal end to the distal end of the luminal stent assembly as a result of a space between the luminal stent and the at least one stent distal to the luminal stent, and the radial stiffness of the luminal stent being greater than the radial stiffness of the at least one distal stent.

[0016] In yet another embodiment, the invention includes a plurality of radially expandable stent components, each having a proximal end and a distal end, at least one of the stent components including struts, where the struts include opposing ends and are coupled to each other at their respective opposing ends thereby forming proximal and distal apices, and the radially expandable stent components are in relative proximal and distal relationship to each other. The radial stiffness of each radially expandable stent component is less than the stiffness of each radially expandable stent component proximal thereto and greater than the stiffness of each radially expandable stent component distal thereto. At least one of a luminal graft component and a polymeric coating couples the plurality of radially expandable stent components.

[0017] In yet another aspect, the present invention relates to a stent graft assembly including a luminal stent assembly, the luminal stent assembly including a luminal stent having a plurality of radially expandable stent components, at least one of the stent components including struts, wherein the struts include opposed ends and are coupled to one another at their respective opposed ends thereby forming proximal and distal apices, the radially expandable stent components are aligned in a proximal and distal relationship relative to one another, and a plurality of bridges are provided immediately proximal and distal radial apices. The radially expandable stent components are connected to each other such that the axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decrease in the number of bridges across the radially expandable stent components with increasing distance from the proximal end of the luminal stent, and the radial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of at least one of an increase in strut length of the radially expandable stent components and a decrease in stent thickness of the radially expandable stent components with increasing distance from the proximal end of the luminal stent. A plurality of bridges connect the immediately proximal and distal radially expandable stent components to each other. At least one of the luminal graft component and the polymeric coating is on the luminal stent. The balloon is in the luminal stent when the luminal stent is in a collapsed position. The fenestrated stent graft of the luminal stent system defines at least one fenestration, where the luminal stent has a diameter smaller than the fenestration when in a collapsed position and is expandable to a diameter that secures the proximal end of the luminal stent within the fenestration, whereby the distal end of the luminal stent extends radially from the stent graft.

[0018] In still yet another aspect, the present invention relates to a method of implanting a stent graft system comprising delivering a fenestrated stent graft of the stent graft system to a branched artery of a subject, wherein the fenestration defined by the fenestrated stent graft is with the proximal end of the branched artery. The luminal stent of the luminal stent system has a plurality of radially expandable stent components, at least one of the stent components including struts, the struts including opposed ends and connected to each other at their respective opposed ends thereby forming proximal and distal apices, the radially expandable stent components are aligned in a proximal and distal relationship relative to each other, a plurality of bridges connect the immediately proximal and distal radially expandable stent components to each other, an axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decreasing number of bridges across the radially expandable stent components with increasing distance from the proximal end of the luminal stent, and a radial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of at least one of an increasing length of the struts of the radially expandable stent components and a decreasing stent thickness of the radially expandable stent components with increasing distance from the proximal end of the luminal stent. A luminal stent of the stent graft system is delivered at least partially through the fenestration to the arterial branch, where the luminal stent has a proximal end at the fenestration of the fenestrated stent graft and a distal end extending radially outwardly from the fenestrated stent graft. The luminal stent is radially expanded within the fenestration and arterial branch by inflating a balloon within the luminal stent, the luminal stent having a larger diameter at the proximal end of the luminal stent and at the distal end of the luminal stent, thereby embedding the stent graft system.

[0019] In yet another aspect, the invention relates to a method of implanting a stent graft system comprising the steps of delivering a fenestrated stent graft of the stent graft system to a branch artery of a subject, wherein a fenestration defined by the fenestrated stent graft is aligned with a proximal end of the branch artery, and a luminal stent assembly of the stent graft system is delivered to the arterial branch at least partially through the fenestration, the luminal stent assembly thereby bridging the fenestrated stent graft and the arterial branch. The luminal stent assembly includes a plurality of stents longitudinally aligned and connected by bridges to form a luminal stent, where the axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decreasing number of bridges across the radially expandable stent component with increasing distance from the proximal end of the luminal stent, and the radial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of at least one of an increasing strut length of the radially expandable stent component and a decreasing stent thickness of the radially expandable stent component with increasing distance from the proximal end of the luminal stent. At least one stent distal to the luminal stent has a radial stiffness less than the stiffness of the luminal stent, and at least one of a luminal graft component and a polymeric coating connects the luminal stent and a stent distal to the luminal stent. The luminal stent assembly is radially expanded within the fenestration and arterial branch by inflating a balloon within the luminal stent assembly, where the balloon, when inflated, has a larger diameter at the luminal stent than at the stent distal to the luminal stent, thereby embedding the stent graft system.

[0020] The present invention has several advantages. For example, by varying the radial and axial stiffness of the lumen or bridging the stent, the physician can place the proximal portion of the luminal stent, which is radially stiff, relative to the distal end of the luminal stent, within the fenestrated opening of the fenestrated stent graft prosthesis, thereby allowing for a better seal with the stent graft prosthesis, and in at least one embodiment, by forming an intaglio configuration on both sides of the fenestration, reducing the likelihood of the luminal stent being dislodged from the fenestration. At the same time, the distal portion of the luminal stent, which has a lower radial stiffness relative to the proximal portion of the luminal stent, can be placed inside the targeted vessel, thereby maintaining adequate radial support and, as a result, reducing the likelihood of the vessel becoming occluded by thrombus formation while allowing axial flexibility within the vessel.

[0021] Selectively including a balloon with a larger diameter at the proximal end of the luminal stent during implantation minimizes or eliminates the need to remove the first balloon and replace it with a second balloon to preferentially widen the proximal end of the luminal stent. This reduces the overall procedure time requirements and reduces trauma to the patient. Marker band locations and configurations can be used to indicate the proximal and distal ends of the stent, along with the location of the transition regions of the balloons with larger and smaller expanded diameters, thereby aiding the physician and the placement of the luminal stent within the fenestration, ensuring that the widened region of the stent properly mates with the fenestration opening in the fenestrated stent graft. Also, optionally, the distal portion of the luminal stent of the present invention can be left uncovered, thereby allowing the luminal stent to be used in a bifurcated vessel without impeding blood flow to either the branch vessel or the branch.

[0022] That is, the gist of the present invention relates to the following. Item 1 a) a plurality of radially expandable stent components, each radially expandable stent component having a proximal end and a distal end, at least one of the stent components including struts including opposed ends and coupled to one another at their respective opposed ends thereby forming proximal and distal apices, and the radially expandable stent components are aligned in a proximal and distal relationship relative to one another; and b) a plurality of bridges connecting the immediately proximal and distal radially expandable stent components relative to one another, thereby forming a luminal stent, and defining a continuous lumen and proximal and distal ends of the luminal stent, wherein an axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decreasing number of bridges across the radially expandable stent components, and a radial stiffness of the luminal stent decreases from the proximal end to the distal end as a result of at least one of an increasing length of the struts of the radially expandable stent components and a decreasing thickness of the struts of the radially expandable stent components with distance from the proximal end of the luminal stent; A luminal stent comprising: Effect of the Invention

[0023] SUMMARY OF THE PRESENT EMBODIMENTS The present invention provides an expandable luminal stent and method of use. [Brief description of the drawings]

[0024] BRIEF DESCRIPTION OF THE DRAWINGS [Figure 1-1] Figure 1 is a side (laser cut flat pattern) view of one embodiment of a luminal stent of the present invention having decreasing axial stiffness with increasing distance from the proximal end. Figure 1A is a detail of Figure 1 showing the strut junctions of the radially expandable stent components of the luminal stent that define the proximal and distal apexes. [Figure 1-2]Figure 1B is a cross-sectional view of Figure 1 taken along line 1B-1B showing the lumen defined by the luminal stent of the present invention, and Figure 1C is a detail of Figure 1 showing the bridges between the distal and proximal apices of each of the proximal and distal radially expandable stents of the luminal stent. [Figure 1-3] FIG. 1D is a side view of the embodiment of the luminal stent shown in FIG. 1, illustrating the axial flexibility of the luminal stent. [Diagram 2] FIG. 2 is a side view of the luminal stent of FIG. 1 in a collapsed position. [Diagram 3] FIG. 3 is a side view of the luminal stent of FIG. 1 in a collapsed position with a collapsed balloon therein. [Figure 4] FIG. 4 is a side view of the luminal stent of FIG. 1 after balloon expansion. [Diagram 5] FIG. 5 is a side view of another embodiment of a luminal stent of the present invention, in which the radial stiffness decreases with increasing distance from the proximal end of the luminal stent as a result of increasing strut length of the radially expandable stent component of the luminal stent with increasing distance from the proximal end of the luminal stent. [Figure 6] FIG. 6 is a side view of the luminal stent of FIG. 5 when in a collapsed position. [Figure 7] Figure 7 is a side view of a stent made of struts that meet at opposite ends and define proximal and distal apices. Figure 7A is an end view taken along line 7A-7A showing a cross section of a strut of the stent of Figure 7. Figure 7B is a detail of Figure 7A showing a width W, which indicates the "thickness" of the struts as that term is used herein, and a depth D, which is different from the "thickness" of the struts. [Figure 8] FIG. 8 is a side view of another embodiment of a luminal stent of the present invention in which the decrease in axial stiffness with increasing distance from the proximal end of the luminal stent is stepped at the junctions. [Figure 9] FIG. 9 is a side view of yet another embodiment of a luminal stent of the present invention, in which the decrease in radial stiffness with increasing distance from the proximal end of the luminal stent is step-like. [Figure 10] Figure 10 is a side view of one embodiment of a luminal stent assembly of the present invention, in which the luminal stent of the present invention is covered on its inner surface with a luminal graft component. Figure 10A is a cross-sectional view of the luminal stent assembly of Figure 10 taken along line 10A-10A, showing that the luminal graft component is within the luminal stent component of the luminal stent assembly. [Figure 11] FIG. 11 is a side view of another embodiment of a luminal stent assembly of the present invention in which the proximal-most radially expandable stent component extends beyond the distal end of the luminal graft component of the luminal stent assembly. [Figure 12] FIG. 12 is a side view of yet another luminal stent assembly of the present invention, in which a luminal stent component exhibits decreasing axial stiffness with increasing distance from the proximal end, and a luminal graft component extends distally from the luminal stent component and connects the luminal stent component to a plurality of distal radially-expanding stents. [Figure 13] FIG. 13 is a side view of yet another luminal stent assembly of the present invention, in which a luminal stent component exhibits a decrease in radial stiffness with increasing distance from the proximal end, and a luminal graft component extends distally from the luminal stent component and connects the luminal stent component to a plurality of distal radially-expanding stents. [Figure 14] FIG. 14 is a side view of yet another luminal stent assembly of the present invention in which a distal stent includes a pair of radially expanding stent components, the struts of the distal stent being longer than the struts of the luminal stent components. [Figure 15] Figure 15 is a side view of another embodiment of a luminal stent assembly of the present invention, in which a polymeric coating covers the luminal stent of the luminal stent assembly, which luminal stent exhibits a decrease in axial stiffness with increasing distance from the proximal end of the luminal stent assembly. Figure 15A is a cross-sectional view of the luminal stent assembly of the present invention of Figure 15 taken along line 15A-15A, showing that in this embodiment, a polymeric coating covers both the inner and outer surfaces of the luminal stent component. [Figure 16] FIG. 16 is a side view of another embodiment of a luminal stent assembly of the present invention, in which a polymeric coating connects the luminal stent and the distal stent. [Figure 17] FIG. 17 is a side view of yet another embodiment of a luminal stent assembly of the present invention, in which the luminal stent has struts that are shorter than the struts of the distal stent which are connected to it by a polymeric coating. [Figure 18] FIG. 18 is a side view of a balloon suitable for use in an embodiment of the luminal stent assembly of the present invention, where the balloon has a larger diameter at the proximal end of the balloon when inflated than at the distal end. [Figure 19-1] FIG. 19 is a side view of another embodiment of a luminal stent assembly of the present invention in which the balloon shown in FIG. 18 is inflated inside the luminal stent and the distal stent of the luminal stent assembly. [Figure 19-2] Figure 19A is a detail of the luminal stent of Figure 19. Figure 19B is a side view of the luminal stent assembly of Figure 19 after radial expansion within the fenestrations of a fenestrated stent graft. [Figure 20] Figure 20 is a side view of yet another embodiment of a luminal stent assembly of the present invention, where the luminal stent exhibits a decrease in axial stiffness with an increase in stiffness from the proximal end of the luminal stent assembly, and a polymeric coating connects the luminal stent to the distal stent of the luminal stent assembly. Figure 20A is a cross-sectional view of the luminal stent assembly of Figure 20 taken along line 20A-20A. [Figure 21] FIG. 21 is yet another embodiment of a luminal stent of the present invention, in which the radially expanding stent components of the luminal stent are nested and bridged at the proximal and distal apices, and the axial stiffness of the luminal stent decreases with increasing distance from the proximal end of the luminal stent. [Figure 22]FIG. 22 is yet another embodiment of a luminal stent of the present invention, in which the radially expanding stent components of the luminal stent are nested and cross-linked only at the proximal apices, and the luminal stent exhibits a decrease in axial stiffness with increasing distance from the proximal end of the luminal stent assembly. [Diagram 23] FIG. 23 is yet another embodiment of the luminal stent of the present invention, in which the radially expanding stent components of the luminal stent are nested and cross-linked only at the distal apices, and the luminal stent exhibits a decrease in axial stiffness with increasing distance from the proximal end of the luminal stent assembly. [Figure 24] FIG. 24 is another embodiment of a luminal stent assembly of the present invention, where a portion of the radially expanding stent components of the luminal stent are non-nested and another portion of the radially expanding stent components are nested, further comprising distal stents that are nested and connected to each other and to the luminal stent by a polymeric coating, the distal stents exhibiting at least one of reduced axial and radial stiffness relative to the luminal stent of the luminal stent assembly. [Diagram 25] FIG. 25 is a side view of another embodiment of a luminal stent assembly of the present invention, in which multiple non-nested stents collectively exhibit a decrease in radial stiffness with increasing distance from the proximal end of the luminal stent assembly, and the radially expanding stents are connected by a polymeric coating. [Figure 26] FIG. 26 is a side view of another embodiment of a luminal stent assembly of the present invention, in which nested stents collectively exhibit a decrease in radial stiffness with increasing distance from the proximal end of the luminal stent assembly, and the radially expanding stents are connected by a polymeric coating. [Figure 27]Figure 27 is yet another embodiment of another luminal stent assembly of the present invention comprising a luminal bridging stent of the present invention and a fenestrated stent graft, where a balloon in a collapsed position is within the luminal bridging stent and the luminal stent of the luminal stent assembly is embedded within the fenestration of the fenestrated stent graft implanted within a subject. [Figure 28] FIG. 28 is a side view of the luminal stent assembly shown in FIG. 27 after inflation of the balloon, thereby securing the luminal stent of the luminal stent assembly within the fenestrations of the fenestrated stent graft. [Figure 29] FIG. 29 is an exploded side view of one embodiment of a stent graft delivery system of the present invention. [Diagram 30] FIG. 30A is a side view of the stent graft delivery system shown in FIG. 29 but in an assembled configuration, where an introducer sheath including a stent graft of the stent graft delivery system of the present invention has been delivered to an aneurysm of a patient. FIG. 30B is a side view of the stent graft delivery system of FIG. 30A after proximal retraction of the introducer sheath along the stent graft delivery device, thereby exposing the stent graft held in a radially contracted position by the wires of the stent graft delivery system. FIG. 30C is a side view of the stent graft delivery system shown in FIGS. 30A and 10B after partial retraction of the wires from the ties that hold the stent graft in a partially radially contracted position when connected by the wires, with the remainder of the stent graft in a radially expanded position. FIG. 30D is a side view of the graft prosthesis delivery system shown in FIGS. 30A-30C after complete retraction of the wires from the stent graft, with the stent graft in a radially expanded position along its entire length. FIG. 30E is a side view of the stent graft delivery system shown in FIGS. 30A-30D following retraction of the remainder of the stent graft delivery system without implantation into the aneurysm, completing implantation of the stent graft in the aneurysm of the patient. [Diagram 31]FIG. 31 is a detail of the branched lumen stent assembly of the present invention of FIG. 30E after inflation of a balloon within the luminal stent assembly. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0025] Detailed Description of the Invention The features and other details of the invention, whether as steps of the invention or as combinations of parts of the invention, are more particularly described and pointed out in the appended claims. It will be understood that the particular embodiments of the invention are shown by way of illustration and not as limitations of the invention. The principal features of the invention can be employed in various embodiments without departing from the scope of the invention.

[0026] The present invention generally relates to luminal stents, luminal stent assemblies and luminal stent systems. The present invention also relates to a method of implanting luminal stents, stent graft assemblies and luminal stent systems in branched arteries to treat diseased tissues in branched arteries. The luminal stent includes a plurality of radially expandable stent components and a plurality of bridges connecting the immediately proximal and distal radially expandable stent components to each other. In one embodiment, the axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decrease in the number of bridges, also referred to as "connecting", across the radially expandable stent components with increasing distance from the proximal end of the luminal stent, and the radial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of at least one of an increase in the strut length of the radially expandable stent components and a decrease in the stent thickness of the radially expandable stent components with increasing distance from the proximal end of the luminal stent.

[0027] A luminal stent assembly, in one embodiment, comprises a luminal stent of the present invention and at least one of a luminal graft component and a polymeric coating on the luminal stent. In another embodiment, a luminal stent assembly comprises a luminal stent of the present invention, at least one of a luminal graft component and a polymeric layer on the luminal stent, and a balloon within the luminal stent when the luminal stent is in a collapsed position and having a larger diameter at one end than the opposite end when expanded. In another aspect, the luminal stent system of the present invention includes a luminal stent from the present invention, at least one of a luminal graft component and a polymeric coating on the luminal stent, a balloon within the luminal stent when the luminal stent is in a collapsed position and having a larger diameter at one end when inflated than the opposite end, and a fenestrated stent graft defining at least one fenestration, wherein the luminal stent has a smaller diameter than the fenestration when in the collapsed position and is expandable to a diameter that fixes the proximal end of the luminal stent within the fenestration, and the distal end of the luminal stent extends radially from the stent graft.

[0028] One embodiment of the method of the invention includes delivering a fenestrated stent graft of a luminal stent system to a branch artery, delivering a luminal stent of the stent graph system at least partially through the fenestrations of the fenestrated stent graft and radially expanding a proximal end of the luminal stent within the fenestration, and expanding a distal end of the luminal stent within the arterial branch of the patient by inflating a balloon within the luminal stent. In another embodiment, the method includes delivering a luminal stent assembly including a plurality of stents longitudinally aligned to form a luminal stent and connected by a bridge, the stent distal to the luminal stent having a radial stiffness less than the radial stent stiffness, and at least one of the luminal graft component and the polymeric coating connecting the luminal stent and the stent distal to the luminal stent. The luminal stent is radially expanded by inflating a balloon within the luminal stent assembly, within the fenestration of the fenestrated graft and within the patient's arterial branch, and where the balloon has a larger diameter at the luminal stent than distal to the luminal stent when inflated, thereby implanting a stent-graph system.

[0029] FIG. 1 depicts a luminal stent of the present invention. The luminal stent 10 includes a proximal end 12 and a distal end 14 and is comprised of radially expandable stent components 16. The struts 18 of each radially expandable stent component 16 include proximal and distal ends 20 and 22 that are opposite one another. As shown in FIG. 1A, the proximal ends 20 of each of the struts 16 are connected as well as the distal ends 22 of the struts 16, thereby forming proximal and distal apices 24 and 26. The radially expandable stent components 16 are aligned in a proximal and distal relationship relative to one another and extend from the proximal end 12 of the luminal stent 10 to the distal end 14 of the luminal stent 10.

[0030] Referring back to FIG. 1, the radially expandable stent components 16 are connected to one another by bridges 28 between the immediately proximal and distal radially expandable stent components 16, as shown in FIG. 1B, which is a cross-section taken along line 1B-1B of FIG. 1, thereby forming a luminal stent 10 and defining a continuous lumen 30 extending from the proximal end 12 to the distal end 14 of the luminal stent 10.

[0031] 1, at least a portion of the bridges 28 connect at least a portion of the distal apices 26 and proximal apices 24 of the respective proximal and distal radially expandable stent components 16. However, it will be understood that in other embodiments not shown, the bridges 28 may connect the immediately distal and proximal radially expandable stent components 16 at the struts 18 of the respective radially expandable stent components 16, or may connect between the distal apices 26 or proximal apices 24 of the radially expandable stent components 16 and the struts 18 of the respective immediately distal or immediately proximal radially expandable stent components 16. In another embodiment, also not shown, the apices of one radially expandable stent component may nest between the proximal and distal apices of the respective distal and proximal radially expandable stent components and may be connected by bridges between the struts of the immediately proximal and distal radially expandable stent components or between the apices and struts of these components.

[0032] 1C, at least some of the bridges 28 have a longitudinal axis 32 transverse to the longitudinal axis 33. The longitudinal axis 33 is parallel to the longitudinal axis 34 of the luminal stent 10 of the continuous lumen 30 defined by the radially expandable stent component 16 of the luminal stent 10. As a result of this orientation of the bridges 28, the luminal stent 10 is axially flexible.

[0033] As can be seen in FIG. 1D, axis 34 perpendicular to proximal end 12 of luminal stent 10 may have variable angles A', A" with axes 48', 48", respectively, perpendicular to distal end 14 of luminal stent 10 due to flexion of luminal stent 10 as shown in FIG. 1D. This flexion is referred to herein as "axial flexibility" or "bending flexibility." As defined herein, "axial stiffness" or "bending stiffness" means resistance to axial flexion.

[0034] The luminal stent 10 of the present invention is in a radially expanded position and has a diameter D', as shown in the embodiment of FIG. 1. In FIG. 2, the luminal stent 10 is shown in a collapsed position, as shown in FIG. 1, where the diameter D" of the luminal stent 10 is less than the diameter D' of the luminal stent 10 when in the radially collapsed position. In one embodiment, the radially expandable stent component 16 resists radial expansion from the radially collapsed position shown in FIG. 2 to the radially expanded position shown in FIG. 1. In this embodiment, the radial expansion of the radially expandable stent component 16 is affected by a balloon 36 disposed within the luminal stent 10 when the luminal stent 10 is in the collapsed position, as shown in FIG. 3. The balloon 36 has a proximal end 38 located at the proximal end 12 of the luminal stent 10 and a distal end 39 located at the distal end 10 of the luminal stent 10. 4. A balloon catheter 42 extends from the distal end 40 of the balloon 36 and is used to inflate the balloon 36 by directing fluid from a suitable source 44 to the balloon during implantation of the luminal stent 10. Inflation of the balloon 36 by directing fluid from the fluid source 44 through the balloon catheter 42 causes radial expansion of the luminal stent 10 to an expanded position, as shown in FIG. 4. In this embodiment, the radially expandable stent component 16 is made of a suitable material, such as at least one member selected from the group consisting of stainless steel, cobalt (Co), nitinol (Ni-Ti), cobalt-chromium alloy (605L), and titanium (Ti).

[0035] In another embodiment, the radial stiffness of the radially expandable stent component 16 comprises resistance to radial collapse from a radially expanded position. In this embodiment, at least a portion of the radially expandable stent component 16 of the luminal stent 10 comprises at least one member selected from the group consisting of stainless steel, cobalt (Co), nitinol (Ni-Ti), cobalt-chromium alloy (605L) and titanium (Ti). In yet another embodiment, the radially expandable stent component 16 comprises a shape memory elastic metal such as nitinol. In a particular embodiment, the shape memory elastic metal of the radially expandable stent component 16 comprises nitinol. In another particular embodiment, the shape memory elastic metal of the radially expandable stent component 16 is nitinol. In yet another embodiment, a portion of the radially expandable stent component 16 of the luminal stent 10 includes or is formed of a shape memory elastic metal, such as Nitinol, and is self-expanding, and another portion of the radially expandable stent component 16 is balloon expandable, for example, formed of at least one member selected from the group consisting of stainless steel, cobalt (Co), Nitinol (Ni-Ti), cobalt-chromium alloy (605L), and titanium (Ti).

[0036] "Radial expandability," as defined herein, means the ability of an elongated object, such as luminal stent 10, to increase in a dimension perpendicular to its longitudinal axis when expanded from the collapsed position shown in Figure 3 to the expanded position shown in Figure 4. Self-expanding stents do not require a balloon to expand unless they are secured to a balloon.

[0037] "Radial-contractability," as defined herein, means the opposite of radial expandability.

[0038] "Radial stiffness," as defined herein, means the resistance to at least one of radial expansion and radial contraction of the diameter of a radially expandable stent component.

[0039] In one embodiment, the luminal stent 10 of the present invention has an axial stiffness that decreases from the proximal end 12 to the distal end 14 of the luminal stent 10. The mechanism of the decrease in axial stiffness along the longitudinal length of the luminal stent 10 from the proximal end 12 to the distal end 14 can be the result of any suitable mechanism known in the art. In one embodiment shown in FIG. 1, the decrease in axial stiffness from the proximal end 12 to the distal end 14 of the luminal stent 10 is the result of a decrease in the number of bridges 28 across the radially expandable stent component 16 with increasing distance from the proximal end of the luminal stent 10.

[0040] In another embodiment, the radial stiffness of the luminal stent 50 decreases with increasing distance from the proximal end 52 of the luminal stent 50 as a result of any suitable mechanism known in the art. For example, as shown in FIG. 5, in which the luminal stent 50 is shown in an expanded position, increasing the strut length L of the radially expandable stent component 16 with increasing distance from the proximal end 52 toward the distal end 56 of the luminal stent 50 results in a decrease in radial stiffness with increasing distance from the proximal end 52. Specifically, L' is greater than L", and may be progressively so with increasing distance from the proximal end 52 toward the distal end 56 of the luminal stent 50. FIG. 6 is a side view of the luminal stent 50 in a collapsed position.

[0041] In yet another embodiment not shown, the decrease in radial stiffness with increasing distance from the proximal end of the stent component is the result of a decrease in thickness of at least some of the struts of the radially expandable stent component with increasing distance from the proximal end of the luminal stent. For example, FIG. 7 is a radially expandable stent 58. FIG. 7A is a cross-section of the radially expandable stent 58 shown in FIG. 7 taken along line 7A-7A. FIG. 7B is a cross-section detail of one strut 60 of the radially expandable stent 58. The "thickness" of a strut, as referred to herein, means the width W of the strut in a plane tangential to the lumen defined by the luminal stent shown in FIG. 7, as opposed to the depth D also shown in FIG. 7, whether or not reference is made to a luminal stent or a radially expandable stent component of a radially expandable stent.

[0042] In other embodiments not shown, the decrease in radial stiffness with increasing distance from the proximal end of the luminal stent is the result of both an increase in the length of the struts of the radially expandable stent components and a decrease in the thickness of the struts of the radially expandable stent components with increasing distance from the proximal end of the luminal stent. In yet other embodiments, also not shown, the luminal stent exhibits both a decrease in axial stiffness as a result of a decrease in the number of bridges across the radially expandable stent components with increasing distance from the proximal end of the luminal stent, and a decrease in radial stiffness with increasing distance from the proximal end of the luminal stent as a result of at least one of an increase in the length of the struts of the radially expandable stent components and a decrease in the thickness of the struts of the radially expandable stent components with increasing distance from the proximal end of the luminal stent. In another aspect, the luminal stent exhibits both a decrease in axial stiffness as a result of a decrease in the number of bridges across the radially expandable stent component with increasing distance from the proximal end of the luminal stent, and a decrease in radial stiffness with increasing distance from the proximal end of the luminal stent, as a result of both an increase in the strut length of the radially expandable stent component and a decrease in the strut thickness of the radially expandable stent component with increasing distance from the proximal end of the luminal stent.

[0043] The decrease in either or both axial and radial stiffness may be gradual or step-like. Whether gradual or step-like, the decrease in either axial or radial stiffness is, in certain embodiments, uninterrupted by an increase in such axial or radial stiffness along such progression. For example, the progression of decrease in radial stiffness may be continuous or step-like along a series of radially expanding stents, regardless of the fact that the stents are connected by luminal grafts or polymeric coatings that do not have a gradual decrease in radial stiffness.

[0044] In one embodiment, at least one of the axial stiffness and radial stiffness of the luminal stent is stepping-stone. For example, in one embodiment, the luminal stent 62 includes incremental junctures 64 in which the number of bridges 66 varies between the radially expanding stent components 68, as shown in FIG. 8, and the axial stiffness of the luminal stent 62 varies in increments between the proximal end 70 and the distal end 72 of the luminal stent 62 as a result of the decreasing number of bridges 66 between the radially expandable stent components 68 with increasing distance from the proximal end 70 of the luminal stent 62. In another embodiment, the radial stiffness of the luminal stent 74 is decreased in steps by either or both of increasing the length of the struts 76 of the immediately proximal radially expandable stent component 77 and the immediately distal radially expandable stent component 78 as shown in FIG. 9, and decreasing the thickness (or "width W" as described above with respect to FIG. 7B) of the struts of the immediately proximal and distal radially expandable stent components, either of which may be used to establish a junction 80 between the radial stiffness proximal to the junction 80 and the radial stiffness distal to the junction 80. The luminal stents of the present invention may include multiple incremental junctions in axial stiffness, radial stiffness, or both, where the axial or radial stiffness of the luminal stent is constant proximal to the most proximal junction, between the junctions, and distal to the most distal junction. As also shown in FIG. 9, radial markers 82 may be fixed at the luminal stent 74, such as at the junctions 80 of the luminal stent 74.

[0045] In yet another aspect, the present invention relates to a luminal stent assembly including a luminal stent such as that described above, the luminal stent having a plurality of radially expandable stent components, each radially expandable stent component having a proximal end and a distal end, at least one of the stent components including struts, where the struts include opposing ends and are connected to each other at their respective opposing ends thereby forming proximal and distal apices, the radially expandable stent components are aligned in a proximal and distal relationship relative to each other, a plurality of bridges connect the immediately proximal and distal radially expandable stent components to each other thereby forming a luminal stent, defining a continuous lumen and proximal and distal ends of the luminal stent, and at least one of an axial stiffness and a radial stiffness of the luminal stent decreasing from the proximal end to the distal end of the luminal stent. In this aspect, the luminal stent assembly further includes at least one of a luminal graft component and a polymeric coating on the luminal stent.

[0046] For example, as shown in FIG. 10, luminal stent assembly 82 includes luminal graft component 84 at luminal stent 86. Luminal stent assembly includes proximal end 83 and distal end 85. Luminal stent 86 includes proximal end 87 and distal end 87b. As can be seen in FIG. 10, the number of bridges between radially expandable stent components of luminal stent 86 decreases with increasing distance from proximal end 87a to distal end 87b of luminal stent 86. FIG. 10A is a cross section of FIG. 10 taken along line 10A-10A. As shown here, the luminal graft component is within lumen 88, which in this embodiment is defined as luminal stent 82. Although not necessarily the case in other embodiments, luminal graft component 84 extends distally from distal end 87b of luminal stent 80.

[0047] 11, a luminal stent assembly 89 includes a luminal stent 90 having a proximal end 91 and a distal end 92, where a portion of the luminal stent 90 is bare at the distal end 92. In another embodiment not shown, the luminal stent is completely covered on the outside by a luminal graft component.

[0048] In another embodiment shown in FIG. 12, a luminal stent assembly 94 includes a luminal graft component 96 having a proximal end 95a and a distal end 95b and extending distally from a distal end 98 of the luminal stent 100, and further includes at least one radially expandable stent 102 at the luminal graft component 96, distal to the luminal stent 100. In one particular embodiment, the axial stiffness of the luminal stent 100 decreases with increasing distance from the proximal end 104 to the distal end 98 of the luminal stent 100 as a result of a decrease in the number of bridges, e.g., from 8 to 4 to 2, with increasing distance from the luminal stent 100 to the distal end 98 as a result of an increase in the distance D between the luminal stent 100 and the distal stent 102, and between the distal stent 102. In one particular embodiment, the radial stiffness of the luminal stent 100 decreases from the proximal end 104 to the distal end 98 of the luminal stent 100. In one such embodiment, the radial stiffness of the luminal stent assembly 94 decreases with increasing distance from the proximal end 104 of the luminal stent to the distal end 98 of the luminal stent 100. In another embodiment, the radial stiffness of the luminal stent 100 is constant from the proximal end 104 to the distal end 98 of the luminal stent 100. In this embodiment, the radial stiffness of the radially expandable stent 102 distal to the luminal stent 100 is less than the stiffness of at least a portion of the radially expandable stent component 106 of the luminal stent 100. In one particular embodiment, the radial stiffness of the radially expandable stent 102 distal to the luminal stent 100 is less than the radial stiffness of the distal-most radially expandable stent component 106 of the luminal stent 100. In another embodiment, the radial stiffness of the radially expandable stent 102 is less than the radial stiffness of the luminal stent 100 at the proximal end 104 of the luminal stent 100.

[0049] It is understood that the radial stiffness of the radially expandable stent 102 may include resistance to radial expansion from a radially collapsed position, or resistance to radial collapse from a radially expanded position, or both. Also, at least one of the radially expandable stents 102 distal to the luminal stent 100 shown in FIG. 12 may include the same material or configuration as that of the luminal stent 100 or may be a different material or configuration than that of the luminal stent 100.

[0050] In another embodiment shown in FIG. 13, a luminal stent assembly 110 includes a luminal stent 112 having a proximal end 111 and a distal end 113 and a proximal end 114 and a distal end 116. A luminal graft component 118 extends distally from the distal end 116 of the luminal stent 114. The struts 120 of the luminal stent 112 become progressively longer from the proximal end 144 to the distal end 116 of the luminal stent 112. A radially expandable stent 122 is distal to the distal end 116 of the luminal stent 112 and includes two radially expandable stent sub-components 124, 126. Each stent sub-component 124, 126 includes struts 128 that define proximal and distal apices 130, 132 and are connected by a bridge 134. It is understood that in alternative embodiments, more than one radially expandable stent may be used. It is also understood that in embodiments in which at least one radially expandable stent 122 distal to the distal end 116 of the luminal stent 112 includes radially expandable stent components 124, 126, more than two radially expandable stent sub-components may be used in each radially expandable stent. In one particular embodiment, and as shown in FIG. 13, a bridge 134 extends from a distal apex 130 of the proximal-most radially expandable stent sub-component 124 of the radially expandable stent 122 to a proximal apex 132 of the distal-most radially expandable stent sub-component 126.

[0051] It is further understood that the struts of the radially expandable stent distal to the luminal stent may have a length that is different from the length of the radially expandable stent component of the luminal stent. For example, as shown in FIG. 14, a luminal stent assembly 133 of the present invention having proximal ends 131a and 131b includes struts 134 of a radially expandable stent 136 distal to the luminal stent 138 that may be longer than struts 140 of a radially expandable stent component 142 of the luminal stent 138, thereby making the radial stiffness of the radially expandable stent 136 distal to the luminal stent 138 less than the radial stiffness of the radially expandable stent component 142 of the luminal stent 138.

[0052] In yet another embodiment shown in Figures 15 and 15A, a luminal stent assembly 146 includes a luminal stent 148 having a proximal end 150 and a distal end 152. The luminal stent assembly 146 further includes a polymeric coating 154. As can be seen in Figure 15A, which is a cross-section of the luminal stent assembly 146 taken along line 15A-15A in Figure 15, the polymeric coating 154 coats an outer surface 158 of the luminal stent 146 and an inner surface 156 of the luminal stent 146. In other embodiments, the polymeric coating 154 may coat only one of the outer surface 158 and the inner surface 156 of the luminal stent 148.

[0053] The polymeric coating 154 includes at least one layer of polymer. In one embodiment, the polymeric coating includes at least one member of the group consisting of polytetrafluoroethylene (PTFE), such as expanded PTFE (ePTFE), polyethylene terephthalate, eSPUN PTFE, FEP, PU (polyurethane), silicone, ePTFE with PU-bound catalyst, and ePTFE with FEP-bound catalyst. In a particular embodiment, the polymeric coating 154 includes ePTFE. In even more particular embodiments, the polymeric coating 154 is ePTFE.

[0054] In another embodiment, the polymeric coating 154 coats the inner surface 156 of the luminal stent 146 and the outer surface 158 of the luminal stent 146 and includes multiple layers on at least one of the inner surface 156 of the luminal stent 146 and the outer surface 158 of the luminal stent 146. In a particular embodiment, the polymeric coating 154 includes multiple polymer layers on both the inner surface 156 and the outer surface of the luminal stent 158. In yet another embodiment, at least one of the distal end 152 and the proximal end 150 of the luminal stent 148 has more layers of polymeric coating than between the distal end 152 and the proximal end 150 of the luminal stent 148. In yet another embodiment, both the distal end 152 and the proximal end 150 of the luminal stent 146 have more layers of polymer of the polymeric coating 154 than between the distal end 152 and the proximal end 150 of the luminal stent 146.

[0055] In yet another embodiment, the polymeric coating 154 on the inner surface 158 and the outer surface 158 of the luminal stent 146 is continuous. In one such embodiment, the luminal stent 146 defines an opening 160, and the polymeric coating 154 seals the opening. In yet another embodiment, the total thickness of the polymeric coating 154 on the inner surface 156 of the luminal stent 148 is greater than the total thickness of the polymeric coating 154 on the outer surface 158 of the luminal stent 148. In one such embodiment, the total thickness of the polymeric coating 154 on the inner surface 156 of the luminal stent 148 ranges from about 0.001 mm to about 0.1 mm. In another such embodiment, the total thickness of the polymeric coating 154 on the outer surface 158 of the luminal stent 148 ranges from about 0.001 mm to about 0.1 mm. In certain embodiments, the total thickness of the polymer coating 154 on the inner surface 156 of the luminal stent 148 may range from 0.001 mm to 0.1 mm, and the total thickness of the polymer coating 154 on the outer surface 158 of the luminal stent 148 may range from 0.001 mm to 0.15 mm.

[0056] In yet another embodiment not shown, the polymeric coating 154 covers the inner surface 156, the outer surface 158 of the luminal stent 148. In one particular embodiment shown in Figures 15 and 15A, both the outer surface 156 and the inner surface 156 of the luminal stent. Optionally and not shown, a graft component may be present, covering the polymeric coating 154 on the outer surface 158 of the luminal stent 148. In at least one embodiment, the proximal and distal ends 162, 164 of the polymeric coating 154 are made to preferentially prevent radial expansion between the proximal and distal ends 150, 152 of the luminal stent 148. In at least one embodiment, such radial expansion, also known as "dog-boning," may be largely or entirely avoided by forming the polymeric coating 154 with more polymeric layers at the proximal and distal ends 162, 164 of the polymeric coating 154 than between the proximal and distal ends 162, 164 of the polymeric coating 154. The benefit of this particular embodiment is that, upon implantation, the potential for damage to the surrounding branch arteries in which the luminal stent assembly 146 is implanted is reduced during radial expansion.

[0057] In one embodiment, as shown in FIG. 16, a luminal stent assembly 165 of the present invention includes a polymeric coating 166 extending distally from a distal end 168 of a luminal stent 170. A radially expandable stent 172 is distal to the luminal stent 170 and is also in the polymeric coating 166. In this embodiment, the radial stiffness of the radially expandable stent 172 is less than the radial stiffness of at least a portion of the luminal stent 170. As previously described, the radial stiffness of the radially expandable stent 172 may include resistance to radial expansion from a radially collapsed position, resistance to radial collapse from a radially expanded position, or both. Additionally and as previously described, at least one of the radially expandable stents 172 distal to the distal end 168 of the luminal stent 170 may be formed of the same material composition as that of the luminal stent 170. Although not shown, the proximal-most of the radially expandable stent components 174 at the proximal end 175 of the luminal stent 170 may be splayed. In another embodiment, and as also described above, at least one of the radially expandable stents 172 distal to the distal end 168 of the luminal stent 170 may include two radially expandable stent sub-components 176, 178, each radially expandable stent component 176, 178 including struts 180 defining proximal and distal apices 182, 184, where the radially expandable stent sub-components 176, 178 are connected by at least one bridge 186. In such an embodiment, at least one bridge 186 of the radially expandable stent 172 may extend from the distal apex 184 of the proximal-most radially expandable stent sub-component 176 to the proximal apex 182 of the distal-most radially expandable stent sub-component 178 of the radially expandable stent 172.In this embodiment, because there are fewer bridges 186 connecting radially expandable stent sub-components 176, 178 of radially expandable stent 172 than bridges 187 connecting radially expandable stent sub-components 174 of luminal stent 170, the axial stiffness of luminal stent assembly 165 is reduced at the distal end 185 of luminal stent assembly 165 relative to the proximal end 183 of luminal stent assembly 165. Because luminal stent 170 has a longitudinal length L that is greater than the length L' of any radially expandable stent 172 distal to the distal end 168 of luminal stent 170, the axial stiffness of luminal stent assembly 165 is also less at the distal end 185 than the proximal end 183 of luminal stent assembly.

[0058] In another embodiment, the struts of the radially expandable stent may have a different length than the length of at least a portion of the radially expandable stent component of the luminal stent. For example, as shown in FIG. 17, a luminal stent assembly 190 of the present invention includes a radially expandable stent 192 having proximal ends 191a and 191b and distal to a luminal stent 194, where the struts 196 of the luminal stent 192 are longer than at least a portion of the struts 198 of the radially expandable stent component 200 of the luminal stent 194. In one embodiment, at least one of the axial and radial stiffness of the luminal stent 194 is stepping-stone, where the luminal stent 194 further includes an incremental junction as described with respect to the previous embodiment above, and at least one of the axial and radial stiffness of the luminal stent 194 varies at at least one incremental junction. In a more particular embodiment, the luminal stent 194 includes a plurality of incremental junctions, and the radial stiffness of the radially expandable stent component 200 of the luminal stent 194 decreases with increasing distance from the proximal end 202 of the luminal stent 194. In yet another embodiment, and as further described above with respect to the previous embodiment, the luminal stent assembly 194 may include at least one radiopaque marker 204 on the luminal stent 190, such as at least one of the plurality of incremental junctions 205 of the luminal stent 190.

[0059] At least one radially expandable stent 192 distal to the distal end 244 of the luminal stent 194 includes two radially expandable stent sub-components 246, 248, each including struts 250 connected to define a distal apex 252 and a proximal apex 254, where the radially expandable stent sub-components 246, 248 are connected by at least one bridge 256. In at least one embodiment, the bridge 256 extends across the longitudinal axis 258 of the luminal stent assembly 190. In another embodiment not shown but as previously described, the struts of the radially expandable stent sub-component have at least one of a length greater than or a thickness less than the length of the radially expandable stent component 200 of the luminal stent 198.

[0060] In yet another embodiment, a luminal stent assembly of the present invention is shown alone in FIG. 18 and includes an inflated balloon 206. The balloon 206 is connected by a catheter 207 to a fluid source, not shown. When inflated, the balloon 206 has a diameter D at a proximal end 207 that is greater than a diameter D' at a distal end 210. As shown in FIG. 19, the balloon 206 is disposed within a luminal stent 208. The luminal stent assembly 208 has a proximal end 210 and a distal end 212 and is composed, at least in part, of a luminal stent 209 and a plurality of radially expandable stents 211 distal to the luminal stent. The luminal stent 209 includes a proximal end 213 and a distal end 215 and radially expandable stent components 214, each having a proximal end 216 and a distal end 218, where at least one of the stent components 214 includes a strut 220. 19A, the struts 220 include opposing ends 221, 222 and are coupled to one another at their respective opposing ends, thereby forming proximal and distal apices 224 and 226. The radially expandable stent components 214 are aligned in relative proximal and distal relationship to one another and are coupled to one another by a plurality of bridges 228 between the immediately proximal and distal radially expandable stent components 214. The luminal stent assembly 208 also includes a radially expandable stent 229 distal to the luminal stent 209, at least one of a luminal graft component (not shown) and a polymeric coating 230 at the luminal stent, and a balloon 206 within the luminal stent assembly 208 when in a collapsed position (not shown). The balloon 206 has a larger diameter D at the proximal end 207 of the luminal stent when inflated. As described above, the diameters D, D' of the balloon 206 may be stepwise along with the distance between the proximal end 207 and the distal end 210, and the balloon 206 includes a proximal diameter D, a distal diameter D', and a transition area 232 between the proximal diameter D and the distal diameter D'. The balloon 206 may be made of any suitable material, such as a semi-compliant material.A radiopaque marker 234 is secured to the balloon 206 and a marker 235 is secured to the luminal stent 209 at a junction region 236 of the luminal stent assembly 208. The transition region 232 of the balloon 206 has a transition length T.

[0061] In this embodiment, the axial stiffness of the luminal stent 209 decreases from the proximal end 213 to the distal end 215 by suitable means, such as by a decrease in the number of bridges 228 across the radially expandable stent component 211. The radial stiffness may also decrease with increasing distance from the proximal end 213 of the luminal stent 209 by suitable means, such as by an increase in the length of the struts 228 of the radially expandable stent component 211 and a decrease in the thickness of the struts 228 of the radially expandable stent component 211 with distance from the proximal end 213 of the luminal stent 209. In one such embodiment, at least one of the axial stiffness and radial stiffness of the luminal stent 209 is stepping-stone, where the luminal stent 209 further includes increasing junctions 236, and the radial stiffness of the luminal stent 209 varies in at least one increment. In one such embodiment, the luminal stent 209 includes a plurality of incremental junctions (not shown) where at least one of the axial stiffness and radial stiffness of the luminal stent 209 decreases with increasing distance from the proximal end 213 of the luminal stent 209.

[0062] 19, the proximal end 206a of the balloon 206 is nearest to the proximal end 210 of the luminal stent assembly 208, and the distal end of the balloon 206b is nearest to the distal end 212 of the luminal stent assembly 208. Upon inflation, the balloon 206 exerts a greater radial expansive force against the inner surface of the luminal stent at the proximal end 210 of the luminal stent assembly 208 than at the distal end 212 of the luminal stent assembly 208, causing the luminal stent to have a larger outer diameter at the proximal end 210 than at the distal end 212, without any contracting forces on the luminal stent 209, such as those applied at the fenestrations in the fenestrated stent graft 238 in which the luminal stent assembly 208 is disposed, as shown in the phantom of FIG. 19B, inflation of the balloon 206 within the fenestration 240 of the fenestrated stent graft 238 causes contraction of the luminal stent 209 at the fenestration 240 against the remainder of the luminal stent 209 on either side of the fenestration 240. In one embodiment, an additional layer of polymer is included at the distal end 206b of the balloon 206 to prevent excessive radial expansion of the distal end 212 of the luminal stent assembly 208 when the balloon does not protrude beyond the distal end of the stent, thereby keeping the distal end of the stent and the balloon from being over-inflated and consequential damage to the vessel branch in which the luminal stent assembly 208 is embedded.

[0063] In one embodiment, the radially expandable stent 229 distal to the luminal stent 209 in this embodiment has at least one of an axial stiffness and a radial stiffness that is less than that of the luminal stent 209. In one particular embodiment, at least one radiopaque marker 234 is secured to the luminal graft component (not shown) or to the polymeric coating 230 between the luminal stent 209 and the radially expandable stent 229 distal to the luminal stent 209. In this embodiment, in one variation, the luminal stent assembly 208 includes a radial stiffness change at the luminal stent 230, where the radial stiffness is stepping stones, thereby forming a junction 238 at the luminal stent 209, and further includes a second radiopaque marker 234 at at least one incremental junction 236 of the luminal stent 209.

[0064] As described above with respect to the earlier embodiments, the radial stiffness of the radially expandable stent 229 can be its resistance to radial expansion from a radially collapsed position. In another embodiment, the material in the radially expandable stent 229 distal to the luminal stent can be made of the same material as that of the luminal stent 209. In such an embodiment not shown, the proximal most radially expandable stent component can be expanded at the proximal end of the luminal stent upon implantation, as described below.

[0065] In yet another embodiment, the invention is a luminal stent assembly including a luminal stent and a polymeric coating on the luminal stent, any or combination of which are collectively denoted. In this embodiment shown in Figures 20 and 20A, as also shown in Figure 12, a luminal stent assembly 250 includes a luminal stent 252 having a proximal end 251 and a distal end 253 and having a plurality of radially expandable stent components 254. However, in Figures 20 and 20B, the luminal graft component 96 of Figure 12 is replaced with a polymeric coating 256 that lines an inner surface 258 and an outer surface 269 of the luminal stent 252.

[0066] 21, luminal stent 260 has proximal and distal ends 261 and 263 and includes at least a portion of nested radially expandable stent components 262. In this embodiment, radially expandable stent components 262 may be connected by bridges 264 extending between respective proximal apices 266 and respective distal apices 268 of adjacent radially expandable stent components 262. In another embodiment, such as that shown in FIG. 22, luminal stent 265 includes proximal and distal ends 265a and 265b and is made of radially expandable stent components 269 and bridges 270 extending only between proximal apices 274. In yet another embodiment shown in Fig. 23, a luminal stent 273 includes radially expandable stent components 271 having proximal and distal ends 273a, 273b, connected by bridges 272 between only the distal apices 267 of the nearest proximal and distal radially expandable stent components 271. In yet another embodiment, such as that shown in Fig. 24, a combination of proximal and distal apices 282a, 282b of nested radially expandable stent components 282 may be connected in a luminal stent assembly 278 including a proximal end 283a and a distal end 283b. Optionally, the number of bridges 284 between radially expandable stent components 282 decreases with distance from the proximal end of the luminal stent. In this or another embodiment, the luminal stent assembly 278 may include a nested distal stent 280, where the radially expandable stent components 282 of the luminal stent 287 may or may not be nested. More specifically, in one embodiment, such as that shown in FIG. 24 , the degree of nesting of the radially expanding stent components 282 decreases with increasing distance from the proximal end 283 to the distal end 283b of the luminal stent assembly 278, such that the axial stiffness (or “bending stiffness”) of the luminal stent assembly 278 decreases with increasing distance from the proximal end 283.S-shaped bridges 285a and 285b may bridge the struts of the radially expandable stent component 282 of the luminal stent 287, either between the non-nested radially expandable stent components shown in FIG. 24, or between the struts of the nested immediately distal and proximal radially expandable stents, not shown, thereby controlling at least one of the axial and radial stiffness.

[0067] 25, a luminal stent assembly 282 includes a luminal stent 284 of non-nestable radially expandable stents 286, where the radially expandable stents 286 are connected by a polymeric coating 288. In this embodiment, it is understood that either or both of the axial stiffness and radial stiffness may decrease with increasing distance from the proximal end 290 to the distal end 292 of the luminal stent assembly 282, either as a result of either or both of a decrease in the axial and radial stiffness of the radially expandable stents 286 relative to one another.

[0068] In yet another embodiment shown in FIG. 26, a luminal stent assembly 294 includes a proximal end 296 and a distal end 298 and a plurality of radially expandable stents 300. Each radially expandable stent 300 includes a proximal end 302 and a distal end 304. The radially expandable stents 300 include struts 306. The struts 306 include opposed ends that are connected to each other to form proximal and distal apices. The radially expandable stents 300 are in relative proximal and distal relationship to each other. The radial stiffness of each radially expandable stent 310 is less than that of each radially expandable stent 310 proximal to it and greater than that of each radially expandable stent 310 distal to it. The radially expandable stents 310 are connected by at least one of a luminal graft component (not shown) and a polymeric coating 312. The radially expandable stents 310 nest relative to one another in a progressively decreasing manner with increasing distance from the proximal end 296 to the distal end 298 .

[0069] In yet another embodiment, the present invention is another embodiment of a luminal stent assembly. As shown in Figures 27 and 28, a luminal stent assembly 314 shown partially implanted within a bifurcated artery 315 includes a luminal stent 316 having a plurality of radially expandable stent components 318 and a plurality of bridges 320 connecting the immediately proximal and distal radially expandable stent components 318 to one another. The radially expandable stent components 318 each include struts 320, where the struts include opposed ends that are connected to one another at their respective opposed ends, thereby forming proximal apices 322 and distal apices 324, similar to the apices previously described. The radially expandable stent components 318 are aligned in proximal and distal relationship relative to one another and connected by bridges 320 at the distal apices 324 and proximal apices 322. A distal radially expandable stent 326 is disposed distal to the luminal stent 316. At least one of the luminal graft components (not shown) and the polymeric coating 328 is on the luminal stent. The balloon 330 extends into the luminal stent 316 when the luminal stent 316 is in the collapsed position as shown in Figure 27 and has a larger diameter at the proximal end than the distal end when inflated as shown in Figure 28. The fenestrated stent graft 332 defines at least one fenestration 334, where the luminal stent 316 has a smaller diameter at the proximal end 335 than the fenestration 334 when in the collapsed position as shown in Figure 27 and is expandable to a diameter that secures the luminal stent 316 within the fenestration 334, and the distal end 336 of the luminal stent assembly 314 extends radially from the fenestrated stent graft 332 to a branch 338 of the branch artery 315 as shown in Figure 28.

[0070] 29 is an exploded side view of another embodiment of a stent graft delivery system of the present invention. As described below, stent graft delivery system 410 is based on the teachings of PCT / US2018 / 019342, filed February 23, 2018, the relevant teachings of which are incorporated by reference in their entirety. More specifically, stent graft delivery system 410 includes a guidewire catheter 412 having a proximal end 414 and a distal end 416. A proximal handle 418 is secured to the proximal end 414 of guidewire catheter 412. A nose cone 420 is secured to the distal end 416 of guidewire catheter 412. A wire 422 includes a proximal end 424 and a distal end 426. Wire 422 may be made of a suitable material such as those known in the art, including, for example, Nitinol or some other shape memory alloy or stainless steel. The wire 422 is sufficiently flexible so as not to traumatize the patient upon advancement into the patient's aortic aneurysm. A wire handle 428 is secured at a proximal end 424 of the wire 422. An introducer sheath 430 includes a proximal end 432 and a distal end 434, and a distal handle 436 is secured to the proximal end 432 of the introducer sheath 430. The stent graft 438 includes a proximal end 440, a distal end 442, a luminal graft component 444, stents 446 distributed along the luminal graft component 444, and strings 448 as described in PCT / US2018 / 019342, the relevant teachings of which are incorporated herein by reference in their entirety.

[0071] FIG 30A is a combined side view of the stent graft delivery system 410 shown in FIG 30, in which the stent graft 438 is loaded into the distal end 434 of the introducer sheath 430 and is at least partially radially contracted by wires 422 threaded through loops 450 at the ends of strings 448 and through stabilizing anchor loops 453 as discussed in PCT / US2018 / 019342. In one embodiment, the stent graft 438 includes fenestrations 439. In a method of the invention, the stent graft delivery system 410 is advanced to an aneurysm 452 of a patient. In one embodiment shown in FIG 30A, the introducer sheath 430 is advanced to the aneurysm site 452, thereby deploying the stent graft 438 at the aneurysm 452. As can be seen in Figure 30B, the distal handle 436 is retracted in a proximal direction indicated by arrow 460, towards the proximal handle 418, thereby retracting the introducer sheath 430 from the stent graft 438 at the aneurysm 452. As can be seen in Figure 30B, regardless of the retraction of the introducer sheath 430, the stent graft 438 is held in a radially contracted position by wires 422 extending through string loops 450 of strings 448 that cross struts of a stent 446 distributed longitudinally along the stent graft 438. However, in an alternative embodiment, it will be appreciated that the stent graft delivery system 410 may be advanced within the artery to a position distal to the aneurysm 452, where the stent graft 438 is directed toward the aneurysm 452 by advancement of the proximal handle 418 and wire handle 428 toward the distal handle 436 in a distal direction indicated by arrow 462, thereby directing the radially contracted stent graft 418 from the introducer sheath 430 toward the aneurysm 452.

[0072] After orientation of the stent graft 438 into position across the aneurysm 452 and at least partial rotational and axial alignment of the stent graft 438 with the aneurysm 452, the wire 422 is partially retracted from the lace loops 450 and from the anchor loops 453. Proximal retraction of the wire handle 428 towards the proximal handle 418 in the direction indicated by arrow 460 can be seen in FIG. 30C. Continued retraction of the wire 422 pulls the wire 422 out of all of the suture loops 450 and anchor loops 453 of the lace 448, thereby allowing the stent graft 438 to fully expand from its radially contracted state shown in FIG. 30B to a radially expanded state shown in FIG. 30D. In one embodiment, the stent graft 438 is positioned such that the fenestration 439 is properly aligned with the arterial branch 454 for subsequent placement of a branch prosthesis 456 through the fenestration 439 and into the arterial branch 454. Thereafter, the stent graft 438 is fully embedded within the aneurysm and the remainder of the stent graft delivery device 410 is retracted from the stent graft 438 and the patient, as shown in FIG. 30E, thereby completing treatment of the patient's aneurysmal site 452 by the method of the present invention.

[0073] Vascular prostheses implanted with the stent graft systems and methods of the invention may be implanted, for example, by transfemoral access. Additional branch prostheses directed within the vascular prosthesis of the invention may be implanted, for example, by supraaortic vessel access (e.g., through a branch artery) or by transfemoral access or access from some other branch or branches of a major vessel, such as a peripheral vessel.

[0074] In a method of implanting a stent graft system, a fenestrated stent graft of the stent graft system is delivered to a bifurcated artery in a subject, where the fenestration defined by the fenestrated stent graft is aligned with the proximal end of the bifurcated artery. A luminal stent or luminal stent assembly is delivered through the fenestration to the arterial branch, where the luminal stent or luminal stent assembly luminal stent has a proximal end at the fenestration of the fenestrated stent graft and a distal end extending radially outward from the fenestrated stent graft, as shown in Figure 30E. The luminal stent is radially expanded within the fenestration and arterial branch by inflating a balloon within the luminal stent, which has a larger diameter at the proximal end of the luminal stent than the distal end of the luminal stent, thereby implanting the stent graft system, as shown above in Figures 27, 28 and 31.

[0075] In one embodiment, the luminal stent of the stent graft system implanted by the method of the present invention comprises a plurality of radially expandable stent components, as described in detail above, where the radially expandable stent components are joined at their respective ends thereby forming proximal and distal apices, and where the radially expandable stents are aligned in relative proximal and distal relationship to one another thereby forming a luminal stent defining a continuous luminal, proximal and distal end of the luminal stent. The luminal stent in this embodiment also comprises a plurality of bridges, each of which connects a relatively proximal radially expandable stent component to an immediately distal radially expandable stent component, and where the luminal stent has at least one of an axial stiffness and a radial stiffness that decreases with increasing distance from the proximal end of the luminal stent. In one such embodiment, the axial stiffness of the luminal stent decreases from the proximal to distal end of the luminal stent as a result of a decreasing number of bridges across the radially expandable stent components, and optionally or alternatively, the radial stiffness decreases with increasing distance from the proximal end of the luminal stent due to at least one of an increasing length of the struts of the radially expandable stent components and a decreasing thickness of the struts of the radially expandable stent components with distance from the proximal end of the luminal stent, all of which are described in detail above.

[0076] In another embodiment of the method of implanting the stent graft system of the present invention, a fenestrated stent graft of the stent graft system, such as those described in detail above, is delivered to a bifurcated artery of a subject, where the fenestration defined by the fenestrated stent graft is aligned with the proximal end of the bifurcated artery of the patient. A luminal stent assembly of the stent graft system is delivered at least partially through the fenestration to the arterial branch, whereby the luminal stent assembly bridges the fenestrated stent graft and the arterial branch, the luminal stent assembly including a plurality of stents aligned longitudinally and connected by a bridge to form a luminal stent. At least one stent distal to the luminal stent has a radial stiffness less than that of the luminal stent. At least one of the luminal graft component and the polymeric coating connects the luminal stent and the stent distal to the luminal stent. The luminal stent assembly is radially expanded within the fenestration of the arterial branch by inflating a balloon within the luminal stent assembly, which when inflated has a larger diameter at the luminal stent than the stent distal to the luminal stent, thereby anchoring the luminal stent within the fenestration and embedding the stent graft system, all of which are described in detail above.

[0077] In one embodiment of the invention, the stent distal to the luminal stent is connected to the luminal stent by a luminal graft component. In another embodiment, the stent distal to the luminal stent is connected to the luminal stent by a polymeric coating. In yet another embodiment, the polymeric coating encases the luminal stent and the stent distal to the luminal stent. In yet another embodiment, at least one of the stent distal to the luminal stent and the luminal stent defines an opening, and the polymeric coating seals the opening and defines a luminal space between the stent distal to the luminal stent and the luminal stent, all of which are described in detail above.

[0078] Once radially expanded within a fenestrated stent graft, such as that shown in Fig. 31, the luminal stent assembly 500 includes a luminal stent 502 that is unfolded at a proximal end 504. Unfolding at the proximal end 504 may be achieved by balloon inflation within the luminal stent assembly 500, as previously described, while the proximal end 504 is within the fenestrations 506 of a fenestrated stent graft 508 previously implanted in a bifurcated artery 496 of a subject, for example, to secure the proximal end 504 of the luminal stent assembly 500 within the fenestrations 506 of the fenestrated stent graft 508. As can be seen in Fig. 31, the proximal end 504 of the luminal stent assembly 500 is covered by a polymeric coating 510, while the luminal stent 502 is exposed or bare at the distal end 512 of the luminal stent assembly 500.

[0079] In one particular embodiment, each radially expandable stent component of a luminal stent has a longitudinal length in the range of about 10 mm to about 80 mm, and the luminal stent has about 3 to about 40 radially expandable stent components, at least some of which have longitudinal lengths in the range of about 3 mm to about 20 mm, each of which includes about 2 to about 4 struts, although as many as about 40 struts may comprise each radially expandable stent component. Also, at least some of the radially expandable stent components may have a longitudinal length along the longitudinal axis of the luminal stent of about 2.5 mm, e.g., the distance between the radially expandable stent component and each radially expandable stent component may be about 0.2 mm. In this or other embodiments, the total length of the luminal stent may range, e.g., from about 2 mm to about 5 mm, e.g., where there are four radially expandable stent components of a luminal stent and the number of struts per radially expandable stent component is 6. The relevant teachings of all patents, published applications and references cited herein are incorporated by reference in their entirety.U.S. Patent Nos. 8,292,943; 7,763,063; 8,308,790; 8,070,790; 8,740,963; 8,007,605; 9,320,631; 8,062,349; 9,198,786; 8,062,345; 9,561,124; 9,173,755; 8,449,595; 8 No. 9,408,734; No. 9,408,735; No. 8,500,792; No. 9,220,617; No. 9,364,314 ; No. 9,101,506; No. 8,998,970; No. 9,554,929; No. 9,439,751; No. 9,592,112; No. 9,655,712; No. 9,827,12 Nos. 3, 9,877,857, 9,907,686; U.S. Patent Application Nos. 14 / 575,673; 15 / 166,818; 15 / 167,055; 14 / 272,818; 14 / 861,479; 15 / 478,424; 15 / 478,737; 15 / 587,664; 15 / 604,032; 15 / 672,404 The relevant teachings of PCT / US2017 / 025844; PCT / US2017 / 025849; PCT / US2017 / 025912; PCT / US2017 / 034223 and PCT / US2017 / 046062 are also incorporated by reference in their entireties.

[0080] The following published applications: US 2019 / 0231568 published on August 1, 2019; US 2019 / 0231514 published on August 1, 2019; US 2019 / 0231571 published on April 9, 2019; US 2019 / 0247178 published on August 15, 2019; US 2019 / 0247213 published on August 15, 2019; US 2019 / 0247179 published on August 15, 2019; US 2019 / 0269498 published on September 5, 2019; US 2019 / 0269537 published on September 5, 2019; All relevant teachings of US 2019 / 0269537, published on September 19, 2019; US 2019 / 0282355, published on October 24, 2019; and US 2019 / 0321207, published on October 24, 2019, are also incorporated by reference in their entirety.

[0081] Equivalent Although example embodiments have been particularly shown and described, it will be understood by those skilled in the art that various changes in form and detail can be made in the invention without departing from the scope of the embodiments embodied by the appended claims.

[0082] The aspects of the present invention include the following. Item 1 a) a plurality of radially expandable stent components, each radially expandable stent component having a proximal end and a distal end, at least one of the stent components including struts including opposed ends and coupled to one another at their respective opposed ends thereby forming proximal and distal apices, and the radially expandable stent components are aligned in a proximal and distal relationship relative to one another; and b) a plurality of bridges connecting the immediately proximal and distal radially expandable stent components relative to one another, thereby forming a luminal stent, and defining a continuous lumen and proximal and distal ends of the luminal stent, wherein an axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decreasing number of bridges across the radially expandable stent components, and a radial stiffness of the luminal stent decreases from the proximal end to the distal end as a result of at least one of an increasing length of the struts of the radially expandable stent components and a decreasing thickness of the struts of the radially expandable stent components with distance from the proximal end of the luminal stent; A luminal stent comprising: Section 2 Item 2. A luminal stent as described in item 1, wherein at least a portion of the bridge connects at least a portion of the distal and proximal apices of each proximal and distal radially expandable stent component. Section 3 Item 2. A luminal stent as described in item 1, wherein at least a portion of the bridges have a longitudinal axis that transverses the longitudinal axis of the continuous lumen, thereby rendering the luminal stent longitudinally flexible. Section 4 Item 2. The luminal stent of item 1, wherein the radial stiffness of the radially expandable stent component comprises resistance to radial expansion from radially collapsed portions. Section 5 Item 5. The luminal stent of item 4, wherein at least a portion of the radially expandable stent component comprises at least one member selected from the group consisting of stainless steel, cobalt, cobalt chromium, nitinol (Ni-Ti), cobalt-chromium alloy (605L) and titanium (Ti). Section 6 Item 2. The luminal stent of item 1, wherein the radial stiffness of the radially expandable stent component includes resistance to radial collapse from a radially expanded position. Section 7 Item 7. The luminal stent of item 6, wherein at least a portion of the radially expandable stent component comprises at least one member selected from the group consisting of stainless steel, cobalt, cobalt chromium, nitinol (Ni-Ti), cobalt-chromium alloy (605L) and titanium (Ti). Section 8 Item 1, a luminal stent according to item 1, wherein at least a portion of the radially expandable stent component is self-expanding and comprises a shape-memory elastic metal. Section 9 Item 10. The luminal stent of item 8, wherein a portion of the radially expandable stent component is balloon expandable and comprises at least one member of the group consisting of stainless steel, cobalt, cobalt chromium, nitinol (Ni-Ti), cobalt-chromium alloy (605L) and titanium (Ti). Item 10 Item 10. The luminal stent according to item 9, wherein the shape memory elastic metal comprises Nitinol. Section 11 Item 11. The luminal stent according to item 10, wherein the shape memory elastic metal is Nitinol. Section 12 Item 1, a luminal stent, wherein the decrease in radial stiffness with increasing distance from the proximal end of the luminal stent is the result of an increase in the length of the struts of the radially expandable stent component with increasing distance from the proximal end of the luminal stent. Item 13 Item 1, a luminal stent, wherein the decrease in radial stiffness with increasing distance from the proximal end of the luminal stent is the result of a decrease in thickness of at least a portion of the struts of the radially expandable stent component with increasing distance from the proximal end of the luminal stent. Section 14 Item 1, a luminal stent, wherein the decrease in radial stiffness with increasing distance from the proximal end of the luminal stent is the result of an increase in the length of the struts of the radially expandable stent component with increasing distance from the proximal end of the luminal stent and a decrease in the thickness of at least some of the struts of the radially expandable stent component with increasing distance from the proximal end of the luminal stent. Item 15 Item 1, a luminal stent, wherein the decrease in axial stiffness is step-like, and the radial stiffness of the luminal stent changes in at least one increment. Section 16 Item 2. A luminal stent as described in item 1, wherein the reduction in the luminal stent includes a plurality of incremental junctions, at each junction, the axial stiffness of the luminal stent decreases with increasing distance from the proximal end of the luminal stent. Section 17 Item 1, a luminal stent, wherein the radial stiffness of the luminal stent is stepping-stone, and the luminal stent further comprises incremental junctions, and the radial stiffness of the luminal stent varies in at least one increment. Section 18 Item 18. The luminal stent of item 17, wherein the luminal stent comprises a plurality of incremental junctions, at each junction the radial stiffness of the luminal stent decreases with increasing distance from the proximal end of the luminal stent. Section 19 Item 19. The luminal stent according to item 18, further comprising at least one radiopaque marker. Section 20 Item 20. The luminal stent of item 19, wherein the radiopaque marker is at least one of the incremental junctions. Section 21 a) i) a plurality of radially expandable stent components, each radially expandable stent component having a proximal end and a distal end, at least one of the stent components including struts including opposed ends and coupled to one another at their respective opposed ends thereby forming proximal and distal apices, the radially expandable stent components being aligned in relative proximal and distal relationship to one another; and ii) a plurality of bridges connecting the immediately proximal and distal radially expandable stent components to one another, thereby forming a luminal stent, and defining a continuous lumen, proximal end and distal end of the luminal stent; luminal stents, b) at least one of a luminal graft component and a polymeric coating on a luminal stent. thereby forming a luminal stent assembly, the luminal stent assembly having a proximal end and a distal end; the axial stiffness of the luminal stent assembly decreases from the proximal end to the distal end of the luminal stent assembly as a result of a decreasing number of bridges across the radially expandable stent component, and the radial stiffness of the luminal stent decreases from the proximal end to the distal end as a result of at least one of an increase in the length of the struts of the radially expandable stent component and a decrease in the thickness of the struts of the radially expandable stent component with distance from the proximal end of the luminal stent; Luminal stent assembly. Section 22 22. The luminal stent assembly of claim 21, comprising a luminal graft component. Section 23 23. The luminal stent assembly of paragraph 22, wherein a portion of the luminal stent is bare. Section 24 23. The luminal stent assembly of paragraph 22, wherein the luminal graft component extends distally from the distal end of the luminal stent. Section 25 25. The luminal stent assembly of paragraph 24, wherein the luminal stent is completely covered by the luminal graft component. Section 26 25. The luminal stent assembly of claim 24, further comprising at least one radially expandable stent in the luminal graft component and distal to the luminal stent. Section 27 27. The luminal stent assembly of claim 26, wherein the radial stiffness of the radially expandable stent is less than the radial stiffness of the luminal stent at a proximal end of the luminal stent. Section 28 28. The luminal stent assembly of paragraph 27, wherein the radial stiffness of the radially expandable stent comprises a resistance to radial expansion from a radially collapsed position. Section 29 28. The luminal stent assembly of paragraph 27, wherein the radial stiffness of the radially expandable stent comprises resistance to radial collapse from a radially expanded position. Item 30 27. The luminal stent assembly of claim 26, wherein at least one of the radially expandable stents distal to the luminal stent comprises the same material as the luminal stent. Item 31 27. The luminal stent assembly of paragraph 26, wherein the proximal most radially expandable stent component of the luminal stent is expanded. Section 32 Item 32. The luminal stent assembly according to item 31, wherein the length of the luminal stent is in the range of about 10 mm to about 80 mm, and the luminal stent has about 3 to about 40 radially expandable stent components, at least a portion of which have longitudinal lengths in the range of about 3 mm to about 20 mm, each of which includes about 2 to about 40 struts. Item 33 27. A luminal stent assembly as described in paragraph 26, wherein at least one radially expandable stent distal to the distal end of the luminal stent includes two radially expandable stent sub-components, each stent sub-component including struts defining proximal and distal apexes, and the radially expandable stent sub-components are connected by at least one bridge. Section 34 34. A luminal stent assembly as described in paragraph 33, wherein at least one bridge extends from the distal apex of the proximal most radially expandable stent subcomponent of the radially expandable stent to the proximal apex of the distal most radially expandable stent subcomponent. Item 35 34. The luminal stent assembly of paragraph 33, wherein the struts of the radially expandable stent have a different length than at least some of the struts of the radially expandable stent component of the luminal stent. Section 36 36. The luminal stent assembly of paragraph 35, wherein the struts of the radially expandable stent distal to the luminal stent are longer than at least a portion of the struts of the radially expandable stent component of the luminal stent. Section 37 22. The luminal stent assembly of paragraph 21, wherein the luminal stent comprises at least one layer of a polymeric coating. Section 38 38. The luminal stent assembly of paragraph 37, wherein the polymeric coating coats at least one of an outer surface of the luminal stent and an inner surface of the luminal stent. Item 39 40. The luminal stent assembly of paragraph 38, wherein the polymeric coating coats the outer surface of the luminal stent. Section 40 40. The luminal stent assembly of paragraph 38, wherein the polymeric layer coats the inner surface of the luminal stent. Section 41 40. The luminal stent assembly of paragraph 38, wherein the polymeric coating coats both the inner and outer surfaces of the luminal stent. Section 42 40. The luminal stent assembly of paragraph 38, wherein the polymeric layer comprises at least a member of the group consisting of polytetrafluoroethylene (PTFE) and polyester. Section 43 43. The luminal stent assembly of paragraph 42, wherein the polymeric coating comprises PTFE. Section 44 44. The luminal stent assembly of paragraph 43, wherein the polymeric coating is PTFE. Section 45 Item 45. The luminal stent assembly of item 44, wherein the polymeric coating coats the inner surface of the luminal stent and the outer surface of the luminal stent, and the polymeric coating comprises multiple layers on at least one of the inner surface of the luminal stent and the outer surface of the luminal stent. Section 46 46. ​​The luminal stent assembly of paragraph 45, wherein the luminal stent has a plurality of polymeric layers on both its inner and outer surfaces. Section 47 46. ​​The luminal stent assembly of paragraph 45, wherein there are more layers of polymeric coating at the distal and proximal ends of the luminal stent than between the distal and proximal ends of the luminal stent. Section 48 38. The luminal stent assembly of paragraph 37, wherein the polymeric coating on the inner and outer surfaces of the luminal stent is continuous. Section 49 49. The luminal stent assembly of paragraph 48, wherein the luminal stent defines an opening and the polymeric coating seals the opening. Section 50 50. The luminal stent assembly of paragraph 49, wherein the total thickness of the polymeric coating on the inner surface of the luminal stent is greater than the total thickness of the polymeric coating on the outer surface of the luminal stent. Section 51 Item 50. The luminal stent assembly of item 49, wherein the total thickness of the polymeric coating on the inner surface of the luminal stent ranges from about 0.05 mm to about 1.0 mm. Section 52 Item 52. The luminal stent assembly according to item 51, wherein the total thickness of the polymeric coating on the outer surface of the luminal stent is in the range of about 0.05 mm to about 1.0 mm. Section 53 50. The luminal stent assembly of paragraph 49, wherein the total thickness of the polymeric coating on the inner surface of the luminal stent is about 0.2 mm and the total thickness of the polymeric coating on the outer surface of the luminal stent is about 0.05 mm. Section 54 46. ​​The luminal stent assembly of paragraph 45, further comprising a graft component covering the polymeric coating on the outer surface of the luminal stent. Section 55 38. The luminal stent assembly of paragraph 37, wherein the polymeric coating extends distally from the distal end of the luminal stent. Section 56 56. The luminal stent assembly of paragraph 55, further comprising at least one radially expandable stent distal to the luminal stent and with a polymeric coating. Section 57 57. The luminal stent assembly of paragraph 56, wherein the radially expandable stent has a radial stiffness less than at least a portion of the luminal stent. Section 58 58. The luminal stent assembly of paragraph 57, wherein the radial stiffness of the radially expandable stent comprises a resistance to radial expansion from a radially collapsed position. Section 59 58. The luminal stent assembly of paragraph 57, wherein the radial stiffness of the radially expandable stent comprises resistance to radial collapse from a radially expanded position. Section 60 57. The luminal stent assembly of paragraph 56, wherein at least one of the radially expandable stents distal to the distal end of the luminal stent comprises the same material as the material of the luminal stent. Section 61 61. The luminal stent assembly of paragraph 60, wherein the proximal most of the radially expandable stent components of the luminal stent are expanded. Section 62 Item 62. A luminal stent assembly as described in item 61, wherein at least one radially expandable stent distal to the distal end of the luminal stent includes two radially expandable stent sub-components, each radially expandable stent sub-component including struts defining proximal and distal apexes, and the radially expandable stent sub-components are connected by at least one bridge. Section 63 Item 63. A luminal stent assembly as described in item 62, wherein at least one bridge of the radially expandable stent extends from the distal apex of the proximal-most radially expandable stent subcomponent of the radially expandable stent to the proximal apex of the distal-most radially expandable stent subcomponent. Section 64 Item 63. The luminal stent assembly of item 62, wherein the struts of the radially expandable stent subcomponents of the radially expandable stent have a different length than at least some of the struts of the radially expandable stent components of the luminal stent. Section 65 65. The luminal stent assembly of paragraph 64, wherein the struts of the radially expandable stent distal to the luminal stent are longer than at least a portion of the struts of the radially expandable stent component of the luminal stent. Section 66 22. The luminal stent of claim 21, wherein the radial stiffness of the luminal stent is stepping-stone, the luminal stent further comprising incremental junctions, and the radial stiffness of the luminal stent varies in at least one increment. Section 67 67. The luminal stent of paragraph 66, wherein the luminal stent comprises a plurality of incremental junctions, and the radial stiffness of the radially expandable stent component of the luminal stent decreases with increasing distance from the proximal end of the luminal stent. Section 68 Item 68. The luminal stent of item 67, further comprising at least one radiopaque marker on the luminal stent. Section 69 Item 69. The luminal stent of item 68, wherein a radiopaque marker is present at at least one of the incremental junctions. Section 70 a) a luminal stent comprising a plurality of radially expandable stent components, wherein each radially expandable stent component has a proximal end and a distal end, at least one of the stent components comprises struts including opposed ends and connected to one another at their respective opposed ends thereby forming proximal and distal apices, the radially expandable stent components are aligned in a proximal and distal relationship relative to one another, and a plurality of bridges connect the immediately proximal and distal radially expandable stent components to one another, wherein an axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decreasing number of bridges across the radially expandable stent components, and a radial stiffness of the luminal stent decreases as a result of at least one of an increasing length of the struts of the radially expandable stent components and a decreasing thickness of the struts of the radially expandable stent components with distance from the proximal end of the luminal stent; and b) a balloon that is within the luminal stent when the luminal stent is in the collapsed position and that, when inflated, has a larger diameter at one end than at the opposite end; 13. A luminal stent assembly comprising: Section 71 71. The luminal stent assembly of paragraph 70, wherein the balloon, when inflated, has a larger diameter at the proximal end of the luminal stent. Section 72 72. The luminal stent assembly of claim 71, wherein the balloon has a stepping-stone diameter when inflated, the balloon comprising a proximal diameter, a distal diameter and a transition region between the proximal and distal diameters. Section 73 73. The luminal stent assembly of paragraph 72, wherein the balloon is semi-compliant. Section 74 Item 72. A luminal stent assembly as described in item 71, wherein the radial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of both an increase in the length of the struts of the radially expandable stent components and a decrease in the thickness of the struts of the radially expandable stent components with distance from the proximal end of the luminal stent. Section 75 71. The luminal stent of claim 70, wherein the radial stiffness of the luminal stent is stepping-stone, the luminal stent further comprising incremental junctions, and the radial stiffness of the luminal stent varies in at least one increment. Section 76 76. The luminal stent of paragraph 75, wherein the luminal stent comprises a plurality of incremental junctions, and the radial stiffness of the luminal stent decreases with increasing distance from the proximal end of the luminal stent. Section 77 76. The luminal stent of paragraph 75, wherein the balloon has a larger diameter at the proximal end of the luminal stent than at the distal end of the luminal stent. Section 78 Item 78. The luminal stent assembly of item 77, wherein the balloon has a stepping-stone diameter when inflated, the balloon comprising a proximal diameter, a distal diameter and a transition region between the proximal and distal diameters, the transition region being at an incremental junction of the luminal stent. Section 79 80. The luminal stent of paragraph 78, further comprising a radiopaque marker at at least one of the incremental junctions and the transition region. Section 80 80. The luminal stent of paragraph 79, wherein the proximal end of the luminal stent is expanded upon inflation of the balloon. Section 81 71. The luminal stent assembly of paragraph 70, further comprising at least one of a luminal graft component and a polymeric coating on the luminal stent. Section 82 82. The luminal stent assembly of paragraph 81, wherein at least one of the luminal graft component and the polymeric coating extends distally from a distal end of the luminal stent. Section 83 83. The luminal stent assembly of paragraph 82, further comprising at least one radially expandable stent distal to the luminal stent and secured to at least one of the luminal graft component and the polymeric coating. Section 84 84. The luminal stent assembly of paragraph 83, wherein the radially expandable stent distal to the luminal stent has a radial stiffness less than the radial stiffness of at least a portion of the luminal stent. Section 85 85. The luminal stent of paragraph 84, further comprising at least one radiopaque marker between the luminal stent and the radially expandable stent distal to the luminal stent. Section 86 Item 86. The luminal stent of item 85, wherein the radial stiffness of the luminal stent is stepping-stone, thereby forming at least one junction in the luminal stent, and further comprising a second radiopaque marker at at least one of the incremental junctions of the luminal stent. Section 87 84. The luminal stent assembly of paragraph 83, wherein the radial stiffness of the radially expandable stent is its resistance to radial expansion from a radially collapsed position. Section 88 84. The luminal stent assembly of paragraph 83, wherein at least one of the radially expandable stents distal to the luminal stent comprises the same material as the luminal stent. Section 89 84. The luminal stent assembly of paragraph 83, wherein the proximal most of the radially expandable stent component is flared at the proximal end of the luminal stent. Section 90 84. A luminal stent assembly as described in paragraph 83, wherein at least one radially expandable stent distal to the distal end of the luminal stent comprises two radially expandable stent sub-components, each radially expandable stent sub-component comprising struts connected to define proximal and distal apexes, and the radially expandable stent sub-components are connected by at least one bridge. Section 91 Item 84. A luminal stent assembly as described in item 83, wherein the radially expandable stent distal to the luminal stent includes struts connected to form proximal and distal apices, and the struts of the radially expandable stent distal to the luminal stent are longer than at least a portion of the struts of the radially expandable stent component of the luminal stent. Section 92 Item 92. A luminal stent assembly as described in item 91, wherein at least one bridge of the radially expandable stent subcomponent includes a bridge extending from the distal apex of the most proximal radially expandable stent subcomponent to the proximal apex of the most distal radially expandable stent subcomponent. Section 93 93. A luminal stent assembly as described in paragraph 92, wherein the struts of the radially expandable stent sub-component have a length greater than at least a portion of the struts of the radially expandable stent component of the luminal stent. Section 94 a) a luminal stent comprising a plurality of radially expandable stent components, wherein each radially expandable stent component has a proximal end and a distal end, at least one of the stent components comprises struts including opposed ends and coupled to one another at their respective opposed ends thereby forming proximal and distal apices, the radially expandable stent components are aligned in a proximal and distal relationship relative to one another, and a plurality of bridges couple the immediately proximal and distal radially expandable stent components to one another, wherein an axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decreasing number of bridges across the radially expandable stent components, and a radial stiffness of the luminal stent decreases as a result of at least one of an increasing length of the struts of the radially expandable stent components and a decreasing thickness of the struts of the radially expandable stent components with distance from the proximal end of the luminal stent; b) at least one of a luminal graft component and a polymeric coating on a luminal stent; and c) A balloon within the luminal stent when the luminal stent is in a collapsed position. 13. A luminal stent assembly comprising: Section 95 95. A luminal stent assembly as described in paragraph 94, wherein the balloon when inflated has a larger diameter at one end than at the opposite end. Section 96 96. The luminal stent assembly of paragraph 95, wherein the balloon has a larger diameter at the proximal end of the luminal stent when inflated. Section 97 97. The luminal stent assembly of paragraph 96, wherein the balloon has a stepping-stone diameter when inflated, the balloon comprising a proximal diameter, a distal diameter and a transition region between the proximal and distal diameters. Section 98 98. The luminal stent assembly of paragraph 97, wherein the balloon is semi-compliant. Section 99 95. A luminal stent assembly as described in paragraph 94, wherein the radial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of both an increase in the length of the struts of the radially expandable stent components and a decrease in the thickness of the struts of the radially expandable stent components with distance from the proximal end of the luminal stent. Item 100 95. The luminal stent of paragraph 94, wherein the radial stiffness of the luminal stent is stepping-stone, the luminal stent further comprising incremental junctions, and the radial stiffness of the luminal stent varies in at least one increment. Section 101 101. The luminal stent of paragraph 100, wherein the luminal stent includes a plurality of incremental junctions, and the radial stiffness of the luminal stent decreases with increasing distance from the proximal end of the luminal stent. Section 102 101. The luminal stent of claim 100, wherein the balloon has a larger diameter at the proximal end of the luminal stent than at the distal end of the luminal stent. Section 103 Item 103. The luminal stent assembly of item 102, wherein the balloon has a stepping-stone diameter when inflated, the balloon comprising a proximal diameter, a distal diameter and a transition region between the proximal and distal diameters, the transition region being at an incremental junction of the luminal stent. Section 104 Item 104. The luminal stent of item 103, further comprising radiopaque markers at the incremental junctions. Section 105 105. The luminal stent of paragraph 104, wherein the proximal end of the luminal stent is expanded upon inflation of the balloon. Section 106 95. The luminal stent assembly of paragraph 94, wherein at least one of the luminal graft component and the polymeric coating extends distally from the distal end of the luminal stent. Section 107 107. The luminal stent assembly of paragraph 106, further comprising at least one radially expandable stent distal to the luminal stent and secured to at least one of the luminal graft component and the polymeric coating. Section 108 108. The luminal stent assembly of paragraph 107, wherein the radially expandable stent distal to the luminal stent has a radial stiffness less than the radial stiffness of at least a portion of the luminal stent. Section 109 108. The luminal stent of paragraph 107, further comprising at least one radiopaque marker between the luminal stent and the radially expandable stent distal to the luminal stent. Section 110 Item 109, a luminal stent, wherein the radial stiffness of the luminal stent is stepping-stone, thereby forming at least one junction in the luminal stent, and further comprising a second radiopaque marker at at least one of the incremental junctions of the luminal stent. Section 111 108. The luminal stent assembly of paragraph 107, wherein the radial stiffness of the radially expandable stent is its resistance to radial expansion from a radially collapsed position. Section 112 108. The luminal stent assembly of claim 107, wherein at least one of the radially expandable stents distal to the luminal stent comprises the same material as the luminal stent. Section 113 108. The luminal stent assembly of paragraph 107, wherein the proximal most of the radially expandable stent component is flared at the proximal end of the luminal stent. Section 114 Item 108. A luminal stent assembly as described in item 107, wherein at least one radially expandable stent distal to the distal end of the luminal stent includes two radially expandable stent sub-components, each radially expandable stent sub-component including struts connected to define proximal and distal apexes, and the radially expandable stent sub-components are connected by at least one bridge. Section 115 Item 108. A luminal stent assembly as described in item 107, wherein the radially expandable stent distal to the luminal stent includes struts connected to form proximal and distal apices, and the struts of the radially expandable stent distal to the luminal stent are longer than at least a portion of the struts of the radially expandable stent component of the luminal stent. Section 116 Item 116. A luminal stent assembly as described in paragraph 115, wherein at least one bridge of the radially expandable stent subcomponent includes a bridge extending from the distal apex of the most proximal radially expandable stent subcomponent to the proximal apex of the most distal radially expandable stent subcomponent. Section 117 117. The luminal stent assembly of paragraph 116, wherein the struts of the radially expandable stent subcomponent have a length greater than at least a portion of the struts of the radially expandable stent component. Section 118 a) a luminal stent including a plurality of radially expandable stent components, wherein each radially expandable stent component has a proximal end and a distal end, at least one of the stent components includes struts including opposed ends and coupled to one another at their respective opposed ends thereby forming proximal and distal apices, and at least a portion of the radially expandable stent components are nested in relative proximal and distal relationship to one another; and b) a luminal stent comprising at least one of a luminal graft component and a polymeric coating; thereby forming a luminal stent assembly. 1. A luminal stent assembly comprising: A luminal stent assembly having a proximal end and a distal end. Section 119 Item 119. The luminal stent assembly of item 118, further comprising a plurality of bridges connecting the immediately proximal and distal radially expandable stent components to one another at at least one of each proximal apex and each distal apex, thereby forming a luminal stent and defining a continuous lumen, proximal end and distal end of the luminal stent. Section 120 Item 119. A luminal stent assembly as described in item 119, wherein the axial stiffness of the luminal stent assembly decreases from the proximal end to the distal end of the luminal stent assembly as a result of a decrease in the number of bridges across the radially expandable stent component, and the radial stiffness of the luminal stent decreases from the proximal end to the distal end as a result of at least one of an increase in the length of the struts of the radially expandable stent component and a decrease in the thickness of the struts of the radially expandable stent component with distance from the proximal end of the luminal stent. Section 121 a) i) a plurality of radially expandable stent components, each radially expandable stent component having a proximal end and a distal end, at least one of the stent components including struts including opposed ends and coupled to one another at their respective opposed ends thereby forming proximal and distal apices, the radially expandable stent components being in relative proximal and distal relationship to one another; and ii) including a plurality of bridges connecting immediately proximal and distal radially expandable stent components to one another, thereby forming a luminal stent and defining continuous lumens, proximal ends and distal ends of the luminal stent; Luminal stents; b) at least one of a luminal graft component and a polymeric coating on a luminal stent; and c) at least one stent distal to the luminal stent and connected to the luminal stent by at least one of a luminal graft component and a polymeric coating, thereby forming a luminal stent assembly; a luminal stent assembly having a proximal end at the luminal stent and a distal end at the stent distal to the luminal stent; A luminal stent assembly, wherein the axial stiffness of the luminal stent assembly decreases from the proximal end to the distal end of the luminal stent assembly as a result of a space between the luminal stent and at least one stent distal to the luminal stent, and the radial stiffness of the luminal stent is greater than the radial stiffness of the at least one distal stent. Section 122 122. The luminal stent assembly of claim 121, wherein at least a portion of the radially expandable stent components are nested. Section 123 123. The luminal stent assembly of claim 122, comprising a plurality of distal stent components. Section 124 124. The luminal stent assembly of claim 123, wherein at least a portion of the distal stent component is nested. Section 125 125. The luminal stent assembly of claim 124, wherein the radial stiffness of at least one distal stent is less than the radial stiffness of the luminal stent. Section 126 Item 126. A luminal stent assembly as described in item 125, wherein the bridge of the luminal stent connects at least one of the proximal apexes of one of the radially expandable stent components to the proximal-most proximal apex of at least one of the radially expandable stent components proximal to the radially expandable stent component and distal to the radially expandable stent component. Section 127 Item 127. A luminal stent assembly as described in item 126, wherein the bridge of the luminal stent connects at least one of the distal apexes of one of the radially expandable stent components to a radially expandable stent component proximal to the radially expandable stent component and to a proximal-most distal apex of at least one of the radially expandable stent components distal to the radially expandable stent component. Section 128 Item 123. A luminal stent assembly as described in item 122, wherein the bridge of the luminal stent connects at least one of the distal apexes of one of the radially expandable stent components to a radially expandable stent component proximal to the radially expandable stent component and to a proximal-most distal apex of at least one of the radially expandable stent components distal to the radially expandable stent component. Section 129 a) a plurality of radially expandable stent components, wherein each radially expandable stent has a proximal end and a distal end, at least one of the stents includes struts including opposed ends and coupled to each other at their respective opposed ends thereby forming proximal and distal apices, the radially expandable stents being in relative proximal and distal relationship to each other, and a radial stiffness of each radially expandable stent being less than a radial stiffness of each radially expandable stent proximal to it and greater than a radial stiffness of each radially expandable stent distal to it; b) at least one of a luminal graft component and a polymeric coating connecting a plurality of radially expandable stents. 13. A luminal stent assembly comprising: Section 130 130. The luminal stent assembly of paragraph 129, wherein at least a portion of the radially expandable stent is nested. Section 131 a) i) a plurality of radially expandable stent components, each radially expandable stent component having a proximal end and a distal end, at least one of the stent components including struts including opposed ends and coupled to one another at their respective opposed ends thereby forming proximal and distal apices, and the radially expandable stent components are aligned in relative proximal and distal relationship to one another; and ii) a plurality of bridges connecting the immediately proximal and distal radially expandable stent components to one another, where the axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decreasing number of bridges across the radially expandable stent components, and the radial stiffness decreases from the proximal end of the luminal stent to the distal end of the luminal stent as a result of at least one of an increase in the length of the struts of the radially expandable stent components and a decrease in the thickness of the struts of the radially expandable stent components with distance from the proximal end of the luminal stent; ; a luminal stent having b) at least one of a luminal graft component and a polymeric coating on a luminal stent; c) a balloon within the luminal stent when the luminal stent is in the collapsed position and which, when inflated, has a larger diameter at one end than at the opposite end; and d) a fenestrated stent graft defining at least one fenestration. 1. A stent graft assembly comprising: the luminal stent has a diameter smaller than the fenestration when in a collapsed position and is expandable to a diameter that secures a proximal end of the luminal stent within the fenestration, with a distal end of the luminal stent extending radially from the stent graft; Stent graft assembly. Section 132 a) delivering a fenestrated stent graft of a stent graft system to a bifurcated artery of a subject, wherein the fenestration defined by the fenestrated stent graft is aligned with a proximal end of the bifurcated artery; b) delivering a luminal stent of the stent graft system into the arterial branch through the fenestration, wherein the luminal stent has a proximal end at the fenestration of the fenestrated stent graft and a distal end extending radially outward from the fenestrated stent graft, wherein an axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decreasing number of bridges across a radially expandable stent component of the luminal stent, and a radial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of at least one of an increasing length of the struts of the radially expandable stent component and a decreasing thickness of the struts of the radially expandable stent component with distance from the proximal end of the luminal stent; and c) radially expanding the luminal stent within the fenestration and arterial branch by inflating a balloon within the luminal stent having a larger diameter at a proximal end of the luminal stent than at a distal end of the luminal stent, thereby implanting the stent graft system. 23. A method of implanting a stent graft system, comprising: Section 133 Luminal stents: a) a plurality of radially expandable stent components, where the radially expandable stent components are linked at respective ends thereby forming proximal and distal apices, and where the radially expandable stents are aligned in relative proximal and distal relationship to one another thereby forming a luminal stent defining a continuous lumen, a proximal end and a distal end of the luminal stent; and b) including a plurality of bridges, each bridge connecting a relatively proximal radially expandable stent component to a radially expandable stent component just distal thereto; 133. The method of claim 132, wherein the luminal stent has an axial stiffness that decreases with increasing distance from the proximal end of the luminal stent. Section 134 The method of claim 132, wherein the radial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of at least one of an increase in the length of the struts of the radially expandable stent component and a decrease in the thickness of the struts of the radially expandable stent component with distance from the proximal end of the luminal stent. Section 135 a) delivering a fenestrated stent graft of a stent graft system to a bifurcated artery of a subject, wherein the fenestration defined by the stent graft is aligned with a proximal end of the bifurcated artery; b) delivering a fenestrated stent assembly of the stent graft system through the fenestration to the arterial branch, whereby the luminal stent assembly bridges the fenestrated stent graft and the arterial branch, wherein the luminal stent assembly comprises: i) a plurality of stents aligned longitudinally and connected by bridges to form a luminal stent, wherein an axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decreasing number of bridges across the radially expandable stent components of the luminal stent, and a radial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of at least one of an increase in the length of the struts of the radially expandable stent components and a decrease in the thickness of the struts of the radially expandable stent components with distance from the proximal end of the luminal stent; ii) at least one stent distal to the luminal stent, the stent having a radial stiffness less than the radial stiffness of the luminal stent; and iii) at least one of a luminal graft component and a polymeric coating connecting the luminal stent and a stent distal to the luminal stent. Including; c) radially expanding the luminal stent assembly within the fenestration and arterial branch by inflating a balloon within the luminal stent assembly, where the balloon, when inflated, has a larger diameter at the luminal stent than the stent distal to the luminal stent, thereby embedding the stent graft system; 23. A method of implanting a stent graft system, comprising: Section 136 136. The method of claim 135, wherein the stent distal to the luminal stent is connected to the luminal stent by a luminal graft component. Section 137 136. The method of paragraph 135, wherein the stent distal to the luminal stent is connected to the luminal stent by a polymeric coating. Section 138 138. The method of paragraph 137, wherein the polymeric coating encapsulates the luminal stent and the stent distal to the luminal stent. Section 139 139. The method of claim 138, wherein at least one of the stent distal to the luminal stent and the luminal stent defines an opening, and the polymeric coating seals the opening to define a luminal space between the stent distal to the luminal stent and the luminal stent.

Claims

[Claim 1] a) a plurality of radially expandable stent components, each radially expandable stent component having a proximal end and a distal end, at least one of the stent components including struts including opposed ends and coupled to one another at their respective opposed ends thereby forming proximal and distal apices, and the radially expandable stent components are aligned in relative proximal and distal relationship to one another; and b) a plurality of bridges connecting the immediately proximal and distal radially expandable stent components relative to one another, thereby forming a luminal stent, and defining a continuous lumen and proximal and distal ends of the luminal stent, wherein an axial stiffness of the luminal stent decreases from the proximal end to the distal end of the luminal stent as a result of a decreasing number of bridges across the radially expandable stent components, and a radial stiffness of the luminal stent decreases from the proximal end to the distal end as a result of at least one of an increasing length of the struts of the radially expandable stent components and a decreasing thickness of the struts of the radially expandable stent components with distance from the proximal end of the luminal stent; A luminal stent comprising:

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