DEVICE FOR REMOVING CLOT MATERIAL FROM AN INTRACIRAL IMPLANTED DEVICE, AND ASSOCIATED SYSTEMS AND METHODS - Patent application

Abstract

Disclosed herein are devices and related systems and methods for mechanically removing clots and / or other material from an implant implanted in a patient's vasculature. In some embodiments, a system for removing clot material from an implant, such as a stent, includes a clot treatment device configured to be deployed within the stent, a handle, and a first elongated member and a second elongated member for coupling the clot treatment device to the handle. The first elongated member couples a first end portion of the clot treatment device to the handle, and the second elongated member couples a second end portion of the clot treatment device to an actuator on the handle. Actuation of the actuator is configured to move the second elongated member relative to the first elongated member, moving the first and second end portions toward each other to radially expand the clot treatment device.

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of U.S. Provisional Patent Application No. 63 / 298,399, entitled "DEVICES FOR REMOVING CLOT MATERIAL FROM INTRAVASCULARLY IMPLANTED STENTS, AND ASSOCIATED SYSTEMS AND METHODS," filed on January 11, 2022, which is incorporated by reference in its entirety.

[0002] The present technology relates generally to stents, embolic protection devices, other implants, and / or devices for cleaning bare blood vessels, and more specifically to devices for the endovascular removal of clots and / or other material, for example, from stents implanted in a patient's vasculature (e.g., venous vasculature). [Background technology]

[0003] A stent is a tube or similar structure that can be implanted within a patient's blood vessel to mechanically hold the vessel open, restore flow, and / or bypass a diseased area in the vessel. Stents are typically made of metal or plastic and can be crimped or packed onto a delivery catheter prior to intravascular delivery to a target location within the vessel.

[0004] After a stent is delivered and implanted in a patient's blood vessel, undesirable material may form around the stent and / or adhere to the stent. For example, clotting material may form and adhere to the inner surface of the stent. Similarly, vascular wall cells may abnormally accumulate within the stent (e.g., intimal hyperplasia).

[0005] Currently, physicians have limited ability to remove adherent clots or intimal hyperplasia from implanted stents, and specifically from venous stents. For example, suction mechanisms exist to remove clot material from venous stents, but these suction mechanisms are limited to non-adherent, acute clots and cannot treat chronic, adherent clots or intimal hyperplasia. Additionally, mechanical clot treatment devices exist to target adherent clot material, but many such devices are currently contraindicated for removing clot material from stents because they can get stuck on the stent and cause damage. Other medical management methods, such as ballooning or restenting, do not remove formed clots and may allow additional clots to form. Pharmacological methods, such as administration of tissue plasminogen activator (tPA), do not work for older, more adherent clots and also have other risks, such as systemic bleeding. Surgery carries the risk of adverse events and is more invasive than the transcatheter approach. Summary of the Invention [Means for solving the problem]

[0006] The present technology is generally directed to devices and associated systems and methods for mechanically removing clots and / or other material from a patient's vasculature. In particular, some of the embodiments are directed to devices for mechanically removing clots and / or other material from an implant implanted in a patient's vasculature, such as a stent implanted in a venous vasculature. In some embodiments described below, a system for removing clot material from an implant, such as a venous stent, includes (i) a clot treatment device, (ii) a handle, and (iii) a first elongate member and a second elongate member coupling the clot treatment device to the handle. The clot treatment device is configured to be deployed within the implant and includes a first end portion, a second end portion, and a plurality of struts extending between the first and second end portions. The first elongate member couples the first end portion of the clot treatment device to the handle, and the second elongate member couples the second end portion of the clot treatment device to the handle (e.g., to an actuator of the handle). Actuation of the actuator in a first direction is configured to move the second elongate member relative to the first elongate member and / or move the first elongate member relative to the second elongate member, moving the first and second end portions toward each other to radially expand the struts. The actuator can be actuated in a second direction (e.g., opposite the first direction) to move the second elongate member relative to the first elongate member and / or move the first elongate member relative to the second elongate member, moving the first and second end portions away from each other to radially collapse the struts.

[0007] Once expanded within the implant, the clot treatment device can be (i) translated proximally and / or distally through the implant by translating the handle and (ii) rotated within the implant by rotating the handle. Such movement can mechanically engage the clot treatment device with clot material adhered to the implant to dislodge the clot material. In some aspects of the present technology, the clot treatment device is configured to translate and / or rotate within the implant without catching on the implant, avoiding potential damage, deformation, migration, and / or movement of the implant. For example, the struts can extend generally axially between the first and second end portions - and without including any cross members connected therebetween that are configured to contact the implant - reducing the likelihood of the struts damaging the implant. [Brief description of the drawings]

[0008] Many aspects of the present technology can be better understood with reference to the following drawings. The components in the drawings are not necessarily to scale, emphasis instead being placed upon clearly illustrating the principles of the present disclosure.

[0009] [Figure 1A] FIG. 1A is a side view of a stent cleaning system in accordance with an embodiment of the present technology. [Figure 1B] 1B and 1C are enlarged side and proximal-facing views, respectively, of a distal portion of the system of FIG. 1A including a clot treatment device, in accordance with an embodiment of the present technology. [Figure 1C] 1B and 1C are enlarged side and proximal-facing views, respectively, of a distal portion of the system of FIG. 1A including a clot treatment device, in accordance with an embodiment of the present technology. [Figure 2A] 2A-2C are proximally facing enlarged views of a distal portion of the system of FIG. 1A including a clot treatment device, in accordance with additional embodiments of the present technology. [Figure 2B]2A-2C are proximally facing enlarged views of a distal portion of the system of FIG. 1A including a clot treatment device, in accordance with additional embodiments of the present technology. [Figure 2C] 2A-2C are proximally facing enlarged views of a distal portion of the system of FIG. 1A including a clot treatment device, in accordance with additional embodiments of the present technology. [Figure 3A] 3A-3D are enlarged side views of a distal portion of the system of FIG. 1A including a clot treatment device in accordance with additional embodiments of the present technology. [Figure 3B] 3A-3D are enlarged side views of a distal portion of the system of FIG. 1A including a clot treatment device in accordance with additional embodiments of the present technology. [Figure 3C] 3A-3D are enlarged side views of a distal portion of the system of FIG. 1A including a clot treatment device in accordance with additional embodiments of the present technology. [Figure 3D] 3A-3D are enlarged side views of a distal portion of the system of FIG. 1A including a clot treatment device in accordance with additional embodiments of the present technology. [Figure 4A] 4A-4C are enlarged isometric views of a distal portion of the system of FIG. 1A including a clot treatment device in accordance with additional embodiments of the present technology. [Figure 4B] 4A-4C are enlarged isometric views of a distal portion of the system of FIG. 1A including a clot treatment device in accordance with additional embodiments of the present technology. [Figure 4C] 4A-4C are enlarged isometric views of a distal portion of the system of FIG. 1A including a clot treatment device in accordance with additional embodiments of the present technology. [Diagram 5] FIG. 5 is a partial cutaway view of the handle of the system of FIG. 1A in accordance with an embodiment of the present technology. [Figure 6A] 6A and 6B are side views of a distal portion of the system of FIG. 1A including a clot treatment device in a first position and a second position, respectively, in accordance with an embodiment of the present technology. [Figure 6B]6A and 6B are side views of a distal portion of the system of FIG. 1A including a clot treatment device in a first position and a second position, respectively, in accordance with an embodiment of the present technology. [Figure 7] FIG. 7 is a flow diagram of a process or method for operating the system of FIG. 1A to remove clotting material from an implanted stent during an endovascular procedure in accordance with an embodiment of the present technology. [Figure 8] FIG. 8 is a distally facing perspective view of a distal portion of the system of FIG. 1A including a clot treatment device expanded within a stent implanted in a blood vessel in accordance with an embodiment of the present technology. [Figure 9A] 9A and 9B are distally facing perspective views of a distal portion of the system of FIG. 1A including a clot treatment device positioned within the stent of FIG. 6 in accordance with an embodiment of the present technology. [Figure 9B] 9A and 9B are distally facing perspective views of a distal portion of the system of FIG. 1A including a clot treatment device positioned within the stent of FIG. 6 in accordance with an embodiment of the present technology. [Figure 10A] 10A-10C are distally facing perspective views of a distal portion of the system of FIG. 1A including a clot treatment device deployed within an implant, radially expanded by different amounts, in accordance with an embodiment of the present technology. [Figure 10B] 10A-10C are distally facing perspective views of a distal portion of the system of FIG. 1A including a clot treatment device deployed within an implant, radially expanded by different amounts, in accordance with an embodiment of the present technology. [Figure 10C] 10A-10C are distally facing perspective views of a distal portion of the system of FIG. 1A including a clot treatment device deployed within an implant, radially expanded by different amounts, in accordance with an embodiment of the present technology. [Figure 11A] FIG. 11A is a side view of a stent cleaning system in accordance with an embodiment of the present technology. [Figure 11B]11B and 11C are side views of a distal portion of the system of FIG. 11A including a clot treatment device in a first position and a second position, respectively, in accordance with an embodiment of the present technology. [Figure 11C] 11B and 11C are side views of a distal portion of the system of FIG. 11A including a clot treatment device in a first position and a second position, respectively, in accordance with an embodiment of the present technology. [Figure 12] FIG. 12 is a side view of a clot treatment device in accordance with an embodiment of the present technology. [Figure 13] FIG. 13 is a side view of a clot treatment device in accordance with an embodiment of the present technology. [Figure 14] FIG. 14 is a side view of a clot treatment device in accordance with an embodiment of the present technology. [Figure 15] FIG. 15 is a side view of a clot treatment device in accordance with an embodiment of the present technology. [Figure 16A] 16A-16C are side views of a clot treatment device in accordance with an embodiment of the present technology. [Figure 16B] 16A-16C are side views of a clot treatment device in accordance with an embodiment of the present technology. [Figure 16C] 16A-16C are side views of a clot treatment device in accordance with an embodiment of the present technology. [Figure 17A] 17A and 17B are side views of a distal portion of a stent cleaning system in accordance with an embodiment of the present technology. [Figure 17B] 17A and 17B are side views of a distal portion of a stent cleaning system in accordance with an embodiment of the present technology. [Figure 18] FIG. 18 illustrates several different chamfers that can be used in clot treatment devices in accordance with embodiments of the present technology. [Figure 19] FIG. 19 is an enlarged side view of a pair of struts of a clot treatment device in accordance with an embodiment of the present technology. [Figure 20] FIG. 20 is a side cross-sectional view of a handle that can be used in the system of FIG. 1A, in accordance with an additional embodiment of the present technology. [Figure 21] FIG. 21 is a side cross-sectional view of a handle that can be used in the system of FIG. 1A in accordance with an additional embodiment of the present technology. [Figure 22] 22 is a side cross-sectional view of an actuation mechanism of a handle that can be used in the system of FIG. 1A in accordance with an embodiment of the present technology. [Diagram 23] FIG. 23 is a side cross-sectional view of a handle that can be used in the system of FIG. 1A in accordance with an additional embodiment of the present technology. [Figure 24] 24 is a side cross-sectional view of a handle that can be used in the system of FIG. 1A in accordance with an additional embodiment of the present technology. [Figure 25A] 25A-25C are close-up perspective, side, and cross-sectional side views, respectively, of a handle that can be used in the system of FIG. 1A in accordance with additional embodiments of the present technology. [Figure 25B] 25A-25C are close-up perspective, side, and cross-sectional side views, respectively, of a handle that can be used in the system of FIG. 1A in accordance with additional embodiments of the present technology. [Figure 25C] 25A-25C are close-up perspective, side, and cross-sectional side views, respectively, of a handle that can be used in the system of FIG. 1A in accordance with additional embodiments of the present technology. [Figure 26] 26 is an enlarged cross-sectional side view of a handle that can be used in the system of FIG. 1A in accordance with an additional embodiment of the present technology. [Figure 27] FIG. 27 is an enlarged cross-sectional side view of a handle that can be used in the system of FIG. 1A in accordance with an additional embodiment of the present technology. [Figure 28] FIG. 28 is a side view of a distal portion of a clot removal system positioned within a blood vessel to treat clot material in accordance with an embodiment of the present technology. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0010] In order to provide a thorough understanding of various embodiments of the present technology, certain details are set forth in the following description and in FIGS. 1-28. In other cases, well-known structures, materials, operations, and / or systems often associated with endovascular procedures, stents, vascular implants, clot removal procedures, catheters, and the like, are not shown or described in detail in the following disclosure to avoid unnecessarily obscuring the description of various embodiments of the present technology. However, those skilled in the art will recognize that the present technology may be practiced without one or more of the details described herein, and / or with other structures, methods, components, and the like. Furthermore, although many of the devices and systems are described herein in the context of removing and / or treating clot material (e.g., clot material adhered to an implant), the present technology may be used to remove and / or treat other undesirable material in addition to or in the alternative to clot material, such as thrombus, embolus, plaque, intimal hyperplasia, post-thrombotic scar tissue, and the like. Thus, as used herein, the terms "clot" and "clot material" may refer to any of the aforementioned materials.

[0011] The terms used below should be interpreted in their broadest reasonable manner, even when used in conjunction with the detailed description of specific examples of embodiments of the present technology. In fact, certain terms may even be emphasized below. However, any terms intended to be interpreted in any limited manner are expressly and specifically defined as such in this detailed description section.

[0012] The accompanying figures depict embodiments of the present technology and are not intended to limit its scope unless expressly indicated. The sizes of the various depicted elements are not necessarily drawn to scale, and these various elements may be enlarged to improve legibility. Details of components may be abstracted in the figures to exclude details such as the location of components and specific precise connections between such components when such details are not necessary for a complete understanding of how to create and use the present technology. Many of the details, dimensions, angles, and other features shown in the figures are merely illustrative of certain embodiments of the present disclosure. Thus, other embodiments can have other details, dimensions, angles, and features without departing from the present technology. However, those skilled in the art will appreciate that further embodiments of the present technology can be practiced without some of the details described below.

[0013] With respect to the terms "distal" and "proximal" in this description, unless otherwise specified, these terms may refer to the relative location of portions of the catheter subsystem with respect to an operator and / or a location within the vasculature. Also, as used herein, designations such as "rear," "forward," "upper," "lower," etc. are not meant to limit the referenced components to a particular orientation. It will be understood that such designations refer to the orientation of the referenced components as illustrated in the figures. The systems of the present technology may be used in any orientation suitable to the user. To the extent that material incorporated herein by reference conflicts with the present disclosure, the present disclosure controls.

[0014] FIG. 1A is a side view of a stent cleaning system 100 ("system 100") in accordance with an embodiment of the present technology. FIG. 1B and FIG. 1C are close-up side and proximal-facing views, respectively, of a distal portion of system 100 including a clot treatment device 130 in accordance with an embodiment of the present technology. Stent cleaning system 100 can be used to remove clot material from (e.g., adhered to) an implant, to clean clot material from a native vessel in which an implant is implanted, and / or to remove clot material from a native vessel in which an implant is not implanted. Thus, system 100 can also be referred to as a clot treatment system, a clot removal system, a thrombectomy system, and the like. Clot treatment device 130 can also be referred to as a clot removal device, a coring element, a clot engagement member, a thrombectomy device, and the like.

[0015] 1A and 1B together, in the illustrated embodiment, the system 100 includes a proximal handle 110 operably coupled to a clot treatment device 130 via an inner elongate member 102 (e.g., a second elongate member, hidden in FIG. 1A ) and an intermediate elongate member 104 (e.g., a first elongate member). The inner elongate member 102 can extend through a lumen of the intermediate elongate member 104 such that the inner elongate member 102 and the intermediate elongate member 104 (collectively “elongate members 102, 104”) are coaxial. The system 100 may further include an outer elongate member 106 (e.g., a third elongate member, a guide catheter), and the elongate members 102, 104 may extend at least partially through the outer elongate member 106 such that the inner elongate member 102, the middle elongate member 104, and the outer elongate member 106 (collectively "elongate members 102-106") are coaxial. In other embodiments, the elongate members 102, 104 may not be coaxial, but instead extend alongside and / or through separate lumens of the outer elongate member 106. The elongate members 102-106 may comprise catheters, tubes (e.g., hypotubes), sheaths, shafts, etc., and may be formed from metals (e.g., stainless steel, nitinol), plastics, fluoropolymers (e.g., polytetrafluoroethylene, PTFE), polymers, and / or other suitable materials. The outer elongate member 106 may comprise a guide catheter.

[0016] 1A, the outer elongated member 106 can include a distal end portion 107a and a proximal end portion 107b. The proximal end portion 107b can be coupled to a tubing assembly 101 (e.g., including one or more tubes, fluid control devices, etc.) via a valve device 109. In some embodiments, the tubing assembly 101 can be used to flush the lumen of the outer elongated member 106. In some embodiments, the handle 110 is movable (translatable, rotatable) relative to the valve device 109 and the outer elongated member 106. In the illustrated embodiment, the handle 110 is advanced toward the valve device 109 such that the clot treatment device 130 extends from the distal end portion 107a of the outer elongated member 106. In some embodiments, the handle 110 can be retracted away from the outer elongate member 106 and / or the outer elongate member 106 can be advanced away from the handle 110 such that the clot treatment device 130 is captured / positioned within the outer elongate member 106. Once the clot treatment device 130 is captured within the lumen of the outer elongate member 106, the clot treatment device 130 is in a radially compressed state. In some embodiments, the clot treatment device 130 can be positioned within the outer elongate member 106 during delivery of the system 100 through the vasculature.

[0017] In the illustrated embodiment, the system 100 includes a tip 108 coupled to the clot treatment device 130 and / or the inner elongate member 102 (FIG. 1B). The tip 108 can have an atraumatic shape configured to minimize, and even prevent, damage to the vasculature as the system 100 is advanced therethrough. In other embodiments, the tip 108 can have other shapes or can be omitted entirely. In some embodiments, the tip 108 can engage the distal end portion 107a of the outer elongate member 106 when the clot treatment device 130 is constrained within the outer elongate member 106, and can be shaped and sized to seal the lumen of the outer elongate member 106. In some embodiments, the tip 108 and the inner elongate member 102 (FIG. 1B) can define a lumen configured (e.g., shaped and sized) to receive a guidewire (not shown) therethrough. The system 100 can be advanceable / trackable over a guidewire.

[0018] 1B, in the illustrated embodiment, the inner elongate member 102 includes a distal end portion 103a coupled to a distal end portion 131a of the clot treatment device 130. Similarly, the middle elongate member 104 includes a distal end portion 105a coupled to a proximal end portion 131b of the clot treatment device 130. Thus, relative movement of the elongate members 102, 104 can longitudinally shorten / lengthen and radially expand / compress the clot treatment device 130 via relative movement of the end portions 131a-b, as will be described in detail below with reference to FIGS. 6A and 6B. The end portions 131a-b of the clot treatment device 130 can be identical and can have a cylindrical or hub-like shape. In some embodiments, the end portions 131a-b are secured to the elongate members 102, 104, respectively, via adhesives (e.g., adhesive bonds), welding, fasteners, crimping (e.g., via crimp tubes), and the like. For example, in some embodiments, one or both of the end portions 131a-b of the clot treatment device 130 can be welded directly to the elongate members 102, 104, or one or both of the end portions 131a-b can be crimped to the elongate members 102, 104 via crimp tubes (e.g., the proximal end portion 131b can be crimped to the intermediate elongate member 104). In some embodiments, the distal end portion 131a includes / defines a distal window 132a extending therethrough, and the proximal end portion 131b includes / defines a proximal window 132b extending therethrough. A coupling member (not shown), such as a steel disk, may be disposed in one or both of the windows 132a-b and welded, soldered, crimped, or otherwise fastened to the elongated members 102, 104, respectively, to secure the end portions 131a-b to the elongated members 102, 104 via a rivet-like lock. In some embodiments, the end portions 131a-b may include a number of windows 132a-b extending circumferentially therearound, each configured to receive a corresponding coupling member.

[0019] The elongated members 102, 104 can be constructed of (i) metal, polymer, and / or metallic (e.g., solid stainless steel, cobalt chrome, nitinol) tubing, (ii) metal, polymer, and / or metallic (e.g., solid stainless steel, cobalt chrome, nitinol) tubing with relief cuts (e.g., laser cuts) for flexibility, (iii) hollow helical spirals (e.g., comprising one or more axial metal (e.g., stainless steel, cobalt chrome, nitinol) wires bent to create a closed pitch coil with a hollow central lumen), (iv) reinforced polymer shafts, and / or (v) the like. In the illustrated embodiment, for example, the inner elongated member 102 is constructed of a solid nitinol tube and the middle elongated member 104 is constructed of a hollow helical spiral (HHS). The hollow helical spiral may be a single layer spiral, or may be a multi-layer spiral (e.g., a two-layer, three-layer, or greater layer spiral) that provides greater torque and / or tensile response. In some aspects of the present technology, such hollow helical spirals allow the overall system 100 to be more flexible, such that the system 100 may be inserted, for example, to treat clot material in more tortuous anatomical structures while biasing the clot treatment device 130 less (e.g., against one side of an implant or vessel). In some aspects of the present technology, as described in more detail below, the elongate members 102, 104 may have relatively high tensile, compressive, and / or torque capabilities / responses, which allows for controlled expansion and movement of the clot treatment device 130 during a procedure to remove clot material from implanted stents, embolic protection devices, other implants, and / or bare vessels.

[0020] 1B and 1C together, the clot treatment device 130 includes a plurality of beams or struts 133 extending between end portions 131a-b and generally axially relative to a longitudinal axis L of the clot treatment device 130. More specifically, the struts 133 may be generally similar or identical to one another and may each include (i) a distal portion 134 extending proximally from the distal end portion 131a in a direction away from the longitudinal axis L (e.g., at an angle relative to the longitudinal axis L) toward the proximal end portion 131b, (ii) an intermediate portion 135 extending proximally from the distal portion 134 and generally parallel to the longitudinal axis L, and (iii) a proximal portion 136 extending from the intermediate portion 135 in a direction toward the longitudinal axis L (e.g., at an angle relative to the longitudinal axis L) to the proximal end portion 131b. In the illustrated embodiment, the clot treatment device 130 does not include any cross struts or other cross members extending between (e.g., circumferentially between) the struts 133. That is, the struts 133 can each extend generally axially separately between the end portions 131a-b. In some aspects of the present technology, the absence of cross struts can allow the clot treatment device 130 to advance and retract through an implanted stent (or other implant) without catching on the stent (e.g., catching on the top or end of the stent), which could potentially damage, destroy, and / or dislodge the stent. In some embodiments, the clot treatment device 130 can include one or more cross members between the struts 133, but which are not configured to contact the implanted stent when the clot treatment device 130 is expanded. For example, such cross members can be positioned near the end portions 131a-b.

[0021] As best seen in FIG. 1B, in the illustrated embodiment, the struts 133 each have an undulating (e.g., wavy, sawtooth, periodic) pattern. The undulating pattern of the struts 133 can create a wear surface for breaking up / engaging clots and / or other material that adheres to the implanted stent. More specifically, because of the undulating pattern, each of the struts 133 can include one or more circumferential portions 137 that extend at least partially circumferentially about the longitudinal axis L. The circumferential portions 137 together can define a wear surface for breaking up clot material. In some aspects of the present technology, the undulations are relatively small to reduce the likelihood that the struts 133 will catch on the implanted stent as the clot treatment device 130 is advanced and retracted through the stent.

[0022] As best seen in FIG. 1C , each of the struts 133 may be at least partially reverse curved radially toward the longitudinal axis L at the intermediate portion 135 (and / or at the transition regions between the intermediate portion 135 and the distal and proximal portions 134, 136) such that the struts 133 have a wavy or hook-like shape when viewed along the longitudinal axis L. In some embodiments, this shape may help facilitate uniform folding of the clot treatment device 130. In an additional aspect of the present technology, the hook-like shape of the struts 133 may improve the ability of the clot treatment device 130 to engage and disrupt clot material within the implant while being atraumatic to areas of the native vessel outside the implant (e.g., proximal and distal to the implant).

[0023] For illustrative purposes, the clot treatment device 130 has nine struts 133 in FIG. 1B and six struts 133 in FIG. 1C. In other embodiments, the clot treatment device 130 can include any number of struts 133 (e.g., 1, 2, 3, 4, 5, 7, 8, 10, or more than 10), and the struts 133 can be positioned symmetrically or asymmetrically about the longitudinal axis L. For example, in some embodiments, the struts 133 can be positioned asymmetrically about the longitudinal axis L to facilitate targeted engagement of the struts 133 with regions of sticky clot and / or to reduce or even prevent the clot treatment device 130 from catching on curved portions of the implant (e.g., when positioning the implant within a tortuous anatomy). 10A-10C, distal portions 134 of struts 133 may be circumferentially offset from proximal portions 136 of struts 133—either permanently or via differential rotation of elongate members 102, 104—such that struts 133 assume a “scoop-like” shape when radially compressed. That is, for example, distal portions 134 of each of struts 133 may be connected to distal end portions 131a at different circumferential locations (e.g., relative to longitudinal axis L) rather than connecting proximal portions 136 of struts 133 to proximal end portions 131b.

[0024] In some embodiments, the clot treatment device 130 is a unitary / continuous structure, such as a laser cut metal (e.g., nitinol, cobalt chrome, stainless steel) element. In some embodiments, the clot treatment device 130 is configured (e.g., heat set) to self-expand from a compressed delivery state (e.g., when the clot treatment device 130 is positioned within the outer elongate member 106) to an expanded, deployed state illustrated in FIGS. 1B and 1C. In other embodiments, the clot treatment device 130 is configured (e.g., heat set) to collapse from the expanded state to the compressed delivery state. In such embodiments, biasing the clot treatment device 130 to collapse can help ensure that the clot treatment device 130 can be removed from the patient if one of the struts 133 or connection points breaks during operation, as the clot treatment device 130 will automatically collapse and be removed.

[0025] In some embodiments, the struts 133 can be curved back more or less toward the longitudinal axis L. Figures 2A-2C, for example, are close-up proximally facing views of a distal portion of a system 100 including a clot treatment device 130, in accordance with additional embodiments of the present technology. Referring together to Figures 2A-2C, the intermediate portions 135 of each of the struts 133 of the clot treatment device 130 have (i) a relatively flat profile in this embodiment of Figure 2A, (ii) a hook-shaped profile in this embodiment of Figure 2B, and (iii) a further hook-shaped profile in this embodiment of Figure 2C. In some aspects of the present technology, (i) the flatter profile shown in Figure 2A can provide a longer cutting edge to engage clot material that is adhered to the implant, (ii) the additional hook-shaped profile shown in Figure 2B can provide a smaller contact area between the clot treatment device 130 and the implant, which can reduce the possibility of the clot treatment device 130 damaging the implant and can be atraumatic to the native vessel when the clot treatment device 130 is at least partially deployed outside the implant, and (iii) the additional hook-shaped profile shown in Figure 2C can provide an even smaller cutting surface than the profile shown in Figure 2B, further reducing the possibility of implant or native vessel damage compared to the profile in Figure 2B. In some embodiments, the flatter profile shown in Figure 2A can be utilized to treat sticky clot material that is firmly adhered to the implant.

[0026] Similarly, in other embodiments, one or more of the struts 133 can have a different shape and / or profile. For example, Figures 3A-3D are close-up side views of a distal portion of a system 100 including a clot treatment device 130, according to additional embodiments of the present technology. In some embodiments, as shown in Figure 3A, the tip 108 (Figure 3B) can be omitted and the struts 133 can extend to and beyond the distal-most end of the inner elongate member 102 in the extended position. As shown in Figure 3B, one or more of the struts 133 can have a profile that includes multiple (e.g., two) bumps or peaks between the end portions 131a-b. As shown in Figure 3C, one or more of the struts 133 can have an axial apex (e.g., including a proximal tapered portion) positioned near the distal end portion 131a. As shown in FIG. 3D, one or more of the struts 133 can have an axial apex (eg, including a distal tapered portion) positioned near the proximal end portion 131b.

[0027] 4A-C are enlarged isometric views of a distal portion of the system 100 including one of the struts 133 of the clot treatment device 130, according to additional embodiments of the present technology. As shown in FIG. 4A, one or more of the struts 133 can have a profile that includes multiple (e.g., two) bumps or peaks between the end portions 131a-b and does not extend radially around the longitudinal axis L and the inner elongated member 102 (FIG. 1B). As shown in FIG. 4B, one or more of the struts 133 can have a profile that includes a smoothly tapered shape between the distal end portion 131a and the proximal end portion 131b. As shown in FIG. 4C, one or more of the struts 133 can extend radially (e.g., helically around) the longitudinal axis L and the inner elongated member 102 (FIG. 1B) between the end portions 131a-b.

[0028] 5 is a partial cutaway view of the handle 110 of FIG. 1A in accordance with an embodiment of the present technology. In the illustrated embodiment, the handle 110 includes a housing 514 having a distal portion 515a and a proximal portion 515b and defining an internal chamber or lumen 516. The housing 514 is shown as partially cut away in FIG. 5 for clarity. The proximal portion 105b of the middle elongated member 104 can be fixedly coupled to the distal portion 515a of the housing 514. In some embodiments, the handle 110 includes a flush port 517 operably (e.g., fluidly) coupled to the lumen of the middle elongated member 104. The inner elongated member 102 can extend through the lumen of the middle elongated member 104, past the proximal portion 105b of the middle elongated member 104, and into the lumen 516 of the housing 514. In some embodiments, the inner elongated member 102 can extend completely through the housing 514 to a flush port 518 coupled to a proximal portion 515 of the housing 514 .

[0029] In the illustrated embodiment, the handle 110 further comprises a lead screw 520 attached to the inner elongate member 102 and movably positioned within the lumen 516 over one or more guide rails 522 (e.g., a pair of guide rails 522). The lead screw 520 can have a threaded outer surface configured to mate with a threaded inner surface of the actuator 112 (shown partially in see-through in FIG. 5 for clarity). Alternatively, the lead screw 520 can have a threaded inner surface configured to mate with a threaded outer surface of the actuator 112, as described in more detail below, for example, with reference to FIG. 26. The actuator 112 can extend out of the housing 514 from one or more openings 519 therein (e.g., a pair of openings on either side of the housing 514) such that a user (e.g., a physician) of the handle 110 can access the actuator 112 outside the housing 514. In some embodiments, the handle 110 further includes a lead screw knob 521 (shown partially see-through in FIG. 2 for clarity) coupled to the actuator 112 and configured to threadably engage the lead screw 520 throughout the entire range of motion of the actuator 112.

[0030] Rotation of the actuator 112 relative to the housing 514 (e.g., by a user) can drive the lead screw 520 to translate proximally and / or distally (e.g., between the distal and proximal portions 515a and 515b of the housing 514), thereby driving the attached inner elongate member 102 to translate relative to the middle elongate member 104. This relative movement of the elongate members 102, 104 lengthens / shortens the clot treatment device 130 (FIGS. 1A-1C) and radially compresses / expands the clot treatment device 130. More specifically, FIGS. 6A and 6B are side views of a distal portion of a system 100 including a clot treatment device 130 in a first position (e.g., a radially expanded position) and a second position (e.g., a radially compressed position), respectively, in accordance with an embodiment of the present technology. 5-6B together, in a first position (FIG. 6A), the clot treatment device 130 is radially expanded to have a first diameter D1 and a first length X1, and in a second position, the clot treatment device 130 is radially compressed to have a second diameter D2 smaller than the first diameter D1 and a second length X2 longer than the first length X1. In both the first and second positions, the clot treatment device 130 has been advanced distally from the outer elongate member 106 (e.g., beyond its distal end portion 107a).

[0031] To move the clot treatment device 130 from a first position to a second position, a user can rotate the actuator 112 in a first direction to drive the lead screw 520 distally through the housing 514. This movement drives the inner elongated member 102 distally through the lumen of the middle elongated member 104, thereby radially compressing the clot treatment device 130 while driving the distal end portion 131a of the clot treatment device 130 distally relative to the proximal end portion 131b, lengthening the clot treatment device 130. Conversely, to move the clot treatment device 130 from the second position to the first position, a user can rotate the actuator 112 in a second direction opposite the first direction to drive the lead screw 520 proximally through the housing 514. This movement drives the inner elongate member 102 proximally through the lumen of the middle elongate member 104, thereby radially expanding the clot treatment device 130 while driving the distal end portion 131a of the clot treatment device 130 proximally relative to the proximal end portion 131b, shortening the clot treatment device 130. Although two separate positions are shown in Figures 6A and 6B, the clot treatment device may be expanded to any number of consecutive positions therebetween, to a position more radially expanded than the first position, and / or to a position less radially expanded than the second position. Additionally, in other embodiments, the intermediate elongated member 104 can be operably coupled to the lead screw 520 and actuator 112 instead of or in addition to the inner elongated member 102 such that actuation of the actuator 112 drives the intermediate elongated member 104 relative to the inner elongated member 102, or drives both the inner elongated member 102 and the intermediate elongated member 104 relative to the handle 110 to radially expand / compress the clot treatment device 130.

[0032] 1A, in some embodiments, the handle 110 can further include an indicator 111, such as a slider, configured to provide a visual indication of the amount of radial expansion of the clot treatment device 130. The indicator 111 can indicate, for example, whether the clot treatment device 130 is in a first position or a second position. In some embodiments, the indicator 111 includes detents and / or other features that provide an indication (e.g., a "click" sound) when the clot treatment device 130 is incrementally (e.g., every millimeter) expanded / collapsed. Similarly, the indicator 111 can include markings that indicate the expanded size of the clot treatment device 130, for example, as described in more detail below with reference to FIGS. 25A-26.

[0033] 1A-1C together, in another embodiment, the handle of the system 100 can include a first member coupled to the inner elongate member 102 and a second member coupled to the middle elongate member 104. One or both of the first and second members can be manually moved relative to one another (e.g., without any mechanical advantage provided by a lead screw, gears, etc.) to radially expand / compress the clot treatment device 130 as shown in FIGS. 6A and 6B.

[0034] 7 is a flow diagram of a process or method 740 for operating system 100 to remove material from a patient-carrying implant during an endovascular procedure in accordance with an embodiment of the present technology. Although certain features of method 740 are described in the context of the embodiment shown in FIGS. 1A-6B for illustrative purposes, one of ordinary skill in the art will readily appreciate that method 740 can be performed using other suitable systems and / or devices described herein.

[0035] At block 741, the method 740 can include advancing the system 100 through the patient's vasculature to or near an implant implanted within the patient. The implant can be identified as having clot material or other undesirable material (e.g., intimal hyperplasia) adhered thereto that would be beneficial to remove. In some embodiments, the implant is a stent implanted within the patient's venous vasculature. In other embodiments, the implant can be a graft, an embolic filter, an inferior vena cava (IVC) filter, and / or other types of implants. In other embodiments, the method 740 can be used to clean and remove clot material from the patient's bare blood vessels. In some embodiments, the elongate members 102-106 can be advanced together through the vasculature with the clot treatment device 130 restrained within the outer elongate member 106. The tip 108 can provide for atraumatic advancement of the system 100 through the vasculature to the implant. In other embodiments, the outer elongate member 106 may first be positioned within the vasculature, and then the clot treatment device 130 may be advanced through the vasculature to the implant.

[0036] At block 742, the method 740 can include deploying the clot treatment device 130 within the implant. For example, the handle 110 can be advanced distally (e.g., by a physician pushing) relative to the outer elongate member 106 to advance the elongate members 102, 104 and the combined clot treatment device 130 distally out of the distal end portion 107a of the outer elongate member 106. In some embodiments, once the clot treatment device 130 is no longer constrained by the outer elongate member 106, the clot treatment device 130 can at least partially radially expand (e.g., self-expand).

[0037] At block 743, the method 740 can include further radially expanding the clot treatment device 130. For example, the clot treatment device 130 can be radially expanded by actuating the actuator 112 of the handle 110 to drive the inner elongate member 102 proximally relative to the middle elongate member 104, thereby moving the distal end portion 131a of the clot treatment device 130 toward the proximal end portion 131b, thereby deflecting the struts 133 radially outward away from the longitudinal axis L. In some embodiments, the clot treatment device 130 expands radially outward to contact clot material adhered to the implant or the implant itself. In some aspects of the present technology, such radial expansion can include a mechanical "ballooning" effect of the clot treatment device 130. For example, the clot treatment device 130 may be expanded within a distorted or compressed stent to balloon the stent open and / or disrupt clot material, intimal hyperplasia, and / or other material within the stent so that the clot treatment device 130 can more effectively engage and disrupt clot material within the stent (block 744). In some embodiments, the clot treatment device 130 may be expanded within a bare vessel (e.g., outside of a stent) to perform angioplasty. The clot treatment device 130 may provide a radially outward mechanical force (e.g., pressure) of about 0.1-30 atmospheres, about 0.1-6 atmospheres, etc. The outward mechanical force may be determined by the width and thickness of the struts 133 and / or the amount the clot treatment device 130 may be expanded (e.g., the distance the lead screw 520 may be advanced), with greater strut thickness, strut width, and / or device expansion producing a greater outward mechanical force (and vice versa). In some aspects of the present technology, the clot treatment device advantageously does not include the rupture failure mode of many conventional balloon treatment devices.

[0038] At block 744, the method 740 includes mechanically engaging the clot treatment device 130 with the clot material within the implant to at least partially remove the clot material. For example, the clot treatment device 130 can rotate, translate, and / or radially compress / expand within the implant to engage and remove the clot material. Thus, in some aspects of the present technology, the clot treatment device 130 can function similar to a mechanical scoring balloon. More specifically, FIG. 8 is a distally facing perspective view of a distal portion of a system 100 including a clot treatment device 130 expanded within an implant 850 (e.g., a stent) implanted in a blood vessel V, according to an embodiment of the present technology. For clarity, FIG. 8 omits the clot material to be removed. The implant 850 can be comprised of multiple interconnected struts of a medical device (e.g., a stent) implantable within a blood vessel, graft material, mesh, and / or other components known in the art.

[0039] In the illustrated embodiment, the clot treatment device 130 is expanded within the lumen 852 of the implant 850 such that the struts 133 contact the inner surface of the implant 850. In some embodiments, the struts 133 are the only portion of the clot treatment device 130 that contacts the implant 850 when the clot treatment device 130 is expanded. With reference together to Figures 1A and 8, the clot treatment device 130 can (i) be translated distally or proximally within the implant 850 (e.g., as shown by arrow A in Figure 8) by moving the handle 110 distally or proximally, and / or (ii) be rotated clockwise or counterclockwise within the implant 850 (e.g., as shown by arrows C and CC, respectively, in Figure 8) by rotating the handle 110. As described in detail above, the elongate members 102, 104 can be formed to be highly torqueable and have high compression / tensile resistance so that movement of the handle 110 can be translated without much loss relative to the clot treatment device 130. In some aspects of the present technology, the struts 133 are configured not to catch, grip, or damage the implant 850 when the clot treatment device 130 is moved relative to the implant 850, e.g., the struts 133 extend generally axially along the translation direction and do not include any cross members or open cells. Additionally, the contours of the struts 133 (e.g., circumferential portion 137) together define wear surfaces for breaking up, cutting, and / or removing clot material adhered to the implant 850. Thus, in some aspects of the present technology, the system 100 can be used to remove chronically adherent clots while significantly reducing the risk of damaging the implant 850.

[0040] Referring again to FIG. 7, at block 745, the method 740 optionally includes folding and repositioning the clot treatment device 130. For example, if the clot treatment device 130 becomes stuck or entangled with the implant, the clot treatment device 130 may be radially compressed (e.g., from a first position to a second position, as shown in FIG. 6A and FIG. 6B, respectively) to disengage the implant. For example, FIG. 9A and FIG. 9B are distally facing perspective views of a distal portion of a system 100 including a clot treatment device 130 positioned within an implant 850 in a blood vessel V, according to an embodiment of the present technology. FIG. 9A illustrates the clot treatment device 130 in a radially expanded position and at least partially entangled with an end portion 954 of the implant 850. If such entanglement occurs, the clot treatment device 130 may be radially compressed as shown in FIG. 9B to release the struts 133 from the implant 850. In some aspects of the present technology, the clot treatment device 130 does not include any cross members between the struts 133, so that radial compression of the clot treatment device 130 can disengage the struts 133 from the implant 850 without catching on or pulling on the implant 850.

[0041] 7, at block 746, the method 740 can include capturing the at least partially dislodged clot material, for example, within the outer elongate member 106. In some embodiments, the clot material dislodged from the implant (block 744) can flow into the outer elongate member 106 via blood pressure in the blood vessel. In some embodiments, the clot treatment device 130 can be retracted proximally into the outer elongate member 106 to pull the clot material into the outer elongate member 106.

[0042] Finally, in block 747, the system 100 may be withdrawn from the patient. For example, the clot treatment device 130 may be retracted proximally into the outer elongate member 106 (e.g., by withdrawing the handle 110 proximally relative to the outer elongate member 106) and radially constrained therein. The outer elongate member 106 and the constrained clot treatment device 130 may then be withdrawn together from the patient.

[0043] 10A-10C are distally facing perspective views of a distal portion of a system 100 including a clot treatment device 130 expanded within an implant 1050 with different radial expansion amounts in accordance with an embodiment of the present technology. More specifically, FIGs. 10A-10C illustrate increasing radial expansion amounts caused by, for example, further actuation of the actuator 112 of the handle 110 to move the distal end portion 131a of the clot treatment device 130 proximally toward the proximal end portion 131b of the clot treatment device, as shown in and described in detail with reference to FIGs. 1A-6B. Alternatively, FIGs. 10A-10C illustrate the same radial expansion amounts of the clot treatment device 130 with the implant 1050 having decreasing diameters E1-E3.

[0044] 10A-10C together, as the clot treatment device 130 expands further within the implant 1050, the struts 133 may gradually flex and bend inwardly, each assuming a scoop-like shape. More specifically, the distal and proximal portions 134, 136 of each strut may flex such that they are circumferentially offset relative to the longitudinal axis L (FIG. 1B) of the clot treatment device 130. Such radial offset may be facilitated by the differing characteristics of the elongated members 104, 106. For example, as described in detail above, the inner elongated member 102 may be constructed of a solid tube, while the middle elongated member 104 may be constructed of a hollow helical spiral, such that a greater degree of rotation is imparted to the middle elongated member 104. Thus, when the clot treatment device 130 rotates to engage a stent or other implant, frictional / engagement forces on the clot treatment device 130 may cause the more flexible middle elongated member 104 to rotate less than the inner elongated member 102, thereby rotating the distal end portion 131a (FIGS. 6A and 6B) of the clot treatment device 130 more than the proximal end portion 131b (FIGS. 6A and 6B) to create the scoop-like shape. In some aspects of the present technology, the scoop-like shape of the struts 133 shown in FIG. 10B and FIG. 10C may facilitate more effective removal of clot material from the implant 1050. In other embodiments, the elongated members 104, 106 may be coupled to handles that are configured to rotate the elongated members 104, 106 at different speeds to circumferentially offset the distal and proximal end portions of the struts 133, thereby facilitating the scoop-like shape.

[0045] 11A is a side view of a stent cleaning system 1100 ("system 1100") in accordance with an embodiment of the present technology. System 1100 may include some features that are at least substantially similar or identical in structure and function to corresponding features of system 1100 described in detail above with reference to FIGS. 1A-10C, and may operate in a substantially similar or identical manner as system 100. For example, in the illustrated embodiment, system 1100 includes a clot treatment device 1130 having a distal end portion 1131a coupled to inner elongate member 102 and a proximal end portion 1131b coupled to middle elongate member 104. Elongate members 102, 104 are operably coupled to a handle 1110 configured to extend through outer elongate member 106 to radially expand / compress clot treatment device 1130. In some embodiments, the system 1100 is configured for use in the peripheral vasculature to treat chronic peripheral clots within a stent or other implant, or within bare blood vessels.

[0046] 11B and 11C are side views of a distal portion of a system 1100 including a clot treatment device 1130 in a first position (e.g., a radially expanded position) and a second position (e.g., a radially compressed position), respectively, in accordance with an embodiment of the present technology. In the illustrated embodiment, the clot treatment device 1130 includes a plurality of interconnected struts 1133 extending between a distal end portion 1131a and a proximal end portion 1131b. In some embodiments, the struts 1133 define a plurality of proximal cells 1160 and a plurality of distal cells 1162. In the illustrated embodiment, the proximal cells 1160 are larger than the distal cells 1162. That is, the clot treatment device 1130 can have fewer struts 1133 near the proximal end portion 1131b than near the distal end portion 1131a. The clot treatment device 1130 can be formed of a self-expanding material such as Nitinol and can be of unitary / one-piece construction. In some embodiments, the clot treatment device 1130 can be at least substantially similar in structure and function, or can be identical in structure and function, to any of the clot treatment devices disclosed in U.S. Patent Application No. 17 / 072,909, filed October 16, 2020, entitled "SYSTEMS, DEVICES, AND METHODS FOR TREATING VASCULAR OCCLUSIONS," which is incorporated herein by reference in its entirety.

[0047] 11A, the handle 1110 can include a first actuator 1112 coupled to one of the elongate members 102, 104 (e.g., the inner elongate member 102). The other of the elongate members 102, 104 (e.g., the middle elongate member 104) can be fixedly coupled to the handle 1110. In the illustrated embodiment, the first actuator 1112 is a tension member configured to pull proximally or advance distally to move the elongate members 102, 104 relative to one another to radially compress or expand the clot treatment device 1130. In some embodiments, the handle 1110 further includes a second actuator 1119 operably coupled to both the elongate members 102, 104 and configured to rotate to rotate the elongate members 102, 104 together to rotate the clot treatment device 1130.

[0048] 11A-11C together, in operation the handle 1110 can be advanced distally and retracted proximally relative to the outer elongate member 106 to advance the clot treatment device 1130 out of and / or retract the clot treatment device 1130 into the outer elongate member 106. Upon advancing the clot treatment device 1130 out of the outer elongate member 106, the clot treatment device 1130 can self-expand, for example, within a stent or other implant being cleaned. The first actuator 1112 can be pulled / retracted to move the clot treatment device 1130 between a first position and a second position shown in FIGS. 11B and 11C. For example, when the first actuator 1112 is coupled to the inner elongate member 102, the first actuator 1112 can be advanced distally to drive the inner elongate member 102 distally relative to the middle elongate member 104 and drive the distal end portion 1131a of the clot treatment device 1130 distally relative to the proximal end portion 1131b to compress the clot treatment device 1130 (e.g., move the clot treatment device 1130 from a first position to a second position). Similarly, the first actuator 1112 can be retracted proximally to drive the inner elongate member 102 proximally relative to the middle elongate member 104 and drive the distal end portion 1131a of the clot treatment device 1130 proximally relative to the proximal end portion 1131b to expand the clot treatment device 1130 (e.g., move the clot treatment device 1130 from the second position to the first position). The second actuator 1119, when rotated, can rotate the elongate members 102, 104 together to rotate the clot treatment device 1130 to either a first position or a second position. Thus, the system 1100, when expanded within a stent or other implant, is operable to radially expand, translate, and / or rotate the clot treatment device 1130 within the stent to mechanically engage and dislodge clots or other material adhered thereto.

[0049] 12 is a side view of a clot treatment device 1230, in accordance with an embodiment of the present technology. The clot treatment device 1230 can include some features that are at least substantially similar or identical in structure and function to corresponding features of the clot treatment devices 130 and / or 1130 described in detail above with reference to FIGS. 1A-11C, and can be employed in a clot treatment system (e.g., system 100 or 110) in a substantially similar or identical manner to mechanically engage and remove clot material within an implanted stent or other implant.

[0050] In the illustrated embodiment, the clot treatment device 1230 includes a plurality of interconnected struts extending between a distal end portion 1231a and a proximal end portion 1231b. More specifically, the clot treatment device 1230 can include (i) a distal strut 1264 extending generally axially from the distal end portion 1231a relative to a longitudinal axis L of the clot treatment device 1230, (ii) a proximal strut 1266 extending generally axially from the proximal end portion 1231b relative to the longitudinal axis L of the clot treatment device 1230, and (iii) a diagonal strut 1265 connecting the distal strut 1264 to the proximal strut 1266. The diagonal strut 1265 can extend at least partially circumferentially relative to the longitudinal axis L in an intermediate region of the clot treatment device 1230 and can have a chevron or ring pattern. In some aspects of the present technology, the diagonal struts 1265 can facilitate increased torque response of the clot treatment device 1230, while the distal struts 1264 and proximal struts 1266 can extend generally axially to allow the clot treatment device 1230 to advance and retract through an implanted stent without snagging on the stent, which could potentially damage or dislodge the stent.

[0051] 13 is a side view of a clot treatment device 1330, in accordance with an embodiment of the present technology. The clot treatment device 1330 can include some features that are at least substantially similar or identical in structure and function to corresponding features of the clot treatment devices 130, 1130, and / or 1230 described in detail above with reference to FIGS. 1A-12, and can be employed in a clot treatment system (e.g., system 100 or 1100) in a substantially similar or identical manner to mechanically engage and remove clot material within an implanted stent or other implant.

[0052] In the illustrated embodiment, the clot treatment device 1330 includes a plurality of interconnected struts extending between a distal end portion 1331 a and a proximal end portion 1331 b. More specifically, the clot treatment device 1330 can include (i) distal struts 1364 extending from the distal end portion 1331 a, (ii) proximal struts 1366 extending from the proximal end portion 1331 b, and (iii) intermediate struts 1365 (e.g., spanning struts, axial struts) extending between the distal struts 1364 and the proximal struts 1366. In some embodiments, the clot treatment device 1330 includes fewer intermediate struts 1365 than the distal struts 1364 and the proximal struts 1366, and the intermediate struts 1365 can be longer than the distal struts 1364 and the proximal struts 1366. In the illustrated embodiment, the middle struts 1365 extend in a spiral or helical pattern relative to the longitudinal axis L of the clot treatment device 1330. The distal struts 1364 and the proximal struts 1366 can have a chevron or ring pattern. In some aspects of the present technology, the spiral shape of the middle struts 1365 can facilitate increased torque response of the clot treatment device 1330 while also reducing engagement of the clot treatment device 1330 with an implanted stent. In some embodiments, the clot treatment device 1330 can be rotated (e.g., by rotating the distal and proximal end portions 1331a, 1331b in opposite directions) such that the middle struts 1365 bend away from the ends of the implanted stent to further reduce stent engagement.

[0053] 14 is a side view of a clot treatment device 1430, in accordance with an embodiment of the present technology. The clot treatment device 1430 can include some features that are at least substantially similar or identical in structure and function to corresponding features of the clot treatment devices 130, 1130, 1230, and / or 1330 described in detail above with reference to FIGS. 1A-13, and can be employed in a clot treatment system (e.g., system 100 or 1100) in a substantially similar or identical manner to mechanically engage and remove clot material within an implanted stent or other implant.

[0054] In the illustrated embodiment, the clot treatment device 1430 includes a plurality of interconnected struts extending between a distal end portion 1431 a and a proximal end portion 1431 b. More specifically, the clot treatment device 1430 can include (i) a distal strut 1464 extending from the distal end portion 1431 a, (ii) a proximal strut 1466 extending from the proximal end portion 1431 b, and (iii) an intermediate strut 1465 (e.g., a spanning strut, an axial strut) extending between the distal strut 1464 and the proximal strut 1466 and generally axially relative to a longitudinal axis L of the clot treatment device 1430. In some embodiments, the clot treatment device 1430 includes fewer middle struts 1465 than the distal struts 1464 and the proximal struts 1466, and the middle struts 1465 can be longer than the distal struts 1464 and the proximal struts 1466. In some aspects of the present technology, the distal struts 1464 and the proximal struts 1466 can facilitate increased torque response of the clot treatment device 1430, while the axially extending middle struts 1465 can reduce engagement of the clot treatment device 1430 with an implanted stent. In some embodiments, the clot treatment device 1430 further includes bumps 1467 (e.g., radially extending portions) on the middle struts 1465 that are configured to increase the radial force of the clot treatment device 1430, for example, to engage and dislodge the most adherent clots or other material within the implanted stent.

[0055] 15 is a side view of a clot treatment device 1570, in accordance with an embodiment of the present technology. The clot treatment device 1570 can include some features that are at least substantially similar or identical in structure and function to corresponding features of the clot treatment devices 130, 1130, 1230, 1330, and / or 1430 described in detail above with reference to FIGS. 1A-14, and can be employed in a clot treatment system (e.g., system 100 or 1100) in a substantially similar or identical manner to mechanically engage and remove clot material within an implanted stent or other implant.

[0056] In the illustrated embodiment, the clot treatment device 1570 includes an inner clot treatment device 1530 and an outer clot treatment device 1572 (e.g., a stent protection element) that houses the inner clot treatment device 1530. The inner clot treatment device 1530 may be identical to any of the clot treatment devices 130, 1130, 1230, 1330, and / or 1430 described in detail above with reference to Figures 1A-14, and in the illustrated embodiment is identical to the clot treatment device 1330 of Figure 13. In the illustrated embodiment, the outer clot treatment device 1572 includes a distal end portion 1571a, a proximal end portion 1571b, and a plurality of struts 1573 extending (e.g., axially) between the distal end portion 1571a and the proximal end portion 1571b. The proximal end portion 1571b can be coupled to the elongate member 1574, and the inner clot treatment device 1530 can be advanced through a lumen of the elongate member 1574 or can be fixed relative to the elongate member 1574. In some embodiments, the outer clot treatment device 1572 is configured to radially expand and / or compress via movement of the inner clot treatment device 1530. For example, the outer clot treatment device 1572 can be formed of nitinol or another relatively flexible material such that expansion of the inner clot treatment device 1530 (e.g., via any of the handles described above) also causes the outer clot treatment device 1572 to expand.

[0057] During a clot treatment procedure, the outer clot treatment device 1572 can directly engage the implanted stent while the inner clot treatment device 1530 rotates within the implanted stent and / or while the clot treatment device 1570 translates distally and / or proximally within the implanted stent. Additionally, the outer clot treatment device 1572 can be secured against rotation with the inner clot treatment device 1530 via connection to the elongate member 1574. In some aspects of the present technology, the outer clot treatment device 1572 can partially or completely protect the implanted stent from direct contact with the inner clot treatment device 1530, thereby reducing stent engagement that may damage or destroy the stent. Additionally, the outer clot treatment device 1572 can provide a large inner diameter that still allows the inner clot treatment device 1530 to engage and destroy clots or other material that has adhered to the stent.

[0058] 16A-16C are side views of a clot treatment device 1630, in accordance with an embodiment of the present technology. The clot treatment device 1630 can include some features that are at least substantially similar or identical in structure and function to corresponding features of the clot treatment devices 130, 1130, 1230, 1330, 1430, and / or 1530 described in detail above with reference to FIGS. 1A-15, and can be employed in a clot treatment system (e.g., system 100 or 1100) in a substantially similar or identical manner to mechanically engage and remove clot material within an implanted stent or other implant.

[0059] 16A-16C together, the clot treatment device 1630 includes a plurality of struts 1633 extending between a distal end portion 1631a and a proximal end portion 1631b. With reference to FIG. 16A, the clot treatment device 1630 can include a distal clot retrieval member 1678. The clot retrieval member 1678 can be comprised of a plurality of high-density cells formed by the struts 1633, or a separate member attached to the struts 1633, such as a bag (e.g., a mesh bag, a short Nitinol bag, etc.). In some aspects of the present technology, the clot retrieval member 1678 can capture clot material as the clot treatment device 1630 moves (e.g., translates, rotates) within the implanted stent. With reference to FIG. 16B, in some embodiments, the clot treatment device 1630 can further include an expandable member 1679, such as a balloon, positioned radially within the struts 1633. The expandable member 1679 can expand to compress the struts 1633 radially outward to provide additional support, for example, to remove sticky clot material from an implanted stent. In the illustrated embodiment, the expandable member 1679 is positioned only in a proximal portion of the clot treatment device 1630. In other embodiments, the expandable member 1679 can be positioned along the entire length of the clot treatment device 1630 or in a different portion (e.g., a distal portion) of the clot treatment device 1630. For example, as shown in FIG. 16C, the expandable member 1679 is positioned along the entire length of the clot treatment device 1630. Additionally, in the illustrated embodiment, the clot retrieval member 1678 is omitted.

[0060] 17A and 17B are side views of a distal portion of a stent cleaning system 1700 ("system 1700") in accordance with an embodiment of the present technology. Referring together to FIGS. 17A and 17B, the system 1700 includes an elongate member 1706 and a clot treatment device 1780 advanceable through the elongate member 1706. The clot treatment device 1780 includes a pair of expandable arms 1782, which may be formed of Nitinol or a similar material. In FIG. 17A, the clot treatment device 1780 is constrained within the elongate member 1706 such that the arms 1782 extend generally linearly through the lumen of the elongate member 1706. FIG. 17B illustrates the clot treatment device 1780 after it has been advanced from the elongate member 1706. In the illustrated embodiment, the arms 1782 are configured to radially expand and reverse curve proximally (e.g., each forming a U-shaped shape) when unconstrained by the elongate member 1706. The clot treatment device 1780 can be deployed within an implanted stent and rotated to engage and remove (e.g., cut) clots or other material adhered to the stent. In some embodiments, the arms 1782 can each have a tapered end portion 1784 configured to prevent the arms 1782 from interacting with or damaging the stent.

[0061] In any of the embodiments described above with reference to Figures 1A-17B, the clot treatment device may include struts with chamfers or angles to improve the ability of the clot treatment device to cut through adherent clot surfaces. At the same time, such chamfers may allow the struts to be relatively thickened to increase the radial force of the struts. More specifically, for example, Figure 18 illustrates several struts with different chamfers that may be used in a clot treatment device in accordance with an embodiment of the present technology. Figure 19 is an enlarged side view of a pair of struts 1933 of a clot treatment device, each having a chamfered edge 1986 in accordance with an embodiment of the present technology.

[0062] In other embodiments, handles in accordance with the present technology can have other configurations for (i) driving a pair of elongate members (e.g., elongate members 102, 104 of FIGS. 1A-1C) relative to one another to radially expand / compress a clot treatment device (e.g., clot treatment device 130) and / or (ii) rotating a clot treatment device. Figures 21-27 illustrate handles and / or handle components that can be incorporated into system 100, system 1100, and / or another suitable system, for example, instead of or in addition to handle 110 and / or handle 1110, in accordance with embodiments of the present technology. The various handles can include some features that are at least substantially similar or identical in structure and function to corresponding features of each other, of handle 110 described in detail above with reference to Figures 1A-1C and 5, and / or of handle 1110 described in detail above with reference to Figures 11A-11C, and can operate in a substantially similar or identical manner to each other, handle 110, and / or handle 1110. Additionally, although often described in the context of operating clot treatment device 130 shown in Figures 1A-1C, the handles of the present technology can be used to operate / control any of the clot treatment devices of the present technology.

[0063] 20 is a side cross-sectional view of a handle 2010 that may be incorporated into (e.g., used in) a system 100 (e.g., in place of handle 110), for example, in accordance with an embodiment of the present technology. In the illustrated embodiment, the handle 2010 includes a housing 2014 and a lead screw 2020 movably positioned within the housing 2014 and constrained by / on one or more guide rails 2022 (e.g., a pair of guide rails 2022). The lead screw 2020 may have a threaded outer surface configured to mate with a threaded inner surface of the actuator 2012, which extends outside of the housing 2014 such that the actuator 2012 is accessible outside of the housing 2014 by a user (e.g., a physician) of the handle 2010. The inner elongated member 102 may be secured to the lead screw 2020, and the middle elongated member 104 (not shown) may be secured to the housing 2014. Thus, actuation (e.g., rotation) of the actuator 2012 drives the lead screw 2020 proximally / distally through the housing 2014, driving the inner elongate member 102 relative to the middle elongate member 104 to radially compress / expand the clot treatment device 130 as shown in Figures 6A and 6B.

[0064] In the illustrated embodiment, the handle 2010 further includes a locking mechanism 2024 coupled to the housing 2014. The locking mechanism 2024 can include a locking member 2025 configured to engage the lead screw 2020 and / or the actuator 2012 to inhibit movement of the lead screw 2020 through the housing 2014. In the illustrated embodiment, the locking mechanism 2024 is in a locked position where the locking member 2025 engages the actuator 2012 to inhibit movement of the actuator 2012 and the lead screw 2020. In some embodiments, a user actuates (e.g., pushes, translates, rotates, depresses) the locking mechanism 2024 to pull the locking member 2025 away from the actuator 2012 to allow the lead screw 2020 to move through the housing 2014. Thus, with additional reference to Figures 6A and 6B, a user can selectively engage the locking mechanism 2024 to lock the clot treatment device 130 in a first position, a second position, or / and another position.

[0065] 21 is a side cross-sectional view of a handle 2110 that may be incorporated into the system 100 (e.g., in place of the handle 110) in accordance with an additional embodiment of the present technology. In the illustrated embodiment, the handle 2110 includes a housing 2114 that contains an actuating fluid 2180. A fluid port 2182 is coupled to the housing 2114 and configured to allow the actuating fluid 2180 to enter and exit the housing 2114 via a fluid control system (not shown). The inner elongated member 102 may be coupled to a flange 2181 positioned within the housing 2114 and configured to sealingly engage the housing 2114 such that the actuating fluid 2180 is positioned only between the flange 2181 and the fluid port 2182. Thus, in operation, the actuating fluid 2180 can be pumped / displaced relative to the housing 2114 to drive the flange 2181 distally / proximally through the housing 2114 and drive the inner elongate member 102 relative to the middle elongate member 104 to radially expand / compress the clot treatment device 130 as shown in Figures 3A and 3B. Thus, in some aspects of the present technology, the handle 2110 can be a pneumatically and / or hydraulically operated handle.

[0066] 22 is an isometric view of an actuation mechanism 2290 of a handle that can be incorporated into the system 100, in accordance with an embodiment of the present technology. In the illustrated embodiment, the actuation mechanism 2290 includes an actuator 2212 operably coupled to a housing or other component of the handle (not shown) via one or more biasing members 2291, such as a coil spring. The actuator 2212 can be operably coupled to (e.g., integrally formed with) a gear rack 2292 having a plurality of teeth configured to engage a first gear 2293 mounted on a first shaft 2294. A second gear 2295 can be mounted on the first shaft 2294 and coupled to the first gear 2293, and can be configured to engage a third gear 2297 mounted on a second shaft 2296. In some embodiments, the second gear 2295 is larger than the first gear 2293. In the illustrated embodiment, the second shaft 2296 is coupled to a one-way ratchet mechanism 2298 that includes, for example, teeth 2286 that interact with circumferentially arranged indentations 2288 to allow only counterclockwise rotation.

[0067] Thus, in operation, a user can press the actuator 2212 linearly against the biasing force of the biasing member 2291 to drive the gear rack 2292 linearly relative to the first gear 2293. The movement of the gear rack 2292 rotates the first gear 2293 through the engagement of the gear rack 2292 and the first gear 2293. The rotation of the first gear 2293 rotates the coupled second gear 2295, which in turn rotates the third gear 2297 through the engagement of the second gear 2295 and the third gear 2297. In some embodiments, the larger size of the second gear 2295 increases the rotational speed of the first gear 2293. In some embodiments, the second gear 2295 can be omitted and the first gear 2293 can be directly engaged with the third gear 2297, or the first shaft 2294 can be directly engaged with the ratchet mechanism 2298. The ratchet mechanism 2298 inhibits or even prevents the third gear 2297 from rotating in more than one direction, such as when the biasing member 2291 returns the actuator 2212 to its initial position after it has been depressed. Thus, the actuation mechanism 2290 translates linear motion of the actuator 2212 into unidirectional rotation of the ratchet mechanism 2298 and the third gear 2297. The ratchet mechanism 2298 and / or the third gear 2297 may be directly coupled to one or both of the elongate members 102, 104 (FIGS. 1A-1C), such that the actuation mechanism 2290 is configured to rotate the elongate members 102, 104, or the ratchet mechanism 2298 and / or the third gear 2297 may be coupled to a lead screw or other device, such that the actuation mechanism 2290 drives the elongate members 102, 104 relative to one another to radially expand / compress the clot treatment device 130 as shown in FIGS. 3A and 3B, as described in detail above.

[0068] In some embodiments, a handle coupled to a clot treatment device can include one or more features to inhibit or even prevent over-extension and / or over-torquing of the clot treatment device. FIG. 23 is a side view of a handle 2310 that can be incorporated into the system 100 (e.g., in place of the handle 110) according to additional embodiments of the present technology, for example. In the illustrated embodiment, the handle 2310 includes a distal handle portion 2370 and a proximal handle portion 2372. The distal handle portion 2370 can be coupled to a lead screw 2320 coupled to one of the elongated members 102, 104 (e.g., the inner elongated member 102). In the illustrated embodiment, the distal handle portion 2370 is coupled to the proximal handle portion 2372 via a number of balls 2371, such as spring-loaded ball bearings, positioned in corresponding detents formed between the distal handle portion 2370 and the proximal handle portion 2372. Thus, in operation, rotation of the proximal handle portion 2372 below a predetermined torque level determined by the ball 2371 and associated detents rotates the distal handle portion 2370 and lead screw 2320, advancing one of the elongate members 102, 104 (e.g., the inner elongate member 102) relative to the other of the elongate members 102, 104 to radially compress / expand the attached clot treatment device 130. However, rotation of the proximal handle portion 2372 above a predetermined torque level (e.g., if the user turns the proximal handle portion 2372 too quickly and / or continues to torque the proximal handle portion 2372 while the clot treatment device 130 is significantly engaged with the implant), causes the upper ball 2371 to slip off the detent, thereby rotating the proximal handle portion 2372 relative to the distal handle portion 2370 without rotating the distal handle portion 2370. In this manner, the handle 2310 is configured to maintain the torque level of the clot treatment device 130 and the associated force on the implant below a predetermined level.

[0069] In other embodiments, some or all of the balls 2371 and corresponding detents can be replaced with other mechanisms for inhibiting over-torquing of the clot treatment device 130. For example, some or all of the balls 2371 can be replaced with multiple pairs of magnets, including a first one of the pairs coupled to the distal handle portion 2370 and a second one of the pairs coupled to the proximal handle portion 2372. The magnets can be selected such that when the handle 2310 is over-torqued, the multiple pairs of magnets disengage from one another (e.g., shear away) to allow the proximal handle portion 2372 to rotate relative to the distal handle portion 2370 without rotating the distal handle portion 2370.

[0070] 24 is a side view of a handle 2410 that can be incorporated into the system 100 (e.g., in place of the handle 110) according to an additional embodiment of the present technology. In the illustrated embodiment, the handle 2410 includes a lead screw 2420 coupled to a midshaft 2474 having a first stop 2475. Rotation of the lead screw 2420 in a first direction can drive the midshaft 2474 to translate distally, and rotation of the lead screw 2420 in a second direction can drive the midshaft 2474 to translate proximally. In the illustrated embodiment, the inner elongated member 102 is configured to nest at least partially within the midshaft 2474 and includes a second stop 2476. A biasing member 2477 (e.g., a coil spring) can extend between the first stop 2475 and the second stop 2476 to couple the inner elongated member 102 to the midshaft 2474. In operation, as the intermediate shaft 2474 is driven proximally via the lead screw 2420, the biasing member 2477 pulls the inner elongated member 102 proximally, causing the clot treatment device 130 to radially expand. However, this proximal movement also elongates the biasing member 2477, reducing the proximal movement of the inner elongated member 102 compared to, for example, an embodiment in which the inner elongated member 102 is directly coupled to the lead screw 2420. Thus, in some aspects of the present technology, the biasing member 2477 limits the radial expansion of the clot treatment device 130 to inhibit excessive expansion that may damage the implant.

[0071] 25A-25C are respectively an enlarged perspective view, an enlarged side view, and an enlarged cross-sectional side view of a handle 2510 that can be incorporated into the system 100 (e.g., in place of the handle 110) according to an additional embodiment of the present technology. Referring together to FIGS. 25A-25C, in the illustrated embodiment, the handle 2510 includes a housing 2514 (shown partially in see-through in FIGS. 25A and 25B for clarity) that defines an internal chamber or lumen 2516 (FIG. 25C). The middle elongated member 104 can be fixedly coupled to the housing 2514. The inner elongated member 102 (not shown in FIGS. 1A-1C) can extend through the lumen of the middle elongated member 104 and into the lumen 2516 of the housing 2514. The handle 2510 can further include a lead screw 2520 attached to the inner elongated member 102 and an actuator 2512 (e.g., a rotatable knob). The lead screw 2520 is movably positioned within the lumen 2516 and can have a threaded outer surface configured to mate with a threaded inner surface of the actuator 2512. The actuator 112 can extend out of one or more first openings 2519 (e.g., a pair of openings on opposite sides of the housing 2514) of the housing 2514 such that a user (e.g., a physician) of the handle 2510 can access the actuator 2512 outside of the housing 2514. In operation, the actuator 2512 can be rotated relative to the housing 2514 to drive the lead screw 2520 proximally and / or distally through the housing 2514, thereby driving the attached inner elongate member 102 in translation relative to the middle elongate member 104, thereby radially expanding / collapse the clot treatment device 130.

[0072] In the illustrated embodiment, the handle 2510 further comprises an indicator 2511 coupled to the lead screw 2520. The indicator 2511 may be coupled to (e.g., integrally formed with, rotatably mounted to) the lead screw 2520 and may protrude into and / or otherwise be visible through one or more second openings 2518 (e.g., slots) of the housing 2514 (e.g., a pair of openings on opposite sides of the housing 2514). The housing 2514 may further include one or more markings 2517 (FIGS. 25A and 25B) adjacent one or more of the second openings 2518 that indicate an amount of expansion of the clot treatment device 130 (e.g., a measurement of radial expansion of the clot treatment device 130, a state of the clot treatment device 130, a position of the clot treatment device 130, etc.). For example, as the actuator 2512 drives the inner elongate member 102 to expand / collapse the clot treatment device 130, the indicator 2511 can move with the lead screw 2520 through and / or along the second opening 2518, and one of the markings 2517 adjacent the indicator 2511 can indicate the amount of expansion (e.g., in millimeters). In some aspects of the present technology, combining the indicator 2511 with the lead screw 2520 in such a manner allows the indicator 2511 to more accurately indicate the amount of radial expansion of the clot treatment device 130, as additional component attachments and manufacturing steps to form the indicator are not required.

[0073] 26 is an enlarged cross-sectional side view of a handle 2610 that may be incorporated into the system 100 (e.g., in place of the handle 110) according to an additional embodiment of the present technology. In the illustrated embodiment, the handle 2610 includes a housing 2614 defining an internal chamber or lumen 2616. The middle elongated member 104 may be fixedly coupled to the housing 2614. The inner elongated member 102 may extend through the lumen of the middle elongated member 104 into the lumen 2616 of the housing 2614. The handle 2610 may further include a lead screw 2620 attached to the inner elongated member 102 and an actuator 2612 (e.g., a rotatable knob). The lead screw 2620 is movably positioned within the lumen 2616 and, in the illustrated embodiment, has a threaded inner surface configured to mate with a threaded outer surface of the actuator 2612. That is, the threaded surfaces of the lead screw 2620 and actuator 2612 are reversed from those shown in Figures 5 and 25A-25C. The actuator 112 can extend out of the housing 2614 such that a user can rotate the actuator 2612 relative to the housing 2614 to drive the lead screw 2620 proximally and / or distally through the housing 2614, thereby driving the attached inner elongate member 102 to move relative to the middle elongate member 104 to radially expand / collapse the clot treatment device 130.

[0074] In the illustrated embodiment, the handle 2610 further comprises an indicator 2611 coupled to the lead screw 2620 and visible through one or more slots / openings in the housing 2614 to provide an indication of the amount of radial expansion of the clot treatment device 130. In some aspects of the present technology, forming the outer surface of the actuator 2612 and the corresponding inner surface of the lead screw 2620 to be threaded can allow for easier visualization of the indicator 2611 as the actuator 2612 does not obstruct the view of the indicator 2611 and the lead screw 2620 anywhere along the path of the lead screw 2620.

[0075] 27 is an enlarged cross-sectional side view of a handle 2710 that may be incorporated into the system 100 (e.g., in place of the handle 110) according to additional embodiments of the present technology. In the illustrated embodiment, the handle 2710 includes a housing 2714 defining an internal chamber or lumen 2716. The middle elongated member 104 may be rotatably coupled to the housing 2714 via a first adaptor 2790 (e.g., a middle adaptor). In some embodiments, the first adaptor 2790 includes a flange 2791 configured (e.g., shaped, sized, positioned) to be positioned and rotatably retained within a corresponding circumferential groove or recess 2792 in the housing 2714. The inner elongated member 102 may extend through the lumen of the middle elongated member 104 and into the lumen 2716 of the housing 2714. The handle 2710 can further comprise a lead screw 2720 rotatably coupled to the inner elongated member 102 via a second adaptor 2794 and an actuator 2712 (e.g., a rotatable knob). In some embodiments, the second adaptor 2794 comprises a flange 2795 configured (e.g., shaped, sized, positioned) to be positioned and rotatably retained within a corresponding circumferential groove or recess 2796 of the lead screw 2720. The first adaptor 2790 can be fixedly attached to the middle elongated member 104 and the second adaptor 2794 can be fixedly attached to the inner elongated member 102 such that rotation of the elongated guide member 2784 rotates the elongated members 102, 104 together to rotate the clot treatment device 130 attached thereto. The lead screw 2720 is movably positioned within the lumen 2716 and, in the illustrated embodiment, has a threaded outer surface configured to mate with a threaded inner surface of the actuator 2712. In operation, the actuator 2712 can be rotated relative to the housing 2714 to drive the lead screw 2720 proximally and / or distally through the housing 2714, thereby driving the attached inner elongate member 102 to move relative to the middle elongate member 104 to radially expand / collapse the clot treatment device 130.

[0076] In the illustrated embodiment, the handle 2710 further comprises one or more elongated guide members 2784 (e.g., torque guide pins) that couple the first adaptor 2790 to the second adaptor 2740 and the rotation motor 2782. The rotation motor 2782 may be operably coupled to an actuator 2780 (e.g., a switch, button), a power source, a controller, or the like, and is operable to cause the rotation motor 2782 to rotate the elongated guide member 2784, thereby rotating the first adaptor 2790 and the second adaptor 2794, thereby rotating the elongated members 102, 104. Thus, while the handle 2710 is motorized to rotate the clot treatment device 130 (e.g., via actuation of the actuator 2780 and operation of the rotation motor 2782), it is still manually actuable by a user to radially expand the clot treatment device 130 (e.g., via actuation of the actuator 2712 and corresponding movement of the lead screw 2720).

[0077] In some embodiments, the rotation motor 2782 is configured to rotate the clot treatment device 130 a full rotation (e.g., 360°) in one or both of a clockwise and counterclockwise direction. In some embodiments, the rotation motor 2782 is configured to rotate the clot treatment device 130 only partially (e.g., about 10°-60°) in a clockwise and / or counterclockwise direction. In some embodiments, the rotation motor 2782 (e.g., an operably coupled controller) and / or other aspects of the techniques described herein may take the form of computer-executable instructions, or machine-executable instructions, or controller-executable instructions, including routines executed by a programmable computer or controller. Those skilled in the relevant art will appreciate that the techniques may be practiced in computer / controller systems other than those illustrated and described below. The techniques may be embodied in a special purpose computer, controller, or data processor specifically programmed, configured, or constructed to execute one or more of the computer-executable instructions described below. Thus, as generally used herein, the terms "computer" and "controller" refer to any data processor, and may include Internet appliances and handheld devices, including palmtop computers, wearable computers, cellular or mobile telephones, multiprocessor systems, processor-based or programmable consumer electronics, network computers, minicomputers, etc. Information manipulated by these computers may be presented on any suitable display medium, including a liquid crystal display (LCD).

[0078] The present technology can also be practiced in a distributed environment, where tasks or modules are performed by remote processing devices linked through a communications network. In a distributed computing environment, program modules or subroutines may be located in local and remote memory storage devices. Aspects of the present technology described below may be stored or distributed on computer-readable media, including magnetic or optically readable or removable computer disks, and may be electronically distributed over a network. Data structures and data transmissions specific to aspects of the present technology are also encompassed within the scope of embodiments of the present technology.

[0079] 28 is a side view of a distal portion of a clot removal system 2800 ("system 2800") positioned within a blood vessel V to treat clot material C, in accordance with an embodiment of the present technology. System 2800 may include some features that are at least substantially similar or identical in structure and function to corresponding features of system 100 described in detail above with reference to FIGS. 1A-10C, and may operate in a substantially similar or identical manner as system 100. For example, in the illustrated embodiment, system 2800 includes a clot treatment device 130, an inner elongate member 102 (hidden in FIG. 28), an intermediate elongate member 104, an outer elongate member 106, and a tip portion 108.

[0080] In the illustrated embodiment, the system 2800 further includes a first balloon 2870 coupled to the outer elongate member 106 (e.g., coupled to a distal portion thereof) and a second balloon 2872 coupled to the innermost (e.g., fourth) elongate member 2807. The innermost elongate member 2807 can be moved (e.g., advanced / retracted) through a lumen of the tip 108 and the inner elongate member 102. The first balloon 2870 and the second balloon 2872 can be inflated to an inflated state shown in FIG. 28, in which the balloons at least partially engage the wall of the vessel V, via one or more of the handle 110 ( FIG. 5 ), a separate handle, and / or different inflation components. Thus, the outer elongate member 106, the innermost elongate member 2807, and / or other components of the system 2800 can include one or more inflation lumens (not shown) for inflating the first balloon 2870 and the second balloon 2872.

[0081] The system 2800 can be used to treat clot material C when it is positioned within an exposed vessel and / or implant. The clot material C can be chronic or sticky clot material that can be difficult to treat and remove otherwise. In operation, during a clot removal procedure, the outer elongated member 106 can be positioned proximal to the clot material C such that the first balloon 2870 is positioned proximal to the clot material C within the vessel V. The innermost elongated member 2807 can be positioned such that the second balloon 2872 is distal to the clot material C within the vessel V. The clot treatment device 130 can be deployed between the first balloon 2870 and the second balloon 2872 within the clot material C. With the first balloon 2870 and the second balloon 2872 inflated, the clot treatment device 130 can be translated and / or rotated through the clot material C to treat and remove the clot material C, for example, as described in detail above with reference to FIG. 7. In some aspects of the present technology, the first balloon 2870 and the second balloon 2872 can help stabilize the blood vessel V - inhibiting or even stopping the blood vessel from moving - as the clot treatment device 130 moves to treat the clot material C. This can help improve the processing efficiency of the system 2800. In some embodiments, the first balloon 2870 and / or the second balloon 2872 can provide embolic protection during a clot treatment procedure with the clot treatment device 130 in addition to or as an alternative to stabilizing the blood vessel.

[0082] Several aspects of the present technology are described in the following examples. Example 1. A system for removing clot material from an implant positioned within a body vessel, comprising: a clot treatment device configured to be deployed within the implant, the clot treatment device including a first end portion, a second end portion, and a plurality of struts extending between the first end portion and the second end portion; a handle including an actuator; a first elongate member connecting a first end portion of the clot treatment device to a handle; a second elongated member coupling a second end portion of the clot treatment device to the handle, wherein actuation of the actuator is configured to move the second elongated member relative to the first elongated member to reduce the distance between the first end portion and the second end portion to radially expand the struts. Example 2. The system of example 1, wherein the implant is a stent. Example 3. The system of example 1 or example 2, wherein the first end portion is a proximal end portion of a clot treatment device and the second end portion is a distal end portion of a clot treatment device. Example 4. The system of example 3, wherein the second elongate member extends through the lumen of the first elongate member. Example 5. The system of example 1 or example 2, wherein the first end portion is a distal end portion of a clot treatment device and the second end portion is a proximal end portion of a clot treatment device. Example 6. The system of any one of Examples 1-5, wherein actuation of the actuator is configured to move both the first elongate member and the second elongate member relative to the handle. Example 7. A system as described in any one of Examples 1-6, wherein the handle is rotatable to rotate the clot treatment device relative to the implant. Example 8. A system as described in any one of Examples 1-7, wherein the handle is longitudinally movable to move the clot treatment device longitudinally relative to the implant. Example 9. A system described in any one of Examples 1 to 8, wherein the handle is rotatable and longitudinally movable to rotate and longitudinally move the clot treatment device relative to the implant. Example 10. A system described in any one of Examples 1 to 9, further comprising a guide catheter, wherein the clot treatment device is configured to (a) be covered by the guide catheter in a first state, and (b) be uncovered from the guide catheter and expand in a second state. Example 11. The system of any one of Examples 1-10, wherein the struts extend generally axially between the first and second end portions and each have an undulating profile. Example 12. A system described in any one of Examples 1 to 11, wherein the struts each extend axially between first and second end portions, and the clot treatment device does not include any cross members interconnecting the struts. Example 13. A system described in any one of Examples 1 to 12, wherein the actuator is a rotatable knob or slider. Example 14. A system described in any one of Examples 1 to 13, wherein the handle includes an indicator configured to indicate the amount the strut has radially expanded. Example 15. A method for removing clot material from an implant positioned within a body vessel, the method comprising: Positioning a clot treatment device at least partially within the implant, the clot treatment device having (a) a first end portion, (b) a second end portion, and (c) a plurality of struts extending between the first end portion and the second end portion; moving the second elongated member relative to the first elongated member to reduce a distance between the first end portion and the second end portion to radially expand the strut; After radially expanding the struts, rotating and / or translating the clot treatment device within the implant to physically engage clot material with at least a portion of the struts. Example 16. The method of Example 15, wherein a first end portion of the clot treatment device is coupled to a first elongated member and a second end portion of the clot treatment device is coupled to a second elongated member, and moving the second elongated member relative to the first elongated member includes actuating an actuator on a handle coupled to the first elongated member and the second elongated member to move the second elongated member relative to the first elongated member. Example 17. The method of example 15 or example 16, wherein the struts each extend axially between first and second end portions, and the clot treatment device does not include any cross members interconnecting the struts. Example 18. The method of any one of Examples 15-17, wherein the implant is a stent. Example 19. A clot treatment device, comprising: a proximal end portion; A distal end portion; and a plurality of struts extending generally axially along a longitudinal axis between a proximal end portion and a distal end portion; movement of the first end portion toward the second end portion is configured to radially expand the strut; each of the struts includes a proximal portion extending from a proximal end portion, a distal portion extending from a distal end portion, and an intermediate portion (a) extending between the proximal and distal portions and (b) having a hook-like shape in a direction about the longitudinal axis; A clot treatment device, wherein each of the struts has an undulating shape in a direction along the longitudinal axis. Example 20. The clot treatment device of example 19, wherein the clot treatment device does not include any cross members interconnecting the struts.

[0083] The above detailed description of the embodiments of the present technology is not intended to be exhaustive or to limit the present technology to the precise form disclosed above. Although specific embodiments and examples of the present technology are described above for illustrative purposes, various equivalent modifications are possible within the scope of the present technology, as those skilled in the art will recognize. For example, while steps are presented in a given order, alternative embodiments may perform steps in a different order. Various embodiments described herein may also be combined to provide further embodiments.

[0084] From the above, it will be understood that, although specific embodiments of the present technology are described herein for illustrative purposes, well-known structures and functions have not been shown or described in detail to avoid unnecessarily obscuring the description of the embodiments of the present technology. Where the context permits, singular or plural terms may also include the plural or singular terms, respectively.

[0085] Further, unless the term "or" is expressly limited to mean only a single item in relation to a list of two or more items, the use of "or" in such a list should be interpreted as including (a) any single item in the list, (b) all of the items in the list, or (c) any combination of the items in the list. Additionally, the term "comprising" is used throughout to mean including at least the recited features, but not excluding any more of the same features and / or other features of additional types. It will also be understood that although specific embodiments have been described herein for illustrative purposes, various modifications may be made without departing from the technology. Furthermore, although advantages associated with some embodiments of the technology have been described in the context of these embodiments, other embodiments may also exhibit such advantages, and not all embodiments necessarily exhibit such advantages to fall within the scope of the technology. Thus, the present disclosure and related technology may encompass other embodiments not expressly shown or described herein.

Claims

1. 1. A system for removing clot material from an implant positioned within a body vessel, comprising: a clot treatment device configured to be deployed within the implant, the clot treatment device including a first end portion, a second end portion, and a plurality of struts extending between the first end portion and the second end portion; a handle including an actuator and an indicator; a first elongate member connecting the first end portion of the clot treatment device to the handle; a second elongated member connecting the second end portion of the clot treatment device to the handle; Equipped with wherein actuation of the actuator is configured to move the second elongate member relative to the first elongate member to reduce a distance between the first end portion and the second end portion, causing the strut to radially expand, and the indicator is configured to indicate an amount the strut has been radially expanded.

2. The system of claim 1 , wherein the implant is a stent.

3. The system of claim 1 , wherein the first end portion is a proximal end portion of the clot treatment device and the second end portion is a distal end portion of the clot treatment device.

4. The system of claim 3 , wherein the second elongate member extends through a lumen of the first elongate member.

5. The system of claim 1 , wherein the first end portion is a distal end portion of the clot treatment device and the second end portion is a proximal end portion of the clot treatment device.

6. The system of claim 1 , wherein actuation of the actuator is configured to move both the first elongate member and the second elongate member relative to the handle.

7. The system of claim 1 , wherein the handle is rotatable to rotate the clot treatment device relative to the implant.

8. The system of claim 1 , wherein the handle is longitudinally movable to move the clot treatment device longitudinally relative to the implant.

9. The system of claim 1 , wherein the handle is rotatable and longitudinally movable to rotate and longitudinally move the clot treatment device relative to the implant.

10. 10. The system of claim 1, further comprising a guide catheter, wherein the clot treatment device is configured to (a) be covered by the guide catheter in a first state, and (b) be uncovered from the guide catheter and expanded to a second state.

11. The system of claim 1 , wherein the struts extend generally axially between the first and second end portions and each have an undulating shape.

12. The system of claim 1 , wherein the struts each extend axially between the first and second end portions, and the clot treatment device does not include any cross-members interconnecting the struts.

13. The system of claim 1 , wherein the actuator is a rotatable knob or slider.

14. The method of claim 1, wherein the first end portion is a proximal end portion of the clot treatment device; the second end portion is a distal end portion of the clot treatment device; the plurality of struts extend generally axially along a longitudinal axis between the proximal end portion and the distal end portion; each strut includes a proximal portion extending from the proximal end portion, a distal portion extending from the distal end portion, and an intermediate portion (a) extending between the proximal and distal portions and (b) having a hook-like shape in a direction about the longitudinal axis; The system of claim 1 , wherein each of the struts has an undulating shape in a direction along the longitudinal axis.

15. The system of claim 14 , wherein the clot treatment device does not include any cross members interconnecting the struts.

16. A system for removing clot material from a blood vessel of a body, comprising: a clot treatment device having a first end portion, a second end portion, and a plurality of struts extending along an axis between the first end portion and the second end portion, each strut having an undulating shape about the axis between the first end portion and the second end portion; a handle including an actuator; a first elongate member connecting the first end portion of the clot treatment device to the handle; a second elongated member connecting the second end portion of the clot treatment device to the handle; Equipped with wherein actuation of the actuator is configured to move the second elongate member relative to the first elongate member to reduce a distance between the first end portion and the second end portion, causing the strut to radially expand.

17. The system described in claim 16, wherein the clot treatment device is configured to be radially expanded within a stent positioned within a blood vessel of the body.

18. The system described in claim 16, wherein the first end portion is a proximal end portion of the clot treatment device and the second end portion is a distal end portion of the clot treatment device.

19. The system described in claim 18, wherein the second elongated member extends through the lumen of the first elongated member.

20. The system described in claim 16, wherein the first end portion is a distal end portion of the clot treatment device and the second end portion is a proximal end portion of the clot treatment device.

21. The system of claim 16, wherein actuation of the actuator is configured to move both the first elongated member and the second elongated member relative to the handle.

22. The system described in claim 16, wherein the handle is rotatable to rotate the clot treatment device relative to the implant.

23. The system described in claim 16, wherein the handle is longitudinally movable to move the clot treatment device longitudinally relative to the body's blood vessels.

24. The system of claim 16, wherein the handle is rotatable and longitudinally movable so as to rotate and longitudinally move the clot treatment device relative to the implant.

25. The system of claim 16, further comprising a guide catheter, wherein the clot treatment device is configured to (a) be covered by the guide catheter in a first state, and (b) be removed from the guide catheter and expanded to a second state.

26. The system described in claim 16, wherein the clot treatment device does not include any cross members interconnecting the struts.

27. The system of claim 16, wherein the actuator is a rotatable knob or slider.

28. The system of claim 16, wherein the handle includes an indicator configured to show the amount the strut has been radially expanded.

29. A system for removing clot material from a blood vessel of a body, comprising: a clot treatment device having a first end portion, a second end portion, and a plurality of struts extending between the first end portion and the second end portion; a handle including an actuator; a first elongate member extending along an axis and connecting the first end portion of the clot treatment device to the handle; a second elongated member extending along the axis and connecting the second end portion of the clot treatment device to the handle; Equipped with wherein actuation of the actuator is configured to move the second elongate member relative to the first elongate member to reduce a distance between the first end portion and the second end portion and radially expand the struts to an expanded position, wherein in the expanded position, individual struts of the struts have a hook-like shape when viewed along the axis.

30. The system described in claim 29, wherein the hook-shaped shape extends radially away from the axis and is at least partially curved back toward the axis.

31. The system described in claim 29, wherein the clot treatment device does not include any cross members interconnecting the struts.

32. The system described in claim 29, wherein the handle is rotatable and longitudinally movable so as to rotate and longitudinally move the clot treatment device relative to the implant while the strut is in the expanded position.

33. A clot treatment device, comprising: a proximal end portion; and a distal end portion; and a plurality of struts extending generally axially along an axis between the proximal end portion and the distal end portion; Compress the A clot treatment device, wherein movement of the distal end portion toward the proximal end portion is configured to radially expand the struts to an expanded position, wherein in the expanded position, each strut (a) has a hook-like shape when viewed along the axis, and (b) has an undulating shape about the axis between the proximal end portion and the distal end portion.

34. The clot treatment device of claim 33, wherein the clot treatment device does not include any cross members interconnecting the struts.

35. A clot treatment device as described in claim 33, wherein the hook-like shape extends radially away from the axis and is at least partially curved back toward the axis.

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