Devices and methods for treating vascular obstruction

Abstract

Disclosed herein are systems and methods for the endovascular treatment of clots in blood vessels of human patients. In one embodiment, the system includes a coring element for coreing and separating the clot. The coring element can include a unitary structure having a first region, a second region, a third region, and a fourth region. The first region is adjacent a proximal portion of the unitary structure and includes a first port configured to core and separate the clot. The second region is distal to the first region, generally tubular, and includes a first plurality of interconnected struts. The third region is distal to the second region and includes a second port configured to core and separate the vascular thrombus. The fourth region is distal to the third region, generally tubular, and includes a second plurality of interconnected struts.

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of U.S. Provisional Patent Application No. 62 / 949,967, filed December 18, 2019, entitled "DEVICES AND METHODS FOR TREATING VASCULAR OCCLUSION," which is incorporated by reference in its entirety.

[0002] The present technology relates generally to systems, methods, and devices for extracting thrombus from blood vessels of a human patient. In particular, some embodiments of the present technology relate to systems for performing thrombus extraction from peripheral blood vessels of a human patient. [Background technology]

[0003] Thrombosis is the localized precipitation or clotting of blood in a part of the circulatory system, and a thrombus is a blood clot that forms in situ within the vascular system. A venous thrombosis is a blood clot that forms within a vein. A common type of venous thrombosis is deep vein thrombosis (DVT), which is the formation of a blood clot within a deep vein (e.g., primarily in the legs). Nonspecific signs of thrombosis may include pain, swelling, redness, warmth, and engorged superficial veins.

[0004] If the clot breaks off (embolises) and travels toward the lungs, it can lead to a life-threatening pulmonary embolism (PE) (e.g., a blood clot in the lungs). In addition to the loss of life that can result from PE, DVT can result in serious health problems such as post-thrombotic syndrome, which can cause chronic swelling, pressure, pain, and ulcers due to valve and blood vessel damage. Furthermore, DVT can result in significant medical costs directly or indirectly through the treatment of associated complications and the inability of the patient to work.

[0005] Three processes are thought to lead to venous thrombosis: first, a decrease in blood flow (venous stasis), second, an increased tendency to clot (hypercoagulability), and third, changes to the vessel wall. DVT formation usually begins inside the valves of the calf veins, where blood is relatively oxygen-deprived, activating certain biochemical pathways. Several medical conditions increase the risk of DVT, including diabetes, cancer, trauma, and antiphospholipid syndrome. Other risk factors include advanced age, surgery, immobilization (as with bed rest, orthopedic casts, and sitting on long-haul flights), combined oral contraceptives, pregnancy, the postpartum period, and genetic factors. Rates of DVT increase dramatically from infancy to old age, and in adulthood, approximately 1 in 1,000 adults develop DVT each year.

[0006] Although current devices and methods for preventing and / or treating DVT exist, there are many drawbacks that remain to be addressed, such as a high incidence of DVT recurrence, the use of devices not designed to remove large clot volumes, and / or complex treatments involving multiple treatment devices and / or medications. Thus, new devices, systems, and methods for treating thrombi, particularly DVT, are desirable. Summary of the Invention [Means for solving the problem]

[0007] The present technology is generally directed to methods and systems for removing clots (e.g., thrombus) from blood vessels of human patients. In some embodiments, a system for removing clots (e.g., thrombectomy system) includes a clot extraction device including (i) a coring element configured to core and separate the clot from the vessel wall, and (ii) a capture element configured to capture the cored and separated clot. In some embodiments, the coring element includes a unitary structure having a first region adjacent a proximal portion of the unitary structure, a second region distal to the first region, a third region distal to the second region, and a fourth region distal to the third region. The first region can include a first port configured to core and separate the clot, and the third region can include a second port configured to core and separate the clot. Each of the second and fourth regions can be generally tubular and can include a plurality of interconnected struts. In one aspect of the present technology, the first and second ports are radially offset such that at least one of the first and second ports is positioned and oriented to effectively core and separate a clot from within a blood vessel during a thrombus extraction procedure using the thrombus extraction device.

[0008] In some embodiments, the thrombectomy system includes a dilator assembly for deploying an expandable funnel coupled to a distal portion of an introducer sheath. The dilator assembly can include a first shaft defining a lumen, a second shaft slidably positioned within the lumen of the first shaft, and a retaining sheath coupled to the second shaft and configured to receive and restrain the funnel therein. A control assembly including a driver is operably coupled to the first and second shafts. Movement of the driver to a first position is configured to distally advance both the first and second shafts to deploy the funnel from the retaining sheath. Movement of the driver to a second position is configured to distally advance the first shaft relative to the second shaft such that the first shaft and the retaining sheath define a generally uniform (e.g., constant diameter) outer surface. In one aspect of the present technology, the generally uniform outer surface of the dilator assembly is less likely to catch on or otherwise damage the funnel or blood vessel as the dilator assembly is retracted through the introducer sheath. In another aspect of the present technology, a dilator assembly can be coupled to the introducer sheath to hinder or even prevent unintended premature deployment of the funnel. The present specification also provides, for example, the following items: (Item 1) 1. A coring element for coring a vascular thrombus in a blood vessel of a patient, comprising: the coring element comprises a unitary structure; The integral structure is a first region adjacent a proximal portion of the unitary structure, the first region including a first port configured to core the vascular thrombus; a second region distal to the first region, the second region being generally tubular and including a first plurality of interconnected struts; and a third region distal to the second region, the third region including a second port configured to core the vascular thrombus; a fourth region distal to the third region, the fourth region being generally tubular and including a second plurality of interconnected struts; and 4. A core removal element, comprising: (Item 2) 2. The coring element of claim 1, wherein the first port is radially offset from the second port. (Item 3) The unitary structure extends along a longitudinal axis; 2. The corer element of claim 1, wherein the first region includes a pair of first curved struts that curve in opposite directions about the longitudinal axis and intersect at a pair of first junctions to define the first mouth. (Item 4) The unitary structure extends along a longitudinal axis; the third region includes: (a) a pair of upper curved struts that are curved about the longitudinal axis and intersect each other at an upper junction; and (b) a pair of lower curved struts that are curved about the longitudinal axis and intersect each other at a lower junction; 2. The coring element of claim 1, wherein the lower and upper curved posts define the second mouth. (Item 5) the lower and upper curved struts define (a) a first mouth portion that opens in a first direction generally perpendicular to the longitudinal axis, and (b) a second mouth portion that opens in a second direction generally perpendicular to the longitudinal axis; 5. The coring element of claim 4, wherein the first and second mouth portions define the second mouth. (Item 6) 6. The coring element of claim 5, wherein the first direction is generally opposite the second direction. (Item 7) 2. The corer element of claim 1, wherein the corer element is expandable from a compressed delivery configuration to an expanded deployed configuration. (Item 8) 8. The coring element of claim 7, wherein the coring element is configured to self-expand. (Item 9) 9. The coring element of claim 8, wherein the coring element is formed from a shape memory material. (Item 10) Item 1. The coring element of item 1, wherein the fourth region of the unitary structure is configured to be connected to a braided filament mesh structure. (Item 11) 1. A dilator assembly for deploying an expandable funnel coupled to a distal portion of an introducer sheath, said dilator assembly comprising: a first shaft defining a lumen; a second shaft slidably positioned within the lumen of the first shaft; a retaining sheath coupled to the second shaft and configured to receive and retain the funnel therein; a control assembly including a driver operably coupled to the first and second shafts, wherein when the driver moves from a first position to a second position, the first and second shafts advance together to deploy the funnel from the retaining sheath, and when the driver moves from the second position to a third position, the first shaft advances relative to the second shaft; 13. A dilator assembly comprising: (Item 12) Item 12. The dilator assembly of item 11, wherein the retaining sheath has substantially the same outer diameter as the first shaft. (Item 13) Item 12. The dilator assembly of item 11, wherein a distal portion of the first shaft contacts a proximal portion of the retaining sheath when the driver moves from the second position to the third position. (Item 14) The control assembly includes: Housing and a first shaft hub slidably positioned within the housing and coupled to the first shaft; a second shaft hub slidably positioned within the housing and coupled to the second shaft; Item 12. The expander assembly of item 11, comprising: (Item 15) Item 15. The dilator assembly of item 14, wherein the first shaft hub is configured to engage the second shaft hub when the driver moves from the first position to the second position such that the first and second shafts advance together. (Item 16) Item 15. The dilator assembly of item 14, wherein the first shaft hub is configured to disengage from the second shaft hub when the drive moves from the second position to the third position such that the first shaft advances relative to the second shaft. (Item 17) the first shaft hub is configured to engage the second shaft hub when the drive moves from the first position to the second position such that the first and second shafts advance together; Item 15. The dilator assembly of item 14, wherein the first shaft hub is configured to disengage from the second shaft hub when the drive moves from the second position to the third position such that the first shaft advances relative to the second shaft. (Item 18) the second shaft hub includes a first engagement feature; the housing includes a second engagement feature; Item 15. The expander assembly of item 14, wherein the first engagement feature is configured to engage the second engagement feature at the second position to prevent movement of the second shaft hub when the drive portion moves from the second position to the third position. (Item 19) the first engagement feature is a snap feature; Item 19. The dilator assembly of item 18, wherein the second engagement feature is a detent formed in the housing. (Item 20) further comprising a biasing member operably coupled to the first shaft hub; Item 15. The dilator assembly of item 14, wherein the biasing member is configured to bias the first shaft hub from the third position toward the second position. (Item 21) The control assembly further includes a housing. the drive portion is movable relative to the housing; the movement of the drive part from the first position to the second position is a distal movement of the drive part relative to the housing; Item 12. The dilator assembly of item 11, wherein the movement of the drive portion from the second position to the third position is a further distal movement of the drive portion relative to the housing. (Item 22) Item 12. The dilator assembly of item 11, further comprising the introducer sheath and the funnel. (Item 23) 1. A system for capturing a vascular thrombus in a blood vessel of a patient, the system comprising: an introducer sheath having a distal portion; an expandable funnel coupled to the distal portion of the introducer sheath; a dilator assembly configured for insertion through the introducer sheath and deploying the expandable funnel, a first shaft defining a lumen; a second shaft slidably positioned within the lumen of the first shaft; a retaining sheath coupled to the second shaft and configured to receive and retain the funnel therein; a control assembly including a driver operably coupled to the first and second shafts, wherein when the driver moves from a first position to a second position, the first and second shafts advance distally together to deploy the funnel from the retaining sheath, and when the driver moves from the second position to a third position, the first shaft advances relative to the second shaft; a dilator assembly including: a clot removal device configured to be inserted through the introducer sheath to capture at least a portion of the vascular thrombus; Including, the system. (Item 24) The clot removal device includes an expandable coring element coupled to an expandable capture element; the coring element is configured to separate at least a portion of the vascular thrombus from a wall of the blood vessel; 24. The system of claim 23, wherein the capture element is configured to capture and retain the portion of the vascular thrombus that has separated from the wall of the blood vessel. (Item 25) the funnel has a first length when deployed from the retaining sheath; 24. The system of claim 23, wherein the coring element, when expanded, has a second length that is shorter than the first length. (Item 26) 1. A system for capturing a vascular thrombus in a blood vessel of a patient, the system comprising: an introducer sheath having a distal portion; an expandable funnel coupled to the distal portion of the introducer sheath; a dilator assembly configured to be inserted through the introducer sheath and deploy the expandable funnel; a clot removal device configured to be inserted through the introducer sheath, the clot removal device including an expandable coring element coupled to an expandable capture element, the coring element including a first region including a first port and a second region including a second port, the first and second ports configured to detach at least a portion of the vascular thrombus from a wall of the blood vessel, the capture element configured to capture and retain the portion of the vascular thrombus that has been detached from the wall of the blood vessel; Including, the system. (Item 27) 27. The system of claim 26, wherein the first port is radially offset from the second port. (Item 28) the coring element is formed from a unitary structure including a plurality of struts; the post defines the first and second mouths; The strut further defines a plurality of apertures; Item 28. The system of item 27, wherein the first and second mouths are larger than each of the gaps.

[0009] Many aspects of the present technology can be better understood with reference to the following drawings, in which the components are not necessarily to scale, emphasis instead being placed upon clearly illustrating the principles of the present disclosure. [Brief description of the drawings]

[0010] [Figure 1] FIG. 1 is a side view of a thrombectomy system configured in accordance with an embodiment of the present technology. [Diagram 2] 1A and 1B are side views of a thrombus extraction assembly of a thrombectomy system including a thrombus extraction device in a partially expanded configuration and a fully expanded configuration, respectively, constructed in accordance with an embodiment of the present technology. [Figure 3A] FIG. 13 is an isometric view of a coring element of a thrombus extraction device constructed in accordance with an embodiment of the present technology. [Figure 3B] FIG. 13 is a side view of a coring element of a thrombus extraction device constructed in accordance with an embodiment of the present technology. [Figure 3C] FIG. 13 is a plan view of a coring element of a thrombus extraction device constructed in accordance with an embodiment of the present technology. [Figure 3D] FIG. 13 is a rear view of a coring element of a thrombus extraction device constructed in accordance with an embodiment of the present technology. [Figure 4] FIG. 13 is an enlarged side view of a thrombus extraction device coupled to a distal portion of a thrombus extraction assembly in a fully expanded configuration in accordance with an embodiment of the present technology. [Figure 5A] FIG. 13 is a side view of a dilator assembly of a thrombectomy system in a first configuration configured in accordance with an embodiment of the present technology. [Figure 5B] FIG. 13 is a side view of a dilator assembly of a thrombectomy system in a second configuration configured in accordance with an embodiment of the present technology. [Figure 6] 1 is an enlarged cross-sectional side view of a portion of a thrombectomy system including a self-expanding funnel constructed in accordance with an embodiment of the present technology. [Figure 7] 1A-D are side views of a dilator assembly located within an introducer assembly of a thrombectomy system illustrating various stages in a process or method for deploying a self-expanding funnel in accordance with an embodiment of the present technology. [Figure 8A] FIG. 13 is a cross-sectional side view of a control assembly of an expander assembly constructed in accordance with an embodiment of the present technology. [Figure 8B] FIG. 13 is an enlarged cross-sectional isometric view of a control assembly of a dilator assembly constructed in accordance with an embodiment of the present technology. [Figure 8C] FIG. 13 is a cross-sectional side view of a control assembly of an expander assembly constructed in accordance with an embodiment of the present technology. [Figure 8D] FIG. 13 is a cross-sectional side view of a control assembly of an expander assembly constructed in accordance with an embodiment of the present technology. [Figure 9] 11A-C are cross-sectional side views of a control assembly constructed in accordance with another embodiment of the present technology. [Figure 10] 1A and 1B are partial cross-sectional side views of a control assembly constructed in accordance with another embodiment of the present technology; [Figure 11] 1 is a schematic diagram of an introduction technique for accessing a thrombus for treatment with a thrombectomy system in accordance with an embodiment of the present technology. [Figure 12A] FIG. 1 is a side view of a thrombectomy system positioned within a blood vessel during a thrombectomy procedure in accordance with an embodiment of the present technology. [Figure 12B] FIG. 1 is a side view of a thrombectomy system positioned within a blood vessel during a thrombectomy procedure in accordance with an embodiment of the present technology. [Figure 12C]FIG. 1 is a side view of a thrombectomy system positioned within a blood vessel during a thrombectomy procedure in accordance with an embodiment of the present technology. [Figure 12D] FIG. 13 is an enlarged side view of a thrombectomy system positioned within a blood vessel during a thrombectomy procedure in accordance with an embodiment of the present technology. [Figure 12E] FIG. 13 is an enlarged side view of a thrombectomy system positioned within a blood vessel during a thrombectomy procedure in accordance with an embodiment of the present technology. [Figure 12F] FIG. 13 is an enlarged side view of a thrombectomy system positioned within a blood vessel during a thrombectomy procedure in accordance with an embodiment of the present technology. [Figure 12G] FIG. 13 is an enlarged side view of a thrombectomy system positioned within a blood vessel during a thrombectomy procedure in accordance with an embodiment of the present technology. [Figure 12H] FIG. 13 is an enlarged side view of a thrombectomy system positioned within a blood vessel during a thrombectomy procedure in accordance with an embodiment of the present technology. [Figure 12I] FIG. 13 is an enlarged side view of a thrombectomy system positioned within a blood vessel during a thrombectomy procedure in accordance with an embodiment of the present technology. [Figure 12J] FIG. 13 is an enlarged side view of a thrombectomy system positioned within a blood vessel during a thrombectomy procedure in accordance with an embodiment of the present technology. [Figure 12K] FIG. 13 is an enlarged side view of a thrombectomy system positioned within a blood vessel during a thrombectomy procedure in accordance with an embodiment of the present technology. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0011] Many of the embodiments are described below with respect to devices, systems, and methods for treating vascular thrombus (e.g., deep vein thrombosis (DVT)), although other applications and other embodiments beyond those described herein are within the scope of the technology (e.g., endovascular procedures other than those for treating emboli, endovascular procedures for treating cerebral embolism, endovascular procedures for treating pulmonary embolism). In general, for example, the devices, systems, and methods of the technology can be used to extract any formation of material within a blood vessel (e.g., a venous or arterial vessel), such as cancerous growths, pathological growths, and the like. Additionally, some other embodiments of the technology can have different configurations, states, components, or procedures than those described herein. It should also be understood that certain elements, substructures, advantages, uses, and / or other features of the embodiments described with reference to FIGS. 1-12K can be suitably interchanged, substituted, or otherwise configured for one another in accordance with further embodiments of the technology. Additionally, suitable elements of the embodiments described with reference to FIGS. 1-12K can be used as stand-alone and / or freestanding devices. Thus, one skilled in the art will appreciate that the present technology may have other embodiments with additional elements or without some of the features shown and described below with reference to Figures 1-12K.

[0012] With respect to the terms "distal" and "proximal" used within this description, unless otherwise indicated, the terms may refer to the relative location of portions of the catheter subsystem with respect to the operator and / or location within the vasculature. Additionally, as used herein, the designations "rear," "forward," "upper," "lower," etc. are not intended to limit the referenced components to use in a particular orientation. Of course, 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 for the user.

[0013] The headings provided herein are for convenience only and should not be construed as limiting the disclosed subject matter.

[0014] I. SELECTED EMBODIMENTS OF THE THROMBEECTOMY SYSTEM FIG. 1 is a side view of a thrombectomy system 100 (which may also be referred to as a thrombus extraction system, clot removal system) configured in accordance with an embodiment of the present technology. In the illustrated embodiment, the thrombectomy system 100 includes an introducer assembly 102, an obturator or dilator assembly 104 (shown positioned within the introducer assembly 102), and a thrombus extraction assembly 106. In general, the thrombectomy system 100 may be used to (i) access a portion of a blood vessel (e.g., a venous vessel of a human patient) that contains a thrombus (e.g., a clot) and (ii) remove all or a portion of the thrombus from the vessel. More specifically, for example, the introducer assembly 102 and the dilator assembly 104 may be partially advanced into the vasculature of the patient (e.g., a blood vessel or venous vessel of the patient). The dilator assembly 104 may be actuated to deploy a self-expanding funnel (e.g., as shown in FIGS. 7A-7C) and then removed from the introducer assembly 102. The thrombus extraction assembly 106 and an associated thrombus extraction device may then be partially inserted through the introducer assembly 102 and deployed at and / or near the location of the thrombus to capture the thrombus. Finally, the thrombus extraction assembly 106 and / or the introducer assembly 102 may be removed from the patient along with the captured thrombus. In some embodiments, the thrombus extraction system 100 and / or methods of operating the thrombus extraction system 100 for removing a thrombus from a patient may include several features the same as or similar to the thrombus extraction systems described in detail in the following documents: No. 9,700,332, filed Sep. 16, 2016, entitled "INTRAVASCULAR TREATMENT OF VASCULAR OCCLUSION AND ASSOCIATED DEVICES, SYSTEMS, AND METHODS," and / or (ii) U.S. Patent No. 10,098,651, filed Apr. 26, 2017, entitled "DEVICES AND METHODS FOR TREATING VASCULAR OCCLUSION," both of which are incorporated by reference in their entirety.

[0015] In the illustrated embodiment, the introducer assembly 102 includes an elongate sheath 112 (which may also be referred to as a shaft, catheter, etc.). The sheath 112 defines a lumen (hidden in FIG. 1 , e.g., identified as lumen 688 in FIG. 6 ) and includes a proximal portion 113a and a distal portion 113b. The proximal portion 113a may terminate at a proximal end, and the distal portion 113b may terminate at a distal end. The lumen of the sheath 112 is sized to slidably receive the dilator assembly 104 and the thrombus extraction assembly 106. For example, the dilator assembly 104 is shown partially positioned within the sheath 112 in FIG. 1 . The sheath 112 may be resilient and / or flexible and may have any suitable length and diameter. In some embodiments, the outer diameter of the sheath 112 can be at least 10 French, at least 12 French, at least 14 French, at least 18 French, at least 20 French, at least 22 French, at least 26 French, greater than 26 French, between 10 French and 26 French, between 14 French and 24 French, between 15 French and 21 French, between 16 French and 22 French, and / or any other or intermediate size. In some embodiments, the inner diameter of the lumen of the sheath 112 can be at least 2 French, at least 10 French, at least 14 French, at least 18 French, at least 20 French, at least 22 French, between 11 French and 12 French, between 10 French and 22 French, between 14 French and 21 French, between 16 French and 20 French, and / or any other or intermediate size. In some embodiments, the sheath 112 can include a radiopaque marker (not shown), for example located on its distal portion 113b.

[0016] The introducer assembly 102 further includes a sealable hub 114 coupled to the proximal portion 113a of the sheath 112. The sealable hub 114 is configured to allow access to the lumen of the sheath 112 and can be self-sealing and / or can include a self-sealing seal. For example, in the illustrated embodiment, the sealable hub 114 is a hemostatic valve. The hemostatic valve is configured to maintain hemostasis during the thrombus extraction procedure by preventing fluid flow in a proximal direction through the sealable hub 114 when various components (e.g., the dilator assembly 104 and / or portions of the thrombus extraction assembly 106) are inserted through the sealable hub 114 to be delivered through the sheath 112 to a treatment site within a blood vessel. More specifically, the sealable hub 114 can be a valve of the type disclosed in U.S. Patent Application No. 16 / 117,519, filed August 30, 2018, entitled "HEMOSTASIS VALVES AND METHODS OF USE." The sealable hub 114 may include one or more buttons or actuators that allow an operator to selectively seal / unseal the sealable hub 114.

[0017] The introducer assembly 102 may further include a suction port 116 connected to the sealable hub 114 (e.g., a side port of the sealable hub 114) and / or the sheath 112 (e.g., a proximal portion 113a of the sheath 112), e.g., via a connecting tube 118. The suction port 116 may be connected to a syringe connector 117 that may be selectively coupled to a syringe or other suction device, or the suction port 116 may be connected to other suitable elements. In some embodiments, the introducer assembly 102 may include a fluid control device 119 configured to selectively fluidly connect the suction port 116 to a lumen of the sheath 112. In the illustrated embodiment, the fluid control device 119 is a stopcock operably coupled to the connecting tube 118 between the lumen of the sheath 112 and the suction port 116. In other embodiments, the fluid control device 119 may be a clamp or another suitable valve.

[0018] The dilator assembly 104 can include a control assembly 120 operably coupled to a retaining sheath 122 via a first shaft (hidden in FIG. 1; e.g., identified as first shaft 580 in FIGS. 5A and 5B). In the illustrated embodiment, the first shaft of the dilator assembly 104 extends through the sealable hub 114 and the sheath 112 such that the retaining sheath 122 is located distal to the distal portion 113b of the sheath 112. The control assembly 120 is also removably coupled (e.g., mated, secured) to the sealable hub 114. Thus, the introducer assembly 102 can carry or retain the dilator assembly 104. As will be described in more detail below with reference to Figures 5A-7D, the dilator assembly 104 (e.g., retaining sheath 122) is configured to (i) retain / restrain a self-expanding funnel (hidden in Figure 1, e.g., identified as funnel 690 in Figure 6) attached to the distal portion 113b of the sheath 112, and (ii) release / deploy the self-expanding funnel. More specifically, for example, the control assembly 120 can include a driver 124. The driver 124 is movable (e.g., in the direction of arrow A in Figure 1) to advance the retaining sheath 122 relative to the sheath 112 (and the self-expanding funnel) attached thereto to deploy / release the self-expanding funnel.

[0019] In some embodiments, the thrombectomy system 100 can further include a loading tool 108 (e.g., a loading funnel). The loading tool 108 is used to load the self-expanding funnel into the dilator assembly 104 (e.g., into the retaining sheath 122). In the illustrated embodiment, the loading tool 108 defines a lumen 127 therethrough and includes a first portion 126 (e.g., a tapered portion, e.g., a funnel portion) of varying diameter and a second portion 128 (e.g., a shaft portion) of generally constant diameter. In other embodiments, the second portion 128 can vary in diameter. The configuration (e.g., size and shape) of the first portion 126 is adapted to receive the self-expanding funnel and move the self-expanding funnel to a constrained configuration when the self-expanding funnel is advanced through the first portion 126. The lumen 127 of the loading tool 108 can be sized to allow the retaining sheath 122 to pass completely through the loading tool 108.

[0020] In the illustrated embodiment, the thrombus extraction assembly 106 includes a catheter portion 130 and a handle portion 140 ("handle 140") operably coupled to the catheter portion 130. In operation, the handle 140 is configured to be actuated / manipulated by a user to control (e.g., deploy) one or more components of the catheter portion 130 and / or a thrombus extraction device (not shown in FIG. 1; e.g., identified as thrombus extraction device 250 in FIGS. 2A and 2B) coupled to the catheter portion 130.

[0021] In the illustrated embodiment, catheter portion 130 includes an outer shaft 132, a middle shaft 133, and an inner shaft 134 that are slidably and coaxially aligned with one another. For example, shafts 132-134 can each define a lumen (e.g., a central axial lumen), and (i) middle shaft 133 can be configured (e.g., size and shape) to slidably fit within the lumen of outer shaft 132, and (ii) inner shaft 134 can be configured to slidably fit within the lumen of middle shaft 133. In some embodiments, outer shaft 132 (e.g., size) is configured to slidably fit within sheath 112 of introducer assembly 102, and can be, for example, at least 8 French, at least 10 French, at least 11 French, at least 12 French, at least 14 French, at least 16 French, 8 French to 14 French, 11 French to 12 French, and / or any other or intermediate size. This arrangement allows each of the shafts 132-134 to be longitudinally offset relative to one another and relative to the sheath 112 of the introducer assembly 102. In some embodiments, each of the shafts 132-134 can be the same length, while in other embodiments, one or more of the shafts 132-134 can be different lengths. For example, in some embodiments, the middle shaft 133 can be longer than the outer shaft 132, and the inner shaft 134 can be longer than the middle shaft 133. In other embodiments, the catheter portion 130 can include any number of shafts (e.g., catheters, sheaths) configured to be slidable relative to one another and / or coaxially positioned relative to one another. For example, in some embodiments, the catheter portion can include three middle shafts as described in detail in U.S. Patent No. 10,098,651, filed April 26, 2017, entitled "DEVICES AND METHODS FOR TREATING VASCULAR OCCLUSION," which is incorporated herein by reference in its entirety.

[0022] The handle 140 includes a proximal portion 141a (e.g., a plunger portion) and a distal portion 141b (e.g., a locking portion). In the illustrated embodiment, the intermediate shaft 133 is coupled to and extends distally from the distal portion 141b of the handle 140. The distal portion 141b of the handle 140 may include a locking feature 142 (e.g., a spin lock, etc.). The locking feature 142 is configured to selectively engage and / or lockably engage with a mating feature 135 disposed near the proximal portion 136a of the outer shaft 132. In some embodiments, the outer shaft 132 can be fixed in position relative to the intermediate shaft 133 by sliding the locking feature 142 proximally over the intermediate shaft 133 until the locking feature 142 engages the mating feature 135. In some embodiments, the intermediate shaft 133 is relatively longer than the outer shaft 132 such that a portion of the intermediate shaft 133 extends distally from the distal portion 136b of the outer shaft 132 when the outer shaft 132 is fixably engaged with the locking feature 142.

[0023] In the illustrated embodiment, the stalk 140 further includes a plunger 144 (e.g., a driver). The plunger 144 is operably coupled to the inner shaft 134 and is movable between a first, non-extended position (e.g., as shown in FIGS. 1 and 2A ) and a second, extended position (e.g., as shown in FIG. 2B ). As such, movement of the plunger 144 relative to the stalk 140 causes the inner shaft 134 to shift relative to the stalk 140, the outer shaft 132, and / or the intermediate shaft 133. For example, proximal retraction of the plunger 144 from the first position to the second position can retract the inner shaft 134 through the intermediate shaft 133. In some embodiments, the length of the inner shaft 134 can be such that the inner shaft 134 extends distally past a distal end of the intermediate shaft 133 when the plunger 144 is in both the first and second positions. In some embodiments, the plunger 144 can be lockable in a first position and / or a second position to lock the position of the inner shaft 134. In other embodiments, the plunger 144 can be operably coupled to other components of the catheter portion 130, such as, for example, the intermediate shaft 133 and / or one or more additional shafts (not shown).

[0024] In the illustrated embodiment, the clot extraction assembly 106 further includes a first flush port 138 connected to the outer shaft 132 and a second flush port 148 connected to the stalk 140. The first flush port 138 may be fluidly connected to the lumen of the outer shaft 132 to allow for flushing of the lumen of the outer shaft 132. The second flush port 148 may be fluidly connected to the lumen of the mid shaft 133 (e.g., via an interior portion of the stalk 140) to allow for flushing of the lumen of the mid shaft 133.

[0025] The thrombus extraction assembly 106 can include and / or be coupled to a thrombus extraction device configured to core and capture a thrombus from a patient. For example, Figures 2A and 2B are side views of the thrombus extraction assembly 106 of Figure 1 operably coupled to a thrombus extraction device 250 configured in accordance with an embodiment of the present technology. The thrombus extraction device 250 is shown in Figure 2A in a deployed, partially expanded configuration and in Figure 2B in a deployed, fully expanded configuration. The thrombus extraction device 250 can be in a non-deployed, constrained (e.g., non-extended) position when located within the outer shaft 132.

[0026] 2A and 2B together, the thrombus extraction device 250 includes an expandable corer element 252 and an expandable capture element 254 coupled (e.g., attached, connected, integrally formed) to the corer element 252. The corer element 252 is located proximal to the capture element 254. In the illustrated embodiment, the corer element 252 includes (i) a proximal portion 253a coupled to the midshaft 133 (e.g., a distal portion of the midshaft 133) and (ii) a distal portion 253b coupled to the proximal portion 255a of the capture element 254. Further, the distal portion 255b of the capture element 254 is coupled to the inner shaft 134 (e.g., a distal portion of the inner shaft 134). As shown, the outer shaft 132 is displaced proximally relative to the shank 140 to cause the mating feature 135 of the outer shaft 132 to contact / engage with the locking feature 142 of the shank 140. This positioning of the outer shaft 132 relative to the shank 140 causes the intermediate shaft 133 , the inner shaft 134 , and the thrombus extraction device 250 to each extend distally beyond the distal portion 136 b of the outer shaft 132 .

[0027] In some embodiments, the thrombus extraction device 250 can further include an atraumatic tip 258. In some embodiments, the atraumatic tip 258 can include a radiopaque marker to assist in intravascular positioning of the thrombus extraction device 250 within a patient. The thrombus extraction device 250 can additionally or instead include one or more radiopaque markers disposed, for example, on the outer shaft 132 (e.g., the distal portion 136b of the outer shaft 132), the midshaft 133 (e.g., the distal portion of the midshaft 133), and / or other components of the thrombus extraction device 250. In some embodiments, the atraumatic tip 258 can define a pathway configured to receive a guidewire.

[0028] In the partially extended configuration shown in Figure 2A, the plunger 144 of the stalk 140 is in a first position. In contrast, in the fully extended configuration shown in Figure 2B, the plunger 144 is in a second position (e.g., retracted proximally away from the stalk 140) such that the inner shaft 134 is retracted proximally relative to the midshaft 133. This proximal retraction of the inner shaft 134 relative to the midshaft 133 forces the corer and capture elements 254 to fully expand, as will be described in more detail below with reference to Figure 4.

[0029] The thrombus extraction assembly 106 may include one or more features configured to secure the thrombus extraction device 250, specifically the core element 252 and / or the expandable capture element 254, in a fully extended position. As used herein, full expansion refers to a state in which the thrombus extraction device 250 is continuously biased in an expanded direction by one or more forces other than the self-expansion force arising from the thrombus extraction device 250. In some embodiments, full expansion occurs when the thrombus extraction device 250 is deployed and the plunger 144 is in the second position (e.g., when the inner shaft 134 is retracted proximally relative to the middle shaft 133). Alternatively or in addition, full expansion can occur when the thrombus extraction device 250 is deployed and biased in an expanded direction via a spring directly or indirectly connected to the thrombus extraction device 250. Thus, when the thrombus extraction device 250 is fully expanded, the diameter of the thrombus extraction device 250 does not change with less than a minimum radial compressive force. Thus, when fully expanded, thrombus extraction device 250 can maintain at least a desired radial force against the blood vessel as thrombus extraction device 250 is withdrawn through the blood vessel. In some embodiments, the dimensions of thrombus extraction device 250 can be selected such that when fully expanded, thrombus extraction device 250 approaches and / or applies a desired force against the wall of the blood vessel.

[0030] In some embodiments, the plunger 144 can be locked in the second position, for example, by rotating the plunger 144 relative to the shank 140, thereby engaging one or more locking features on and / or in the shank 140. Locking the plunger 144 in the second position fixes the position of the inner shaft 134 relative to the midshaft 133, thereby fixing the thrombus extraction device 250 in a fully extended position. In other embodiments, the inner shaft 134 and the midshaft 133 can be directly locked together, for example, via (i) a static coupling, in which the position of the inner shaft 134 is fixed relative to the position of the midshaft 133, or (ii) a dynamic coupling, in which the position of the inner shaft 134 is limited (rather than fixed) relative to the midshaft 133. For example, the inner shaft 134 can be dynamically locked to the plunger 144 via a compliant spring (e.g., a tension spring, a compression spring), thereby allowing limited movement of the inner shaft 134 relative to the intermediate shaft 133 when the plunger 144 is locked in the second position.

[0031] II. SELECTED EMBODIMENTS OF THE COREING ELEMENT 3A-3D are isometric, side, plan, and rear (facing proximally) views, respectively, of the coring element 252 of the thrombus extraction device 250 of FIGS. 2A and 2B configured in accordance with an embodiment of the present technology. Referring together to FIGS. 3A-3D, the coring element 252 includes a plurality of struts 360 that together define a plurality of interstices or holes 362. The struts 360 can have a variety of shapes and sizes, and in some embodiments, the thickness and / or diameter of the struts 360 can be about 0.05-0.15 inches, about 0.075-0.125 inches, about 0.09-0.1 inches, about 0.096 inches, and / or other dimensions. Generally, the struts 360 can together form a single fenestrated structure configured to core and separate a portion of the thrombus (e.g., a vascular thrombus) from a blood vessel containing the thrombus. In some embodiments, the coring element 252 can include a stent or stent-like device.

[0032] As best shown in Figures 3B and 3C, the corer element 252 includes a first region 363 including the proximal portion 253a, a second region 364 distal to the first region 363, a third region 365 distal to the second region 364, and a fourth region 366 distal to the third region 365 and including the distal portion 253b. The second region 364 and the fourth region 366 may be generally tubular. The first region 363 and the third region 365 have relatively few struts 360 compared to the second region 364 and the fourth region 366. For example, the first region 363 may have a pair of curved struts 367 (separately identified as first struts 367a and second struts 367a, as best shown in Figures 3A and 3C). A pair of curved struts 367 curve in opposite directions around the central axis L of the corer element 252 and intersect and / or terminate at a pair of first joints 361 (separately identified as a lower first joint 361a and an upper first joint 361b) to define a proximal first mouth 370. The third region 365 can include (i) a pair of curved lower struts 368 (separately identified as first lower strut 368a and second lower strut 368b shown together in FIG. 3A ) extending distally from the lower second joint 371 a and curved about the central axis L, and (ii) a pair of curved upper struts 369 (separately identified as first upper strut 369a and second upper strut 369b shown together in FIGS. 3A and 3C ) extending distally from the upper second joint 371 b and curved about the central axis L. The lower and upper struts 368, 369 together define a distal first mouth portion 372a and a distal second mouth portion 372b (collectively, “second mouth 372”). In the illustrated embodiment, the first mouth portion 372a is rotationally offset from the second mouth portion 372b. In other embodiments, the first mouth portion 372a can be positioned differently (e.g., different rotationally and / or longitudinally) than the second mouth portion 372b and / or the second mouth 372 can include more than two separate portions (e.g., three, four, or more openings). In general, the first and second mouths 370, 372 can be defined by / at regions of differing porosity of the coring element 252.

[0033] In some embodiments, the corer element 252 is formed from a shape memory material (e.g., a shape memory alloy and / or a shape memory polymer). For example, the corer element 252 can include Nitinol and / or a Nitinol alloy. Similarly, the corer element 252 can be formed using a variety of techniques, such as welding, laser welding, cutting, laser cutting, and / or expanding. For example, the corer element 252 can first be laser cut from a piece of Nitinol (e.g., Nitinol tubing) and then expanded and / or expanded. In general, the size (e.g., length and diameter) of the corer element 252 can be selected based on the size (e.g., diameter) of the blood vessel from which the thrombus is to be extracted. In some embodiments, the length M of the corer element 252 can be about 0.2 to 5 inches (e.g., about 1.5 to 2.5 inches, about 1.75 to 2.25 inches, about 1.9 to 2.0 inches, about 1.5 to 1.8 inches, about 1.6 inches, about 1.7 inches, about 1.96 inches, about 3.0 inches, about 4.0 inches, less than 0.5 inches). In some embodiments, the diameter D of the corer element 252 can be about 2 to 50 mm (e.g., about 4 to 25 mm, about 6 to 20 mm, about 8 to 16 mm) in an unconstrained, fully extended position within the vessel. In some embodiments, the length M of the corer element 252 can be selected based on the fully extended, unconstrained diameter D of the corer element 252 to prevent undesirable tilting and / or rotation of the corer element 252 within the vessel during operation. Generally, the length M and unconstrained diameter D of the coring element 252 will vary depending on the size of the vessel for which the coring element 252 is designed. For example, the coring element 252 will generally have a smaller length M and diameter D when designed for smaller (e.g., 4 mm) vessels as opposed to larger (e.g., 25-35 mm) vessels.

[0034] The coring element 252 is configured to core (e.g., shear, separate) the thrombus from within the vessel as the coring element advances / retracts through the thrombus in a fully expanded configuration. For example, as described in more detail below with reference to FIGS. 12D-12K, the coring element 252 can be retracted proximally through the thrombus to core the thrombus. As the coring element 252 is retracted through the thrombus, the fully expanded diameter of the coring element 252 flexes to match the diameter of the vessel. More particularly, the configuration (e.g., size, shape, and / or location) of the first and second ports 370, 372 is provided to provide most of the coring function (e.g., coring force) during operation of the coring element 252. For example, a proximally facing surface of the strut 367 can define a first leading edge that cuts open and cores the thrombus. Similarly, the proximally facing surfaces of the lower and upper struts 368, 369 can define a second leading edge that can also cut open and core the thrombus. In some embodiments, a portion of the struts 367, lower struts 368, and / or upper struts 369 can be sharpened and / or have a cutting element (e.g., a knife or knife edge) attached or otherwise integrated thereto to further facilitate core-out of the thrombus.

[0035] In one aspect of the present technology, the first port 370 and the second port 372 are longitudinally offset relative to each other. Also, the leading edge of the strut 367 and the leading edges of the lower and upper struts 368, 369 are oriented differently, for example, such that the first port 370 and the second port 372 are oriented at different angles when the coring element 252 is in a vessel. The arrangement may be more effective in coreing thrombus, for example, as compared to when the coring element includes only a single port (e.g., includes only the first port 370). The coring element 252 is expected to have a longer core length to engage the vessel wall and core the (e.g., sticky) thrombus than a coring element with only a single port. Also, the coring element 252 may be relatively flexible in the first and third regions 363, 365, which have fewer struts 360 than the second and fourth regions 364, 366. For example, the corer element 252 can bend / curve at the first junction 361 and / or the second junction 371. In some embodiments, the first and second junctions 361, 371 allow the corer element 252 to bend in different directions (e.g., laterally and vertically). In one aspect of the present technology, this ability of the corer element 252 to bend allows the corer element 252 to maintain a selected orientation even as it travels through a tortuous vessel. In another aspect of the present technology, the arrangement of the first and second ports 370 and 372 ensures that at least one of the first port 370, the first port portion 372a, and the second port portion 372b are positioned and oriented to effectively core a thrombus from within a vessel during a thrombus extraction procedure with the corer element 252. In some embodiments, the first port 370 and / or the second port 372 can further facilitate collapsing the coring element 252 into an unextended configuration.

[0036] In the embodiment illustrated in Figures 3A-3D, a first connection feature 374 and a second connection feature 376 are coupled to the corer element 252. As will be described in more detail below with reference to Figure 4, the middle shaft 133 (Figure 1) can be operably coupled to the first connection feature 374 and the inner shaft 134 can be operably coupled to the second connection feature 376 to control the movement (e.g., movement and expansion) of the corer element 252. In the illustrated embodiment, the first connection feature 374 is a ring coupled to the proximal portion 253a of the corer element 252, more specifically, to the lower first joint 361a. In other embodiments, the first connection feature 374 can be located on a different portion of the corer element 252 (e.g., at the upper first joint 361b, on one of the struts 367). Similarly, the second connecting feature 376 may also be a ring and may be coupled to one or more of the struts 360 in the second region 364 or another region of the coring element 252. As best seen in FIG. 3D, in some embodiments, the diameter E1 of the first connecting feature 374 may be larger than the diameter E2 of the second connecting feature 376, and the first and second connecting features 374, 376 may be axially aligned along an axis extending parallel to the central axis L of the coring element 252. In other embodiments, the first and second connecting features 374, 376 may have other shapes and / or configurations and / or may be positioned differently relative to one another. The first and second connecting features 374, 376 may be of the same material as the coring element 252 or may be of a different material than the coring element 252. Similarly, the first and second connection features 374, 376 may be integrally formed with the core removal element 252 and / or may be attached to the core removal element 252 via one or more of, for example, a weld, an adhesive, a mechanical fastener, or the like.

[0037] 4 is an enlarged side view of a thrombus extraction device 250 in a fully expanded configuration coupled to a distal portion of a thrombus extraction assembly 106 in accordance with an embodiment of the present technology. In the illustrated embodiment, the corer element 252 is coupled to the midshaft 133 (e.g., a distal portion of the midshaft 133) via a first connection feature 374. In some embodiments, the corer element 252 is fixedly coupled to the midshaft 133 such that movement of the midshaft 133 also moves the corer element 252. The proximal portion 255a of the capture element 254 is connected to the distal portion 253b of the corer element 252. In some embodiments, the capture element 254 is formed on the distal portion 253b of the corer element 252 such that the thrombus extraction device 250 is of unitary / integral construction. For example, the capture element 254 can include a mesh (e.g., a braided filament mesh structure) woven onto the distal portion 253b of the corer element 252. In some embodiments, the distal portion 255b of the capture element 254 is coupled to the inner shaft 134 (eg, a distal portion of the inner shaft 134).

[0038] In the illustrated embodiment, the inner shaft 134 slidably extends through the second connecting feature 376. That is, the outer diameter of the inner shaft 134 can be smaller than the diameter E2 ( FIG. 4 ) of the second connecting feature 376 such that the second connecting feature 376 is slidable along the inner shaft 134. The inner shaft 134 can include a stop feature 478 configured to engage the second connecting feature 376 of the corer element 252 to cause expansion of the corer element 252. In some embodiments, the stop feature 478 can include a polymeric and / or metallic member applied to a portion of the inner shaft 134 distal from the second connecting feature 376.

[0039] The stop feature 478 (e.g., size and shape) is configured to contact and engage the second connecting feature 376, for example, when the inner shaft 134 is retracted proximally relative to the corer element 252 via movement of the plunger 144 (FIGS. 1-3) from a first position to a second position. This arrangement selectively couples the corer element 252 to the inner shaft 134 such that the stop feature 478 can apply a proximally directed force to the corer element 252 that can expand all or a portion of the corer element 252 to a fully expanded configuration. For example, movement of the inner shaft 134 can force expansion of at least a first region 363 (FIGS. 3B and 3C) of the corer element that is between the first and second connecting features 374, 376. In some embodiments, the second connecting feature 376 can be positioned differently relative to the corer element 252 such that when the stop feature 478 is pulled against the second connecting feature 376, a greater or lesser portion of the corer element 252 is forced to expand.

[0040] In some embodiments, the capture element 254 can include a braided filament mesh structure (e.g., a braid of elastic filaments having a generally tubular elongated portion 477 and a distal tapered portion 479). In other embodiments, the capture element 254 can be any porous structure and / or have other suitable shapes, sizes, and configurations. The distal portion 255b of the capture element 254 is coupled to the inner shaft 134, such that axial movement of the inner shaft 134 expands / shortens and collapses / lengthens the capture element 254. For example, proximal movement of the inner shaft 134 can compress the capture element 254 along its longitudinal axis, such that (i) the radius of the capture element 254 increases and (ii) the length of the capture element 254 decreases. Conversely, distal movement of the inner shaft 134 can stretch the capture element 254 along its longitudinal axis, such that (i) the radius of the capture element 254 decreases and (ii) the length of the capture element 254 increases. 2A, 2B, and 4 together, distal movement of the plunger 144 can move the capture element 252 to a fully collapsed position before the plunger 144 reaches the fully depressed first position shown in FIG. 2A. Thus, continued distal movement of the plunger 144 (e.g., from the second position toward the first position) can pull the corer element 252, collapsing / longitudinally extending the corer element 252. That is, when the plunger 144 is depressed distally while the corer element 254 is fully collapsed, the plunger 144, the inner shaft 134, and the capture element 254 can collectively act to stretch / collapse the corer element 252. In other embodiments, proximal displacement of the inner shaft 134 can selectively separate the inner shaft 134 from the capture element 254 to expand the corer element 252 without causing any movement of the capture element 254. In some embodiments, the length of the capture element 254 can be (i) about 5-30 inches (e.g., about 10-20 inches, about 16 inches) in the collapsed configuration, and (ii) about 1-25 inches (e.g., about 10-20 inches, about 11 inches) in the expanded configuration.

[0041] In some embodiments, the capture element 254 can be formed by a braider and / or loom, while in other embodiments, the capture element 254 can be braided and / or woven manually. In some embodiments, the capture element 254 is formed as a tubular braid and then further shaped using a heat setting process. The braid can be, for example, a tubular braid of thin metal wires, such as Nitinol (nickel-titanium alloy), platinum, cobalt-chromium alloy, stainless steel, tungsten, or titanium. In some embodiments, the capture element 254 can be formed at least in part from a cylindrical braid of elastic filaments. Thus, the braid may be radially constrained without plastic deformation to allow it to self-expand when the radial constraint is released. Such a braid of elastic filaments may be referred to herein as a "self-expanding braid." In some embodiments, the braided filaments may have a thickness of less than about 0.15 mm. In some embodiments, the braid may be made from filaments and / or wires having a diameter in the range of about 0.05-0.25 mm. In some embodiments, braided filaments of different diameters may be combined to impart different properties (e.g., stiffness, resilience, structure, radial force, pore size, embolic capture or filtering capabilities, etc.). In some embodiments, the capture element 254 and / or the coring element 252 may be coated to reduce its surface friction / abrasion (e.g., for arterial applications). Similarly, the capture element 254 and / or the coring element 252 may be covered with a film (e.g., via dip or spray coating) to form an impermeable membrane to contain clots and prevent them from becoming embedded in the interstices of the capture element 254 and / or the coring element 252, thereby facilitating ease of cleaning. In some embodiments, the number of filaments used to form the capture element 254 may be between about 20 and 300 (e.g., including 144 filaments, 244 filaments, etc.). In some embodiments, the size of the hole formed by capture element 254 (eg, in elongated portion 477) can be between about 0.05 and 4.0 mm (eg, between about 0.5 mm and 2.5 mm, less than 0.4 mm).

[0042] III. SELECTED EMBODIMENTS OF DILATE ASSEMBLIES AND ASSOCIATED METHODS 5A and 5B are side views of the dilator assembly 104 of FIG. 1 in a first configuration and a second configuration, respectively, configured in accordance with an embodiment of the present technology. Referring to both FIGS. 5A and 5B, the dilator assembly 104 includes a first shaft or sheath 580 extending between and operably coupling the control assembly 120 and the retaining sheath 122. The dilator assembly 104 can further include a second shaft or sheath 582 slidably positioned on the first shaft 580 and operably coupled to the control assembly 120. Stated another way, the second shaft 582 can define a lumen sized to slidably receive the first shaft 580 such that the first and second shafts 580, 582 can be axially displaceable relative to one another. In the illustrated embodiment, the first shaft 580 is longer than the second shaft 582, with the retaining sheath 122 located distal to a distal portion 583b (opposite a proximal portion 583a) of the second shaft 582. The control assembly 120 further includes a housing 595 configured to engage (e.g., mate with) the sealable hub 114 (FIG. 1) of the introducer assembly 102.

[0043] The retaining sheath 122 includes a proximal portion 585a and a distal portion 585b. In the illustrated embodiment, the distal portion 585a includes an atraumatic tip 584, and the proximal portion 585a includes a first engagement feature 586. Similarly, the distal portion 583b of the second shaft 582 includes a second engagement feature 589. In some embodiments, the atraumatic tip 584 is radiopaque.

[0044] When the dilator assembly 104 is in the first configuration shown in FIG. 5A, the second shaft 582 is positioned proximally relative to the first shaft 580 (e.g., retracted) and the first engagement feature 586 does not engage the second engagement feature 589. As will be described in more detail below with reference to FIG. 7A, when the dilator assembly 104 is in the first configuration, the first engagement feature 586 is configured to engage (e.g., connect, mate) with the distal portion 113b ( FIG. 1 ) of the sheath 112 of the introducer assembly 102. In some embodiments, a seal can be formed when the first engagement feature 586 engages the sheath 112.

[0045] When the dilator assembly 104 is in the second configuration (FIG. 5B), the second engagement feature 589 of the second shaft 582 is configured to engage the first engagement feature 586 of the retaining sheath 122. As shown, the diameter of the second shaft 582 can be equal or substantially equal to the outer diameter of the retaining sheath 122 such that in the second configuration, the dilator assembly 104 has a uniform or substantially uniform (e.g., smooth) outer surface. That is, for example, there are no steps or discontinuities in the outer surface between the first shaft 580 and the retaining sheath 122. In other embodiments, the second shaft 582 and the retaining sheath 122 can have different diameters and the first and second engagement features 586, 589 can be configured to provide a smooth transition between the second shaft 582 and the retaining sheath 122. In some embodiments, the first engagement feature 586 can engage the second engagement feature 589 to form a seal. In some embodiments, the operator can move the dilator assembly 104 from the first configuration to the second configuration by actuating the driver 124 of the control assembly 120 (e.g., by advancing the driver 124 in the direction of arrow A). More specifically, as described in more detail below with reference to Figures 7A-7D, actuation of the driver 124 can (i) advance both the first and second shafts 580, 582 distally relative to the sheath 112, and (ii) advance the second shaft 582 distally relative to the first shaft 580.

[0046] 6 is an enlarged cross-sectional side view of a portion of the thrombectomy system 100 shown in FIG. 1. More particularly, shown in FIG. 6 is a self-expanding funnel 690 coupled to a distal portion 113b of the sheath 112 of the introducer assembly 102 and constrained within the retaining sheath 122 of the dilator assembly 104 in accordance with an embodiment of the present technology. In the illustrated embodiment, the retaining sheath 122 includes a shell portion 692 coupled to the tip 584 and defines a lumen 693. While in some embodiments, the shell portion 692 and the tip 584 are integrally formed together, in other embodiments, the tip 584 can be a separate component coupled to the shell portion 692, for example, by positioning at least a portion of the tip 584 within the lumen 693 and securing the shell portion 692 to the tip 584 (e.g., by adhesive, friction fit).

[0047] The first shaft 580 of the dilator assembly 104 extends through a lumen 688 of the sheath 112 and at least partially through a lumen 693 of the shell portion 692. In the illustrated embodiment, a portion of the tip 584 snugly receives a distal portion (e.g., a distal portion) of the first shaft 580 to secure the first shaft 580 to the retaining sheath 122. In other embodiments, the first shaft 580 can be otherwise coupled to the retaining sheath 122. As further shown in FIG. 6 , the first shaft 580 and the tip 584 can define a continuous lumen 691 for receiving a guidewire (not shown). In some embodiments, the diameter of the guidewire can be about 0.038 inches, 0.035 inches, about 0.018 inches, 0.014 inches, greater than about 0.38 inches, less than about 0.1 inches, or less than about 0.05 inches.

[0048] In the illustrated embodiment, the inner diameter F1 of the shell portion 692 is larger than the outer diameter F2 of the first shaft 580, forming an annular retaining / receiving space 694 between the outer surface of the first shaft 580 and the inner surface of the shell portion 692. The receiving space 694 (e.g., size and shape) is configured to receive and / or retain the funnel 690 in the constrained configuration. Thus, in some embodiments, the diameter of the funnel 690 can substantially match the inner diameter F1 of the shell portion 692 when the funnel 690 is in the constrained configuration. In some embodiments, the first engagement feature 586 of the retaining sheath 122 can engage (e.g., sealingly engage) the distal portion 113b of the sheath 112 when the funnel 690 is retained within the retaining sheath 122.

[0049] 7A-7D are side views illustrating various stages in a process or method for deploying a funnel 690 according to an embodiment of the present technology. Referring initially to FIG. 7A, the dilator assembly 104 is initially positioned within the introducer assembly 102 in a first configuration (FIG. 5A) with (i) the housing 595 of the control assembly 120 coupled / engaged to the sealable hub 114 and (ii) the first engagement feature 586 of the retaining sheath 122 sealingly engaged to the distal portion 113b of the sheath 112. In other embodiments, the first engagement feature 586 need not sealingly engage the sheath 112. In the initial position shown in FIG. 7A, the drive portion 124 of the control assembly 120 is in a first position (e.g., a fully retracted position) and the funnel 690 is contained within the retaining sheath 122 in a constrained configuration as shown in FIG. 6.

[0050] In the arrangement shown in FIG. 7A , introducer assembly 102 and dilator assembly 104 (collectively “assemblies 102, 104”) can be used to percutaneously access a patient's venous vessel, for example, through an access site (e.g., a popliteal access site, a femoral access site, an internal jugular access site, and / or other access site). In some embodiments, assemblies 102, 104 are inserted through a separate introducer sheath (not shown). In some embodiments, assemblies 102, 104 are advanced within the venous vessel to a treatment location where distal portion 113b of sheath 112 is adjacent (e.g., proximal) to a thrombus within the venous vessel.

[0051] 7B, after the assemblies 102, 104 are positioned, the funnel 690 (shown as transparent in FIGS. 7B and 7C for clarity) can be deployed, for example, by moving the driver 124 from a first position (FIG. 7B) to a second position (e.g., a mid-position, a mid-stroke position, a drop position) to advance both the first and second shafts 580, 582 distally relative to the sheath 112. Distal advancement of the first shaft 580 moves the retaining sheath 122 distally past and away from the funnel 690. When the funnel 690 is no longer constrained by the retaining sheath 122, the funnel 690 self-expands to an expanded (e.g., unconstrained) configuration. In other embodiments, the control assembly 120 is configured to advance only the first shaft 580 of the expander assembly 104 distally by moving the drive portion 124 from the first position to the second position, rather than advancing both the first and second shafts 580, 582 distally together.

[0052] The funnel 690 can include a variety of shapes and sizes and can be formed from a variety of materials. In some embodiments, in the expanded configuration, the funnel 690 can have (i) a maximum diameter greater than and / or equal to the diameter D (FIGS. 3B and 3C) of the coring element 252 when the coring element 252 is in a fully expanded configuration, and (ii) a minimum diameter substantially equal to the outer diameter of the sheath 112. In some embodiments, the funnel 690 can have a length N greater than and / or equal to the length M (FIGS. 3A-3D) of the coring element 252 such that the coring element 252 can be received and accommodated within the funnel 690. In other embodiments, the funnel 690 can have a length N less than the length M of the coring element 252. In some embodiments, the funnel 690 can have a cone-shaped portion, specifically, a frusto-conical portion. In some embodiments, the funnel 690 can be formed from at least one of a castellated nitinol braid, a nitinol braided stent, laser cut nitinol, laser cut polymer tubing, an injection molded polymer structure, or an inflatable balloon. In some embodiments, the funnel 690 can include a mesh having a pore size small enough to prevent passage of blood clots through the pores of the mesh. In some embodiments, the funnel 690 can be blood permeable.

[0053] 7C, after the funnel 690 is deployed, the dilator assembly 104 can be moved to the second configuration (FIG. 5B). For example, the operator can move the drive 124 of the control assembly 120 from the second position (FIG. 7B) to a third position (e.g., a fully advanced position) to advance the second shaft 582 distally relative to the first shaft 580 until the second engagement feature 589 of the second shaft 582 engages the first engagement feature 586 of the retaining sheath 122. As shown in FIG. 7D, after the dilator assembly 104 is moved to the second configuration, the dilator assembly 104 can be fully retracted and retracted from the introducer assembly 102. For example, the dilator assembly 104 can be retracted proximally through the lumen of the sheath 112 and from the sealable hub 114 of the introducer assembly 102.

[0054] 7A-7D together, in one aspect of the present technology, moving the dilator assembly 104 to the second configuration prior to retracting the dilator assembly 104 from the introducer assembly 102 can hinder or even prevent the dilator assembly 104 from damaging the funnel 690 or other components of the introducer assembly 102 while the dilator assembly 104 is being retracted. More specifically, if the dilator assembly 104 did not include the second shaft 582, the retaining sheath 122 (e.g., first engagement feature 586) could catch on or damage the deployed funnel 690 as the retaining sheath 122 retracts proximally into the sheath 112. However, because the diameter of the second shaft 582 is equal or substantially equal to the outer diameter of the retaining sheath 122, in the second configuration the dilator assembly 104 has a uniform or nearly uniform (e.g., smooth) outer surface and is therefore less likely to catch on or otherwise damage the funnel 690, the sealable hub 114, and / or other components of the introducer assembly 102 during retraction. In other embodiments, the second shaft 582 and the retaining sheath 122 can have different diameters and the first and second engagement features 586, 589 can be configured to provide a smooth transition between the second shaft 582 and the retaining sheath 122.

[0055] In another aspect of the present technology, the movement of the driver 124 from the first position to the third position both (i) advances the first and second shafts 580, 582 together to deploy the funnel 690 (e.g., when the driver 124 moves from the first position to the second position) and (ii) advances the second shaft 582 relative to the first shaft 580 (e.g., when the driver 124 moves from the second position to the third position) so that the dilator assembly 104 has a generally uniform outer diameter. This "double action" allows the control assembly 120 to be coupled to the sealable hub 114 during both the deployment of the funnel 690 and the advancement of the second shaft 582 toward the first shaft 580. This can advantageously hinder or prevent inadvertent advancement of the retaining sheath 122, which would result in premature deployment of the funnel 690. For example, if the funnel 690 is prematurely deployed, the dilator assembly 104 and introducer assembly 102 must often be completely removed from the patient in order to reload the funnel 690, potentially increasing trauma to the patient and the duration of the thrombectomy procedure. In contrast, some conventional dilator assemblies include dilators that are "floating" (e.g., not locked or engaged to the introducer assembly), such that an inadvertent collision or other force against the dilator assembly can cause corresponding movement of the dilator assembly.

[0056] Figures 8A, 8C, and 8D are cross-sectional side views of a control assembly 120 configured in accordance with an embodiment of the present technology, and Figure 8B is an enlarged cross-sectional isometric view of a control assembly 120 configured in accordance with an embodiment of the present technology. In Figures 8A and 8B, the driver 124 is in a first position shown in Figure 7A, in Figure 8C, the driver 124 is in a second position shown in Figure 7B, and in Figure 8D, the driver 124 is in a third position shown in Figure 7C.

[0057] 8A, control assembly 120 includes a proximal portion 801a and a distal portion 801b and defines a lumen 802 extending therethrough between the proximal and distal portions 801a,b. In the illustrated embodiment, control assembly 120 includes a sealable member 804 at or adjacent to the proximal portion 801a and a connecting portion 806 at or adjacent to the distal portion 801b. Sealable member 804 may be configured to selectively seal lumen 802 of control assembly 120 and, in some embodiments, may receive a guidewire (not shown) therethrough. As previously described in detail with reference to FIGS. 7A-7C, connecting portion 806 is configured to mate / engage with sealable hub 114 of introducer assembly 102 to secure control assembly 120 thereto. For example, in some embodiments, the connection portion 806 may include a snap feature (e.g., having one or more teeth, a flange), a twist lock (e.g., a bayonet or luer type fitting), and / or other features for engaging and / or locking with the sealable hub 114.

[0058] 8A and 8B together, in the illustrated embodiment, the control assembly 120 further includes a first shaft hub 810 and a second shaft hub 850. The first shaft hub 810 is configured to be coupled to a first shaft 580 of the dilator assembly 104, and the second shaft hub 850 is configured to be coupled to a second shaft 582 of the dilator assembly 104. For clarity, the first and second shafts 580, 582 are not shown in FIGS. 8A-8D. In the illustrated embodiment, the second shaft hub 850 is connected to (e.g., integrally formed with) the driver 124. The driver 124 extends outside the housing 595 and is configured to be advanced distally and / or retracted proximally by an operator. The first shaft hub 810 includes a first body portion 812 and one or more first engagement or snap features 814 (only one first engagement feature 814 is visible in FIGS. 8A-8D ). The engagement or snap features 814 extend radially and / or axially away from the first body portion 812 into corresponding first tracks 830 formed in the housing 595. The second shaft hub 850 similarly includes a second body portion 852 and a second engagement or snap feature 854 (e.g., a pair of similar or identical second engagement features 854). The second engagement or snap features 854 extend radially and / or axially away from the second body portion 852 into corresponding second tracks 840 formed in the housing 595.

[0059] In the illustrated embodiment, the first track 830 includes one or more proximal detents 832 (hidden in FIGS. 8A and 8B, shown in FIG. 8C), one or more distal detents 834, and a distal terminus 835. In some embodiments, the first track 830 can include a pair of opposing (e.g., radially opposed) proximal detents 832 and a pair of opposing distal detents 834. The second track 840 includes a first portion 842 (FIG. 8A) having a first track width or height G1 and a second portion 844 (FIG. 8A) having a second track width or height G2 that is greater than the first track width G1. In some embodiments, the transition (e.g., slope or step) between the first and second portions 842, 844 of the second track 840 is generally aligned on and / or adjacent to the distal detents 834 of the first tack 830.

[0060] In operation, the first and second shaft hubs 810, 850 are configured to slide within the lumen 802 along the first and second tracks 830, 840, respectively. In some embodiments, the first engagement feature 814 and / or the second engagement feature 854 are flexible such that the first and second shaft hubs 810, 850 can bend / curve as they move along the first and second tracks 830, 840. The configuration / arrangement of the first and second shaft hubs 810, 850 and the first and second tracks 830, 840 (e.g., the arrangement of the proximal and distal detents 832, 834, the first portion 842, and / or the second portion 844) can facilitate movement of the dilator assembly 104 from the first configuration ( FIG. 5A ) to the second configuration ( FIG. 5B ).

[0061] More specifically, in a first position shown in FIGS. 8A and 8B, the drive 124 is located at a proximal-most position along the housing 595. For example, the first shaft hub 810 can abut the proximal wall portion 807 of the housing 595. In the first position, the first portion 842 of the second track 840 compresses (e.g., presses, constrains) the second engagement feature 854 of the second shaft hub 850 radially inward toward the first shaft hub 810 to engage the first shaft hub 810 (e.g., first body portion 812). In other words, when the second shaft hub 850 is in a relaxed state and is not constrained by the first portion 842 of the second track 840, the distance (e.g., diameter) of the second shaft hub 850 between the second engagement features 854 can be greater than the first diameter G1. With this arrangement, the second shaft hub 850 is secured to the first shaft hub 810 such that movement of the drive 124 along the first portion 842 of the second track 840 moves both the first and second shaft hubs 810, 850. In some embodiments, the first body portion 812 of the first shaft hub 810 can include various features (e.g., grooves, channels, teeth) for mating with the second engagement feature 854 of the second shaft hub 850 such that the first and second shaft hubs 810, 850 are secured together.

[0062] Also, in the first position, at least a portion of the first engagement feature 814 of the first shaft hub 810 can be located proximally relative to the proximal detent 832 (FIGS. 8C and 8D). Thus, the proximal detent 832 can hold the first shaft hub 810 (and the second shaft hub 850 and the driver 124 secured thereto) in the first position until a predetermined force is applied to the driver 124 in a distal direction. In one aspect of the present technology, this arrangement can prevent unintended distal advancement of the first shaft 580 (and thus premature deployment of the funnel 690 (FIGS. 7A-7C)). In some embodiments, when a predetermined force is applied to the driver 124, the first engagement feature 814 bends inwardly, allowing the first shaft hub 810 to slide distally.

[0063] 8A-8C together, after the first engagement feature 814 disengages from the proximal detent 832, the driver 124 may be advanced distally from the first position to a second position as shown in FIG. 8C. Moving the driver 124 distally moves both the first and second shaft hubs 810, 850 distally (resulting in the first and second shafts 580, 582 advancing together as shown in FIG. 7B) until the first shaft hub 810 reaches the distal end 835 of the first track 830 and / or the second shaft hub 840 reaches the second portion 844 of the second track 840. More specifically, the distal end 835 and / or the distal detent 834 of the first track 830 may engage the first engagement feature 814 to prevent the first shaft hub 810 (and thus the first shaft 580) from moving further distally. At the same time, the larger diameter second portion 844 of the second track 840 allows the second engagement feature 854 to move radially outward (e.g., bend radially outward toward a relaxed state) and out of engagement with the first shaft hub 810. That is, the control assembly 120 is configured such that the second engagement feature 854 of the second shaft hub 850 reaches the transition point between the first and second portions 842, 844 of the first track 840 at substantially the same time that the first engagement feature 814 of the first shaft hub 810 reaches / engages the distal detent 834 of the first track 830.

[0064] Thus, as shown in Figure 8D, the second shaft hub 850 can advance further distally to a third position, leaving behind the first shaft hub 810. As the first shaft hub 810 remains stationary and the second shaft hub 850 moves distally, as shown in Figure 7C, the second shaft 582 advances distally towards the retaining sheath 122. In some embodiments, the second shaft hub 850 can abut the distal wall portion 809 of the housing 595 at the third position.

[0065] 5A-8D together, in one aspect of the present technology, the control assembly 120 facilitates the movement of the dilator assembly 104 from the first configuration to the second configuration with only a single movement of the drive 124 from the first to the third position. As previously mentioned, this advantageously allows the control assembly 120 to be coupled to the sealable hub 114 at any time during the deployment of the funnel 690, thereby controlling the deployment of the funnel 690 and preventing inadvertent deployment of the funnel 690. This is expected to reduce the chance that other components of the system (e.g., the retaining sheath 122) will get caught on the funnel 690 as the dilator is retracted through the sheath 112. Also, the deployment of the funnel 690 and the advancement of the second shaft 582 are accomplished with a single stroke, which is greatly simplified.

[0066] In some embodiments, the driver 124 can be moved proximally (e.g., from the third position toward the first position) to facilitate loading of the funnel 690. For example, when the control assembly 120 is in the third position, the dilator assembly 104 can be inserted into the sheath 112 such that the retaining sheath 122 extends distally from the distal portion 113b of the sheath 112 and beyond the funnel 690. The operator can then force the second shaft hub 850 into engagement with the first shaft hub 810 via narrowing the second track 840 from the second portion 844 to the first portion 842 by moving the driver 124 to the second position. The loading tool 108 (FIG. 1) can then be slid proximally over the retaining sheath 122 and funnel 690 until the funnel 690 is fully enclosed by the loading tool 108 and / or until the funnel 690 is in a constrained configuration. The operator can then load / capture the funnel 690 within the receiving space 694 of the retaining sheath 122 by moving the driver 124 from the second position to the first position to retract the retaining sheath 122 over the funnel 690. Finally, the loading tool 108 can be removed.

[0067] In other embodiments, a control assembly in accordance with the present technology can include other components and / or configurations to facilitate the dual action of (i) advancing the first and second shafts 580, 582 to deploy the funnel 690 and (ii) advancing the second shaft 582 relative to the first shaft 580 to obtain a uniform outer surface that facilitates retraction of the dilator assembly 104. Figures 9A-9C are cross-sectional side views of a control assembly 920 including the drive portion 124 in a first position, a second position, and a third position (Figures 7A-7C), for example, as configured in accordance with another embodiment of the present technology.

[0068] The control assembly 920 may include several features generally similar to the control assembly 120 previously described in detail with reference to FIGS. 8A-8D. For example, referring together to FIGS. 9A-9C, the control assembly 920 includes a first shaft hub 910 coupled to the first shaft 580 of the dilator assembly 104 and a second shaft hub 950 coupled to the second shaft 582 of the dilator assembly 104. In the illustrated embodiment, the second shaft hub 950 is connected to (e.g., integrally formed with) the driver 124. The driver 124 extends outside a housing 995 of the control assembly 920 and is configured to be advanced distally and / or retracted proximally by an operator. The first and second shaft hubs 910, 950 are configured to slide at least partially through a lumen 902 extending through the housing 995.

[0069] In the illustrated embodiment, the control assembly 920 further includes an elongated member 960 (shown as transparent in FIGS. 9A-9C for clarity). The elongated member 960 has (i) a proximal portion 961a located proximal to the first shaft hub 910 and (ii) a distal portion 961b located distal to the first shaft hub 910 and coupled to the second shaft hub 950. The first shaft hub 910 may be slidably positioned within the elongated member 960. A biasing member 964 (e.g., a compression spring) extends between the proximal portion 961a of the elongated member 960 and the first shaft hub 910. In some embodiments, a proximal portion 965a of the biasing member 964 is connected to the proximal portion 961a of the elongated member 960 and a distal portion 965b of the biasing member 964 is connected to the first shaft hub 910.

[0070] The control assembly 920 may further include a stop member 970 coupled to the first shaft 580 (e.g., a proximal portion of the first shaft 580). The stop member 970 is configured to slide at least partially through the housing lumen 902 during operation of the control assembly 920 and may be fully contained within the housing 995 (e.g., as shown in FIGS. 9B and 9C) and / or may extend fully or partially outside the housing 995 (e.g., as shown in FIG. 9A). As shown in FIG. 9B, a dimension (e.g., diameter) H1 of the stop member 970 is greater than a dimension H2 of a stop portion 972 of the housing 995. With this arrangement, the stop member 970 is configured to contact the stop portion 972 of the housing 995 and thereby prevent the first shaft 580 (and the retaining sheath 122 attached thereto) from advancing further distally.

[0071] 9A , in the first position, the first shaft hub 910 engages (e.g., meshes) with the second shaft hub 950 such that distal advancement of the driver 124 moves both the first and second shaft hubs 910, 950. Also, the biasing member 964 is in a balanced state, e.g., does not exert any force on the first shaft hub 910. In some embodiments, the driver 124 and / or the second shaft hub 950 can include a first engagement feature 954 (e.g., a ridge, protrusion). The first engagement feature 954 can engage (e.g., mesh) with a corresponding first detent 957 in the housing 995 to releasably secure the driver 124 in the first position until a predetermined force is applied distally to the driver. In some embodiments, when a predetermined force is applied to the drive portion 124, the first engagement feature 954 bends outward from the first detent 957 to allow the first and second shaft hubs 910, 950 to move distally.

[0072] 9A and 9B together, after the first engagement feature 954 disengages from the first detent 957, the driver 124 may advance distally from the first position to the second position. As the driver 124 moves distally, the first and second shaft hubs 910, 950 move distally together (thereby advancing the first and second shafts 580, 582 together, as shown in FIG. 7B ) until the stop member 970 reaches and contacts the stop portion 972 of the housing 995. More specifically, the biasing member 964 may exert a force against the first shaft hub 910 to move the second shaft hub 950 with the first shaft hub 910. When the stop member 970 contacts the stop portion 972, the first shaft hub 910 is stopped from advancing distally further.

[0073] 9B and 9C together, as the driver 124 moves further distally to the third position, the second shaft hub 950 can leave the first shaft hub 910 behind. As the first shaft hub 910 remains stationary and the second shaft hub 950 moves distally, the second shaft 582 advances distally toward the retaining sheath 122, as shown in FIG. 7C. In some embodiments, the second shaft hub 950 can abut the distal wall portion 909 of the housing 995 at the third position, preventing the second shaft hub 950 from advancing further. As further shown in FIG. 9C, as the second shaft hub 950 advances to the third position, the biasing member 964 compresses between the first shaft hub 910 (which remains stationary) and the proximal portion 961a of the elongated member 960 (which continues to move with the second shaft hub 950). In some embodiments, the biasing force exerted by the biasing member 964 can facilitate subsequent movement of the drive 124 from the third position to the second position. In some embodiments, the drive 124 can include a second engagement feature 958 (e.g., a ridge, a protrusion). The second engagement feature 958 can engage (e.g., interlock) with a corresponding second detent 959 in the housing 995 to releasably secure the drive 124 in the third position until a predetermined force is applied proximally to the drive. In some embodiments, the force can be less than the force required to disengage the first engagement feature 954 from the first detent 957 due to the biasing force of the biasing member 964. In other embodiments, the detent 959 can include a track (e.g., an L-shaped track). The second shaft hub 950 can be rotated to rotate the second engagement feature 958 into the track to releasably secure the drive 124 in the third position.

[0074] In other embodiments, the stop member 970 is not configured to stop distal advancement of the first shaft 580. Rather, the stop member 970 may instead be a luer flush port 970 (or another component) that simply moves with the first shaft 580, or may be omitted altogether. In such embodiments, the first shaft hub 910 may move along a track (not shown) formed in the housing 995 similar to the first shaft hub 810 described in detail with reference to FIGS. 8A-8D. For example, the first shaft hub 910 may include a first engagement or snap feature 914 (only one first engagement feature 914 is visible in FIGS. 9A-9C). The first engagement or snap feature 914 extends (i) radially and / or axially away from a body portion of the first shaft hub 910, (ii) from the elongated member 960, and (iii) into a track in the housing 995. The track may include a detent or other feature (not shown) configured (e.g., located and molded into) to stop the first shaft hub 910 from moving further distally when the first shaft hub 910 reaches the second position shown in FIG. 9B.

[0075] 10A and 10B are partial cross-sectional side views of a control assembly 1020 configured in accordance with another embodiment of the present technology. In general, the control assembly is movable between (i) a first position (shown in FIG. 10A) in which the second shaft 582 is proximally retracted relative to the first shaft 580, as shown in FIGS. 5A and 7A, and (ii) a third position (shown in FIG. 10B) in which the second shaft 582 is distally advanced relative to the first shaft 580 to form a generally uniform outer surface of the dilator assembly 104, as shown in FIGS. 5B and 7C. In one aspect of the present technology, the control assembly 1020 fluidly moves between the first and third positions without an intermediate second position (FIG. 7B).

[0076] The control assembly 1020 may include several features generally similar to the control assembly 120 and / or the control assembly 920 previously described in detail with reference to Figures 8A-9C. For example, with reference to both Figures 10A and 10B, the control assembly 1020 includes a drive 1024 (e.g., a plunger 1024) movable relative to / through a lumen 1002 of the housing 1095. The plunger 1024 is coupled to (i) a first shaft hub 1010 coupled to a first shaft 580 of the dilator assembly 104 and (ii) a second shaft hub 1050 coupled to a second shaft 582 of the dilator assembly 104. The first and second shafts 580, 582 are not shown in Figures 10A and 10B for clarity.

[0077] In the illustrated embodiment, the second shaft hub 1050 includes an engagement feature 1054. The engagement feature 1054 (e.g., size and shape) is configured to engage a corresponding stop 1056 formed in the housing 1095 when the plunger 1024 is in the first position shown in FIG. 10A. The first shaft hub 1010 is configured to slide along a track 1080 formed in / along a portion of the plunger 1024. In some embodiments, the track 1080 includes at least one detent 1084 at its distal portion and is configured to stop / block distal advancement of the first shaft hub 1010. In other embodiments, the housing 1095 can include a flange or other component configured to stop distal advancement of the first shaft hub 1010.

[0078] A first biasing member 1064 (e.g., a compression spring) extends between and is operably coupled (e.g., connected) to the first shaft hub 1010 and the proximal portion 1096 of the housing 1095. A second biasing member 1066 (e.g., a compression spring) extends between and is operably coupled (e.g., connected) to the first and second shaft hubs 1010, 1050. In the first position shown in FIG. 10A, the first and second biasing members 1064, 1066 are both compressed under load, thus urging the first and second shaft hubs 1010, 1050, respectively, distally. In some embodiments, the compressive force of the first biasing member 1064 is greater than the second biasing member 1066.

[0079] In the first position shown in FIG. 10A, the plunger 1024 is locked in a proximally retracted position by engagement of the engagement feature 1054 with a stop portion 1056 of the housing 1095. To move the control assembly 1020 to a third position shown in FIG. 10B, an operator can rotate the plunger 1024 (e.g., as shown by arrow I in FIG. 10A) to unlock the second shaft hub 1050 and the plunger 1024. When the plunger 1024 is unlocked, the first biasing member 1064 is configured to drive the first shaft hub 1010 distally until the first shaft hub 1010 stops by / in the detent 1084. In one aspect of the present technology, because the first biasing member 1064 is stronger than the second biasing member 1066, the second biasing member 1066 remains substantially compressed until the first shaft hub 1010 engages the detent 1084. As such, both the first and second shaft hubs 1010, 1050 (and thus both the first and second shafts 580, 582) move together until the first shaft hub 1010 reaches the detent 1084. The second biasing member 1066 is then configured to drive the second shaft hub 1050 distally relative to the first shaft hub 1010 (e.g., away from the first shaft hub 1010). In the third position, shown in FIGURE 10B, the first and second biasing members 1064, 1066 can bias the first and second shaft hubs 1010, 1050 distally to maintain the control assembly 1020 in the third position. This arrangement automatically moves the first and second shafts 580, 582 from the first configuration (FIGURE 5A) to the second configuration (FIGURE 5B) to deploy the funnel and prepare for retraction of the dilator assembly 104, as shown in FIGS. 7A-7D.

[0080] In other embodiments, the first and second biasing members 1064, 1066 can be arranged in an opposite configuration. For example, the first biasing member 1064 can extend between and be operably coupled to the first and second shaft hubs 1010, 1050, and the second biasing member 1066 can extend between and be operably coupled to the second shaft hub 1050 and the distal portion 1098 of the housing 1096. Similarly, the compressive force of the second biasing member 1066 can be greater than the first biasing member 1064. Thus, the first and second biasing members 1064, 1066 can bias the control assembly 1020 to the first position. To move the control assembly 1020 to the third position, a user can advance the plunger 1024 against the compressive force of the first and second biasing members 1064, 1066 until the second shaft hub 1050 reaches the third position. In some embodiments, the user can then rotate the plunger 1024 to lock the control assembly 1020 in the third position.

[0081] IV. SELECTED EMBODIMENTS OF THROMBEECTOMY METHODS FIG. 11 is a schematic diagram of an introduction technique for accessing and treating a thrombus 1190 with a thrombectomy system 100 in accordance with an embodiment of the present technology. A thrombus 1190 (e.g., a clot) can be located within a blood vessel 1196 and accessed through an access site 1192 (e.g., a popliteal access site, or other venous or arterial access site). The introducer assembly 102 can extend from the popliteal access site 1192 (or other venous or arterial access site) to a deployment location 1194 where a self-expanding funnel 690 can be deployed to approximate the thrombus 1190. As described in more detail below with reference to FIGS. 12A-12K, the thrombus extraction device 250 can be passed through the thrombus 1190 in the direction of blood flow and retracted through the thrombus 1190 in the direction of blood flow. During retraction, the coring element 252 can core / separate the thrombus 1190 and the capturing element 254 can capture all or a portion of the thrombus 1190. In some embodiments, part or all of the thrombus extraction device 250 can extend into one of the iliac vein and / or the inferior vena cava.

[0082] More specifically, Figures 12A-12C are side views, and Figures 12D-12M are enlarged side views, of a thrombectomy system 100 positioned within a blood vessel 1196 during a thrombectomy procedure to treat (e.g., remove) a thrombus 1190 in accordance with an embodiment of the present technology.

[0083] 12A illustrates the thrombectomy system 100 positioned intravascularly within a blood vessel 1196 after (i) deploying the self-expanding funnel 690 (e.g., as described in detail with reference to FIGS. 5A-10B ), (ii) removing the dilator assembly 104 from the introducer assembly 102, and (iii) advancing the outer shaft 132 of the thrombus extraction assembly 106 through the sheath 112 and the thrombus 1190. Distal advancement of the outer shaft 132 through the thrombus 1190 may be with or against the direction of blood flow.

[0084] 12B illustrates the thrombus extraction system 100 after the thrombus extraction device 250 has been advanced through the outer shaft 132 to a deployed position distal to the thrombus 1190. In some embodiments, the thrombus extraction device 250 can be constrained within the outer shaft 132 and inserted together with the outer shaft 132 into the lumen of the sheath 112 via the sealable hub 114. In some embodiments, the thrombus extraction device 250 can be deployed by advancing the thrombus extraction device 250 past the distal portion 136b of the sheath 112 and / or by retracting the outer shaft 132 relative to the thrombus extraction device 250 until the thrombus extraction device 250 is past the distal portion 136b of the outer shaft 132.

[0085] 12C illustrates the thrombectomy system 100 after the thrombus extraction device 250 has been fully expanded. In some embodiments, at least a portion of the coring element 252 and / or the capture element 254 contacts the wall 1297 of the blood vessel 1196 in the fully expanded position. As already described in detail with reference to FIGS. 2A and 2B, in some embodiments, the thrombus extraction device 250 can be fully expanded by moving the plunger 144 from a first position to a second position and fixing the plunger 144 in the second position, thereby fixing the relative position of the inner shaft 134 with respect to the intermediate shaft 133.

[0086] Generally, FIGS. 12D-12K illustrate the thrombus extraction device 250 retracting proximally through the thrombus 1190 to capture at least a portion of the thrombus 1190, and the thrombus extraction device 250 and the captured thrombus 1190 subsequently retracting together into the funnel 690 and the sheath 112.

[0087] 12D, proximal retraction of the thrombus extraction device 250 causes the coring element 252 to separate and / or core the distal portion 1298b of the thrombus 1190 from the wall 1297 of the blood vessel 1196. As shown in FIG. 12E, continued proximal retraction of the thrombus extraction device 250 through the thrombus 1190 causes the capturing element 254 to capture the distal portion 1298b of the thrombus 1190 therein. FIGS. 12F-12H illustrate further proximal retraction of the thrombus extraction device 250 to further separate, core, and / or capture the thrombus 1190. As seen in FIG. 12H, the proximal portion 1298a of the thrombus 1190 is cored and captured as the thrombus extraction device 250 is proximally retracted toward the funnel 690 and the sheath 112.

[0088] As already described in detail with reference to Figures 3A-4, the corer element 252 can include both a first port 370 and a second port 372 (identified in Figure 12D). Thus, the first port 370, the first port portion 372a, and / or the second port portion 372b can facilitate corerization / separation of the thrombus 1190 during proximal retraction of the thrombus extraction device 250. In one aspect of the present technology, the first port 370 and the second port 372 are radially offset from one another to enhance the effectiveness of the corerization (even when the vessel 1196 is highly tortuous and / or the thrombus 1190 is strongly adherent to the wall 1297 of the vessel 1196) by ensuring that at least one of the first port 370 and the second port 372 is positioned and oriented to effectively core the thrombus 1190.

[0089] 12I and 12G, the thrombus extraction device 250 can be retracted proximally until the proximal portion 253a of the corer element 252 is received (e.g., positioned) within the funnel 690. More specifically, the thrombus extraction device 250 can be retracted proximally until all or a portion of the first port 370 and / or second port 372 of the corer element 252 is received within the funnel 690. In some embodiments, when one or both of the first and second ports 370, 372 are located within the funnel 690, the thrombus extraction device 250 can be moved or converted from an expanded, deployed state to a compressed state to compress and secure the thrombus 1190 captured by the thrombus extraction device 250. In some embodiments, for example, the middle shaft 133 (FIG. 12H) can be unlocked and / or decoupled from the inner shaft 134 (e.g., via user actuation of the plunger 144 shown in FIGS. 1-2B) to allow the inner shaft 134 to be advanced distally relative to the middle shaft 133 to collapse or compress the thrombus extraction device 250.

[0090] After the thrombus extraction device 250 is collapsed, it can be retracted proximally through the funnel 690 and into the sheath 112, as shown in FIG. 12K. The thrombus extraction device 250 can continue to be retracted proximally until the thrombus extraction device 250 and captured thrombus 1190 are fully contained within the sheath 112. In some embodiments, the thrombus extraction device 250 and captured thrombus 1190 can then be retracted through the sheath 112 and the sealable hub 114 (FIG. 12B).

[0091] In some embodiments, a vacuum (e.g., a pre-charged vacuum) can be applied to the sheath 112 at any time during retraction of the thrombus extraction device 250. In some embodiments, application of the vacuum can create an instantaneous or near-instantaneous suction at the distal portion of the sheath 112 to draw any remaining portions of the thrombus 1190 into and / or through the sheath 112. For example, the suction created can draw in any of the thrombus 1190 that has been trapped or pushed out by the funnel 690. Also, in some embodiments, application of the vacuum can facilitate smooth retraction of the trapped thrombus 1190 through the sheath 112. For example, the burst of suction created by application of the vacuum can help reduce clogging of the sheath 112 and / or help break up (e.g., break apart) obstructions that have formed within the sheath 112 during retraction.

[0092] V. Working Examples The following examples illustrate some aspects of the present technology. Example 1. 1. A coring element for coring a vascular thrombus in a blood vessel of a patient, comprising: the coring element comprises a unitary structure; The integral structure is a first region adjacent a proximal portion of the unitary structure, the first region including a first port configured to core the vascular thrombus; a second region distal to the first region, the second region being generally tubular and including a first plurality of interconnected struts; and a third region distal to the second region, the third region including a second port configured to core the vascular thrombus; a fourth region distal to the third region, the fourth region being generally tubular and including a second plurality of interconnected struts; and 4. A core removal element, comprising: Example 2. The coring element of Example 1, wherein the first port is radially offset from the second port. Example 3. The unitary structure extends along a longitudinal axis; The corer element of Example 1 or Example 2, wherein the first region includes a pair of first curved struts that curve in opposite directions about the longitudinal axis, the pair of first curved struts intersecting at a pair of first junctions to define the first mouth. Example 4. The unitary structure extends along a longitudinal axis; the third region includes: (a) a pair of upper curved struts that are curved about the longitudinal axis and intersect each other at an upper junction; and (b) a pair of lower curved struts that are curved about the longitudinal axis and intersect each other at a lower junction; The coring element of any one of Examples 1-3, wherein the lower and upper curved posts define the second mouth. Example 5. the lower and upper curved struts define (a) a first mouth portion that opens in a first direction generally perpendicular to the longitudinal axis, and (b) a second mouth portion that opens in a second direction generally perpendicular to the longitudinal axis; The coring element of Example 4, wherein the first and second mouth portions define the second mouth. Example 6. The coring element of Example 5, wherein the first direction is generally opposite the second direction. Example 7. The coring element of any one of Examples 1-6, wherein the coring element is expandable from a compressed delivery configuration to an expanded deployed configuration. Example 8. The corer element of Example 7, wherein the corer element is configured to self-expand. Example 9. The coring element of Example 8, wherein the coring element is formed from a shape memory material. Example 10. The coring element of any one of Examples 1-9, wherein the fourth region of the unitary structure is configured to be connected to a braided filament mesh structure. Example 11. 1. A dilator assembly for deploying an expandable funnel coupled to a distal portion of an introducer sheath, said dilator assembly comprising: a first shaft defining a lumen; a second shaft slidably positioned within the lumen of the first shaft; a retaining sheath coupled to the second shaft and configured to receive and retain the funnel therein; a control assembly including a driver operably coupled to the first and second shafts, wherein when the driver moves from a first position to a second position, the first and second shafts advance together to deploy the funnel from the retaining sheath, and when the driver moves from the second position to a third position, the first shaft advances relative to the second shaft; 13. A dilator assembly comprising: Example 12. The dilator assembly of Example 11, wherein the retaining sheath has substantially the same outer diameter as the first shaft. Example 13. The dilator assembly of Example 11 or Example 13, wherein a distal portion of the first shaft contacts a proximal portion of the retaining sheath when the driver moves from the second position to the third position. Example 14. The control assembly includes: Housing and a first shaft hub slidably positioned within the housing and coupled to the first shaft; a second shaft hub slidably positioned within the housing and coupled to the second shaft; The expander assembly of any one of Examples 11 to 13, comprising: Example 15. The dilator assembly of Example 14, wherein the first shaft hub is configured to engage the second shaft hub when the driver moves from the first position to the second position such that the first and second shafts advance together. Example 16. The dilator assembly of Example 14 or Example 15, wherein the first shaft hub is configured to disengage from the second shaft hub when the driver moves from the second position to the third position such that the first shaft is advanced relative to the second shaft. Example 17. the first shaft hub is configured to engage the second shaft hub when the drive moves from the first position to the second position such that the first and second shafts advance together; The dilator assembly of any one of Examples 14-16, wherein the first shaft hub is configured to disengage from the second shaft hub when the drive moves from the second position to the third position such that the first shaft advances relative to the second shaft. Example 18. the second shaft hub includes a first engagement feature; the housing includes a second engagement feature; The expander of any one of Examples 14 to 17, wherein when the drive portion moves from the second position to the third position, the first engagement feature is configured to engage the second engagement feature at the second position to prevent movement of the second shaft hub. Example 19. the first engagement feature is a snap feature; 19. The dilator assembly of Example 18, wherein the second engagement feature is a detent formed in the housing. Example 20. further comprising a biasing member operably coupled to the first shaft hub; The dilator assembly of any one of Examples 14 to 19, wherein the biasing member is configured to bias the first shaft hub from the third position toward the second position. Example 21. The control assembly further includes a housing. the drive portion is movable relative to the housing; the movement of the drive part from the first position to the second position is a distal movement of the drive part relative to the housing; 21. The expander assembly of any one of Examples 11-20, wherein the movement of the drive portion from the second position to the third position is a further distal movement of the drive portion relative to the housing. Example 22. The dilator assembly of any one of Examples 11-21, further comprising the introducer sheath and the funnel. Example 23. 1. A system for capturing a vascular thrombus in a blood vessel of a patient, the system comprising: an introducer sheath having a distal portion; an expandable funnel coupled to the distal portion of the introducer sheath; a dilator assembly configured for insertion through the introducer sheath and deploying the expandable funnel, a first shaft defining a lumen; a second shaft slidably positioned within the lumen of the first shaft; a retaining sheath coupled to the second shaft and configured to receive and retain the funnel therein; a control assembly including a driver operably coupled to the first and second shafts, wherein when the driver moves from a first position to a second position, the first and second shafts advance distally together to deploy the funnel from the retaining sheath, and when the driver moves from the second position to a third position, the first shaft advances relative to the second shaft; a dilator assembly including: a clot removal device configured to be inserted through the introducer sheath to capture at least a portion of the vascular thrombus; Including, the system. Example 24. The clot removal device includes an expandable coring element coupled to an expandable capture element; the coring element is configured to separate at least a portion of the vascular thrombus from a wall of the blood vessel; 24. The system of Example 23, wherein the capture element is configured to capture and retain the portion of the vascular thrombus that has separated from the wall of the blood vessel. Example 25. the funnel has a first length when deployed from the retaining sheath; The system of Example 23 or Example 24, wherein the corer element has a second length when expanded that is shorter than the first length. Example 26. 1. A system for capturing a vascular thrombus in a blood vessel of a patient, the system comprising: an introducer sheath having a distal portion; an expandable funnel coupled to the distal portion of the introducer sheath; a dilator assembly configured to be inserted through the introducer sheath and deploy the expandable funnel; a clot removal device configured to be inserted through the introducer sheath, the clot removal device including an expandable coring element coupled to an expandable capture element, the coring element including a first region including a first port and a second region including a second port, the first and second ports configured to detach at least a portion of the vascular thrombus from a wall of the blood vessel, the capture element configured to capture and retain the portion of the vascular thrombus that has been detached from the wall of the blood vessel; Including, the system. Example 27. 27. The system of Example 26, wherein the first port is radially offset from the second port. Example 28. the coring element is formed from a unitary structure including a plurality of struts; the post defines the first and second mouths; The strut further defines a plurality of apertures; The system of Example 27, wherein the first and second mouths are larger than each of the gaps.

[0093] VI. Conclusion 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 of and examples for the present technology have been described above for illustrative purposes, those skilled in the art will recognize that various equivalent modifications are possible within the scope of the present technology. For example, while steps are shown in a given order, alternative embodiments may perform the steps in a different order. Various embodiments described herein may be combined to produce further embodiments.

[0094] From the foregoing, it should be understood that, although specific embodiments of the technology have been described herein for purposes of explanation, well-known structures and functions have not been shown or described in detail in order to avoid unnecessarily obscuring the description of the embodiments of the technology. Where the context permits, singular or plural terms may include the plural or singular terms, respectively.

[0095] Also, unless the term "or" is expressly limited in relation to a list of two or more items to mean only a single item exclusive of the other 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. Furthermore, the term "comprising" is used throughout to mean at least the inclusion of the described feature(s), without excluding any more of the same features and / or other features of additional types. It should also be understood that, although particular embodiments have been described herein for purposes of illustration, various changes may be made without departing from the technology. Moreover, while 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 need to 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 coring element for coring a vascular thrombus in a blood vessel of a patient, comprising: the coring element includes a unitary structure extending along a longitudinal axis; The integral structure is a first region adjacent a proximal portion of the unitary structure, the first region including a first port configured to core the vascular thrombus; a second region distal to the first region, the second region being tubular and including a first plurality of interconnected struts forming first cells; a third region distal to the second region, the third region including a second port configured to core the vascular thrombus; and a fourth region distal to the third region, the fourth region being tubular and including a second plurality of interconnected struts forming a second cell, the first mouth and the second mouth being larger than each of the first cell and the second cell; a connecting feature configured to be coupled to a shaft for retracting the unitary structure proximally relative to the vascular thrombus; Including, A corer element, wherein the first port is defined by a pair of curved struts extending from a common proximal junction to a distal junction, the first port is configured to core the vascular thrombus when the unitary structure is retracted proximally relative to the vascular thrombus, the common proximal junction is radially offset from the longitudinal axis, and the connecting feature is coupled to the common proximal junction.

2. The coring element of claim 1 , wherein the first port is circumferentially offset from the second port.

3. The coring element of claim 1 , wherein the pair of curved struts are curved in opposite directions about the longitudinal axis.

4. The third region includes: (a) a pair of upper curved struts curved about the longitudinal axis and intersecting each other at an upper joint; and (b) a pair of lower curved struts curved about the longitudinal axis and intersecting each other at a lower joint; The coring element of claim 1 , wherein said pair of lower curved posts and said pair of upper curved posts define said second mouth.

5. the pair of lower curved struts and the pair of upper curved struts define (a) a first mouth portion that opens in a first direction perpendicular to the longitudinal axis, and (b) a second mouth portion that opens in a second direction perpendicular to the longitudinal axis; The coring element of claim 4 , wherein said first and second mouth portions define said second mouth.

6. The coring element of claim 5 , wherein the first direction is opposite the second direction.

7. The coring element of claim 1 , wherein the coring element is expandable from a compressed delivery configuration to an expanded deployed configuration.

8. The coring element of claim 7 , wherein the coring element is configured to be self-expanding.

9. The coring element of claim 8 , wherein the coring element is formed from a shape memory material.

10. The coring element of claim 1 , wherein the fourth region of the unitary structure is configured to be connected to a braided filament mesh structure.

11. 1. A system for capturing a vascular thrombus in a blood vessel of a patient, the system comprising: an introducer sheath having a distal portion; an expandable funnel coupled to the distal portion of the introducer sheath; a dilator assembly configured for insertion through the introducer sheath and deploying the expandable funnel, the dilator assembly comprising: a first shaft defining a lumen; a second shaft slidably positioned within the lumen of the first shaft; a retaining sheath coupled to the second shaft and configured to receive and retain the funnel therein; a control assembly including a driver operably coupled to the first and second shafts, wherein when the driver moves from a first position to a second position, the first and second shafts advance distally together to deploy the funnel from the retaining sheath, and when the driver moves from the second position to a third position, the first shaft advances relative to the second shaft; a dilator assembly including:

11. A clot removal device configured to be inserted through the introducer sheath to capture at least a portion of the vascular thrombus, the clot removal device including a corer element according to claim 1; Including, the system.

12. the coring element is coupled to an expandable capture element; the coring element is configured to separate at least a portion of the vascular thrombus from a wall of the blood vessel; The system of claim 11 , wherein the expandable capture element is configured to capture and retain the portion of the vascular thrombus that has separated from the wall of the blood vessel.

13. the funnel has a first length when deployed from the retaining sheath; The system of claim 11 , wherein the coring element, when expanded, has a second length that is shorter than the first length.

14. 1. A system for capturing a vascular thrombus in a blood vessel of a patient, the system comprising: an introducer sheath having a distal portion; an expandable funnel coupled to the distal portion of the introducer sheath; a dilator assembly configured to be inserted through the introducer sheath and deploy the expandable funnel; a clot removal device configured to be inserted through the introducer sheath, the clot removal device comprising the coring element of claim 1 , the coring element coupled to an expandable capture element, the coring element configured to detach at least a portion of the vascular thrombus from a wall of the blood vessel, the expandable capture element configured to capture and retain the portion of the vascular thrombus that has been detached from the wall of the blood vessel; Including, the system.

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