Aspiration catheter system designed for rapid clot removal

Abstract

A suction catheter system is described that includes a suction extension that interconnects with a guide catheter to form a continuous suction lumen that extends through a portion of the guide catheter and through the suction extension. The suction extension can be positioned by moving a proximal section of the suction extension within the lumen of the guide catheter while tracking the suction nozzle through the blood vessel. The suction extension can include a connecting section having a non-circular cross-section that interconnects with the lumen of the engagement section of the guide catheter. The proximal fitting can include a docking manifold that docks the connecting suction of the suction extension to allow removal of the suction extension from hemostatic isolation and evacuation of clots from the suction extension without the use of a separate fitting, thereby effectively reinserting the suction extension cleaned of foreign matter for further use.

Description

[Technical Field]

[0001] The present invention relates to an aspiration catheter system with an attachment designed for efficient and safe operation of aspiration treatments for use in body vessels having tortuous paths, such as the cerebral arteries. In particular, the present invention relates to an aspiration catheter system including a guide catheter and an aspiration extension slidably disposed within the guide catheter, and an attachment that allows for efficient evaluation and reuse of the treatment of the aspiration extension. [Background technology]

[0002] Treatment of intracerebral blood vessels is becoming a popular approach for ameliorating acute stroke events or other interventions within intracerebral blood vessels. Intracerebral blood vessels can follow particularly complex and tortuous paths, making it more difficult to reach target locations within these vessels. Other blood vessels in a patient may also follow tortuous paths, making it more difficult to reach target locations.

[0003] Aspiration catheters have been used to remove blood clots from blood vessels. Furthermore, a significant reason for ischemic injury during percutaneous procedures may be the formation of emboli that clog more peripheral blood vessels. Aspiration catheters used alone or in conjunction with embolic protection devices may be effective in capturing thrombi that form during procedures. It remains difficult to deliver effective instruments to the small blood vessels of the brain to remove clots and / or capture emboli.

[0004] Ischemic strokes can be caused by blood clots in cerebral arteries. The clots can block blood flow, which can cut off brain tissue from its blood supply. The clots can be thrombus, which occurs locally, or emboli that have traveled to the site of the vascular occlusion from another location. Time is a critical factor to reduce the effects of the blockage of blood supply to tissue. In particular, it is desirable to restore blood flow in as short a time as possible. The cerebral arterial system is also a highly branched vascular system connected to the internal carotid artery. The cerebral arteries are highly circuitous. To be placed within the cerebral arteries, therapeutic devices must be able to navigate along the circuitous paths provided by the cerebral arteries. Summary of the Invention [Means for solving the problem]

[0005] In a first aspect, the present invention relates to an aspiration catheter system including a guide catheter, a suction extension catheter, a proximal fitting, and a second branch manifold. The guide catheter generally includes a tubular shaft with a central lumen having a proximal end and a distal opening. The suction extension catheter generally includes a connecting section with the central lumen, a tubular extension including a tube connected to the connecting section and extending distally from the connecting section to form a continuous lumen through the tube of the tubular extension and the central lumen of the connecting section, and a control structure including an elongate structure extending proximally from the connecting section. The connecting section of the suction extension is generally configured to slide within at least a portion of the central lumen of the guide catheter to change the relative position of the connecting section within the central lumen and extend at least a portion of the tubular extension outward from the distal opening of the tubular shaft in appropriate configuration of the connecting section. The proximal fitting can be connected to a proximal end of the guide catheter, and the proximal fitting can include a first fitting element having a tubular body having a distal connector connected to the proximal end of the guide catheter and a first hemostatic valve, and the suction extension is configured to pass through the first hemostatic valve. The docking branch manifold can include an input tubing segment connected to at least one Y-branch having a valve and terminating in a connector, and a second branch having a hemostatic valve. The input tubing segment generally includes a docking structure that engages with a proximal end of the connecting section of the suction extension at a location distal to the Y-branch to form a continuous fluid channel from the central lumen to the docking branch manifold. At least a portion of the input tubing segment can be configured to be inserted through and secured within the first hemostatic valve.

[0006] In a further aspect, the present invention relates to a method of using an aspiration catheter to remove thrombi from a patient's vasculature. To carry out this method, the aspiration catheter system can include a guide catheter having a lumen, a suction extension having a tubular portion with a distal opening and a control structure, a proximal fitting connected to a proximal end of the guide catheter with a first fitting element, the first fitting element having a first hemostatic valve configured to allow access to the lumen of the first fitting element, and a docking branch manifold including a distal portion partially insertable through the first hemostatic valve with a hemostatic seal, a first branch with a second hemostatic valve, and a second branch connected to a flushing fluid source. In some embodiments, with the proximal end of the aspiration extension catheter within the lumen of the guide catheter, the aspiration lumen extends from a vacuum device to a distal opening of the tubular section of the aspiration catheter extension, and the proximal end of the tubular section of the aspiration catheter extension can be docked to a distal portion of the second manifold to form a fluid pathway from the second branch through the aspiration extension catheter. The method can include aspirating fluid from the patient's vasculature into a distal opening of the suction extension catheter; using a control structure to retract a tubular portion of the suction extension catheter to dock a proximal end of the tubular portion within a distal section of a docking branch manifold; detaching the docking branch manifold and the suction extension catheter from the proximal fitting through a first hemostasis valve; and flushing the suction extension catheter to remove debris from the suction extension catheter.

[0007] In another aspect, the present invention relates to an aspiration catheter system including a guide catheter, a suction extension catheter, and a proximal fitting. The guide catheter generally includes a tubular shaft with a central lumen having a proximal end and a distal opening. The suction extension catheter generally includes a connecting section with the central lumen, a tubular extension including a tube connected to the connecting section and extending distally from the connecting section to form a continuous lumen through the tube of the tubular extension and through the central lumen of the connecting section, and a control structure including an elongate structure extending proximally from the connecting section and a knob at or near the proximal end of the elongate structure configured to manipulate the control space. The connecting section generally is configured to slide within at least a portion of the central lumen of the guide catheter to change the relative position of the connecting section within the central lumen and extend at least a portion of the tubular extension outward from the distal opening of the tubular shaft in an appropriate configuration of the connecting section. The proximal fitting can be connected to the proximal end of the guide catheter, and the proximal fitting generally includes a first attachment element. In some embodiments, the handle has a larger diameter than the connecting section, such that the tubular extension distal to the handle, the connecting section, and the control structure can pass through a valve that the handle cannot pass through, and the length between the distal opening of the suction extension catheter and the handle defines a distance that prevents the connecting section from exiting the distal opening of the guide catheter. In some embodiments, the first attachment element provides a length between the first hemostatic valve and the proximal end of the tubular shaft of the guide catheter that is at least as long as the length of the tubular extension of the suction extension. [Brief explanation of the drawings]

[0008] [Figure 1] FIG. 1 is a side view of an aspiration catheter system including a guide catheter with an aspiration extension, where the guide catheter is shown transparent to allow visibility of structures within the guide catheter. [Figure 2] FIG. 1 is a side view of an embodiment of a guide catheter extending from a luer fitting to a distal tip. [Figure 3]3 is a partial cross-sectional view of the guide catheter of FIG. 2 between points 3-3 in FIG. 2, taken along a plane passing through the central axis of the catheter. [Figure 4] 4 is a partial cross-sectional view of the guide catheter of FIG. 2 between points 4-4 in FIG. 2, taken along a plane passing through the central axis of the catheter. [Figure 5] 3 is a side view of a branched hemostatic valve suitable for connection to a luer fitting of the guide catheter of FIG. 2. FIG. [Figure 6] FIG. 10 is a side view of an embodiment of a suction extension. [Figure 7] FIG. 7 is a top view of the suction extension of FIG. 6, with some hidden structure shown in dashed lines. [Figure 8] 8 is a side cross-sectional view of the suction extension of FIG. 6 taken along line 8-8 of FIG. 7. [Figure 9] FIG. 9 is a partial cross-sectional view taken along line 9-9 of FIG. 6. [Figure 10] FIG. 10 is a partial cross-sectional view taken along line 10-10 of FIG. 6. [Figure 11] 11 is a partial cross-sectional view of the catheter of FIG. 11 taken along the orthographic projection indicated by line 11-11 in FIG. 9. [Figure 12] 12 is a cross-sectional end view of the catheter of FIG. 6 taken along line 12-12 of FIG. 8. [Figure 13] FIG. 10 is a partial cross-sectional view of an alternative embodiment of a suction extension, with the enlarged inset showing the attachment of the control wire to the proximal portion using the coiled end of the control wire. [Figure 14] FIG. 14 is a cross-sectional view taken along line 14-14 of FIG. 13. [Figure 15] FIG. 10 is a top view of an alternative embodiment of a suction extension, in which the tubular extension has two tubular sections of different diameters connected by a tapered section. [Figure 16] 16 is a cross-sectional view of an alternative embodiment of the suction extension shown in FIG. 15 taken along line 16-16 of FIG. 15. [Figure 16A] 10 is an alternative embodiment of the proximal end of the control structure where the handle is attached to the control structure and the end of the control structure is twisted to limit movement of the handle relative to its position on the control structure. [Figure 17]1 is a cutaway portion of the catheter wall showing some of its configurations. [Figure 18] FIG. 10 is a partial cross-sectional view of an aspiration tip having a bend. [Figure 19] FIG. 13 is a partial side view of an aspiration tip having a bend and an angled opening. [Figure 20] FIG. 13 is a partial cross-sectional view of an aspiration tip having a gentle curve. [Figure 21] FIG. 10 is an end cross-sectional view of a connecting section of a suction extension contacting an engagement section of a guide catheter having a non-circular cross-section. [Figure 22] A series of side views showing the configuration of a catheter structure on a mandrel, where one or more steps are performed including applying a wire braid, placing a metal coil, applying a polymer to the sheet, and heating the polymer to embed the metal structure in the polymer. [Figure 23] 1 is a schematic illustration of a collection of medical devices that can be used together or in selected subcombinations for selected percutaneous procedures in body vessels, including an aspiration system as described herein. [Figure 24A] FIG. 10 is a partial side view of the proximal fitting shown with two separate components adjacent to the guide catheter, these two components being a Y-branch manifold and an extended hemostatic fitting. [Figure 24B] FIG. 10 is a partial side view of a first alternative embodiment having a single component without branches with a proximal hemostasis valve adjacent to the guide catheter, suitable for use with a docking branch manifold. [Figure 25] FIG. 10 is a partial side view of another alternative embodiment of a proximal fitting attached to a guide catheter, comprising a three-branch manifold extending from the guide catheter and an extended hemostatic fitting attached to one branch. [Figure 26] FIG. 10 is a partial side view of a further alternative embodiment of a proximal fitting extending from a guide catheter, the fitting comprising a Y-branch manifold, a T-branch manifold connected to one branch of the Y, an extended hemostatic fitting extending from the straight branch of the T-branch, and a negative pressure device attached along the T-branch conduit. [Figure 27]FIG. 10 is a perspective view of a Y-branch manifold adapted for connection to a pump and to a pressure sensor. [Figure 28] FIG. 1 is a side view of a Y-branch manifold attached to a tubing fitting adapted for a pressure sensor with an electronic connector. [Figure 29] FIG. 10 is a side view of a Y-branch manifold with a terminal pressure sensor along one branch and an electrical connector for connecting to the pressure sensor. [Figure 30] FIG. 1 is a side view of a first embodiment of a docking branch manifold with branching fluid delivery channels. [Figure 31A] FIG. 10 is a side view of an alternative embodiment of a docking branch manifold with docking elements. [Figure 31B] FIG. 31B is a side view of the docking branch manifold of FIG. 31A with a negative pressure device attached to one of the branches of the branch manifold. [Figure 31C] FIG. 31B is a partial cross-sectional view of the docking branch manifold of FIG. 31A showing the distal end with docking elements. [Figure 32] FIG. 1 is a side view of a guide catheter, a first attachment element with a branch manifold forming part of a proximal attachment for an aspiration system, and a docking branch manifold, with hidden docking elements shown in dashed lines. [Figure 33] 10A-10C are side views of a guide catheter, an alternative embodiment of a first attachment element comprising a branch manifold with additional branches, and a docking branch manifold. [Figure 34A] FIG. 31B is a side view of the fitting components connected to the guide catheter shown in FIG. 31A with the suction extension loaded, the control structure of the suction extension shown extending from the proximal end of the fitting. [Figure 34B] 34B is a partial cross-sectional view of a portion of the first attachment element and docking branch manifold of FIG. 34A with suction applied through the central axis of the lumen, and the suction extension in a docked position and engaged with the docking branch manifold. [Figure 34C]34B is a partial cross-sectional view of a portion of the first attachment element and docking branch manifold of FIG. 34A, except with the suction extension in an undocked position. FIG. [Figure 35A] FIG. 1 is a side view of an assembled pin vise handle. [Figure 35B] FIG. 35B is a cross-sectional view of the collet separated from the pin vise of FIG. 35A. [Figure 35C] FIG. 1 is a side view of a pin vise with the head removed. [Figure 35D] FIG. 35B is an exploded view of the pin vise handle of FIG. 35A with the components separated along the central axis. [Figure 36] 1 is a schematic representation of a human patient and an alternative access approach for guiding a catheter into a cerebral vessel. [Figure 37] 1 is a view within a branching vessel segment showing delivery of a medical device along a guidewire from a guide catheter to a clot, with the inset showing a close-up of two interior sections of the guide catheter. [Figure 38] 1 is a schematic diagram of an aspiration system in use to remove a blood clot within a compartment of a blood vessel. [Figure 39] 1 is a schematic diagram of a segment of a blood vessel with an aspiration system positioned upstream of a clot and a fiber-based filter deployed downstream of the clot. [Figure 40] 39A is a schematic diagram of the vascular segment of FIG. 39 with a fiber-based filter pulled toward the aspiration tip to draw the clot toward the tip to facilitate clot removal. [Figure 41] 1 is a schematic diagram of a segment of a blood vessel with an aspiration system positioned upstream of a clot, a fiber-based filter deployed downstream of the clot, and other medical devices positioned at the clot. [Figure 42] 42 is a schematic diagram of the vascular segment of FIG. 41 in conjunction with other medical devices for the removal of a blood clot. [Figure 43]FIG. 1 is a partial view of a treatment system extending from a location within the neurovasculature to a proximal attachment, shown after application of suction to remove a blood clot and optional other treatment steps, with an inset showing a cross-section of the tubular extension within the guide catheter. [Figure 44] 44 is a partial view of the distal portion of the treatment system of FIG. 43 with the tubular extension retracted into the guide catheter, with the inset showing a cross-sectional view of the distal end of the tubular extension within the guide catheter. [Figure 45] 44 is a partial view of the proximal end of the treatment system of FIG. 43 in which the tubular extension has been fully retracted so that the connecting section of the suction extension is within the proximal fitting on the exterior of the guide catheter, as shown in the cross-sectional view of the inset. [Figure 46] FIG. 44 is a partial view of the proximal end of the treatment system of FIG. 43 , with the tubular extension retracted from the guide catheter but remaining enclosed within the proximal fitting; the inset on the left shows a cross-sectional view of the distal end of the tubular extension within the Y-branch manifold (and an alternative placement of the distal extension within the extension fitting shown in dashed lines); and the inset on the right shows the connection section of the suction extension within the extension hemostasis fitting, with the control wire extending through the hemostasis valve. [Figure 47] 44 is a partial view of the proximal end of the treatment system of FIG. 43, with the tubular extension retracted from the guide catheter but the hemostatic valve remaining enclosed within the sealed proximal fitting; the left inset shows a cross-sectional view of the distal end of the tubular extension within the Y-branch manifold (and an alternative position of the distal extension within the extended hemostatic fitting is shown in dashed lines); the right inset shows the connection section of the suction extension within the extended hemostatic fitting, where the branch manifold is connected with the hemostatic valve and the control wire extends through the hemostatic valve of the branch manifold. [Figure 48] A partial view of the proximal end of the treatment system of Figure 43, with a tubular extension containing at least a portion of a blood clot at its distal end docked into the branch manifold and fully withdrawn from the sealed hemostasis valve of the treatment system. DETAILED DESCRIPTION OF THE INVENTION

[0009] The suction catheter system can include a guide catheter configured with a suction extension having a narrow distal tube capable of providing suction at a high flow rate. This two-part system offers the advantage of powerful suction capabilities while also providing some flexibility in terms of efficiently performing the procedure while leaving the guide catheter in place. A fitting design is described that allows the suction extension to be quickly cleared of debris and removed for reinsertion while maintaining the guide catheter in place. Specifically, the fitting element engages the proximal opening of the suction extension in a docking configuration, allowing for debris removal from the suction extension. In additional or alternative embodiments, a proximal fitting can be provided to allow the tubular portion of the suction extension (the tubular extension) to be retracted from the guide catheter without passing the tubular extension through a hemostasis valve. A docking fixture docked to the end of the suction extension provides contact with the fixture while simultaneously blowing debris from the suction extension, thereby allowing the cleared suction extension to be subsequently reinserted through the hemostatic valve and reinserted for further suction. Over multiple procedures, the suction nozzle can be cleared one or more times to reopen the blocked vessel. Efficient clearance of the suction extension greatly facilitates the procedure.

[0010] In some embodiments, the aspiration extension has a connecting section with an asymmetric circumference that contacts the inner surface of the guide catheter, providing an effective fluid seal while still providing translation of the aspiration extension within the guide catheter. In alternative or additional embodiments, the guide catheter can have a distal portion of the tubular element with a smaller diameter, which effectively limits distal movement of the aspiration extension. Methods of use of the aspiration catheter system are described in which the tubular extension of the aspiration extension, which provides a portion of the aspiration lumen, remains in a sealed configuration relative to the guide catheter lumen throughout the entire time the guide catheter is within the patient's body. Real-time line pressure measurement with a pressure transducer associated with an appropriate back-end tool can be used to improve treatment. Aspiration catheters can be advantageously used to remove thrombi and clots from body vessels, such as arteries. Some vessels may have small diameters, and treatment sites may be downstream along circuitous paths, limiting the catheter configurations that can reach the treatment site within the vessel.

[0011] The designs described herein include a slidable aspiration extension that can be adapted for use with a corresponding guide catheter, forming a majority of the overall aspiration lumen when the aspiration extension is deployed from the distal end of the guide catheter. In improved embodiments of the present application, a fitting located at the proximal end of the catheter system can be designed to improve medical procedures and enable more efficient revascularization of occluded blood vessels. This increased efficiency can reduce the time the catheter spends within the patient's vasculature and reduce the time medical personnel spend performing the procedure. While the aspiration catheter system can be used in any suitable blood vessel within the body, the system may be particularly desirable in cerebral blood vessels, for example, for the treatment of acute stroke. The aspiration catheter system can be effectively used as a stand-alone aspiration catheter for thrombus removal. Furthermore, the aspiration catheter system can be effective as a component of a thrombectomy treatment system or other medical system that provides suction using other medical devices, such as a clot engagement device for disrupting thrombi and / or a filter structure capable of capturing emboli generated during the procedure, that are used to pull toward the aspiration catheter system. Effective treatment systems can be designed for the treatment of stroke.

[0012] Less invasive procedures, commonly referred to in the art as minimally invasive procedures, are desirable in the medical context, where appropriate, to shorten patient recovery time and often improve outcomes. Particularly in the vascular system, minimally invasive procedures are commonly performed using catheter-based systems to reach remote sites within selected blood vessels and perform various therapeutic processes. These procedures may also be referred to as percutaneous or transluminal procedures, as opposed to open surgical procedures, to emphasize delivery through the vascular lumen. While the discussion herein focuses on the treatment of ischemic stroke because the devices can be effective for treating these clinically important conditions, the devices can be used for other procedures in both the vascular system and other body vessels. Patients include humans and other mammals, such as pets and livestock. The terms proximal and distal are used in their conventional sense in the art, i.e., proximal refers to a location closer to the point of entry into the patient's body along a pathway within the vascular system or other vessel, and distal refers to a location further from the point of entry along a pathway within the vascular system.

[0013] The slidable aspiration extension generally includes a connecting section that engages with the inner wall of the guide catheter to make a suitably tight fit. The connecting section generally connects a control structure, such as a control wire, extending proximally from the connecting section to a tubular extension extending distally from the control structure. The control structure generally extends outside the patient's body and provides for positioning the aspiration extension, having a distal tip, near a treatment site within a blood vessel. The tubular extension may optionally have a curved tip to better track over the guidewire and reach hard-to-reach locations within a blood vessel.

[0014] Because the thrombus can be held at the distal tip of the suction extension while suction is applied to remove the clot from the vessel, it may be desirable to retract the tubular extension of the suction extension into the guide catheter by applying suction to reduce the chance of embolization of the thrombus and loss of emboli that may migrate upstream in the vessel. To further reduce the risk of embolization, it may be desirable to apply suction to completely remove the tubular extension from the guide catheter before removing the guide catheter from the patient. In most procedures, it may be beneficial to remove the foreign body from the suction extension and reinsert the suction extension to remove any additional thrombus from the vessel. It may be effective to repeat the suction process two, three, or perhaps more times to achieve the best outcome.

[0015] Described herein is a desired proximal attachment for the back end of a catheter system that allows for removal of the tubular extension from the guide catheter without passing the tubular extension through the hemostasis valve. Because the proximal end of the tubular extension is generally open, passing the proximal end of the tubular extension through the hemostasis valve may expose the tubular extension, and potentially the inner lumen of the guide catheter, to the surrounding environment, which may or may not be desirable. An additional attachment element allows for the suction extension to be removed through the hemostasis valve for catheter purging while the attachment remains attached to the suction extension at all times, thereby allowing for rapid redeployment of the suction extension. The docking attachment may include a distal docking structure that allows the proximal end of the suction extension to be docked to the docking structure in an effective fluid-tight manner and then detached from the hemostasis valve. As previously described, this suction extension purging can be repeated multiple times.

[0016] The proximal fittings provide hemostatic isolation for the device interior exposed to the blood vessel interior. The guide catheter then forms an integral component of the aspiration system for the introduction of additional components, including, but not limited to, a suction extension. The fittings allow for the hemostatic introduction of such other components while allowing connection to a negative pressure device, such as a pump or syringe, and possibly a delivery port for introducing contrast, medication, or other desired fluids. IV contrast fluids are well known in the art. Medications can be delivered in a suitable liquid form. These fittings thereby allow for relative movement of the aspiration nozzle within and out of the guide catheter, as well as other functions.

[0017] The control structure for the suction extension can be a wire-like element, as described further below. With a desirably simple design for the guide catheter and suction extension, the suction extension can be pushed out of the distal end of the guide catheter, making it difficult or impossible to retrieve the suction extension from the patient while leaving the guide catheter in place. Markings on the control structure can inhibit this movement of the control structure, but users may ignore the markings. To avoid this possibility, a handle or grip can be secured to the control structure. If appropriate based on the handle design, the control structure can be bent, twisted, or otherwise distorted to make it difficult or impossible to remove the handle. The handle can then limit the distal extension of the suction extension within the guide catheter, thereby preventing the suction extension from extending beyond the distal end of the guide catheter.

[0018] In some embodiments, a suitable proximal fitting suitable for retracting the tubular extension out of the guide catheter but into the hemostatic isolation has a tubular portion of the fitting following a bifurcated structure, the tubular portion being long enough to hold the suction extension within the isolation area behind the hemostatic valve but outside the tubular element of the guide catheter. Some suitable configurations are described below, and other configurations will be apparent from the description of these embodiments. Note that suction is generally applied from a separate branch of the fitting, providing multiple branches into an overall manifold, which may or may not be separable components assembled for use. This isolation structure allows for assessment of the nozzle condition before retraction from the hemostatic isolation and, when used with the fitting, allows for effective removal of the suction extension outside of the hemostatic isolation without removing the suction extension for a suitable fitting.

[0019] Measuring the pressure within the proximal fitting can provide valuable information regarding the procedure. Possible configurations for pressure sensor placement are described below. When pressure is near zero within the proximal fitting, flow through the line to the pump is effectively unrestricted. It is observed that the pressure as flow passes through the aspiration extension creates a measurable pressure drop, but remains significantly lower than the pump pressure. If the aspiration extension becomes clogged with a clot or kinked, the measured pressure may approach the pump pressure, which generally indicates that flow is essentially blocked within the catheter. Understanding occlusions can significantly improve the procedure in terms of efficacy and safety. For example, if an occlusion occurs early in the procedure, it may be indicative of a kink. An occlusion later in the procedure may indicate that the catheter has become occluded with trapped clots, which generally indicates that contrast or other perfusion fluid should not be delivered through that catheter, as the pressure of delivery may push clots that have already occluded the catheter further into the vessel. Alternative methods for introducing pressure transducers are possible. For example, a pressure transducer can be installed along the inside wall of a manifold fitting or in a tube connected to the fitting in a configuration that provides a pressure measurement. The pressure sensor may or may not be sterile depending on its location.

[0020] For stroke treatment, therapeutic devices can be advanced through arteries to the blood vessels of the brain. Blood vessels typically associated with acute stroke treatment are those downstream from the internal carotid artery, which generally branch and decrease in average diameter as the vessels travel downstream through the arterial vasculature. The body includes the right and left internal carotid arteries. For convenience, blood vessels downstream from the internal carotid artery are referred to herein as the cerebral arteries. Cerebral arteries can be accessed with catheter-based systems, for example, from the femoral artery in the groin, the arteries in the arm, or the carotid artery in the neck, using hemostatic procedures and appropriate fittings, such as those known in the artery. Cerebral arteries are known to follow circuitous routes, and tracking devices along them can also be complicated due to the vessel's small diameter as well as the risk of vascular injury, which can lead to hemorrhagic stroke. Nevertheless, accessing small, tortuous arteries can be desirable for stroke treatment. Although the devices described herein are designed for advantageous use in these small, tortuous cerebral arteries, those skilled in the art will appreciate the utility of these devices in other medical procedures.

[0021] The present aspiration catheter system incorporates a guide catheter with a slidable aspiration extension suitable for cerebral procedures. For vascular procedures, the use of a guide catheter generally facilitates delivery of the therapeutic device while providing a protected channel to the treatment site in most cases, allowing for faster, more accurate delivery with less risk to the vessel wall. For cerebral procedures, the guide catheter can be placed at the point of entry into the vascular system from outside the patient's body, with the distal end of the guide catheter positioned within the carotid or internal carotid artery. The guide catheter can therefore provide a lumen relatively close to the treatment site. In some embodiments, a conventional guide catheter can be used to assemble the desired aspiration catheter, while in other embodiments, a specific guide catheter design is used to form the aspiration catheter system. While the size of the guide catheter limits the diameter of the therapeutic structure delivered to the treatment site, this is generally not a major issue because extendable devices can be delivered in a lower profile configuration and then deployed in an extended configuration, and because the size of the vessel generally decreases distally from the guide catheter, reducing the need for larger therapeutic devices. The suction devices described herein provide a suction extension that can protrude an adjustable amount from the distal end of the guide catheter by positioning a connecting section of the suction extension in contact with the inner wall of the lumen of the guide catheter. The connecting section can form a sufficiently tight seal with the wall of the guide catheter so that suction within the lumen of the guide catheter is transmitted along the lumen of the suction extension. A desired degree of suction can be obtained through the suction extension using suction applied to the proximal end of the guide catheter.

[0022] The suction extension generally comprises a connecting section, a control structure extending proximally from the connecting section, and a tubular extension extending distally from the connecting section. The suction extension generally can be designed to interface with a guide catheter and position its tip at a selected location distal to the guide catheter to perform a procedure at the selected location, such as near the location of a thrombus occluding a cerebral vessel. Because the relative location of the treatment site and the distal end of the guide catheter generally varies depending on the specific medical situation, the extent to which the suction extension extends from the guide catheter can be adjusted through relative movement of the suction extension using a control structure, such as a control wire. The suction extension should move within the guide catheter lumen without excessive force, which may be facilitated by the use of a low-friction polymer on one or both adjacent surfaces.

[0023] The connecting section of the suction extension provides an interface with the inner wall of the guide catheter to largely or completely prevent flow around the connecting section that does not flow through the lumen of the suction extension, while retaining at least a portion of the connecting section within the guide catheter and providing for proper, trouble-free sliding of the suction extension relative to the guide catheter within the patient's vasculature. Various embodiments of components forming such an interface are discussed in U.S. Patent Application Publication No. 2017 / 0143938 to Ogle et al., entitled "Catheter Systems for Applying Effective Suction in Remote Vessels and Thrombectomy Procedures Facilitated by Catheter Systems" (hereinafter the '938 Application), which is incorporated herein by reference. The connecting section, referred to as the proximal portion in the '938 Application, can have a non-cylindrical cross-sectional shape. Such a non-cylindrical cross-sectional shape can advantageously contact the guide catheter at two locations along its circumference and provide a small void space around the remainder of the circumference of the connecting section. Upon contact with the guide catheter lumen, the connecting section exerts some force, causing it to partially round its circumference. This non-cylindrical shape of the connecting section effectively blocks flow between the guide catheter wall and the connecting section, while allowing the tip of the suction extension to be positioned within the vessel without inhibiting longitudinal movement of the connecting section. The introduction of a non-cylindrical shape for the connecting section is described in U.S. Pat. No. 10,478,535 to Ogle, entitled "Suction Catheter Systems for Applying Effective Aspiration in Remote Vessels, Especially Cerebral Arteries" (hereinafter the '535 patent), which is incorporated herein by reference.

[0024] The non-circular cross-sectional shape of the connecting section of the suction extension can be generally described as an ellipse. The ellipse can be characterized, at least in part, by a major axis along the longer dimension of the ellipse and a minor axis along the shorter dimension of the ellipse that is orthogonal to the longer dimension. The connecting section can then contact or come very close to the inner surface of the engagement section of the guide catheter at two locations associated with points along the circumference associated with the major axis. Correspondingly, the non-circular cross-section can be characterized by an average radius that can provide an overall very small clearance with the guide catheter while still providing the desired function.

[0025] To form a non-circular cross section, the connection of the control wire along the surface of the connecting section can form a bump with additional polymer that strengthens the connection between the connecting section and the control wire and provides the desired shape. Further embodiments of connecting section structures having elliptical cross sections are described below. In this manner, the non-circular shape of the connecting section cross section can be designed for interface with the guide catheter where it fits with the overall structure of the suction extension.

[0026] Additionally, because it may be desirable to prevent the connecting section of the suction extension from extending beyond the distal end of the guide catheter, the suction extension and / or catheter may be designed to limit distal movement of the suction extension. Several different designs for the features of the guide catheter and / or suction extension are described in the '938 application and the '535 patent. To simplify the guide catheter structure and / or allow the use of conventional guide catheter designs, it may be desirable to use a guide catheter without any special structural features that limit distal movement of the suction extension. However, in such cases, movement of the suction extension should be limited through movement of the control structure. User instructions based on markings on the control structure are prone to user error, which could result in the connecting section of the suction extension extending too far beyond the distal end of the guide catheter. Additional elements added to the control structure described herein prevent the user from overextending the suction extension.

[0027] In comparison with aspiration catheters in which suction flow is delivered through a guide catheter, where the suction catheter is confined to the aspiration catheter, the present invention replaces a significant portion of the length of the aspiration catheter with a control element for the aspiration catheter system. By replacing a significant portion of the length of the aspiration catheter with a control element, a device can be realized that reduces friction when advancing the tip of the aspiration catheter through a patient's blood vessels, because the control wire or other control element faces less resistance to movement. The tip of the aspiration extension can be provided with a curved tip to facilitate tracking the device over a guidewire. In the design described herein, an aspiration extension for aspiration with a curved tip for tracking the tip over a guidewire can be effectively guided to hard-to-reach locations using a control wire or other control element that moves a sliding portion at or near the distal end of the aspiration extension. This design provides good aspiration capabilities without sacrificing the ability to reach hard-to-reach blood vessels, such as cerebral blood vessels. The guide catheter portion of the aspiration lumen can be held in place while the aspiration extension is moved.

[0028] When suction is applied at or near the proximal end of the guide catheter with a suitable negative pressure device, fluid is drawn into the distal opening at the end of the suction extension. It has been found that powerful suction can be transmitted through the suction extension. The suction lumen extends from a negative pressure device, typically attached to a fitting associated with a proximal section at or near the proximal end of the suction system, through the guide catheter lumen to the suction extension, and through the connecting section of the suction extension and suction extension tubular extension to the distal opening. Suitable negative pressure devices include, for example, syringes, pumps, etc. The guide catheter can provide a large lumen as a significant section of the overall suction lumen. The effective suction lumen can then be viewed as having a large proximal section contributed by the guide catheter and a tapered distal section contributed by the suction extension, which can have one or more tapered sections.

[0029] The tubular extension of the aspiration extension has a small diameter lumen relative to the guide catheter lumen and is highly flexible, allowing its distal end to be placed in smaller blood vessels. However, the lumen of the tubular extension remains large enough to allow additional treatment devices to be delivered through the lumen to the treatment site. The outer diameter of the tip of the aspiration extension is generally at least about 1.5 Fr smaller than the outer diameter of the distal section of the guide catheter (diameter units are mm = (Fr value) / 3, where Fr represents the French catheter scale). The smaller diameter of the tubular extension allows access to desired blood vessels, such as cerebral vessels.

[0030] It has been found that good aspiration characteristics are achieved with aspiration catheters that taper in diameter at the distal segment. Thus, for example, an aspiration catheter with an outer diameter of 6 French for most of its length but a 5 French outer diameter at the distal segment roughly corresponds to a reduced inner diameter. Such a catheter can provide vascular access suitable for a 5 French catheter, but can provide significantly better aspiration than an aspiration catheter with a 5 French catheter body along its entire length. Commercially available stepped-down catheters, such as the Mi-Axus™ catheter (MIVI Neuroscience, Inc.) and the ACE™ 64 catheter (Penumbra, Inc.), have demonstrated good clinical outcomes. Tapered aspiration catheters and their use for thrombectomy in cerebral arteries are described in U.S. Pat. No. 9,532,792 to Galdonik et al., entitled "Aspiration Catheters for Thrombus Removal," (hereinafter the '792 patent), which is incorporated herein by reference. While these catheters provide better suction than catheters with a constant diameter corresponding to the distal diameter, the present suction catheter system with a sliding suction extension has been found to provide better suction, suggesting that the diameter over the majority of the length of the suction lumen contributes significantly to the suction provided to the distal opening of the suction lumen.

[0031] The initial portion of a procedure using the devices described herein generally involves accessing the treatment site within a blood vessel. Guidewires are designed to facilitate access to hard-to-reach locations. The term "guidewire" is used herein broadly to refer to wire structures that may or may not have internal structures. They are referred to as guidewires whether or not they are made of solid metal or woven metal, such as corewire-overtube monoliths or coils, which may not have an enclosed lumen over at least a portion of the length of the device.

[0032] In particular, the devices described herein enable procedures to be performed to provide reperfusion of blood vessels completely or partially occluded by a blood clot. Because blood clots in cerebral arteries can cause strokes with correspondingly severe consequences, time is of the essence in treating these conditions. A suction extension with a guide catheter can be used to provide suction, which can be beneficial for removing blood clots or their debris. Therefore, the combination of a suction extension with a guide catheter and a negative pressure device can be used as a standalone device for thrombectomy. However, a suction extension with suction functionality can be effectively used as part of a treatment system that also includes, for example, a fiber-based filter and / or other components that facilitate removal of a blood clot or portion thereof. The design of a delivery catheter with an expandable tip makes it useful as a tool for performing various other procedures.

[0033] In some embodiments of the procedure, a guidewire can be placed at or near the occlusion, and a guide catheter with a positionable suction extension can be placed in the blood vessel upstream of the occlusion, with the guidewire extending through the inside of the suction extension. If the suction catheter system is used alone, the suction extension can be advanced to an appropriate location near the clot using a control wire on the guidewire. Suction can then be initiated, with or without the guidewire removed, to suck the clot, or a portion of it, into the distal opening or against the tip of the suction extension. Suction may or may not be continued when the suction extension and / or guide catheter are removed from the patient.

[0034] While suction with a suction extension can be effective as a device for clot removal alone, additional therapeutic systems can be combined with other devices for use with the aspiration catheter system. In particular, a filter device can be used to provide both embolic protection and a tool to facilitate removal of a clot or portion thereof, which may involve directly engaging the clot with the filter device. Fiber-based filter / embolic protection systems have been developed that can be effectively used in small targeted vessels. In particular, fiber-based filter systems with an appropriate actuation system can be used to deliver through an occlusion in a low-profile configuration and can be deployed to provide protection from clot debris released during the removal process.

[0035] During the process of removing the aspiration catheter system, and possibly other components of the treatment system, from the patient, suction is generally continued until the risk of thrombus embolization has been sufficiently reduced. The aspiration extension may have thrombus within its lumen and / or trapped at its tip. The proximal end of the tubular section of the aspiration extension is generally open, thereby potentially exposing the aspiration lumen of the tubular extension to the surrounding environment when the proximal end of the tubular extension is removed from the hemostatic valve. Because exposing the lumen of the tubular extension while still within the patient's body may be undesirable, as described herein, a fitting has been devised that allows the tubular extension to be parked outside the guide catheter while still within an isolated compartment of the system outside the patient's body. Suction can continue while the tubular extension is removed from the patient and isolated from the environment but outside the guide catheter.

[0036] In some procedures, it may be desirable to remove the tubular extension from the patient while it is still removed. Once removed, the tubular extension can be reintroduced into the patient's body to further retrieve thrombus. In such procedures, the docking branch manifold can be configured to quickly remove the tubular extension and facilitate removal. It is desirable to return the extension catheter to the blood vessel before thrombus embolizes in the clot. The docking branch manifold generally has an input tubular segment and at least one Y-branch with a fitting connected to a flow valve at the end of one branch. The flow valve generally has at least a second port connected to a flush fluid source, although in some embodiments, that flow valve or additional flow valves can be used to control alternative fluid and / or suction sources. The docking branch manifold generally has a second branch with a hemostatic valve. The docking branch manifold has a tubular input at its distal end, which includes a docking structure. The docking structure can pass through the hemostasis valve of the first branch manifold, thereby positioning it within the tubing segment of the first branch manifold.

[0037] The docking branch manifold generally allows for the catheter to be flushed with fluid from a fluid source, such as a syringe, pressurized container, or pump connected to a reservoir. The docking branch manifold can include multiple fluid sources, such as a contrast fluid source, a therapeutic fluid source, and / or a flush fluid source, e.g., buffered saline, but can also be used to flush a catheter clogged with contrast fluid. Also, instead of or in addition to configuring suction to be delivered from the first attachment element, suction can be delivered from the docking branch manifold to an aspiration system, which optionally does not include a manifold as shown in the previous figures. When the docking branch manifold is used to deliver the second fluid and / or suction, as well as any additional fluids, the docking branch manifold can include additional branches and / or additional branches along the second branch.

[0038] Generally, the control structure of the proximally extending suction extension can pass through the hemostatic valve, with the valve closing around the control structure with an appropriate seal. Generally, the control structure can pass through both the hemostatic valve of the first branch manifold and the hemostatic valve of the second branch manifold, allowing it to be operated from outside the manifolds. The docking structure can slide over the control structure. In this configuration, the proximal end of the tubular extension can be retracted into a docked position with the docking structure. The docking structure can be configured to releasably retain the tubular extension. For example, the docking structure can secure the tubular extension using an interference fit. In embodiments, the docking structure can include a narrowed portion of the inner wall of the tubular input. For example, the inner surface of the tubular input can narrow inward until the inner diameter of the tubular input is smaller than the outer diameter of the tubular extension. In alternative or additional embodiments, the docking structure can include a flange on the inner surface of the tubular input. In embodiments, the docking structure may include a material on the inner surface of the tubular input that creates a frictional fit to secure the tubular extension. In embodiments, the docking structure may include a structure on the inner surface of the tubular input configured to mate with a corresponding structure on the outer surface of the tubular extension. For example, the docking structure may include an indentation on the inner surface of the tubular input configured to mate with a detent on the outer surface of the tubular extension.

[0039] Once the tubular extension is docked into the docking structure, the docking manifold can be disconnected from the first manifold. The docking branch manifold can be separated along with the suction extension by opening the hemostatic valve on the first attachment element, pulling the docking branch manifold away from the first attachment element, and resealing the first hemostatic valve once the tubular extension is free of the valve. When the tubular extension is outside the first attachment element, any blood clots trapped therein can be removed from the tubular extension. By opening a source valve attached to the docking branch manifold, fluid can be allowed to flow through the tubular extension. The fluid can flush blood clots and other debris trapped within the tubular extension. Once the tubular extension is cleared of foreign matter, it can be returned to the patient's body. While it may be desirable to re-sterilize any components exposed to the environment before reintroducing them into the patient's body, the suction extension generally remains sterile outside the patient's body and can be returned to the vascular system without further sterilization. To reintroduce the tubular extension, the first hemostatic valve of the first attachment element should be opened, thereby allowing the tubular extension and docking structure to enter the first attachment element. The hemostatic valve can be closed when the docking structure is in place within the first attachment element. A control structure can be used to move the tubular extension out of the docking structure, into the guide catheter, and back to the desired location within the patient. In some instances, suction can remain applied while the tubular extension is being removed. In other instances, it can be preferable to stop suction when the tubular extension is not deployed within the guide catheter.

[0040] After revascularization of the blood vessel is complete, the catheter is removed from the patient. Depending on the particular fitting used, several alternative procedures can be used to safely remove the catheter. If the fitting has an isolation section for removing the suction extension within the hemostatic seal and the tubular extension is safely stopped outside the guide catheter, the procedure can be completed, typically including stopping suction and verifying occlusion relief. At the end of the procedure, the guide catheter can be safely removed from the patient. If the fitting does not include an isolation section, the suction extension may or may not be removed through the hemostatic valve before removing the guide catheter. If the suction extension is not isolated from its guide catheter by disengaging from the hemostatic valve, the distal end of the suction extension will generally be safely positioned within the guide catheter lumen when the guide catheter is removed, and suction may continue during at least a portion of the procedure, including removal of the guide catheter.

[0041] In some embodiments, the pressure in the proximal fitting can be monitored throughout the suction portion of the procedure. If the pressure in the proximal fitting remains within an expected range, the physician performing the procedure can proceed based on that knowledge. If the pressure increases, the physician can take appropriate action, such as removing the suction extension from the patient, generally without delivering fluid through the tubular extension.

[0042] The devices and corresponding processes described herein provide improved capabilities for performing therapeutic procedures to remove blood clots from blood vessels. As described herein, the devices can be used in various combinations in medical systems for percutaneous procedures. The improved procedures provide practical steps to be performed by medical personnel handling the devices while providing additional safety measures.

[0043] [Suction system with sliding suction extension] Aspiration systems are described that utilize the guide catheter lumen as a proximal aspiration lumen, taking advantage of the improved aspiration provided by an aspiration catheter lumen with a larger proximal aspiration and a smaller diameter aspiration extension. A laterally slidable aspiration extension extends from a proximal section within the guide lumen, with the aspiration extension having a smaller distal diameter to provide access to small blood vessels and provide the desired level of aspiration for delivering other therapeutic and / or embolic protection structures, as well as for removing debris from the blood vessel. Control wires or other control structures can be attached to the aspiration extension to control the sliding movement and allow the aspiration extension to be selectively positioned laterally relative to a fixed guide catheter and target treatment site. In some embodiments, the aspiration extension includes a connecting section that has a non-cylindrical cross-section and contacts the guide catheter lumen at two circumferential contact points. This non-cylindrical contact allows the aspiration extension to slide relatively easily relative to the guide catheter while blocking flow between the outside of the proximal section of the aspiration extension and a proximal location within the guide catheter. A particular guide catheter design may incorporate various tubing elements along its shaft to provide the desired flexibility, with smaller diameter distal tubing elements being used to retain the proximal section of the suction extension within the guide catheter lumen.

[0044] Referring to FIG. 1 , aspiration system 100 includes an aspiration guide catheter 102 and an aspiration extension 104. The aspiration guide catheter 102 includes a proximal section 106 and a tubular shaft 108. The proximal section 106 is generally also suitable for use as a handle and generally includes a proximal fitting 120, an aspiration port 122, and optionally, a control wire port 124, as well as possibly other additional ports and / or fittings providing desired functionality and access, all of which may be arranged in a bifurcated or other suitable configuration. Generally, the proximal fitting 120 may include an appropriate hemostatic valve, luer fitting, or the like, for entry of a guidewire and / or structure to be delivered into the guide catheter lumen over the guidewire, such as an alternative therapeutic structure and / or an embolic protection device.

[0045] In improved embodiments described herein, the proximal fitting 120 can include a segment into which the tubular extension of the suction extension 104 can be placed without extending into the tubular shaft 108 of the guide catheter 102 or through a hemostasis valve to the surrounding environment. While desired features of a fixture at the proximal end of the suction system 100 can be integrated into the proximal fitting 120, design flexibility can be achieved through embodiments of the proximal fitting 120 that include connectors, such as a Tuohy-Borst connector, and fitting connections to provide other desired features, such as a Y-junction, a hemostasis valve, and an extension tubular fitting that houses the tubular extension of the suction extension, as fitting components attached for use to the proximal fitting 120. Suitable fittings having additional functional features for integration with the proximal fitting 120 are discussed in more detail below in the Treatment System section, with the understanding that the present disclosure below may be considered an integral part of the proximal fitting 120 rather than as separate components.

[0046] For use with aspiration system 100, a suitable embolic protection device can be attached to the guidewire and / or other treatment structure can be used. Suitable treatment structures are further described below and can include, for example, a fiber-based filter, a stent, a stent retriever, an atherectomy device, or the like. As shown in FIG. 1 , a negative pressure device 126 is shown connected to aspiration port 122; suitable negative pressure devices include, for example, a syringe, a pump such as a peristaltic pump or other suitable pump, an aspirator / venturi, or the like. Suitable pumps are available from Allied Healthcare Products, Inc., such as the Gomco™ Brad Pump or the DRE DM-660™ Pump.

[0047] Generally, the tubular shaft 108 can have a generally constant diameter along its length, or some guide catheters can have sections of different diameters, generally with a smaller diameter section distal to a larger diameter section. In some embodiments described herein, the majority of the length of the tubular shaft has a constant diameter to provide the desired contact with the connecting section of the suction extension, which can be referred to as the tubular shaft's engagement section and is designed to engage with the suction extension in a configuration suitable for delivering suction to a patient. The portion of the tubular shaft proximal to the engagement section can have a larger inner diameter and generally larger outer diameter relative to the engagement section. Conventional guide catheters can be used in some embodiments with the suction catheter system, with specific designs described below. The distal tubular section of the tubular shaft can have a slightly smaller inner diameter to retain a portion of the suction extension 104 within the tubular shaft 108. The tubular shaft 108 can have one or more radiopaque marker bands to facilitate positioning of the tubular shaft within the patient as well as positioning of the connecting section of the suction extension within the guide catheter lumen; although Figure 1 shows the marker bands 128 near the distal end of the tubular shaft 108, alternative locations can be used as desired. As described below, the tubular shaft 108 can have a coating on its inner and / or outer surface or portions thereof.

[0048] The suction extension 104 generally comprises a connecting section 140, a tubular extension 142, and a control structure 148, such as a control wire. All or a portion of the connecting section 140 can be configured to remain within the lumen of the guide catheter 102. As shown in FIG. 1 , the connecting section 140 can include a radiopaque marker band 152, although the connecting section can have no marker band in some embodiments and can include multiple marker bands in other embodiments; while the tubular extension 142 is shown with a radiopaque marker band 154 near its distal tip, again, the tubular extension 142 can include multiple radiopaque marker bands as desired. The control structure 148 connects to the proximal portion 140 and, in the assembled device, extends outside the catheter, such as by a control wire exiting through the control wire port 124 or the proximal fitting 120. The control structure 148 can be used to control the positioning of the connecting section 140 within the lumen of the shaft 106. The control structure 148 can include a control tool 156, such as a handle, slide, or other structure to which a control wire or other connecting element can be secured to facilitate movement of the control wire. In some embodiments, alternative structures, such as multiple wires or a cylindrical wire assembly, can connect the proximal portion to the proximal end of the aspiration catheter system to provide a desired level of control over the positioning of the proximal section.

[0049] As previously described, the connecting section of the suction extension engages the lumen of the guide catheter with an appropriate interface, allowing the user to translate the suction extension relative to the guide catheter and position the tip of the tubular extension while reducing or eliminating blood flow between the connecting section of the suction extension. The desired design, in which the connecting section of the suction extension has a non-circular cross-section, has been found to particularly meet these criteria. The selection of materials described herein also allows for a very small average clearance between the connecting section of the suction extension and the interior of the guide catheter. When assembled, the lumen of the guide catheter can contact the connecting section of the suction extension at two circumferential locations, which allows the cross-section of the connecting section to be partially rounded. This two-point contact configuration allows the user to slide the suction extension with reasonable ease while providing the desired flow containment.

[0050] The non-circular cross-section of the connecting section (or portion thereof) of the suction extension can generally be approximately elliptical in shape. While not intended to be limiting by this term, in some embodiments, the cross-section can have one axis of symmetry, similar to a traditional oval cross-section. As discussed below, the elliptical shape can be generated by attaching a wire control structure to the proximal section, but other structural features can be used to introduce the elliptical shape, e.g., providing approximately one or two axes of symmetry, although the ellipse can also be asymmetric. Generally, the cross-section of an ellipse can be characterized in part by its major axis, e.g., the longer dimension along the axis of symmetry, and its minor axis, e.g., the longest line segment connecting the circumference that is perpendicular to the major axis. While the specification of the major and minor axes does not fully identify the ellipse because the specific shape is not specified, the major and minor axes can provide important information regarding the size and relative shape of the ellipse, especially since the shape is generally not far from a circular shape. Additionally, the average gap can be defined by using the maximum circumference (C) of the elliptical cross-section and converting it to a transparent circle to find the appropriate average diameter (D a =C / π).

[0051] An embodiment of a guide catheter is shown in Figures 2-4. Referring to Figure 2, guide catheter 160 includes a connector attachment hub 162, which may be a Tuohy-Borst connector, a luer connector, or other part, a shaft 164, and a strain relief support 166. In this embodiment, the proximal end of shaft 164 passes through strain relief support 166 to connector attachment hub 162, and the components may be secured together with an adhesive. Also, a female connector 168 is disposed at the proximal end of connector attachment hub 162 for connection with a male connector fitting on a proximal fitting, such as a bifurcated connector having one or more branches and which may have a rotating hemostatic valve.

[0052] A cross-sectional view of a portion of the shaft 164 near its proximal end is shown in FIG. 3. Referring to the embodiment of FIG. 3, the shaft 164 includes a polymer tube 180 with an embedded stainless steel wire braid 182 and a lubricious liner 184, such as polytetrafluoroethylene (PTFE) or other fluoropolymer. FIG. 4 shows the distal end of the shaft 164. As shown in FIG. 4, a radiopaque marker band 186 is embedded within the polymer tube near the distal end of the shaft 164. A distal section 188 of the tube, described further below, is also located at the distal end of the shaft 164 and has a slightly reduced inner diameter. As shown in FIGS. 3 and 4, the metal braid terminates near the marker band 186 (or overlaps and then terminates), and the distal section 188 is free of the metal braid in this embodiment. As further described below, the composition of the polymer tubing contained within the shaft can vary along the length of the shaft 164, thereby, for example, increasing the flexibility of the shaft toward its distal end. In some embodiments, adjacent sections of the polymer tubing can be bonded together by heating and further supported by an arched metal braid and / or coil at the top, which strengthens the majority of the shaft. In some embodiments, the majority of the shaft 164, except for the distal section 188, can have a constant inner diameter, allowing suction to be applied through a suction extension positioned anywhere in the guide catheter proximal to the distal section 188. However, in alternative embodiments, the proximal section of the shaft 164 can have a larger diameter, as desired, since the proximal section of the guide catheter may not be used to position the connecting section of the suction extension for applying suction. Appropriate markers on the control wire can be used to ensure the suction extension is properly positioned for applying suction.

[0053] A lubricious coating, such as a hydrophilic coating, can be applied to the exterior surface of shaft 164 or portions thereof. Suitable hydrophilic coatings include, for example, polyvinyl alcohol, heparin-based coatings, or others. Hydrophilic coating solutions are commercially available, such as, for example, LUBRICENT® (Harland Medical System, Minnesota, USA) or SERENE™ (Surmodics, Inc., Minnesota, USA). Further description of materials and manufacturing processes is provided below.

[0054] The outer diameter (D) of the guide catheter can be from about 5.5 Fr (1.667 mm diameter) to about 10 Fr (3.333 mm diameter), in further embodiments from about 6 Fr (1.833 mm diameter) to about 9 Fr (3 mm diameter), and in some embodiments from about 6.25 Fr (2 mm diameter) to about 8.5 Fr (2.833 mm diameter). Measurements of the guide catheter generally refer to the outer diameter, with the inner diameter being twice the wall thickness less than the outer diameter. Generally, the inner diameter (d1) of the main portion of the shaft 164 can range from about 0.8 mm to about 3.175 mm, in further embodiments from about 0.9 mm to about 2.85 mm, and in further embodiments from about 1.00 mm to about 2.7 mm. The reduction in the inner diameter (d2) of the distal section 188 relative to the inner diameter (d1) of the engagement section of the shaft 164 can be from about 0.034 mm (0.00134 inches) to about 0.25 mm (0.0098 inches), and in further embodiments from about 0.05 mm (0.002 inches) to about 0.20 mm (0.0079 inches). The length of the guide catheter shaft can be from about 30 cm to about 150 cm, in further embodiments from about 35 cm to about 130 cm, and in further embodiments from about 40 cm to about 120 cm, and is generally selected to suit the corresponding procedure. In some embodiments, the length (L) of the distal section 18 ... d ) can be from about 1 mm to about 50 mm, in further embodiments from about 1.5 mm to about 25 mm, and in other embodiments from about 2 mm to about 20 mm. A person of ordinary skill in the art will recognize that additional ranges of dimensions within the explicit ranges above are contemplated and are within the present disclosure.

[0055] To form a proximal attachment similar to that of FIG. 1 using the guide catheter of FIG. 2, a Y-branch hemostatic valve connector 190 can be used, as in the embodiment shown in FIG. 5. The Y-branch hemostatic valve connector 190 includes a male connector 192, a Y-branch frame 194 with branching flow paths, a rotating hemostatic valve 196, a connector 198, a tube 200 connected to the Y-branch frame 194 by the connector 198, and a suction device 202 connected to the tube 200. The male connector element 192 can be attached to the female connector element 168 of FIG. 2. As shown schematically in FIG. 5, both a control wire 204 and a guidewire 206 are shown exiting the hemostatic valve 196, and the guidewire 206 can be used to guide a treatment device from the guide catheter through the hemostatic valve. Various branched hemostatic valve connectors are available from commercial suppliers, such as Merit Medical of Utah, USA. More generally, various fittings can be attached to the connector attachment hub 162 of the guide catheter 160, and improved embodiments of fittings that include portions for mounting tubular extensions of suction extensions are described in more detail in the Treatment Systems section below.

[0056] Embodiments of suction extensions are shown in FIGS. 6-12. Referring to FIG. 6, suction extension 230 includes a control wire 232, a connecting section 234, and a tubular extension 236. Connecting section 234 connects control wire 232, which extends proximally from the connecting section, to tubular extension 236, which extends distally from the connecting section. Generally, control wire 232 can be a solid wire, coil, or the like that transmits pulling and pushing forces to connecting section 234, which can move correspondingly relative to the guide catheter along with tubular extension 236 in the assembled suction catheter system. Control wire 232 can have any reasonable cross-sectional shape, which may vary at various points along its length. Additionally, control wires can be tapered toward their distal end, resulting in a smaller circumference. Typically, control wire 232 is fabricated from stainless steel, titanium, or other biocompatible metals, although other materials with an appropriate balance of stiffness and flexibility can in principle be used. In some embodiments, the control wire is a round metal wire having an average diameter along its length of from about 0.010 inches (0.254 mm) to about 0.040 inches (1.01 mm), and in further embodiments, from about 0.0125 inches (0.32 mm) to about 0.030 inches (0.76 mm). The length of the control wire 232 is generally somewhat longer than that of the guide catheter, such that the guidewire extends from the proximal end of the guide catheter, for example, 5 cm or more longer than the guide catheter. A person of ordinary skill in the art will recognize that additional ranges of dimensions within the explicit ranges above are contemplated and are within the present disclosure.

[0057] The connecting section 234 is generally distinguished by a larger outer diameter than the tubular extension 236, which extends distally from the connecting section 234. In the embodiment of Figures 6-12, the tubular extension 236 has substantially constant outer and inner diameters, with further embodiments in which the diameter decreases along the tubular extension being described below. Referring to the cross-sectional view of Figure 10, the tubular extension comprises a polymer tube 240, a metal coil reinforcement 242, and a radiopaque marker band 244. The metal coil reinforcement 242 can comprise a flat metal wire, which in some embodiments extends approximately from the radiopaque marker band 244 to the radiopaque marker band within the connecting section 234, as described further below, although the metal coil reinforcement can extend above the marker band. The polymer tube 240 can remain the same along the length of the tubular extension 236, or the polymer can vary at different locations along the tubular extension 236, e.g., becoming more flexible distally. The different sections of polymer can be heated and bonded during construction, and the metal coil reinforcement 242, as well as an optional polymer coating layer, can further stabilize the connected sections of polymer tubing. The tip 246 of the tubular extension 236, distal to the radiopaque marker band 244, can comprise a polymer tubing 240 without a metal reinforcement. A low-friction liner 248, such as PTFE or other fluoropolymer, can extend along the length of the tubular extension 236 and / or the connecting section 234, or a portion thereof.

[0058] The relationship between the connecting section 234, the control wire 232, and the tubular extension 236 is shown in FIGS. 6-8. Partial cross-sectional views of the connecting section 234 are shown in FIGS. 9, 11, and 12, illustrating certain details of its construction. The connecting section 234 can comprise a polymer tube 260 and a radiopaque marker band 262. The polymer tube 260 has a proximal opening 264, which can be angled relative to the longitudinal axis of the polymer tube to facilitate delivery of the device from the suction extension, although a right angle can be used if desired. The angle α is shown in FIG. 8 and can range from 25 degrees to about 85 degrees, in further embodiments from about 30 degrees to about 80 degrees, and in further embodiments from about 33 degrees to about 75 degrees. A person of ordinary skill in the art will recognize that additional ranges of dimensions within the explicit ranges above are contemplated and are within the scope of the present disclosure.

[0059] The contact between the control wire 232 and the connecting section 234 serves both to secure the components together and to help shape the connecting section 234, which can be selected to provide the desired contact with the interior of the guide catheter lumen. Specifically, the connection between the connecting section and the control wire can facilitate forming an elliptical cross-section of the connecting section. In an alternative embodiment, the control wire 232 can terminate in a flat wire coil, which is embedded in a polymer tube to substantially retain the shape of the connecting section, as described in the '938 application and below. In further or alternative embodiments, the elliptical shape of the connecting section can be introduced through molding or other shaping of the polymer, which may or may not be combined with a protuberance due to the embedded control wire. Suitable dimensions for the elliptical cross-section and processing for forming the connecting section are discussed further below. A low-friction liner 248 can extend through the lumen of the connecting section 234, as shown in FIGS. 9 and 11, or in some embodiments, a separate low-friction liner can be included in the connecting section 234, if desired.

[0060] 8, 11, and 12, the distal end of the control wire 232 is embedded within a polymer associated with the polymer tube 260. By anchoring the control wire 232 to the complementary polymer wall, the cross-sectional shape changes, resulting in a change in the longitudinal axis (L ), as can be clearly seen in FIG. M ) is the minor axis (L m ) longer. As mentioned above, a non-circular cross-section is advantageous for contact between the suction extension and the guide catheter. A cross-section of an alternative embodiment of a non-circular shaped connecting section 280 is shown in FIGS. 13 and 14. In this embodiment, a flat metal coil 282 on the end of a control wire 284 is embedded in a polymer tube 286 of non-circular cross-section. The non-circular cross-section is formed in this embodiment through forming a thicker wall of polymer along one circumferential edge, as can be seen in the cross-section of FIG. 14. A corresponding circular embodiment is shown in FIGS. 21 and 22 of the '938 application. The connecting section may or may not have a substantially constant outer diameter along its entire length, and the outer diameter may taper, e.g., a gradual taper, a step-wise taper, or a combination thereof, to the outer diameter of the adjacent section of the tubular extension over at least a portion of its length.

[0061] In some embodiments, the proximal end of the connecting section is adapted to dock the attachment element to the docking element so that the suction extension can be detached from the hemostatic isolation associated with the attachment element. Such an attachment, docked with the suction extension, can be used to expel blood clots from the suction extension in the docked position. Once the clots have been expelled, the suction extension can be reintroduced into the patient for further use in removing blood clots from the patient's blood vessels. Suitable attachments are described in more detail below.

[0062] An alternative embodiment of a suction extension is shown in FIGS. 15 and 16. The suction extension 300 includes a control wire 302, a connecting section 304, and a tubular extension 306. The control wire 302 and connecting section 304 may be the same as the control wire 232 and connecting section 234, respectively, of the embodiment of FIGS. 6-12. Referring to FIG. 16, the distal end of the control wire 302 is embedded in the connecting section 304 in a polymer, forming an expansion section 308 along the surface of the connecting section 304. A proximal opening 310 to the lumen of the connecting section 304 forms an angle α with respect to the axis of the connecting section 304. The connecting section 304 includes a radiopaque marker band 312. The body of the connecting section 304 is a polymer tube 314. A low-friction liner 316, e.g., PTFE or other fluoropolymer, may extend along or select portions of the lumen of the connecting section 304 and / or tubular extension 306. A metal reinforcement, such as a flat metal wire coil, can reinforce the polymer tube 314, or a portion thereof. As shown in Figure 16, a flat metal wire coil 318 is embedded throughout the polymer tube 314 distal to the radiopaque marker band 312 and extends to the tubular extension 306. Additionally, the asymmetric cross-sections shown in Figures 12 and 14, as well as the control wire attachment schemes of Figures 11 and 13, are also applicable to the embodiments of Figures 15 and 16.

[0063] 15 and 16 , the tubular extension 306 comprises a first tubular section 330, a tapered section 332, and a second tubular section 334 having a smaller diameter than the first tubular section 330. The tapered section 332 tapers between the diameter of the first tubular section 330 and the diameter of the second tubular section 334. The second tubular section 334 includes a radiopaque marker band 336. A flat metal wire coil 318 extends from the radiopaque marker band 336 to the radiopaque marker band 312 embedded in the polymer tube within the connecting section 304. The end of the second tubular section 334 distal to the radiopaque marker band 336 may be free of metal reinforcement. As previously mentioned, the low-friction liner 316 can extend along the lumen wall for the length of the tubular extension 306, or a selected portion thereof. The bodies of the first tubular section 330, the tapered section 332, and the second tubular section 334 generally comprise thermoplastic polymer tubing. The polymer tubing sections are heated and bonded together, and may be further supported by an embedded flat metal wire coil 318, optionally with a heat-shrinkable polymer film covering the metal reinforcement, or otherwise. A partial cross-section of the first tubular section 330 is shown in FIG. 17 , showing the flat metal wire coil 318 embedded within the polymer tubing 338; cross-sections of the tapered section 332 and the second tubular section 334 would show a similar configuration. The composition of the polymer tubing can be varied along its length to select a particular flexibility, generally being more flexible toward the distal end of the device, as desired, and the polymer composition can be varied in different sections 330, 332, 334, and / or within the sections.

[0064] 15 and 16, the tapered section 332 provides a linear transition in diameter from the larger diameter of the first tubular section 330 to the smaller diameter of the second tubular section 334. In alternative embodiments, the diameter of the tapered section can be non-linear as desired, although the change is generally monotonic. The tapered section can be formed through extrusion, by conforming a thermoplastic polymer to a mandrel shape, or by any other suitable process known in the art.

[0065] An important aspect of the aspiration extension is the small diameter aspiration tip relative to the guide catheter, and the reduced diameter of the second tubular section in the embodiment of Figures 15 and 16 allows for further reach into small neurovasculature. The effective aspiration lumen then extends from the guide catheter into the connecting section of the aspiration extension and into the tubular extension, which may have a further reduced diameter. The inner diameter of the connecting section may or may not be the same as the inner diameter of the first tubular section. The small diameter of the tubular extension allows for reach into small, tortuous vessels, and the use of a larger diameter proximal aspiration lumen significantly improves aspiration performance without compromising the ability to reach the appropriate site.

[0066] FIG. 16A shows an alternative embodiment of a suction extension, where the control structure has a handle at or near its proximal end. Referring to FIG. 16A, the control structure / wire 340 has a handle 342 secured near its proximal end. The handle 342 may or may not include a structure for detaching the handle. Specific handle embodiments are described in more detail below. The control structure / wire 340 has a kink 344 at its distal end that prevents the handle 342 from detaching from the control structure 340. The kink 344 can refer to or be replaced by a bend, knot, anchor, or other structure or distortion that prevents or inhibits the handle 342 from detaching from the control structure 340.

[0067] To further provide suction strength, the tubular extension itself can have distinct sections of decreasing diameter, as shown in the embodiments of FIGS. 15 and 16. Because arteries generally have a gradually decreasing diameter, a somewhat larger diameter section may be desirable to allow the suction tip to reach selected small vessels. With respect to the first tubular section, this section generally has a substantially constant diameter (generally, inner or outer diameter, assuming a substantially constant wall thickness), which is generally from about 0.95D to about [d + 0.1(Dd)], in further embodiments from about 0.925D to about [d + 0.25(Dd)], and in some embodiments from about 0.9D to about [d + 0.35(Dd)], where d is the diameter of the second tubular section and D is the average diameter of the connecting section. The length of the first tubular section can be the total length of the tubular extension, e.g., the total length of the first tubular section, the second tubular section, and the optional transition section, or, in corresponding embodiments, the total length of only the single tubular section (L in FIG. 6). T 6), and in further embodiments, from about 20% to about 80%, and in further embodiments, from about 30% to about 70% of the length of the connecting section (L in FIG. 6). C ) can be from about 4 mm to about 8 cm, and in further embodiments, from about 5 mm to about 6 cm. One of ordinary skill in the art will recognize that additional size and relative size ranges within the above explicit ranges are contemplated and are within the scope of the present disclosure. While FIGS. 15 and 16 depict a tubular extension with a single decrease in diameter to a second tubular section, in other embodiments there can be additional tubular sections of constant diameter with further decreases in diameter, which further divide the overall length of the tubular extension. For example, there can be one additional intermediate tubular section, two additional intermediate tubular sections, or three or more additional intermediate tubular sections.

[0068] In embodiments having a tubular extension or multiple tubular segments of different inner diameters, the distal tubular segment of the tubular extension can be about 20 percent to about 90 percent of the inner diameter of the engagement segment of the guide catheter, in further embodiments about 30 percent to about 85 percent, and in further embodiments about 35 percent to about 80 percent of the inner diameter of the engagement segment of the tubular shaft. For example, the inner diameter of the distal tip of the tubular extension can range from about 0.5 mm to about 1.9 mm, in further embodiments about 0.6 mm to about 1.8 mm, and in other embodiments about 0.65 mm to about 1.75 mm. The length of the tubular extension can be about 3 cm to about 60 cm, in some embodiments about 5 cm to about 55 cm, and in further embodiments about 8 cm to about 50 cm. A person of ordinary skill in the art will recognize that additional ranges within the explicit ranges above are contemplated and are within the scope of the present disclosure.

[0069] The distal tip of the tubular extension may be bent or curved in its natural, unstressed state. Generally, a bent-tip catheter can facilitate tracking of the catheter over a guidewire without adversely altering aspiration capabilities. See, for example, U.S. Pat. No. 8,021,351 to Boldenow et al., entitled "Tracking Aspiration Catheter," incorporated herein by reference. Two general forms of bent aspiration tips are shown in FIGS. 18 and 19. Referring to FIG. 18, an aspiration tip 350 includes a straight section 352, a bent section 354, and a bent tip section 356 having a flat distal opening 358 that is approximately perpendicular to the axis of the bent tip section 356. Referring to FIG. 19, an aspiration tip 364 includes a straight section 366, a bent section 368, and a bent tip section 370 having an oblique distal opening 372 at an angle other than perpendicular to the axis of the bent tip section 370. The bent tip sections 356, 370 may be generally cylindrical and have approximately the same diameter as the corresponding straight sections 352, 366. Although two shapes of openings are shown in Figures 18 and 19, any suitable shape of opening may generally be used.

[0070] A specific embodiment of a bent tip of the suction extension 380 is shown in Figure 20. In this embodiment, the distal tip 382 is curved, and although there is no straight section at the distal end of this embodiment, in alternative embodiments there may be a short straight section at the distal end. The distal tip 382 extends from a straight section 384 of the suction extension 380. The arc of the curve is approximately circular, although other gentle arcs can be used, in which case the radius of curvature can be the average of the arc.

[0071] In this embodiment, the curvature of the tip is gradual, and the distal tip may not have a straight segment. The angle γ can be defined based on the natural position of the tip taken from the initial curvature point at the center of the distal opening. In some embodiments, the angle γ can be about 5 degrees to about 21 degrees, and in further embodiments, about 7 degrees to about 20 degrees. To achieve a gradual curvature, the radius of curvature is generally relatively large; in some embodiments, the radius of curvature can be about 21 mm to about 100 mm, and in further embodiments, about 25 mm to about 75 mm. In some embodiments, the length of the straight portion of the tip after the curve can be about 1 cm or less, in other embodiments, about 0.1 mm to about 6 mm, and in further embodiments, about 0.5 mm to about 4 mm. In alternative embodiments, the curve comprises a gradual arc without a large straight segment distal to it, thereby defining the curve or bend by the angle and radius of curvature. A person of ordinary skill in the art will recognize that additional angle, radius, and length ranges within the explicit ranges above are contemplated and are within the scope of the present disclosure.

[0072] As previously described, the connecting section of the suction extension can have a non-circular, elliptical cross-section, which can then interface with the inner surface of the lumen of the guide catheter by contacting the inner surface at two circumferential locations. The interface between the connecting section of the suction extension and the engagement section of the guide catheter reduces or eliminates flow between these surfaces, thereby directing essentially all of the aspiration flow through the lumen of the suction extension. At the same time, the suction extension can be longitudinally positioned within the engagement section, allowing the user to position the suction extension by sliding the control structure. These various conditions can be usefully balanced to provide the desired functionality.

[0073] Referring to FIG. 21 , a cross-sectional view of the connecting section 400 of the suction extension within the engagement portion 402 of the guide catheter is shown. The non-cylindrical nature of the cross-section of the connecting section 400 is readily apparent. Due to the interface between the elements, the elliptical shape of the connecting section 400 may be distorted relative to its shape upon separation from the guide catheter, particularly if the undistorted length of the major axis of the connecting section 400 is greater than the inner diameter of the engagement portion 402. The connecting section 400 may contact the inner surface of the lumen of the engagement section 402 at two contact points 404, 406. The size of the contact points 404, 406 generally depends on the dimensions of the elements, the shape of the connecting section 400, and the material properties. Generally, the boundaries of the contact points need not be precisely defined.

[0074] As previously discussed, a non-cylindrical connecting section can be characterized by its major axis, minor axis, and average diameter derived from its circumference. Based on these parameters, critical points of the interface between the connecting section 400 and the engaging portion 402 can be identified by the difference between the major and minor axes, the difference between the major axis of the unconstrained connecting section 400 and the inner diameter of the engaging section 402, and the difference between the inner diameter of the engaging section 402 and the average diameter of the connecting section 400. For example, the difference between the major and minor axes can be from about 30 micrometers to about 160 micrometers, and in further embodiments, from about 50 micrometers to about 140 micrometers. In some embodiments, the tolerance, measured as the difference between the diameter of the inner surface of the engagement section 402 and the average diameter of the connecting section, can be, for example, about 4 thou (1 thou = 1 / 1000 inch, 4 thou to 102.6 micrometers) or less, in further embodiments about 3 thou (76.2 micrometers) or less, in further embodiments about 1.75 thou (45 micrometers) or less, and in other embodiments about 1 thou (25.4 micrometers) to about 1.75 thou (45 micrometers), and can have a measurement uncertainty of about zero. For embodiments in which the major axis of the connecting section separated from the guide catheter is larger than the inner diameter of the guide catheter, the difference between the major axis of the unconstrained (i.e., separated from the guide catheter) connecting section 400 and the inner diameter of the engagement section 402 can be about 0 to about 250 micrometers, in further embodiments about 15 micrometers to about 150 micrometers, and in other embodiments about 20 micrometers to about 100 micrometers. A person of ordinary skill in the art will recognize that additional ranges of dimensional deviations within the explicit ranges above are contemplated and are within the present disclosure.

[0075] Catheter components can be formed from one or more biocompatible materials, including metals such as stainless steel or alloys, e.g., Nitinol®, or polymers such as polyetheramide block copolymers (PEBAX®), nylon (polyamide), polyolefins, polytetrafluoroethylene, polyesters, polyurethanes, polycarbonates, polysiloxanes (silicones), polycarbonate urethanes (e.g., ChronoFlex AR®), blends thereof, combinations thereof, or other suitable biocompatible polymers. Radiopacity can be achieved by adding metal markers, such as wires or bands, platinum-iridium alloys, tantalum, tungsten, gold, platinum-tungsten alloys, or blends thereof, or through radiopacifiers, such as barium sulfate, bismuth trioxide, bismuth subcarbonate, powdered tungsten, or powdered tantalum, added to the polymer resin. Medical-grade PEBAX® with barium sulfate and various Shore hardness values is commercially available. Additionally, selected sections of the catheter can be formed from materials that impart the desired stiffness / flexibility to that particular section of the catheter. Similarly, the attachment components can be formed from suitable materials, such as one or more metals and / or one or more polymers.

[0076] In some embodiments, the guide catheter, its suction extension, or suitable portions thereof, comprises a thermoplastic polymer, such as those described above, with embedded metal elements that reinforce the polymer. The wire can be braided, coiled, or otherwise placed over the polymer tube liner with some tension to maintain the wire in place over the tube liner. In some embodiments, a polymer jacket, such as a heat-shrink polymer, can be placed over the top and heated to shrink and fuse the covering over the structure, and / or the polymer tube can be thermally softened to allow the incorporation of the metal reinforcement. Upon heating above the softening and / or heat-shrink temperature of the polymer and subsequent cooling, the reinforcing metal becomes embedded within the polymer. In suitable embodiments, the liner and jacket can be the same or different materials. Suitable wires include, for example, flattened stainless steel wire. The wire diameter may range from about 0.00025 inches (0.00635 mm) to about 0.004 inches (0.1 mm), and in further embodiments, from about 0.0005 inches (0.013 mm) to about 0.003 inches (0.075 mm). In suitable embodiments, the braid picks per inch may be from about 20 to about 250 picks / inch, and in further embodiments, from about 50 to about 150 picks / inch. In suitable embodiments, the coil may be a single-filament or multi-filament coil having a pitch of, for example, from about 0.005 inches (0.13 mm) to about 0.1 inches (2.54 mm), and in further embodiments, from about 0.01 inches (0.26 mm) to about 0.050 inches (1.27 mm). One of ordinary skill in the art will recognize that additional ranges within the explicitly stated ranges below are contemplated and are within the scope of the present disclosure. The wire adds additional mechanical strength while maintaining an appropriate amount of flexibility. Although the wire may provide some radiopacity, the radiopaque band generally provides a darker, more discernible image of the wire, however, the image of the wire may provide additional visualization of the catheter during the procedure.

[0077] To reduce the chance of accidental removal of the radiopaque band from the catheter and the chance of the radiopaque band catching on other objects within the vessel, a metal reinforcing wire can be used to cover or encapsulate the radiopaque band, which is then embedded in a polymer. In some embodiments, a polymer jacket can be placed over the metal wire, which correspondingly covers the radiopaque band, and the heat bond also embeds a radiopaque marked band. Placing a marker band under the metal wire can prevent the band from separating from the catheter if the wall kinks or collapses. If the catheter wall collapses or kinks, the braided wire over the surface of the band folds over the marker band, preventing it from separating from the structure.

[0078] Referring to FIG. 22, an example of a procedure for forming a reinforced catheter section is shown. A polymer liner 420 is placed over a mandrel 422. In FIG. 2, a metal braid 424 is placed over the polymer liner; commercially available braiding equipment can be used for this step. As shown in FIG. 3, a metal coil 426 is placed over the braided metal 424, and a polymer cover 428 is placed over the coil 426. As shown in FIG. 4, a heat source 430 can be used to heat the heat-shrink polymer cover 428 to complete the reinforced catheter section 432. Of course, in some embodiments, only a coil or only a metal braid can be used, with the procedure modified accordingly. Similarly, and alternatively, a heat-shrink cover may or may not be used, with the procedure modified accordingly.

[0079] [Treatment System] The aspiration systems described herein can be used to effectively remove blood clots from blood vessels, such as intracerebral vessels, when treating acute stroke conditions. In particular, the thin-tip catheter of the '792 patent performed well in human clinical trials to restore blood flow in patients with acute embolic stroke, with favorable patient outcomes. The devices described herein can be expected to provide even better aspiration while retaining the ability to access difficult-to-navigate blood vessels. However, in some acute stroke conditions or other embolic events, it may be desirable to use the aspiration catheter systems described herein in conjunction with other medical instruments for treatment. Additionally, certain preferred embodiments of proximal attachments that provide improved procedures for using the aspiration extensions described herein are described in this section. In particular, modifications to the proximal attachment allow for removal of the tubular extension of the aspiration extension from the guide catheter without passing through a hemostasis valve. In some embodiments, the proximal attachment can further include an additional branch attachment with a proximal end that docks the proximal end of the aspiration extension, allowing convenient removal from its isolated location behind the hemostasis valve, convenient evacuation of thrombotic occlusions from the aspiration extension, and reinsertion. Thrombotic occlusions can be evacuated through flushing delivered from the branch of the docking Y-connector, at which point the aspiration extension is docked for rapid exchange to additionally remove additional occlusions from the patient's vessel. Additionally, the proximal fitting can be modified with a pressure sensor that can provide valuable information about the status of the aspiration process. The availability of pressure information can be used to improve various aspects of the procedure, increasing efficiency and reducing potential risks to the patient.

[0080] 23 , a treatment system 450 is shown that includes a guidewire 452, an embolic protection system 454, an aspiration catheter system 456 with a guide catheter 458 and an aspiration extension 460 shown separated, a percutaneous medical device 462, a microcatheter 464, a delivery catheter 466, a proximal attachment 468, and a negative pressure device, such as a pump or syringe 470. Suitable components of the proximal attachment 468 are described below. Not all medical system embodiments will have all of these components, and some medical system embodiments may have multiple components of each type, for example, multiple different percutaneous medical devices. Suitable structures, including preferred embodiments of the proximal attachment 468, are described in the following sections.

[0081] Guidewires suitable for use in tortuous body vessels are described in U.S. Patent No. 10,518,066 to Pokorney et al., entitled "Medical Guidewires for Tortuous Vessels," which is incorporated herein by reference. In some embodiments, the embolic protection system 454 can include a guide structure for delivering the device; these systems may or may not use a separate guidewire. Aspiration catheter systems 456 are described in detail herein, and various embodiments described herein can be adapted for use with medical systems and as stand-alone devices. If desired for particularly challenging device delivery, the medical system can include a delivery catheter 466, as described in the '938 application.

[0082] Embolic protection devices have been developed that have small filter longitudinal extents suitable for use in the medical systems described herein and are designed for suitable manipulation to facilitate intravascular delivery. See, for example, U.S. Patent No. 7,879,062 to Galdonik et al., entitled "Fiber-Based Embolic Protection Device," and U.S. Patent No. 8,092,483 to Galdonik et al., entitled "Steerable Device Having a Corewire Within a Tube and Combination with a Medical Device," both of which are incorporated herein by reference. A further fiber-based filter device specifically designed for delivery into tortuous vessels is described in U.S. Patent No. 8,814,892 to Galdonik et al., entitled "Embolectomy Devices and Method of Treatment of Acute Ischemic Stroke Condition" (hereinafter the '892 patent), which is incorporated herein by reference. The use of complementary structures is also contemplated in the procedures described herein. The '892 patent describes the use of a filter device as a clot engaging instrument for use with an aspiration catheter. The '892 patent also contemplates the use of complementary structures to facilitate engagement with the clot. The DAISe™ Clot Removal System, which includes a fiber-based filter, is under development by MIVI Neurosicence, Inc. The use of complementary structures is also contemplated in the procedures described herein.

[0083] Microcatheters are designed to access small blood vessels, such as cerebral vessels. Commercially available cerebral microcatheters include, for example, the Prowler Select™ (Cordis Neurovascular Inc.) and the Spinnaker Elite™ (Boston Scientific Co.). Of course, the term microcatheter covers a wide range of devices, and this description will focus on catheters useful for the procedures described herein. In some embodiments, a microcatheter can include a distal segment that is narrower than the proximal segment. However, in further embodiments, the microcatheter can have a nearly constant diameter along its length, thereby facilitating the delivery of other devices over the microcatheter. The small distal diameter allows the catheter to navigate the tortuous blood vessels in the brain. The distal segment is highly flexible, sufficient for navigation within the blood vessels, yet resilient enough to resist kinking. The microcatheter includes at least one lumen. The microcatheter can then be used to deliver other therapeutic devices, suction, therapeutic agents, or other means of treating a condition. The microcatheter can have a selected size, and in some embodiments, the distal outer diameter of the microcatheter can be from about 1.0 Fr to about 3.5 Fr, and in further embodiments, from about 1.5 Fr to about 3 Fr, and the length can be from about 30 cm to about 200 cm, and in further embodiments, from about 45 cm to about 150 cm. A person of ordinary skill in the art will recognize that additional ranges of sizes within the explicit ranges above are contemplated and are within the present disclosure.

[0084] With respect to the percutaneous medical device 762, suitable devices include, for example, atherectomy devices such as clot engagement devices, angioplasty balloons, stent delivery devices, stent retrievers, etc. Desirable thrombus engagement devices are described in U.S. Patent No. 10,463,386 to Ogle et al., entitled "Thrombectomy Devices and Treatment of Acute Ischemic Stroke With Thrombus Engagement," which is incorporated herein by reference. Stents may be, for example, balloon-expandable, self-expandable, or expandable using any other suitable mechanism. Balloon-expandable stents may also be crimped onto a balloon for delivery to engage a clot in a blood vessel. Some balloon-stent structures are further described in U.S. Pat. No. 6,106,530, entitled "Stent Delivery Device," U.S. Pat. No. 6,364,894, entitled "Method of Making an Angioplasty Balloon Catheter," and U.S. Pat. No. 6,156,005, entitled "Ballon Catheter For Stent Implantation," each of which is incorporated herein by reference. Self-expanding stents are further described in U.S. Pat. No. 8,764,813, entitled "Gradually Self-Expanding Stem," to Jantzen et al., and U.S. Pat. No. 8,419,786, entitled "Self-Expanding Stent," to Cottone, Jr. et al., both of which are incorporated herein by reference. Stent retrievers are described, for example, in U.S. Pat. No. 8,795,305, entitled "Retrieval systems and methods of use thereof," which is incorporated herein by reference.

[0085] After the clot treatment process is complete, it has been found advantageous to at least partially detach the tubular extension of the aspiration extension from the guide catheter before removing the guide catheter from the patient. If a portion of the tubular extension is removed through the hemostatic valve during this removal process, isolation between the blood vessel and the outside of the patient's body may be lost because the proximal end of the tubular extension is not designed to close. Loss of isolation between the outside of the patient's body and the inside of the catheter system may result in undesirable amounts of bleeding and may complicate the control of trapped clots associated with the nozzle. In some embodiments, the fitting designs described herein address these issues by including a tubular storage area distal to the hemostatic valve that is connected to access the proximal end of the tubular extension. Some suitable designs are described below. Blood loss resulting from this retraction of the tubular extension can be reduced or eliminated through the use of the docking branch manifold described herein. As noted below, the fitting structure can be assembled for commercial use or designed as a specialized fitting specifically for the aspiration system and / or treatment system described herein.

[0086] During a procedure using the aspiration system, the tubular extension of the aspiration extension is removed from the patient, clots are evacuated, and the tubular extension can be reinserted for further clot removal. Clearing the clot from the tubular extension typically involves removal from the guide catheter and out of the hemostatic valve. After the tubular extension is cleared of obstruction, it is reinserted into the patient through the hemostatic valve. Clearing the clot typically involves backflow of fluid from the proximal end to the distal end. The fittings described herein allow the connecting section of the aspiration extension to be docked to a docking element of a docking Y fitting and detached through the hemostatic valve. Once detached through the hemostatic valve, flushing fluid can be delivered from one branch of the Y fitting to flush the tubular extension, eliminating the need for further attachment to the aspiration extension. The other branch of the Y generally includes a hemostatic valve or other device through which a control structure passes and closes the valve, allowing the direction of flushing fluid through the tubular extension.

[0087] First attachment elements have previously been described in published U.S. Patent Application Publication No. 2019 / 0183517 to Ogle, entitled "Suction Catheter Systems for Applying Effective Aspiration in Remote Vessels, Especially Cerebral Arteries," which is incorporated herein by reference. While the first attachment element herein can essentially encompass the proximal attachment, in preferred embodiments herein, the proximal attachment further includes a docking branch manifold. Using a docking branch manifold allows the attachment to include additional options regarding the location of suction provision and / or irrigation fluid delivery, such as contrast or therapeutic compound delivery. Thus, while the previously described proximal attachment can be transitioned to a first attachment element for engaging a docking branch manifold, the first attachment element can be designed with fewer or different branches, as desired, if certain functions are performed using the docking branch manifold. Therefore, some of the embodiments described herein can be correspondingly simplified in some embodiments.

[0088] Three representative embodiments for the first attachment element of the proximal attachment, which provides for the pullback of the suction extension within the hemostatic confinement, are shown in FIGS. 24-26 , in which the device holds the tubular extension of the suction extension within a manifold sealed behind one or more hemostatic valves. As shown in FIGS. 24A-26 , the proximal attachment is assembled from multiple attachment components, which are designed to allow suction from these first attachment elements. However, if desired, one or more of the components can be manufactured as a unitary structure, correspondingly eliminating the need for one or more sets of connectors, particularly configurations that may involve various trade-offs, such as ease of use, cost, packaging, industry standards, and design flexibility during use. As shown in FIGS. 24A and 24B , the components are shown separated, whereas in FIGS. 25 and 26 , the components are shown connected. Of course, in certain applications, additional components of the overall manifold can be assembled into the final proximal attachment structure. For example, an embodiment that allows for the attachment of a pressure sensor is shown below. Also, as will be shown below, additional components of the manifold may allow for docking and retraction of the suction extension relative to the fitting to eliminate blockages within the suction extension.

[0089] Referring to FIG. 24A , fitting 500 includes a Y-branch manifold 502 suitable for connection to a guide catheter 504 and an extended hemostatic fitting 506. Guide catheter 504 may be any of the guide catheter embodiments described above. Y-branch manifold 502 provides multiple connectors for fluid communication with guide catheter 504. As shown in FIG. 24A , Y-branch manifold 502 includes three connectors 510, 512, and 514, which may be Tuohy-Borst connectors, Luer connectors, or other suitable connectors. Connector 510 may be selected to connect to guide catheter 504. Connector 512 may connect to additional branch manifolds to provide various connections, such as for a negative pressure source such as a pump or an irrigation fluid source, and generally includes at least one connection to a negative pressure device. Connector 514 is configured to connect to extended hemostatic fitting 506. The extension hemostatic fitting 506 includes a connector 516 for mating connection with the Y-branch manifold 502, a hemostatic valve 518, and a tubular portion 520 between the connector 516 and the hemostatic valve fitting 518. The tubular portion 520 can have a length suitable for removing the tubular extension of the suction extension from the guide catheter 504 without any portion of the tubular extension or connecting section passing through the hemostatic valve, in some embodiments, although the proximal control structure generally passes through the hemostatic valve, which is a possible configuration throughout the procedure. FIG. 24B shows an alternative embodiment of a first attachment element without a branch, which is suitable for use with a docking branch manifold configured to deliver suction. The first attachment element without a branch 522 includes a connector 524, a tubular element 526 without a branch, and a hemostatic valve 528.

[0090] The length of the tubular portion 520 can be selected depending on the length of the tubular extensions, as well as potentially the associated length of the Y-branch manifold 502, as desired, which can collectively be referred to as a tubular section for placing the tubular extensions in hemostatic isolation with the connecting section external to the guide catheter. It may or may not be desirable to fully retract the tubular extensions into the tubular portion 520, leaving the remainder of the manifold open. With respect to the unbranched tubular element 526 of FIG. 24B, this element may or may not have a length suitable for retracting the tubular extensions so that they are fully isolated within the unbranched tubular element 526. For the range of alternative embodiments contemplated for the first attachment element of the proximal attachment of FIGS. 24A and 24B, the dimensions of the tubular section can be specified as appropriate for the particular configuration. Generally, the length of the tubular portion 520 of the extended hemostatic attachment 506 can be from about 8 cm to about 55 cm, from about 9 cm to about 50 cm in further embodiments, and from about 10 cm to about 45 cm in other embodiments. A person of ordinary skill in the art will recognize that additional ranges of lengths within the explicit ranges above are contemplated and are within the present disclosure.

[0091] In alternative or additional embodiments, the extended hemostatic fitting 506 can include a tubular element with two connectors on either end and a separate hemostatic valve with a luer or other connector on the opposite end, which are interconnected to form a structure essentially equivalent to that shown in FIG. 24. Similarly, one or more additional fitting components can be connected using appropriate connectors, such as additional branch elements, between the extended hemostatic fitting 506 and the Y-branch manifold 502, and similarly, additional fitting components can be connected at connector 512 to provide additional features to the fitting, such as connection of a pressure sensor or other structure. Thus, the proximal fitting can be modified with appropriate structure to provide the desired functionality while providing the ability to retract the tubular extension into the closed fitting. While this description has focused on assembling multiple fitting components to provide an overall fitting structure, one or more of these components can be formed as an integral part of a corresponding unitary structure, such as integrating Y-branch manifold 502 and extended hemostatic fitting 506 into a single structure by replacing connectors 514 and 516 with a single tubing section, and similar integration can be performed to add additional structures. A unitary structure incorporating the features of Y-branch manifold 502 and extended hemostatic fitting 506, including a branch manifold with an extended hemostatic valve portion, can be a suitable alternative to the structure of Figure 24. Therefore, various combinations of connecting elements, redesigns of single components, and so forth can be implemented to form a desired proximal fitting design.

[0092] Referring to an alternative configuration of the first fitting element in FIG. 25 , a three-branch manifold 530 is connected to the guide catheter 504, and an extended hemostatic fitting 520 is connected to the connector of one branch of the three-branch manifold 530. The three-branch manifold 530 includes a first connector 534 connected to a proximal connector 536 of the guide catheter 504, a first branch connector 538, a second branch connector 540, and a hemostatic valve 542. The second branch connector 540 is connected to the extended hemostatic fitting 506, as described in detail with respect to FIG. 24 . The first branch connector 536 can be connected to a negative pressure source directly or through an additional branch manifold. The hemostatic valve 542 can be used for the introduction of a supplemental treatment structure or other desired device. Again, the structure shown in FIG. 25 can be further divided into additional components as desired. For example, the three-branch manifold can effectively be formed using two consecutive Y-branch connectors. Again, as discussed above with respect to Figure 24, additional fixture components can be connected to the proximal fixture structure of Figure 25 to provide additional features. Similarly, one or more separate components of the proximal fixture can be configured as a unitary structure. Thus, component addition and / or combination / bonding processes can be combined to design a desired proximal fixture configuration.

[0093] Referring to FIG. 26, a further embodiment of the first attachment element of the proximal attachment is shown, employing a symmetric Y-branch configuration. As shown in FIG. 26, a symmetric Y-branch manifold 550 includes a first connector 552 connected to the guide catheter 504, a branch hemostatic valve 554, and a branch connector 556. The branch connector 556 is connected to a T-branch attachment 558. The T-branch attachment 558 has a T-connector 560, which is shown connected to a negative pressure device 562, such as a syringe or pump. The T-branch connector 556 is further connected to an extended hemostatic attachment 506, which is described in detail with respect to FIG. 24, including, but not limited to, the dimensions of its components. The T-branch connector 556 includes connectors 564 and 566 for connecting to mating connectors 556 and 516, respectively. The structure shown in Figure 26 can be formed with multiple components used to form the structure, for example, a separate component comprising hemostasis valve 554 connected by an appropriate connector to a mating connector on a correspondingly modified symmetrical Y-branch manifold 550. Again, additional fitting components can be connected to the proximal fitting structure of Figure 26 to provide the additional features described above with respect to Figure 24. Similarly, one or more separate components of the proximal fitting can also be constructed as a unitary structure. Thus, component addition and / or combination / bonding processes can be combined to design a desired proximal fitting configuration.

[0094] The proximal fitting, including its various possible components, can be formed from materials suitable for sterile assembly, which in some embodiments can include exposing the components to radiation. The components can be formed from either rigid and / or flexible materials, such as the polymers listed herein, and the connector can be formed from a combination of materials suitable for forming a seal, such as an elastomer. The rigid components can be formed from, for example, polycarbonate or other suitable polymers. The tubular portion 520 of the extended hemostatic fitting 506 can be formed from a more flexible polymer, such as one or more of the polymers previously described for the catheter body, such as polyetheramide block copolymer (PEBAX®), nylon (polyamide), polyolefin, polytetrafluoroethylene, polyester, polyurethane, polycarbonate, polysiloxane (silicone), polycarbonate urethane (e.g., ChronoFlex AR®), blends thereof, combinations thereof, or other suitable biocompatible polymers. As previously mentioned, various fixture structures can be assembled from additional components that are in addition to or subdivide various components of the embodiments, and / or components can be formed as correspondingly molded unitary structures. Thus, particular designs can be assembled from existing commercially available components, or all or part of the fixture can be manufactured specifically for these applications.

[0095] The proximal fitting may also include a pressure sensor to help guide the procedure. When a pump is used to provide negative pressure, the pressure set at the pump establishes a differential pressure limit. When fluid flows freely to the pump, the differential pressure in the conduit to the pump may be relatively small. When flow is virtually completely blocked, the gauge pressure in the line may be approximately the pump pressure, which is a negative pressure indicative of suction. Intermediate pressure levels may indicate flow restriction due to normal catheter or suction extension configurations that may cause some flow resistance, or a less severe blockage of flow from various possible sources. In either case, measuring the line pressure in the proximal fitting can provide valuable information to aid in the procedure, as discussed further below.

[0096] There are various possible configurations for the pressure sensor associated with the proximal fitting, with three representative embodiments shown in FIGS. 27-29. Referring to FIG. 27, a pump 570 and a pressure gauge 572 are connected to a Y-manifold 574 that includes a connector 576 that can be attached to a manifold connector in a fitting that connects to a guide catheter, as shown in FIGS. 5 and 24-26. The pump 570 and the pressure gauge 572 can be connected to the Y-manifold 574 using tubing 578, 580, respectively. The connection of tubing 578, 580 to the Y-manifold 574 can be achieved with suitable connectors, or they can be formed integrally with the components. In this embodiment, the pump 570 and optionally the pressure gauge 572 need not be sterile, although it is intended that no flow from these devices reach the patient. This configuration may be acceptable even if the device is not sterile, provided that non-sterile components are properly isolated from the patient's fluids. A selected length of parting line, e.g., 6 feet, to provide adequate sterile isolation is shown diagrammatically in Figure 27 by a dashed line annotated with an arrow. Commercially available suction pumps for medical use, some exemplary pumps of which are described above, can operate at gauge pressures of about -1 to about -26 inches of mercury (-25 mmHg to -660 mmHg). Medical high-pressure tubing is also available, for example, from MIVI Neuroscience, Inc. or Penumbra, Inc.

[0097] A further embodiment of a fitting modified with a pressure sensor is shown in FIG. 28 . The fitting components of FIG. 28 include a Y-branch connector 590 with a distal connector 592, a proximal connector 594, and a branched connector 596, and a pressure sensor component 598 with a first connector 600 and a second connector 602 shown connected to the branched connector 590. The pressure sensor component 598 further includes a pressure sensor 604 attached to a sidewall of the pressure sensor component 598. An electrical wire 606 extends from the pressure sensor 604 and terminates in an electrical connector 608, which may be a multi-pin clip or other suitable connector configuration. The electrical connector 608 may be suitable for connection to a suitable monitor or display. Commercially available pressure sensor components for use as the pressure sensor component 598 are available, for example, from PendoTECH of Princeton, New Jersey, USA. These components can be purchased sterile, or they can be sterilized prior to use using a convenient method, such as using gamma irradiation. A pump or other negative pressure device can be connected to the second connector 602 or to any other suitable part of the final assembled proximal assembly, such as a connector associated with the docking branch manifold.

[0098] Another embodiment of a fitting component modified with a pressure sensor is shown in FIG. 29. In this embodiment, a Y-manifold 620 includes a connector 622 for connecting to other components of the proximal fitting and a connector 624 connected to tubing 626 for connection to a pump or other device. The Y-manifold 620 further includes a branch 628 modified to include a pressure sensor 630 at the end of a conduit. The pressure sensor 630 can be fitted onto a connector cap, or it can sealingly mate with the branch 628, or it can otherwise be modified with a sealed attachment. The pressure sensor 630 is operatively attached to an electrical cable 632 that terminates in an electrical connector, such as a multi-pin clip. Pressure sensor dies or assemblies suitable for medical use are commercially available, for example, from Merit Medical Systems, Inc. (Merit Sensors), and can be modified for such connection.

[0099] As previously mentioned, the proximal attachment can include a docking branch manifold to facilitate the occlusion removal process of the tubular extension. Two specific embodiments are described to illustrate some possible features, but as with the first attachment element, various designs of components may be appropriate. A first representative embodiment of a docking branch manifold is shown in FIG. 30. As shown in FIG. 30, the docking branch manifold is shown with a first fluid source, a second fluid source, and a suction source. In alternative embodiments, only the first fluid source can be used, or only the first fluid source and a suction source can be used. Similarly, only the first fluid source and the second fluid source can be used. In further embodiments, a third or more fluid sources can be incorporated. The docking branch manifold 561 includes a tubular body 563, a docking inlet tube 565, a side port channel 567, and a proximal hemostasis valve 569 proximal to the side port channel 567 along the tubular body 563. Side port channel 567 is connected to valve 571, access manifold 573, first fluid source 575, second fluid source 577, and suction source 579. Fluid sources 575 and 577 may include reservoirs, syringes, pumps, or other delivery systems, and may optionally include valves. Suitable valves may include, for example, stopcocks, flow control switches such as those available from Merit Medical, various mechanical or motorized valves, and the like. The suction source may include a pump or other negative pressure device and appropriate pressure piping, and may optionally be associated with another valve.

[0100] A second exemplary embodiment of a docking branch manifold, a docking branch manifold 601 that can be used to detach a suction extension, evacuate any clots or other matter associated with the suction extension, and return the suction extension to the patient's body for clot retrieval, is shown in FIGS. 31-34. FIG. 31A shows a side view of the docking branch manifold 601. The docking branch manifold 601 includes an input tubing segment 603 at its distal end. Proximal to the input tubing segment 603 is a first branch 612 with a connector 605. In embodiments, a source valve 607 is connected to the docking branch manifold 601 at the connector 605. The source valve 607 has a second port 623. The source valve 607 can be a two-way valve or a multi-port valve. In some embodiments, the source valve 607 is a stopcock, although other flow control elements, such as some of the valves described above, can be used and may be desirable. The source valve 607 is in fluid communication with a fluid source, and opening the source valve 607 allows fluid to flow into the docking branch manifold 601, while closing the source valve 607 blocks fluid from flowing into the docking branch manifold 601. Examples of fluid sources, such as a positive pressure device such as a pump or pressurized container, a filled syringe 609, or the like, are shown in Figure 31B. The branches of the docking branch manifold 601 generally include hemostasis valves 611 through which control structures associated with the suction extensions can pass.

[0101] The docking branch manifold 201 generally includes a tubular body 613, which may include a tapered connector 614 connected to the input tubular segment 603, although the exact configuration of the connecting section is generally not important. In some embodiments, the tubular body 613 of the docking branch manifold 601 may include a distal section 616 made of a material selected to seal within the hemostasis valve, and a proximal section 618 made of a different material than the distal section, which may be molded to further include a Y-junction. A connector 625 may optionally be used to join the distal section 616 and the proximal section 618, and the connector 625 may be made of a suitable material. The connector 625 may or may not be visible externally and may or may not change the outer diameter, inner diameter, or both. If a suitable material is selected, the tubular body 613 may be formed from a single material.

[0102] FIG. 31C shows a partial cross-sectional view of the docking branch manifold 601, illustrating that the distal portion of the input tubular segment 603 includes a docking structure 617. The docking structure 617 may be configured to releasably retain the proximal end of the suction extension, as in any of the previously described embodiments. For example, the docking structure 617 may use an interference fit to secure the proximal end of the connecting section of the suction extension. In embodiments, the docking structure 617 may be configured to have an inner taper of the inner wall 619 of the input tubular segment 603. For example, the inner surface 621 of the input tubular segment 603 may thin inward until the inner diameter of the tubular input is eventually smaller than the outer diameter of the distal end of the suction extension. In additional or alternative embodiments, the docking structure 617 may have a flange on the inner surface 621 of the input tubular segment 603, which may be considered an infinite, sharp taper. In embodiments, the docking structure 617 may also include structure on the inner surface 621 of the tubular input segment 603 configured to interface with corresponding structure on the proximal end of the connecting section of the suction extension. For example, the docking structure 617 may include a detent on the inner surface 621 of the tubular input segment 603 configured to interface with an indent on the outer surface of the tubular extension. In general, however, the docking structure may be any suitable structure, such as a narrowing tubular structure, that provides at least a substantially fluid-tight fit with the proximal end of the connecting section of the suction extension.

[0103] As shown in the partial view of FIG. 32 , the aspiration catheter system generally includes a guide catheter 631, and a Y-branch manifold 633 is shown as the first attachment element; any of the previously described guide catheter embodiments and first attachment elements can generally be used with this embodiment. As shown in FIG. 32 , the docking branch manifold is of the structure shown in FIG. 31A , and the alternative structures described with respect to this figure equally apply to the embodiment of FIG. 32 . The first attachment element 633 includes a connector 635, a tubular body 637, a branch connector 639 with a connector 641, and a hemostasis valve 643. Similarly, other embodiments of the first attachment element and docking branch attachment can be incorporated into the assembled system. The docking branch manifold 601 can be designed to interface with the Y-branch manifold 633, with the proximal section 618 inserted into the hemostasis valve 643. It should be understood that various manifold configurations are within the scope of the present application. For example, the disclosed suction catheter system is not limited to the two pathways available in the Y-branch manifold 633. For example, a first attachment element without branches, as shown in FIG. 24B, can be used. As another example, FIG. 33 shows a suction catheter system including a three-branch manifold 651. Manifolds with more branches can also be used. Alternatively, manifolds can be interconnected to create more pathways. For example, additional manifolds can be attached to connector 653 or second connector 655. The three-branch manifold 651 is connected to the guide catheter 631 at connector 658. At the proximal end of the three-branch manifold 651, the input tubing section 603 is inserted into a hemostasis valve 659 and docks with a suction extension within the Y-branch manifold 633. Similarly, the first attachment element can include an integral structure or structural component that functions as an extended hemostatic attachment, such as shown in Figures 24-26, allowing the tubular extension of the suction extension to be detached from the guide catheter in a hemostatic environment, and the structures of Figures 30-34 can be interpreted as including this capability with corresponding structural and dimensional adjustments.

[0104] Figure 34A shows the assembled system of Figure 32 with the suction extension deployed among the components and the control wire 661 extending from the hemostasis valve 615. Figure 34B shows a cross-sectional view of a portion of the suction catheter system shown in Figure 34A. The control wire 661 passes through the docking manifold 601 and is secured to the suction extension 663. As mentioned above, in embodiments where the docking branch manifold is configured to connect to a negative pressure device, the first attachment element with the branch manifold can be replaced with a non-branched first attachment element if desired, although the system can optionally provide suction from a connector selected from multiple available connectors, or the first attachment element manifold connection can be used to deliver contrast or therapeutic compounds in place of the connection to the negative pressure device.

[0105] 34B shows the suction extension 663 docked to the docking structure 617. However, the control wire 661 can be manipulated, for example, by pushing on it to exert an axial force in a distal direction, to release the suction extension 663 from the docking structure 617 and reintroduce the suction extension 663 into the patient's body. Conversely, when the suction extension 663 is undocked, the control wire 661 can be manipulated to pull the proximal end of the suction extension 663 into the docking structure 617, thereby securing the tubular extension of the suction extension 663. For example, the control wire 661 can be pulled proximally until the suction extension 663 forms an interference fit with the tapered portion of the input tubular section 603. Alternatively, as shown in FIG. 34C, the control wire 661 can be extended until it extends throughout the docking structure 617, thereby causing the tubular extension of the suction extension 663 to be distal to the docking branch manifold 601.

[0106] Once the suction extension 663 is docked to the docking structure 617, the docking branch manifold 601 can be separated from the Y-branch manifold 633, causing the suction extension 663 to be pulled proximally back through the hemostatic valve 635. Once the structures are separated, the source valve 607 can be opened to allow fluid to flow into the docking branch manifold 601, through the docking structure 617, and then through the suction extension 663. The fluid flow can dislodge blood clots or other material trapped within the tubular extension of the suction extension 663. Examples of fluids include, for example, sterile water, saline, contrast media, or other sterile fluids. If the procedure is ongoing, once the suction extension 663 has been evacuated of obstructing material, it can be reinserted into the Y-branch manifold 633 through the hemostatic valve 635. Once the docking branch manifold 601 is reinserted and secured within the Y-branch manifold 633, the control wire 661 can be used to detach the suction extension 663 from the docking structure 617, allowing the tubular extension of the suction extension 663 to be reintroduced into the patient's body to retrieve further blockage from the occluded blood vessel.

[0107] While the particular embodiment of the docking branch manifold of FIGS. 31-34 is an exemplary embodiment, other embodiments can have more than two branches with appropriate additional connectors, additional flow control elements, branches at different angles, etc. In particular, the features described with respect to FIG. 30 can also be applied to the second exemplary configuration of FIGS. 31-34. For example, the first branch of the docking branch manifold can include a source valve that controls flow that can originate from a fluid source or to a suction source, such as a pump, that draws fluid from the manifold. Rather than using additional branches from the first branch, additional branches can be provided on the manifold to allow access to even more fluid and / or suction sources, similar to the additional branches for the first branch manifold of the proximal fitting shown in FIG. 25. One skilled in the art can adjust the design based on functional constraints based on the teachings herein.

[0108] The docking branch manifold generally has suitable dimensions for convenient handling and manipulation, with internal dimensions suitable for accommodating the various devices described herein. The components of the docking branch manifold can be formed from either rigid and / or flexible materials, such as the polymers provided herein, and the connectors can be formed from any combination of materials suitable for the intended function of the components. Rigid components can be formed from, for example, polycarbonate, polyimide, metal, or other suitable polymers. The portion of the docking branch manifold that is secured to the hemostasis valve of the proximal fitting should have sufficient mechanical strength to avoid being crushed by the hemostasis valve, which can be achieved by appropriate selection of materials and wall thickness. In embodiments, the tubular portion can be formed from a more flexible polymer, such as one or more of the polymers previously described for the catheter body, such as polyetheramide block copolymer (PEBAX®), nylon (polyamide), polyolefin, polytetrafluoroethylene, polyester, polyurethane, polycarbonate, polysiloxane (silicone), polycarbonate urethane (e.g., ChronoFlex AR®), blends, combinations thereof, or other suitable biocompatible polymers. As previously described, the various attachment structures can be assembled from additional components added to or separate from the various components of the embodiments, and / or the components can be formed from a correspondingly molded, one-piece structure. Thus, certain designs can be assembled from existing, commercially available components, or all or part of the fitting can be manufactured specifically for these applications. In embodiments, some of the components can be translucent or transparent. It can be advantageous for the user to be able to see the interior of a component. In some procedures, it may be desirable for the user to be able to visually confirm that the suction extension has entered the manifold or engaged with the docking structure. Therefore, transparency should be considered, especially for fixtures, where there is a docking structure, so that visual inspection as well as physical tactile evaluation can aid in verifying docking.In some procedures, it may be desirable for the user to visually inspect the tubular extension for trapped thrombus or other debris before removing the tubular extension from the hemostatic environment.

[0109] Use of the aspiration systems described herein involves manipulating a control structure, such as a control wire, to move the body of the suction extension within the guide catheter. Movement generally involves extending the tubular extension from the distal end of the guide catheter as well as removing the suction extension from the proximal end of the guide catheter. In some embodiments, the guide catheter does not include a stop or other interface structure that engages with the connecting section of the suction extension to prevent it from moving out of the distal opening of the guide catheter. If the connecting section of the suction extension passes through the distal opening of the guide catheter, it may be difficult to restore the objective of the procedure without removing the guidewire from the patient, causing undesirable delays, thereby creating risks to the patient and increasing costs associated with the procedure time. While the control structure may include markings instructing medical personnel not to insert the control structure, such a system may involve an undesirable level of risk in terms of user error.

[0110] A handle can be secured to the control structure at or near its proximal end to facilitate gripping the control structure and prevent it from being inserted too far into the guide catheter. The grip or handle can then be shaped to prevent insertion of the handle into the hemostasis valve or have a sufficient thickness perpendicular to the control structure. Various configurations for the grip or handle may be appropriate, but generally, they should be easy for a medical professional to grasp with one hand for manipulation during a procedure. The handle can be rigidly attached to the control structure, or the grip can be reattachable on the control structure. If the grip is reattachable, the proximal end of the control structure can be bent, tied, twisted, or otherwise altered to make it difficult or impossible to remove the grip without destroying the components. In use, the handle should be appropriately secured if it is not permanently fixed in a particular position. If the handle is reattachable, for example, for use with a different embodiment of the attachment or guidewire, the handle can be secured with screws, clips, snaps, other fasteners, or other suitable structures that can be fastened by the user during product manufacturing or with appropriate instructions.

[0111] In one exemplary embodiment, the handle is provided with a pin vise. FIGS. 35A-35C show an embodiment of a pin vise 671 having a knurled collet holder 673, a collet 675, and a head 677. In an embodiment, the head 677 may have one or more ribs 679. The ribs 679 may facilitate turning the head 677 to hold or release a control wire 681. Additionally, the ribs 679 may help prevent the pin vise 671 from rolling when placed on, for example, a surgical tray or table. The collet 675 has a through hole 683 configured to receive a control wire. Once a control wire is inserted into the through hole 683, turning the head 677 about the threads 685 in a first direction causes the collet 675 to grip the control wire within the vise, and turning the head 677 in the opposite direction causes the collet 675 to release the control wire. Once the control wires are secured by the collet 675, the collet holder 673 may be manipulated to control the control wires and corresponding suction. For example, twisting the collet holder 673 may apply torque to the control wires. Pulling the collet holder 673 axially may retract the suction extension from the patient and / or dock the suction extension within the docking structure. Similarly, pushing the collet holder 673 axially may release the suction extension from the docking structure and / or reposition the suction extension within the patient's vasculature.

[0112] The aspiration catheter system is typically suitably sterilized, such as by e-beam or gas sterilization. The components of the aspiration catheter system can be packaged together or individually in a sealed package, such as a plastic package known in the art. The package is typically appropriately labeled in accordance with the regulations of the FDA or other regulatory agencies. The aspiration catheter system can be packaged with guidewires, filter devices, and / or other medical devices. The packaged system is typically sold with detailed instructions for use in accordance with regulatory requirements.

[0113] [Treatment using the treatment system] As previously mentioned, medical systems including the aspiration catheter systems described herein can be used with the aspiration catheter system as a standalone treatment device, possibly in conjunction with a guidewire and / or other delivery assistance devices, or with supplemental treatment devices for the treatment of ischemic vascular occlusions. In particular, in some embodiments, the aspiration system is used with an embolic protection device, and in further embodiments, any form of clot engagement device, stent, balloon, atherectomy device, etc. may also be used. In either case, a guidewire is generally used to provide access to the treatment site. The guide catheter portion of the aspiration catheter system may or may not be positioned prior to introducing the aspiration extension. The structure of certain components has already been described in detail above, and will not be repeated in this section so as to allow the focus to be on the use of the device. Those skilled in the art will be able to employ alternative embodiments of the various fitting components based on the teachings herein.

[0114] To treat an acute ischemic stroke condition, referring to FIG. 36 , a patient 700 is shown with three alternative vascular access points: a femoral artery 702, an artery in an arm 704, or a carotid artery in a neck 706. Regardless of the access point, a catheter and associated devices are guided into the left or right carotid artery to reach a clot 508 in a cerebral artery 710 of the brain. Referring to the schematic diagram of FIG. 37 , a clot 708 is shown in the cerebral artery 710, with a guidewire 712 positioned with its distal tip past the clot. A guide catheter 714 is positioned over the guidewire within the carotid artery 706. A suction extension 716, along with a connecting section 718, resides within the guide catheter 714, and a tubular extension 720 extends from the guide catheter 714 over the guidewire 712. Referring to FIG. 38 , the tubular extension 720 can be advanced over the guidewire to a position proximate to the clot 708. Suction can be applied as indicated by the flow arrows in the figure. The guidewire 712 may or may not be removed before suction is applied. The aspiration catheter has been successful in removing clots causing ischemic stroke without intervention with additional medical devices. However, for more difficult clots, additional treatment devices can be used, as described in more detail below.

[0115] Using embodiments of the proximal fitting with pressure sensing capabilities, as shown above, the initiation of suction described with respect to FIG. 38 can be confirmed for effectiveness. Once negative pressure is applied to the catheter system and adequate flow is established, the pressure within the proximal fitting can be within an appropriate range. The exact range of expected pressures will generally depend on the specific design of the suction extension, and the acceptable pressure range can be adjusted accordingly. In either case, the pressure can be checked in real time during the procedure and compared to the specifications met for the particular suction catheter component. If the pressure immediately following the initiation of suction is closer to the pump negative pressure than would be expected based on the established acceptable range, the physician can at least partially retract the suction extension from its delivered state, with or without stopping suction. Partial retraction can be used to attempt to untwist the suction extension without completely removing it. As further described below, if a proximal fitting is used that allows the tubular extension to be removed from the patient without passing through a hemostasis valve, the tubular extension can be visually checked without exposing it to the ambient atmosphere. After verifying that the tubular extension is ready for use, or after replacing the suction extension, the suction extension can be delivered again.

[0116] When using an aspiration system to remove the actual clot involved in an acute ischemic stroke, the tubular extension itself often becomes blocked before the blockage in the blood vessel is completely removed. Therefore, it may be desirable to remove the clot from the tubular extension and then reinsert the aspiration extension into the cerebral vessel to further remove the clot. The blockage removal and reinsertion can be repeated as necessary. This process can be facilitated by the fittings described herein, and the implementation of this process using these fittings is further described below. The desire to remove the clot from the aspiration extension and the reintroduction of the aspiration extension can also be implemented in conjunction with the use of additional treatment structures, as described below.

[0117] 39 and 40, the use of a fiber-based filter device is shown in conjunction with an aspiration catheter system. As shown in FIG. 39, a blood clot 708 is shown in a cerebral artery 710, and a deployed fiber-based filter 734 supported on a guidewire 736 is positioned with the filter deployed past the clot. The fiber-based filter 734 can have fiber elements that extend essentially to the wall of the blood vessel, i.e., the cerebral artery 710. A tubular extension 736 can be positioned with its distal tip just proximal to the clot; the remainder of the aspiration catheter system is not shown in this view. Referring to FIG. 40, the fiber-based filter 734 can be pulled toward the tubular extension 736 while suction is applied to facilitate removal of the blood clot 730. The clot 708 can be broken up and removed by suction, and / or all or a portion of the clot 708 can be drawn into the tubular extension 736, optionally along with all or a portion of the fiber-based filter, and / or all or a portion of the clot 708 can be held up to the opening of the tubular extension 736, with the fiber-based filter holding the clot. In either case, once the clot has been properly stabilized, the device and any clot still within the vessel or catheter can be removed from the patient. Device removal is discussed further below.

[0118] Further use of additional medical devices to facilitate clot removal is illustrated in FIGS. 41 and 42. As shown in FIG. 41, a clot 708 is shown in a cerebral artery 710, a treatment device 754 is positioned at the clot, and a deployed fiber-based filter 756 supported on a guidewire 758 is positioned with the filter deployed past the clot. Suitable treatment devices for engaging the clot have been described above. The selected treatment device is deployed, generally with protection from the deployed fiber-based filter and, optionally, with suction. Once the treatment device has engaged the clot, the collection of the remaining portion of the clot and the treatment device can be removed, as shown in FIG. 42, similar to the process illustrated in FIG. 41. Notably, the treatment device can be removed, although portions such as a stent may remain in place, and removal can proceed or occur in conjunction with removal of the filter and / or remaining clot debris. All or a portion of the clot 708, if not already broken up and removed by suction, can be drawn into the tubular extension 736, optionally along with all or a portion of the fiber-based filter, and / or all or a portion of the clot 708 can be held to the distal opening of the tubular extension 736, with the fiber-based filter retaining the clot. Again, once the clot has been adequately stabilized, the device and any clot still within the vessel or catheter can be removed from the patient. The use of multiple additional therapeutic devices can be accomplished by extending the procedure outlined above and repeating the steps involving the additional medical devices.

[0119] Additionally, in the embodiments of Figures 37-42, a pressure sensor connected to the proximal fitting can be used to guide the procedure. If the pressure in the proximal fitting rises to a pressure outside the target range when vacuum is initiated, appropriate corrective action can be taken, such as untwisting, replacing / removing the suction extension, or other appropriate action. Additionally, once suction is applied and the clot appears to be addressed, the pressure in the proximal fitting can be checked to assess the condition of the clot and catheter, such as whether the clot is lodged in the distal end of the suction extension. Appropriate action can be taken based on the pressure in the proximal fitting.

[0120] FIG. 43 shows the aspiration treatment system after treating a blood clot in a cerebral artery 750. A tubular extension 752 is positioned so that its distal tip is within the cerebral artery 750, and a thrombus 754 may or may not be at the orifice. A guide catheter 756 is positioned with its distal end within a carotid artery 758. The interior compartment of the guide catheter 756 is shown in the balloon inset view of FIG. 43. A connecting section 760 of the aspiration extension 752 is within the guide catheter 756, with a control wire 762 extending proximally. A patient's leg 764 is shown with an introducer sheath 766 with a hemostatic valve 768 extending from the leg. The guide catheter 756 extends from the hemostatic valve 768. A Y-branch manifold 770 is connected to the distal end of the guide catheter 756 at a connector 772. The extended hemostatic fitting 774 connects to the Y-branch manifold 770 at connector 776 and terminates at a hemostatic valve 778. A control wire 762 extends from the hemostatic valve 778. The Y-branch manifold 770 has a connector 780 that is connectable to a further Y-branch manifold 782 having a connector 784 for connecting to connector 780. The Y-branch manifold can be connected to a vacuum line 786 that can be connected to a pump or other vacuum device, and a pressure sensor line 788 that can be connected to a suitable pressure sensor, such as those shown in Figures 27-29. The fitting of Figure 43 can be combined in a docking branch manifold and hemostatic valve 778, suitable embodiments of which have been described above. The combination of the Y-branch manifold 770 and the extended hemostatic fitting 774 can be considered components of a first fitting element.

[0121] At the stage of the procedure shown in Figure 38 (assuming the clot has been removed to the desired extent) and Figure 43, procedural steps can begin to gradually remove the device from the patient. Figures 44-46 illustrate the removal process using an extension fitting, which allows the suction extension to be completely removed from the guide catheter behind the hemostatic valve. Figures 47 and 48 illustrate the use of a docking Y-fitting, which allows for efficient removal and reintroduction of the suction extension. It may be advantageous to keep the guide catheter in place during removal of other components and during confirmation of the success of the procedure. It is generally desirable to keep the guide catheter in place until the entire procedure is complete, as this is critical for guidewire placement. As previously mentioned, the suction extension may be removed before the entire procedure is complete and reintroduced to expel clots and further remove thrombus. This removal and reintroduction of the suction extension can be performed while the guide catheter remains fixed in place. Pressure measurements at the proximal fitting can provide useful information regarding the state of possible flow blockage to the suction extension 752, but other more qualitative assessments can also be made, such as the termination of fluid flow to the pump.

[0122] Referring to Figure 44, the guide catheter 756 is still in place within the carotid artery 758, and the cerebral artery 750 is free of devices and clots. Referring to the balloon inset associated with Figure 44, a further enlarged cross-sectional view shows the distal end of the suction extension 752 within the interior of the guide catheter 756. A thrombus may or may not be associated with the distal end of the guide catheter 756 (thrombus 790), which may be deposited in situ as the suction extension 752 is retracted into the guide catheter 756 and / or at the distal end of the suction extension 752 (thrombus 754). Again, pressure measurements at the proximal fitting can provide useful information regarding a thrombus potentially blocking flow from the catheter system to a negative pressure device, such as a pump.

[0123] 45 , the balloon inset shows a further enlarged cross-sectional view of the connecting section 760 of the suction extension 752 within the T-junction manifold 770 as the suction extension 752 is further withdrawn from the patient. Continuing to apply negative pressure in this state will cause fluid to be drawn out of the guide catheter 756 rather than through the suction extension 752. Whether or not the suction extension 752 is clogged, this state can provide the ability to further remove any clots 790 at the end of the guide catheter 756, and the suction can further stabilize any clots 790 for the subsequent portion of the procedure. At this stage of the procedure, the pressure within the proximal fitting can provide information regarding fluid flow into the guide catheter 756.

[0124] The suction extension 752 is shown fully removed from the guide catheter 756 in FIG. 46. The distal balloon inset in FIG. 46 shows a further enlarged view where the distal end of the suction extension 752 is within the T-junction manifold 770, but can be fully retracted into the extended hemostatic fitting 774, as indicated by the dashed line connected to the balloon inset. The proximal balloon inset in FIG. 46 shows a further enlarged cross-sectional view where the connecting section 760 within the extended hemostatic fitting 774 is in a position distal to the hemostatic valve 778. Again, the pressure within the proximal fitting can be useful in providing information during this portion of the procedure.

[0125] Although the guide catheter 756 can be removed from the patient after treating the clot, it may be desirable to at least partially remove the suction extension 752 relative to its deployed position while the guide catheter is in place to reduce the risk of embolization of thrombus that may have become trapped associated with the aspiration system components but not fully removed from the patient. Figures 44-46 illustrate three stages of suction extension removal, at which point the guide catheter 756 can be selected to be removed from the patient, generally through the hemostatic valve 768 of the introducer 766. As shown in Figure 44, with the distal end of the suction extension 752 within the guide catheter 756, any thrombus associated with the suction extension 752 is not within the guide catheter 756, thereby reducing the likelihood of embolization. 45, as previously described, when the connecting section 760 is within the Y-branch manifold 770, suction is applied directly to the lumen of the guide catheter 756, regardless of whether the suction extension 752 is clogged or not; this application of suction directly to the guide catheter 756 provides additional safety in reducing the chance of embolization. Furthermore, as shown in FIG. 46, completely removing the suction extension 752 from the guide catheter 756 provides additional safety against embolization of thrombus associated with the suction extension 752. As shown in FIG. 46, the suction extension 752 remains isolated behind the hemostatic valve 778, which allows for desirable control of pressure within the guide catheter 756, further reducing the risk of embolization as well as contamination.

[0126] FIG. 47 illustrates the docking branch manifold 601 with its distal end inserted into the hemostasis valve 778 and the control wire 762 extending proximally. As previously described, the use of the docking branch manifold 601 allows for efficient removal and reintroduction of the suction extension. As shown in FIG. 47, the suction extension 752 is detached from the guide catheter 756 but remains isolated behind the hemostasis valve 778. If the suction extension 752 becomes clogged, the illustrated configuration provides additional safety against embolization of thrombi. However, to safely reintroduce the suction extension 752 into the patient, the clog should first be removed from the suction extension 752. As previously described, the control wire 762 can be used to dock the suction extension 752 to the docking branch manifold 601.

[0127] FIG. 48 shows both the docking branch manifold 601 and the suction extension 752 fully withdrawn from isolation behind the hemostasis valve 778. In this configuration, the proximal end of the suction extension 752 is docked within the input tubing segment 603. Additionally, at least a portion of a clot 708 is shown lodged in the distal end of the suction extension 752. Reintroducing the suction extension 752 into a patient with the clot 708 occluding a portion of the suction extension 752 can be dangerous. Therefore, once the suction extension 752 is fully removed from the hemostasis valve 778, valve 607 can be opened and a positive pressure device, such as syringe 609, can eject fluid to flush the clot 708 from the suction extension 752. Once the suction extension 752 has been cleared, the suction extension 752 can be reinserted into the hemostasis valve 778. Sterilization procedures can be used to maintain the suction extension 752 sterile for reintroduction into the patient. In some procedures, the cleaned suction extension 752 may be completely reintroduced into the patient for further emboli retrieval. As previously mentioned, the docking manifold can be configured to deliver suction, contrast fluid, or other fluids to facilitate administration of the procedure. The procedure can be easily modified for these additional or alternative embodiments.

[0128] Bench tests and calculations were performed to evaluate the general aspiration performance of using an aspiration extension in contact with a guide catheter or other commercially available aspiration catheters. These results are described in the '938 application and are incorporated herein by reference.

[0129] The above-described embodiments are intended to be illustrative, not limiting. Further embodiments are within the scope of the following claims. Moreover, while the present invention has been described with reference to specific embodiments, those skilled in the art will recognize that changes can be made in form and detail without departing from the spirit and scope of the present invention. Any incorporation by reference of the above-mentioned documents is limited to not incorporating any subject matter contrary to the explicit disclosure herein. Unless expressly indicated otherwise, and as suggested in the discussion, to the extent that certain structures, configurations, and / or processes are described with components, elements, ingredients, or other moieties, the disclosure herein should be understood to encompass embodiments comprising certain components, elements, ingredients, other moieties, or combinations thereof, as well as embodiments consisting essentially of such certain components, ingredients, or other moieties, or combinations thereof, which may include additional features that do not alter the basic nature of the subject matter.

Claims

1. a guide catheter including a tubular shaft with a central lumen having a proximal end and a distal opening; a suction extension catheter including: a connecting section having a central lumen; a tubular extension including a tube connected to the connecting section and extending distally from the connecting section to form a continuous lumen through the tube of the tubular extension and through the central lumen of the connecting section; and a control structure including an elongate structure extending proximally from the connecting section, wherein the connecting section is configured to slide within at least a portion of the central lumen of the guide catheter to change the relative position of the connecting section within the central lumen and extend at least a portion of the tubular extension outward from the distal opening of the tubular shaft in an appropriate configuration of the connecting section; a proximal fitting connected to the proximal end of the guide catheter, the proximal fitting comprising: a first fitting element having a tubular body having a distal connector connected to the proximal end of the guide catheter; and a first hemostatic valve configured to allow the suction extension catheter to pass through the first hemostatic valve; and a docking branch manifold including an input tubing segment connected to a first branch having a valve and terminating in a connector, and a second branch having a hemostatic valve, the input tubing segment including a docking structure that engages with the proximal end of the connecting section of the suction extension catheter at a location distal to the first branch to form a continuous fluid channel from the central lumen to the docking branch manifold, at least a portion of the input tubing segment being configured to be inserted through and secured therein; Including, Suction catheter system.

2. a port of the valve in the first branch of the docking branch manifold is connected to a fluid source, and the valve is configured to move between an open position that allows fluid to flow from the fluid source to the docking branch manifold and a closed position that prevents the flow of fluid to the docking branch manifold; The aspiration catheter system of claim 1 .

3. the fluid source comprises sterile saline or a contrast agent; The aspiration catheter system of claim 2 .

4. the docking branch manifold including a connection to a suction source configured to deliver suction force to the input tubular segment; The suction catheter system according to any one of claims 1 to 3.

5. the first attachment element includes a branch connected to a negative pressure source; The suction catheter system according to any one of claims 1 to 4.

6. the docking structure of the input tubular segment narrows in inner diameter in the proximal direction; The suction catheter system according to any one of claims 1 to 5.

7. the docking structure of the input tubular segment includes an elastic polymer that engages with the proximal end of the connecting section to form the continuous fluid channel. The aspiration catheter system of claim 6.

8. the input tubular segment includes an engagement section having an outer surface adapted to engage with the first hemostatic valve to provide a hemostatic seal; The suction catheter system according to any one of claims 1 to 7.

9. the first attachment element further includes a first tubular segment providing a length between the first hemostatic valve and the proximal end of the tubular shaft of the guide catheter that is at least as long as the length of the tubing of the suction extension catheter; The suction catheter system according to any one of claims 1 to 8.

10. a guide catheter including a tubular shaft with a central lumen having a proximal end and a distal opening; a tubular extension catheter including a connecting section having a central lumen; a tubular extension including a tube connected to the connecting section and extending distally from the connecting section to form a continuous lumen through the tube of the tubular extension and through the central lumen of the connecting section; and a control structure including an elongate structure extending proximally from the connecting section and a handle at or near a proximal end of the elongate structure configured to manipulate the control structure, the connecting section configured to slide within at least a portion of the central lumen of the guide catheter to change the relative position of the connecting section within the central lumen and extend at least a portion of the tubular extension outwardly from the distal opening of the tubular shaft in an appropriate configuration of the connecting section; a proximal fitting connected to the proximal end of the guide catheter, the proximal fitting including a first hemostatic valve; Including, the handle is reattachable to the connecting section and has a larger diameter than the connecting section, whereby the tubular extension, the connecting section, and the control structure distal to the handle can pass through a valve that does not allow passage through the handle, and the length between the distal opening of the suction extension catheter and the handle defines a length that prevents the connecting section from exiting the distal opening of the guide catheter. Suction catheter system.

11. The proximal end of the control structure extends proximally relative to the handle and is capable of limiting movement of the handle relative to the control structure in the proximal direction. The aspiration catheter system of claim 10.

12. the control structure has a bend, knot, anchor, or distortion near its proximal end that limits movement of the handle relative to the control structure; 12. The aspiration catheter system according to claim 10 or 11.

13. The handle is provided with a pin vise.

12. The aspiration catheter system according to claim 10 or 11.

14. the proximal fitting further includes a tubing segment providing a length between the first hemostatic valve and the proximal end of the tubular shaft of the guide catheter that is at least as long as the length of the tubing of the suction extension catheter; The suction catheter system according to any one of claims 10 to 13.

15. the proximal fitting further includes a docking branch manifold including an input section securable to the first hemostasis valve, a docking element in the input section capable of docking in a substantially fluid-tight manner with the proximal end of the tubular extension, and a hemostasis valve through which the elongate structure can extend. The suction catheter system according to any one of claims 10 to 14.

16. The end of the elongated structure is a flat wire coil embedded in the polymer tube of the connecting section. The suction catheter system according to any one of claims 10 to 15.

17. The connecting section has a larger outer diameter than the tubular extension. The suction catheter system according to any one of claims 10 to 16.

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