Clot Removal Distal Protection Assembly

Abstract

Provided herein are methods for protecting distal vessels from emboli during aspiration, the methods including delivery and deployment of an embolic protection device, which is advanced and deployed deep into the cerebral vascular bed distal to the clot load and thereafter fully against the vessel wall upon deployment, forming a circumferential seal across the vessel. The methods utilizing the embolic protection device protect the distal vasculature from vulnerable clot emboli, which are dislodged and captured within the embolic protection device during clot removal and / or aspiration.

Description

[Technical Field]

[0001] The inventions disclosed herein relate generally to the field of clot removal protection devices and / or clot removal protection device systems and / or implantable devices for using clot removal protection. [Background technology]

[0002] There is a great demand for the development of embolic protection devices for the safer removal of clot material in patients suffering from an ischemic stroke event. Currently, there is an unmet need for such devices that provide a means of presenting a protective barrier while preventing clinical sequelae that may lead to longer-term morbidity and prolonged patient rehabilitation. Safer removal of blood clots will contribute to reducing medical costs associated with treating patients affected by ischemic stroke. While proximal protection devices are used in the carotid artery, such devices are unable to provide deeper protection of the cerebral vascular bed, particularly for delivery distally within the brain.

[0003] Thus, the inventive methods disclosed herein adapt the design of implantable devices used in aneurysm and vascular occlusion treatment to innovative treatment techniques for deep brain and / or vascular embolic protection. See U.S. Patent No. 10,130,372, Aneurysm Treatment / Occlusion Device, which is incorporated herein by reference in its entirety.

[0004] All publications and references cited in this specification and the referenced patents are hereby incorporated by reference. Summary of the Invention

[0005] Disclosed herein is a method for protecting distal vessels from dislodged emboli during clot aspiration or mechanical clot removal using an embolic protection device that functions as a mesh shield, thereby capturing the emboli so that they can be retrieved and removed through an aspiration catheter.

[0006] In one embodiment, a method for protecting a distal blood vessel from emboli includes advancing an aspiration catheter to a position proximal to the clot burden, delivering a microcatheter through the aspiration catheter and over a guidewire to the distal end of the clot burden within the blood vessel to be treated, removing the guidewire, delivering and deploying an embolic protection device through the microcatheter via an exchange length delivery wire and positioning the deployed device distal to the clot burden until it fully opposes the wall of the blood vessel to create a circumferential seal across the blood vessel, removing the microcatheter and leaving the embolic protection device and exchange length delivery wire in place within the blood vessel, loading an aspiration catheter over the exchange length delivery wire and advancing the aspiration catheter proximal to the clot burden, and commencing aspiration of the clot, whereby aspiration dislodges and captures fragile clot emboli within the embolic protection device.

[0007] In one embodiment of the methods disclosed herein, the embolic protection device is an implantable device, the embolic protection device comprising: (a) a substantially solid marker having a proximal end and a distal end; and (b) an elastic mesh body attached to the distal end of the marker, the body having a delivery shape and a deployment shape capable of conforming to the wall of a blood vessel, the body being a double layer of elastic mesh that is folded over itself to create a circumferential fold around the circumference of the body and folded ends of the elastic mesh, all of the folded ends of the double layer of mesh within the marker.

[0008] In another embodiment, a substantially solid marker is attached to the exchange length delivery wire. In one embodiment, the marker cannot be removed from the exchange length delivery wire, i.e., is permanently attached to the delivery wire.

[0009] In further embodiments of the methods disclosed herein, additional or modified steps include, but are not limited to, advancing an aspiration catheter through the clot, using a guidewire within the aspiration catheter to navigate the large lumen device into position, and / or removing the embolic protection device and continuing / pulling back suction, thereby ensuring that all trapped emboli are safely removed from the vessel.

[0010] In another embodiment of the methods disclosed herein, the embolic protection device is an implantable device, the embolic protection device comprising: (a) a substantially solid marker having a proximal end and a distal end; and (b) an elastic mesh body attached to the distal end of the marker, the body having a delivery shape and a deployment shape capable of conforming to the wall of the vessel, the body having a diameter greater than the diameter of the vessel to be treated. In another embodiment, the elastic mesh body has a low-profile height-to-width ratio. In another embodiment, the height of the elastic mesh body is about 10-20% of its width.

[0011] In another embodiment, the elastic mesh body of the device is a double or two-fold layer mesh. In a further embodiment, the double layer of mesh comprises a single layer of circumferentially folded mesh.

[0012] In another embodiment, the proximal end of the marker of the embolic protection device is attached to the exchange length delivery wire.

[0013] In further embodiments, the marker is a radiopaque marker, the marker includes a rigid member, and / or the marker is a solid ring.

[0014] Also disclosed herein are kits that include the embolic protection devices disclosed herein and a delivery means for deploying the devices.

[0015] In other embodiments, the device in the previous paragraph may incorporate any of the previously or subsequently disclosed embodiments.

[0016] This Summary is not intended to define the claims or to limit the scope of the invention in any way.

[0017] Other features and advantages of the invention will be apparent from the following drawings, detailed description, and claims. [Brief explanation of the drawings]

[0018] [Figure 1] FIG. 1 is a perspective view of one embodiment of a blood clot removal protection device disclosed herein, illustrating the low profile capabilities of the device in terms of its diameter and height in free air. [Figure 2] FIG. 10 is a cross-sectional perspective view of one embodiment of a clot removal protection device, showing both an embodiment of a double layer end of elastic mesh terminating within the marker, and an embodiment of a dovetail end of an exchange delivery within the marker. [Figure 3] FIG. 1 is a perspective view of one embodiment of the embolic protection method disclosed herein, illustrating the advancement of an aspiration catheter to position it proximal to the clot load, followed by advancement of a microcatheter and guidewire through the aspiration catheter positioned proximal to the clot load, and continued advancement of the microcatheter through the clot load to a position distal to the clot load. [Figure 4] FIG. 1 is a perspective view of one embodiment of the embolic protection method disclosed herein, illustrating removal of the guidewire and delivery advancement of the embolic protection device through the microcatheter to a location distal to the clot load. [Figure 5] FIG. 1 is a perspective view of one embodiment of the embolic protection method disclosed herein, illustrating the placement of the embolic protection device distal to the clot load as it opens and begins to oppose the wall of the vessel to create a circumferential seal across the vessel. [Figure 6]FIG. 1 is a perspective view of one embodiment of the embolic protection method disclosed herein, illustrating removal of the microcatheter over the exchange delivery wire, leaving the embolic protection device (attached to the exchange delivery wire) in place at a location distal to the clot load. [Figure 7] FIG. 1 is a perspective view of one embodiment of the embolic protection method disclosed herein, showing the aspiration catheter at a location proximal to the clot load for aspiration initiation. [Figure 8] FIG. 1 is a perspective view of one embodiment of the embolic protection method disclosed herein, illustrating that the clot load is being aspirated while the fragile clot emboli are dislodged and captured within the embolic protection device. [Figure 9] FIG. 1 is a perspective view of one embodiment of the embolic protection method disclosed herein, illustrating that, concurrent with continued clot loading and emboli aspiration, fragile clot emboli are dislodged and captured within the embolic protection device. [Figure 10] FIG. 1 is a perspective view of one embodiment of the embolic protection method disclosed herein, illustrating the combination of continuing suction while retracting the embolic protection device into the aspiration catheter for the purpose of ensuring that all trapped emboli are safely removed from the blood vessel. DETAILED DESCRIPTION OF THE INVENTION

[0019] The invention disclosed herein is illustrated in the drawings and description, where like elements are assigned the same reference numerals. However, while specific embodiments are shown in the drawings, there is no intention to limit the invention to the particular embodiment or embodiments disclosed. Rather, the invention disclosed herein is intended to cover all modifications, alternative constructions, and equivalents that are within the spirit and scope of the invention. Accordingly, the drawings are intended to be illustrative, not limiting.

[0020] Unless otherwise defined, all technical terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this technology belongs.

[0021] Exemplary embodiments of the invention disclosed herein are shown in FIGS.

[0022] Exemplary embodiments of the present invention disclosed herein and illustrated in FIGS. 1-10 are as follows.

[0023] 15: Delivery device

[0024] 20: Device with indwelling shape

[0025] 26: Circumferential fold

[0026] 28: Core wound with EDW coil

[0027] 30: Double layer elastic mesh

[0028] 32: Mesh height

[0029] 40: Blood vessels

[0030] 50: Marker

[0031] 60: Clot burden

[0032] 70: Microcatheter

[0033] 80: Guidewire

[0034] 90: Suction catheter

[0035] 100: Embolic material

[0036] 110: Replacement delivery wire

[0037] 120: Dovetail portion of replacement delivery wire

[0038] For purposes of the inventions disclosed herein, the term "corresponding to" means that there is a functional and / or mechanical relationship between objects that correspond to one another. For example, an embolic protection device delivery system corresponds to (or is compatible with) an embolic protection device for its delivery and placement.

[0039] For purposes of the invention disclosed herein, the terms "embolic protection device" or "distal protection device" may mean and / or be interchangeable with terms such as, but not limited to, "device" or "device system" or "system" or "device implant" or "implant."

[0040] As disclosed herein, the term "low profile" means that in free air, the elastic mesh body has a height of about 10-20% of its width.

[0041] The invention disclosed herein is a method for protecting a blood vessel distal or downstream of a clot (60) occlusion while the clot (60) is being removed from the brain or elsewhere in the body within a blood vessel (40). Typically, when a clot is removed, either by mechanical clot extraction or aspiration, small fragments of the clot can break off and travel downstream, potentially causing further blockage and clinical sequelae. The invention disclosed herein utilizes an embolic protection device (15) disclosed herein that is delivered and deployed (20) distal to the clot load (60) by navigating a small catheter (70) through the clot load (60) within the blood vessel (40) while minimizing fragmentation of the clot (60). As the clot load (60) is being removed, the deployed device (20) functions to protect the distal blood vessel from the risk of fragile embolic material (100) dislodged from the clot load (60). The embolic protection device (20) is constructed of a bi-folded (or double) layer of elastic mesh (30) that opens into a cup-like configuration in which the elastic mesh circumferentially opposes the blood vessel (40), thereby capturing dislodged clot debris (100) during aspiration of the clot load (60), or alternatively, during mechanical clot extraction. Once the clot load (60) is removed, the device (20), including the trapped debris (100) within the elastic mesh body of the device, is pulled back into the opening of the aspiration catheter (90) (away from the distal vasculature, i.e., in the opposite direction of the distal vasculature), such that the trapped debris (100) is released as the device is drawn into the catheter (90) lumen. are simultaneously aspirated.

[0042] Disclosed herein is a method for protecting distal vessels from dislodged emboli (100) during clot aspiration using a device (20) that acts as a mesh shield, thereby capturing emboli (100) that can be retrieved and removed through an aspiration catheter (90). The method disclosed herein utilizes a device (20) constructed from a woven elastic mesh material, the ends of which originate and terminate in substantially solid markers, such as radiopaque markers, at which points an exchange-length delivery wire (110) is secured for advancing the device to a target site.

[0043] The inventive method disclosed herein involves the use of an embolic protection device (20) whose body is constructed from an elastic mesh that is circumferentially folded (folded back upon itself) to create a mesh shield for capturing and removing any vulnerable emboli (100) from a blood vessel (40) containing a clot burden (60). In one embodiment, the embolic protection device (20) body is a double layer of elastic mesh (30) that is folded back upon itself to create circumferential folds around the circumference of the body and folded ends of the elastic mesh, all of which are within the marker. See U.S. Pat. No. 10,130,372, which is incorporated herein by reference in its entirety, for an aneurysm treatment / occlusion device.

[0044] In one embodiment, a method for protecting a distal blood vessel from emboli includes: a) advancing an aspiration catheter to a position proximal to the clot burden and delivering a microcatheter (70) through the aspiration catheter and over a guidewire (80) to the distal end of the clot burden (60) within the blood vessel (40) to be treated; b) removing the guidewire (80); and c) delivering and deploying an embolic protection device (20) through the microcatheter (70) and extending the device (20) proximal to the clot burden (60) until the embolic protection device (20) is fully against the wall of the blood vessel (40). d) removing the microcatheter (70) and leaving the embolic protection device (20) and exchange-length delivery wire (110) in place distal to the clot load (40); and e) commencing suction of the clot (60), whereby the suction dislodges and captures the fragile clot embolism (100) within the embolic protection device (20).

[0045] In another embodiment, the method for protecting a distal vessel from emboli includes additional or modified steps, including, but not limited to, g) advancing an aspiration catheter (90) through the clot (60); h) using a guidewire (80) within the aspiration catheter (90) to navigate a large lumen device into position; and / or i) removing / pulling back the embolic protection device (20) while continuing aspiration, thereby ensuring that all trapped emboli (100) are safely removed from the vessel (40).

[0046] In one embodiment of the embolic protection device (20) disclosed herein, the location of the distal end of the substantially solid marker (50) is approximately centrally attached to the underside of the elastic mesh body, i.e., the marker (50) faces the folded mesh on the upper side of the device (20). Such positioning of the marker on the mesh body provides full docking capability for the exchange length delivery wire (110) of the device (20) used in the methods disclosed herein. In one embodiment, the exchange delivery wire (110) is attached to the device via its dovetail portion (120) residing within the marker (50), so that the device (20) cannot be detached from the exchange delivery wire (110). See FIG. 2. In another embodiment, all of the folded ends of the elastic mesh are within the marker (50). See FIG. 2. In another embodiment, all of the folded ends of the double layer of elastic mesh (30) originate and terminate within the marker (50). See FIG. 2. In another embodiment, the embolic protection device (20) used herein is "oversized" relative to the blood vessel (40) containing the blood clot load (60) to be treated. In this case, the diameter (x) of the device (20) is larger than the diameter of any blood vessel (40) containing the blood clot load (60) to be treated, such that the body of the device (20) can conform to the wall of the blood vessel (40) by creating a circumferential seal against and across the wall of the blood vessel (40).

[0047] In one embodiment, the embolic protection device (20) disclosed herein is constructed with DFT Nitinol (NiTi) (DFT = Drawn Filled Tubing), allowing the device to return to its preformed disk-like configuration and expand circumferentially against the vessel (40) upon deployment, thereby ensuring capture of any fragile and dislodged clot debris (100). In one embodiment, the number of wires in the device structure ranges from 24 to 32 wire ends, folded over each other to create a two-fold layer of elastic mesh, giving the equivalent of 48 to 64 strands in the elastic mesh body of the device. In one embodiment, the body of the device is relatively flat or curved to create a cup-like appearance within the vessel (40), which provides a protective barrier as the device (20) faces against the vessel (40) wall.

[0048] In one embodiment, the embolic protection device (20) disclosed herein is the vascular implant device disclosed in U.S. Pat. No. 10,130,372, the entirety of which is incorporated herein by reference. In another embodiment, the device disclosed herein is similar to the vascular implant device disclosed in U.S. Pat. No. 10,130,372, except that the device used herein to protect the distal vessel from dislodged emboli (100) does not have a separation point between the device marker (50) and the end of the replacement delivery wire (110). Instead, the device (20) is attached to and cannot be detached from the replacement delivery wire (110). In one embodiment, the replacement delivery wire (110) is attached to the device via its dovetail portion (120), which resides within the marker (50), thereby preventing the device (20) from being detached from the replacement delivery wire (110). In one embodiment, the replacement delivery wire has a diameter of approximately 0.014 inches. The appropriate diameter is determined to ensure sufficient bond strength between the device (20) and the exchange delivery wire (110) when retrieved inside the aspiration catheter (90) in the final step of the method disclosed herein.

[0049] The methods disclosed herein provide deeper protection of the cerebral vascular bed (i.e., deeper into the vasculature distal to, for example, the clot load in the brain) due to the unique structure of the embolic protection device (20) for use therein, but also due to the distal placement of the device relative to the clot load (60). The embolic protection device (20) disclosed herein is scalable to treat larger vessels, and its particular structure of an elastic mesh with ends originating and terminating within the markers (50), combined with its low-profile delivery (15) and deployment (20) geometry, uniquely confers the ability to be delivered deeper distally into the distal vasculature in the brain, beyond the clot load. In particular, the device (20) disclosed herein is flexible enough to conform to vessels (40) of various diameters, ranging from as little as about 2.5 mm up to about 4 mm in diameter.

[0050] For purposes of the embolic protection device (20) and methods of use disclosed herein, the term "low profile" means that, in free air, the elastic mesh body has a height (32) that is approximately 10-20% of its width, such that, in its deployed configuration, the elastic mesh body of the device (20) creates a circumferential seal across the vessel (40) against the wall of the vessel (40). This means that the device (20) can conform to the walls of the blood vessel (40). In another embodiment of the device (20) used in the methods disclosed herein, the single or double layer (30) of elastic mesh material of the device comprises a relatively uniform distribution of wire mesh strands or braids, such as, but not limited to, a 32-strand Nitinol (NiTi) wire mesh braid configuration. In other embodiments, the device comprises wire mesh strands or braids ranging from 24 to 64 NiTi strand braid configurations. In another embodiment, the number of wires in the device structure ranges from 24 to 32 wire ends folded over each other to create a bi-fold layer of elastic mesh, giving the equivalent of 48 to 64 strands in the elastic mesh body of the device. In one embodiment, the body of the device is relatively flat or curved to create a cup-like appearance within the blood vessel (40), which provides a protective barrier when the device (20) is against the wall of the blood vessel (40).

[0051] In another embodiment, the embolic protection device (20) disclosed herein is constructed of a wire mesh that is circumferentially folded (circumferential folds (26)) and thus folded back upon itself to create a double layer of elastic mesh (30). The ends of the doubled or folded layer (30) intersect with markers (50) located approximately at the core of the body of the device (20). In this regard, the device is constructed by circumferentially folding a single layer of mesh material back upon itself on a preferential (or circumferential) fold, effectively resulting in a device (20) comprising a double layer (30) of wire mesh material; i.e., the double layer (30) of mesh comprises a single layer of circumferentially folded (circumferential folds (26)) mesh. The doubled or double layer (30) of wire mesh material contributed to the increased acute thrombogenicity of the device (20) in previous animal studies. This is also believed to provide the device (20) with the ability to create a circumferential seal across the vessel (40) completely against the wall of the vessel (40) when placed deep in the vasculature and distal to the clot load (60).

[0052] In its low-profile deployed configuration (20), the elastic mesh body with the folded double layer (30), combined with its deeper placement within the vasculature when compared to the folded double layer of the undeployed elastic mesh (15), accounts for approximately a 15% width change, which leads to an increase in diameter (x) of the device (20) when pressure is applied with the marker (50). This width change / increase in diameter (x) is an effective anchoring function of the deployed device (20) when blood pressure is applied to the mesh body stretched across the vessel (40). Such a configuration also provides sufficient apposition of the mesh body of the device (20) against the wall of the vessel (40).

[0053] 1-10 illustrate the location of a marker (50) having a proximal end and a distal end on the embolic protection device (20) of the presently disclosed invention. In one embodiment, the distal end of the marker (50) is attached to the elastic mesh body of the embolic protection device (15, 20). In another embodiment, the proximal end of the marker (50) is fixed to the exchange length delivery wire (110) and cannot be removed from the exchange length delivery wire (110). In another embodiment, the exchange delivery wire (110) is attached or secured to the device (20) by the dovetail portion (120) end of the exchange delivery wire (110).

[0054] In one embodiment, the marker (50) of the devices disclosed herein is a substantially solid collar or rigid member, such as a solid ring constructed of a material such as, but not limited to, gold, platinum, stainless steel, and / or combinations thereof. In another embodiment, a radiopaque material such as, but not limited to, gold, platinum, platinum / iridium alloy, and / or combinations thereof can be used. Such a marker (50) provides for visualization of the device (20) during delivery and placement. In one embodiment, the marker (50) is positioned within the device (20) such that the proximal end of the marker (50) is coupled to the exchange length delivery wire (110). The marker 50 is centrally positioned within the vessel 40. The solid structure of the marker 50 helps provide stability to the device 20 within the vessel 40, preventing the transfer or transmission of forces through the elastic mesh body, thereby preventing misplacement or accidental movement of the device 20. In one embodiment, the marker 50 is configured with a joint for cooperating with and releasing / attaching to or coupling to an appropriate corresponding delivery means, such as, but not limited to, a delivery microcatheter 70, a catheter, an exchange length delivery wire 110, a guidewire 80, and / or pusher wire technology.

[0055] In another embodiment, the substantially solid marker (50) comprises a radiopaque material (such as, but not limited to, platinum, gold, platinum / iridium alloy, and / or combinations thereof) to facilitate visualization of the device (20) under fluoroscopy during delivery, placement, and / or deployment. The marker (50) has a proximal end and a distal end. An elastic mesh body is attached to the distal end, and the proximal end of the marker (50) may be configured to affect the shape, diameter, and / or curvature of the elastic mesh body upon expansion of the device (20) disclosed herein. The marker (50) may be designed with various shapes to affect the overall profile of the embolic protection device (20) and ensure a precise fit of the expanded / deployed device (20) within the blood vessel (40).

[0056] Figures 2-10 illustrate an exemplary method for delivery and / or placement through a clot load within a blood vessel. In one embodiment, device 15 is delivered in a confined, compacted state (delivery configuration) as shown in Figures 3 and 4, such that the thin, elastic mesh body is confined or compressed within itself via a pusher wire mechanism within microcatheter 70. When device 20 is pushed and / or deployed to a location distal to clot load 60, the ends of the thin, elastic mesh body open outward like an opening in a cup-like configuration, with the open end of the cup facing away from or away from clot 60 (as shown in Figures 5-9), and the open body then conforms to and fully opposes the wall of blood vessel 40, creating a circumferential seal across blood vessel 40. In one embodiment, as shown in Figures 6-8, the device 20 with its double layer of elastic mesh 30 can deepen or increase in depth, allowing for a change in width and an increase in diameter of the device 20 when pressure is applied to the marker 50. This change in width / increase in diameter effectively anchors the deployed device 20 when blood pressure is applied to the body of the elastic mesh 30, which is expanded and sealing across the vessel 40 distal to the clot load 60. The results of the animal studies provided herein confirm that the circumferential seal created by the cup-like configuration of the double layer of elastic mesh 30 provides efficient apposition of the mesh body against the wall of the vessel 40.

[0057] In other embodiments, the devices (20) disclosed herein may further incorporate separate or combined auxiliary elements and / or components, such as coiling technology, framing coils, embolic agents, additional markers, polymers, resorbable polymers, and / or combinations thereof.

[0058] Elastic mesh materials for the design and / or manufacture of the devices disclosed herein are readily available and well known to those skilled in the art. Elastic mesh materials therefore span a wide variety of available materials, such as, but not limited to, nickel titanium (nitinol or otherwise known as NiTi), stainless steel, polymers, and / or combinations thereof. Exemplary known biomedical polymer families include, but are not limited to, polymers such as polyphosphazenes, polyanhydrides, polyacetals, poly(orthoesters), polyphosphoesters, polycaprolactones, polyurethanes, polylactides, polycarbonates, polyamides, and / or combinations thereof (see, e.g., J. Polym. Sci. 2004, 144:145-147). See ci B Polym Phys. Author's final manuscript; available in PMC on 15 June 2012.

[0059] In one exemplary embodiment, the elastic mesh material is formed from woven strands of a polymeric material, such as, but not limited to, nylon, polypropylene, or polyester. The polymeric strands can be filled with a radiopaque material, which allows a physician treating the aneurysm to visualize the location of the device within the vasculature under a fluoroscopic microscope. Radiopaque fillers preferably include radiopaque dyes such as bismuth trioxide, tungsten, titanium dioxide, or barium sulfate, or iodine. The elastic mesh material can be formed from strands of radiopaque material. The radiopaque strands allow a physician and / or radiologist to visualize the location of the mesh under a fluoroscopic microscope without the use of a filled polymeric material. Such radiopaque strands may be formed from materials such as, but not limited to, gold, platinum, platinum / iridium alloys, and / or combinations thereof. In one embodiment, the elastic mesh material is composed of a 10%-20% platinum-cored NiTi. In another embodiment, the elastic mesh material is composed of 10% platinum-core NiTi, 15% platinum-core NiTi, or 20% platinum-core NiTi, with the 10% platinum-core NiTi structure being sufficient to provide a ghost image of the device under x-ray.

[0060] Such constructed combination or composite wires having a radiopaque core and a non-radiopaque outer layer or casing are readily available and are well known in the medical device and metallurgy arts as DFT® (drawn-filled-tube) wire, cable, or ribbon. DFT® wire is a metal-metal composite constructed to combine the desired physical and mechanical attributes of two or more materials into a single wire. By placing a more radiopaque but more ductile material in the core of the wire, a NiTi outer layer can provide the resulting composite wire with mechanical properties similar to those of a 100% NiTi wire. DFT® wire is available from Fort Wayne Metals Corp., Fort Wayne, Indiana, USA. See also, for example, the journal article by Schaffer entitled "Biocompatible Wire," Advanced Materials & Processes, October 2002, pp. 51-54, incorporated herein by reference.

[0061] If the elastic mesh material is formed of radiopaque metal strands, the strands may be coated with a polymer coating or extrusion. The coating or extrusion on the radiopaque wire strands provides fluoroscopic visualization but may also increase the strands' resistance to bending fatigue and may also increase the strands' lubricity. In one embodiment, the polymer coating or extrusion is coated or treated with a drug that tends to resist clotting, such as heparin. Such clotting-resistant coatings are commonly known. The polymer coating or extrusion can be any suitable extrudable polymer, or any polymer that can be applied in a thin coating, such as Teflon® or polyurethane.

[0062] In yet another embodiment, the strands of elastic mesh material are formed using braided strands of both metal and polymer. Braiding metal strands in combination with polymer strands alters the flexibility characteristics of the mesh. The force required to deploy and / or collapse such a mesh section is significantly reduced compared to the force required for a mesh section containing only metal mesh strands. However, the radiopaque properties of the mesh for fluoroscopic visualization are maintained. Metal strands forming such devices include, but are not limited to, stainless steel, gold, platinum, platinum / iridium, nitinol, and / or and combinations thereof. The polymer strands forming the device may include nylon, polypropylene, polyester, Teflon®, and / or combinations thereof. Additionally, the polymer strands of the mesh material may be chemically modified to render them radiopaque using known techniques, including, but not limited to, by using gold deposition on the polymer strands or by using ion beam plasma deposition of appropriate metal ions on the polymer strands.

[0063] The elastic mesh material can also be formed with filaments or strands of varying diameters and / or varying flexibility. Varying the size or flexibility of the polymer strands can also vary the flexibility characteristics of the mesh during deployment. By varying the flexibility characteristics, both the deployment and folded configuration of the elastic mesh body can be varied or altered to virtually any desired shape.

[0064] The mesh can be formed from both polymeric and metallic strands or filaments, as well as filaments of different polymeric materials. For example, different polymeric materials with different flexibility properties can be used to form the mesh. This alters the flexibility properties and the resulting configuration of the mesh body in both the deployed and collapsed positions. Such biomedical polymers are readily known and available in the art and can be derived from polymer families such as, but not limited to, polyphosphazenes, polyanhydrides, polyacetals, poly(orthoesters), polyphosphoesters, polycaprolactones, polyurethanes, polylactides, polycarbonates, polyamides, and / or combinations thereof.

[0065] Elastic mesh materials suitable for use within the mesh body may take the form of plain woven sheets, knitted sheets, or laser-cut wire mesh. Generally, the material should include two or more sets of substantially parallel strands, with the parallel strands in one set at a pitch of 45 degrees to 135 degrees relative to the parallel strands in the other set. In some embodiments, the two sets of parallel strands forming the mesh material are substantially perpendicular to each other. The pitch and general structure of the mesh material can be optimized to meet the performance needs of the device.

[0066] The wire strands of the metal fabrics used in the invention disclosed herein should be formed of a material that is both resilient and capable of being heat-treated to substantially set a desired shape. Materials that may be suitable for this purpose include the cobalt-based low-thermal expansion alloy known in the medical device industry as Elgiloy®, the nickel-based high-temperature, high-strength "superalloy" sold by Haynes International under the trade name Hastelloy®, the nickel-based heat-treatable alloy sold by International Nickel under the name Incoloy®, and several different grades of stainless steel. A key factor in selecting a suitable material for the wires is that the wire retains the appropriate amount of deformation induced by the mold surface (or shape memory, as described below) when subjected to the prescribed heat treatment.

[0067] One class of materials that meets these requirements are so-called shape memory alloys. Such alloys tend to have a temperature-induced phase change, whereby the material has a preferred configuration that can be fixed by heating the material above a specific transition temperature to induce a phase change in the material. When the alloy cools, it will "remember" the shape it had during the heat treatment and, from doing so, will tend to assume the same and / or similar configuration unless constrained.

[0068] One particular shape memory alloy for use in the invention disclosed herein is Nitinol, which is a nearly chemically correct alloy of nickel and titanium that achieves the desired properties. The material may also contain small amounts of other metals to form the desired shape memory alloy. NiTi alloys, such as nitinol, including the appropriate composition and handling requirements, are well known in the art, and such alloys need not be described in detail here. For example, U.S. Patent Nos. 5,067,489 and 4,991,602, the teachings of which are incorporated herein by reference, discuss the use of shape memory NiTi alloys in guidewire-based technology. Such NiTi alloys are preferred, at least in part, because they are commercially available and more is known about the handling of such alloys than other known shape memory alloys. NiTi alloys are also highly elastic. In fact, they are said to be known as "superelastic" or "pseudoelastic." This elasticity will help the embolic protection device (20) disclosed herein return to its previous expanded configuration for deployment.

[0069] In some embodiments, the wire strands comprise standard monofilaments of the selected material, i.e., standard wire stock is used. In some embodiments, 24-wire strands and / or a 24-strand braid configuration is used. In other embodiments, the device comprises a wire mesh strand or braid ranging from 24 to 48 NiTi strand braid configurations. However, if desired, individual wire strands may be formed from a "cable" made of multiple individual wires. For example, cables formed from metal wires in which several wires are helically wound around a central wire are commercially available, and NiTi cables with outer diameters of 0.003 inches or less can be purchased. One advantage of certain cables is that they tend to be "softer" than monofilament wires of the same diameter and formed from the same material. Furthermore, the use of cables increases the effective surface area of ​​the wire strands, which tends to promote thrombus formation.

[0070] The embolic protection device (20) disclosed herein is constructed of a thin, elastic mesh material with a mesh density sufficient to function as a scaffold for endothelial cells within a blood vessel. For purposes of the invention disclosed herein, the term "mesh density" refers to the level of porosity or ratio of metal to open area in the mesh body. Mesh density relates to the number and size of the openings or pores in the mesh, as well as the degree to which the pores are open or closed, in situations where the openness of the openings or pores changes between delivery and deployment. Generally, high mesh density regions of an elastic mesh material have a metal area of ​​approximately 40% or more and an open area of ​​approximately 60% or less.

[0071] In some embodiments, the elastic mesh body of device 20 is uniformly formed of the same material, however, such materials may have different knit, stitch, braid, and / or cut structures.

[0072] The primary use of a suction catheter is to remove blood clots from a patient's arteries to prevent thrombosed blood vessels from becoming blocked due to stroke or occlusion. The suction catheters (90) used in the distal protection methods disclosed herein are readily available in the art. The suction catheters (90) typically consist of an over-the-wire, single-lumen system with a distal radiopaque tip marker and a proximal luer lock port attached to a manually suctioned syringe or mechanical / aspiration pump for thrombus removal. The catheter further includes an aspiration port to which a negative pressure source can be attached. In one embodiment, the aspiration catheter (90) is approximately 95-135 cm long. Suction in the aspiration catheter can be provided by a pump, e.g., a vacuum pump, or a device such as a syringe. In some embodiments, the aspiration catheter (90) is a large-bore aspiration catheter. In some embodiments, the aspiration catheter (90) is an aspiration pump. The aspiration catheters used in the distal protection methods disclosed herein are standard-sized aspiration catheters. A radiopaque marker is positioned at the distal end of the catheter, Aspiration catheters can assist in positioning the catheter within the body. Aspiration catheters are generally constructed with varying flexibility along the length of their shafts to be flexible enough to be manipulated through the patient's vasculature without causing injury, yet retain adequate stiffness to allow the axial pushing necessary to accurately position the catheter and withstand aspiration pressures. Aspiration catheters as used herein may vary in size, typically ranging from 5 to 8 French (Fr.) (1 Fr. = 0.013 inches). (As is known in the art, the French scale or French gauge system is commonly used to measure catheter size.)

[0073] The microcatheters (70) used herein are typically standard in size and readily available in the art. For example, commonly used microcatheter profiles such as 017 (17 / 1000 inch inner diameter) and 021 are well known and readily available. In certain embodiments, the 017 microcatheter is small enough to allow the clinician (or operator) to minimize or prevent disturbance of the clot (60) when advancing it through the clot load (60). The microcatheters used herein are selected based on criteria such as anatomy, vessel size, pressure fluctuations, ability to avoid trauma, and system compatibility.

[0074] The devices (20) and methods disclosed herein may incorporate reasonable design parameters, features, modifications, advantages, and variations that will be readily apparent to those skilled in the medical device art. [Example]

[0075] An animal study was performed to evaluate the mechanism of the procedure and the device's interaction with other devices used in clot aspiration procedures. The study was conducted at the Research Institute of Neurointervention, Animal Lab, Salzburg, Austria, under the supervision of veterinarians and experienced neurointerventional radiologists.

[0076] A blood clot doped with tantalum to facilitate visualization was prepared and introduced into the vascular system of the animal.

[0077] The first step in the clot removal distal protection procedure was to advance a 0.014" guidewire through the clot burden, followed by a microcatheter to the distal end of the clot. The microcatheter was then strategically positioned to place the embolic protection device distal to the clot burden. Thus, the embolic protection device was advanced through the microcatheter and placed distal to the clot burden. With the device successfully placed and the microcatheter in place, an aspiration catheter was advanced over the microcatheter to a location proximal to the clot burden. The microcatheter over the exchange length wire of the embolic protection device was then removed before aspirating the clot.

[0078] The clot load was successfully aspirated by two methods.

[0079] The distal protection device remained in place while the clot was aspirated, and the aspiration catheter was advanced up to the device and eventually retracted inside the lumen, removing any collected emboli dislodged during aspiration.

[0080] After approximately 50% of the clot load was aspirated, the operator pulled the distal protection device proximally and, while still applying suction, drew the remaining clot load into the aspiration catheter.

[0081] The device used in this study was delivered through an 0.21 microcatheter, similar to the one delivered through a stentriever for mechanical clot removal. The optimal device configuration is variable for each patient being treated. In one embodiment, the distal protection device is delivered through a smaller, e.g., 0.17 microcatheter, to minimize disturbance of the clot load as it advances through the distal end of the clot to deploy the device. In another embodiment, the device is constructed with 48 wire strands of 0.001" DFT Nitinol, which allows the surgeon to observe the device being successfully deployed and opening beyond the clot.

[0082] In certain embodiments, device configurations range from 2.5 to 4.5 mm in diameter, with the size of the device being selected depending on the size of the vessel in which it is being placed to provide good wall apposition and distal protection.

[0083] Manipulation and placement control of the occlusion device was performed while visualizing the device's radiopaque markers relative to the catheter tip. Device development will involve the incorporation of platinum-core NiTi wire radiopaque struts to aid in visualization.

[0084] Manipulation and placement of the device was easy to manipulate with pinpoint precision, particularly with regard to navigation through the blood vessel and clot burden, and placement of the device distal to the clot burden in treated animals.

[0085] Several embodiments of the present invention have been described. Reasonable features, modifications, advantages, and design variations of the claimed apparatus will be readily apparent to those skilled in the art by following the guidance set forth in the foregoing detailed description and embodiments without departing from the scope and spirit of the invention disclosed herein. Accordingly, other embodiments are within the scope of the following claims.

Claims

1. 1. An assembly for protecting a distal vessel from dislodged emboli, comprising: a. an aspiration catheter (90) configured to be advanced proximal to the clot load (60); a microcatheter (70) and a guidewire (80) configured to be advanced through the aspiration catheter (90) to pass the clot load (60) in the blood vessel (40) to be treated and distal to the clot load (60), the guidewire (80) configured to be inserted into the microcatheter (70), the guidewire (80) further configured to be removed after the microcatheter (70) and the guidewire (80) have advanced through the aspiration catheter (90) to pass the clot load (60) in the blood vessel (40) to be treated and distal to the clot load (60); c. an embolic protection device (20) comprising an elastic mesh body (30), the embolic protection device (20) configured to be deployed through the microcatheter (70) and positioned distal to the clot load (60) until the embolic protection device (20) fully opposes the wall of the blood vessel (40), thereby creating a circumferential seal across the blood vessel (40), the embolic protection device (20) being attached to an exchange delivery wire (110); Equipped with The embolic protection device (20) is an implantable device, and the embolic protection device (20) comprises: a. a fluoroscopically visible marker (50) having a proximal end and a distal end; b. the elastic mesh body (30), the elastic mesh body (30) attached to the distal end of the marker (50), the elastic mesh body (30) having a delivery configuration (15) and a deployment configuration (20) capable of conforming to the wall of the blood vessel (40), the elastic mesh body (30) being a double layer of elastic mesh (30) folded over itself to create circumferential folds around the circumference of the elastic mesh body (30) and folded ends of the elastic mesh, all of the folded ends of the double layer of elastic mesh (30) within the marker (50); Equipped with The microcatheter (70) is further configured to be removed, leaving the embolic protection device (20) and the exchange delivery wire (110) in place within the blood vessel (40); The embolism protection device (20) is configured to capture the clot emboli (100) when the clot emboli (100) are dislodged under the influence of suction of the clot load (60) by the suction catheter (90). assembly.

2. The assembly of claim 1 , wherein the marker (50) is attached to the exchange delivery wire (110).

3. The assembly of claim 1 , wherein the aspiration catheter is further adapted to advance into the clot load (60) as the aspiration catheter applies suction.

4. 2. The assembly of claim 1, wherein the guidewire within the aspiration catheter is configured to navigate the aspiration catheter into position.

5. An assembly as described in claim 1, wherein the elastic mesh body (30) has a diameter larger than the diameter of the blood vessel (40) to be treated.

6. The assembly of claim 1, wherein the elastic mesh body (30) of the embolic protection device (20) has a height that is 10-20% of its width.

7. The assembly of claim 1, wherein the resilient mesh body (30) of the embolic protection device (20) is a double or two-fold layer mesh (30).

8. 8. The assembly of claim 7, wherein the double or two-fold layer mesh (30) of the elastic mesh body comprises a single layer of circumferentially folded mesh.

9. 2. The assembly of claim 1, wherein the proximal end of the marker of the embolic protection device is attached to the exchange delivery wire in a manner that prevents the embolic protection device from being detached from the exchange delivery wire.

10. The assembly of claim 9, wherein the exchange delivery wire (110) includes a dovetail portion (120) that ends within the marker (50) of the embolic protection device (20).

11. The assembly of claim 1, wherein the marker (50) is a radiopaque marker.

12. The assembly of claim 1 , wherein the marker (50) comprises a rigid member.

13. The assembly of claim 1, wherein the marker (50) is a solid ring.

14. 1. An assembly for removing a blood clot burden from a blood vessel, comprising: a. an aspiration catheter (90) configured to be advanced to a location proximal to said clot load (60); b. A microcatheter (70) and a guidewire (80) advanced to a position distal to the clot load (60) within the blood vessel (40) to be treated, the guidewire (80) configured to be inserted within the microcatheter (70), the guidewire (80) further configured to be removed after the microcatheter (70) and the guidewire (80) have advanced to a position distal to the clot load (60) within the blood vessel (40) to be treated; 、 c. an embolic protection device (20) comprising an elastic mesh body (30), the embolic protection device (20) configured to be placed in a predetermined position distal to the clot load and fully opposed to the wall of the blood vessel (40) to create a circumferential seal across the blood vessel (40); Equipped with The embolic protection device (20) is an implantable device, and the embolic protection device (20) comprises: a. a fluoroscopically visible marker (50) having a proximal end and a distal end; b. the elastic mesh body (30), the elastic mesh body (30) attached to the distal end of the marker (50), the elastic mesh body (30) having a delivery configuration (15) and a deployment configuration (20) capable of conforming to the wall of the blood vessel (40), the elastic mesh body (30) being a double layer of elastic mesh (30) folded over itself to create circumferential folds around the circumference of the elastic mesh body (30) and folded ends of the elastic mesh, all of the folded ends of the double layer of elastic mesh (30) within the marker (50); Equipped with The microcatheter (70) is further configured to be removed, leaving the embolism protection device (20) in place within the blood vessel (40), prior to initiating aspiration of the clot load (60) with the aspiration catheter (90); The embolism protection device (20) is configured to capture the clot emboli (100) when the clot emboli (100) are dislodged under the influence of suction of the clot load (60) by the suction catheter (90). assembly.

15. The assembly of claim 14, wherein the elastic mesh body (30) of the embolic protection device (20) has a height that is 10 to 20% of its width.

16. 15. The assembly of claim 14, wherein the resilient mesh body (30) of the embolic protection device (20) is a double or two-fold layer mesh (30).

17. 17. The assembly of claim 16, wherein the double or two-fold layer mesh (30) of the elastic mesh body comprises a single layer of circumferentially folded mesh.

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