Vasculature closure devices and methods
36 claims: 8 independent, 28 dependent
- 1脈管構造閉鎖デバイスであって、 脈管内に配置可能な拡張式支持フレームと、 少なくとも部分的に前記拡張式支持フレームによって支持される封止膜と、を備え、 前記 支持フレーム及び前記封止膜 は、全体的に前記脈管の長さに整合され前記脈管の長さに沿って延在する縦軸に沿って 折り畳み構成へと 巻き、 拡張構成へと 解くことができるように構成され、 前記デバイスは、前記支持フレーム及び前記封止膜を前記折り畳み構成で解放可能に維持するために、前記支持フレーム及び前記封止膜を解放可能に囲む柔軟なループ状部材を有する封じ込め機構をさらに備え、 前記脈管内で 前記ループ状部材を解放しかつ 前記支持フレームを拡張すると、前記 支持フレーム は、脈管壁に存在する穿刺部位に対して前記封止膜を腔内から位置決めするように構成される、脈管構造閉鎖デバイス。
- 2前記封止膜はその周囲に外縁を画定し、前記支持フレームは周囲支持フレームを有し、その少なくとも一部は前記封止膜の前記外縁の少なくとも一部に又はその付近に位置決めされる、請求項1に記載のデバイス。
- 3前記封止膜の少なくとも一部にわたって延在する横材支持体をさらに備える、請求項1に記載のデバイス。
- 4前記横材支持体は、前記支持フレームの対向する側部に取り付けられる、請求項3に記載のデバイス。
- 5前記横材支持体は、前記封止膜より高い剛性である、請求項3に記載のデバイス。
- 6前記横材支持体は、前記支持フレームより高い剛性である、請求項3に記載のデバイス。
- 7前記横材支持体は、前記横材支持体の長さの少なくとも一部に形成された案内流路を有し、前記案内流路は、自身を通って少なくとも1つの案内ワイヤを受け、前記脈管内の前記デバイスの送出を容易にするように構成される、請求項3に記載のデバイス。
- 8前記 支持フレーム及び前記封止膜 は、前記横材支持体によって画定された縦軸に沿って巻かれた 前記 折り畳み構成へと巻かれるように構成される、請求項3に記載のデバイス。
- 9拡張時に、前記支持フレームは、解かれて、前記脈管の曲率半径より大きい曲率半径を有する 前記 拡張構成になるように構成される、請求項3に記載のデバイス。
- 10前記脈管内に前記支持フレームを配置すると、前記支持フレームと前記封止膜と前記横材支持体との全体が前記脈管内に位置決めされる、請求項3に記載のデバイス。
- 11前記脈管内で前記支持フレームを拡張すると、前記デバイスは、前記封止膜が前記穿刺部位に対して位置決めされるように、前記支持フレームと前記封止膜と前記横材支持体とを前記脈管の内表面に腔内から位置決めする、請求項3に記載のデバイス。
- 12前記支持フレームは、非生体分解性材料で形成され、前記横材支持体は、生体分解性材料で形成されたワイヤ であ る、請求項3に記載のデバイス。
- 13前記支持フレームは、非生体分解性金属で形成され、前記ワイヤは、生体分解性ポリマーで形成される、請求項12に記載のデバイス。
- 14前記封止膜の少なくとも一部にわたって延在しかつ前記支持フレームの対向する側部に取り付けられる少なくとも2つの横材支持体をさらに備え、前記2つの横材支持体は略平行である、請求項1に記載のデバイス。
- 15前記支持フレーム及び前記封止膜は、全体的に前記脈管の長さに整合され前記脈管の長さに沿って延在する縦軸に沿って 前記折り畳み構成へと 巻き、 前記拡張構成へと 解くことができるように構成される一方、前記2つの横材支持体は、前記縦軸に略平行である、請求項14に記載のデバイス。
- 16前記封止膜の対向する縁部間の中間場所にて前記デバイスに固定されるアンカータブ又はプルストリングをさらに備える、請求項1に記載のデバイス。
- 17前記アンカータブ又は前記プルストリングは、(a)前記封止膜、(b)前記支持フレーム、又は(c)前記封止膜の少なくとも一部にわたって延在しかつ前記支持フレームの対向する側部に取り付けられる横材支持体、のうち少なくとも1つに固定される、請求項16に記載のデバイス。
- 18前記脈管内に前記支持フレームを配置すると、前記デバイスは、前記アンカータブ又は前記プルストリングを除いて全体が前記脈管内に位置決めされる、請求項17に記載のデバイス。
- 19前記封止膜は、その周囲の外縁を画定し、自身から延在する複数のタブをさらに有し、前記支持フレームは、周囲支持フレームを有し、その少なくとも一部は前記封止膜の前記外縁の少なくとも一部に又はその付近に位置決めされて、前記複数のタブによって前記封止膜に保持される、請求項1に記載のデバイス。
- 20前記 ループ状部材は、前記支持フレーム及び前記封止膜を解放可能に囲む糸である 、請求項1に記載のデバイス。
- 21前記封じ込め機構は、前記 支持フレーム及び前記封止膜が前記 折り畳み構成 にあるときに前記支持フレーム及び前記封止膜に沿って延在する ループ 保持器支持体 を さらに 備え 、 前記糸は、前記ループ保持器支持体に固定された固定端を有する 、請求項20に記載のデバイス。
- 22前記糸は、ループ状端部をさらに有し、 前記封じ込め機構は、 前記糸の前記ループ状端部と前記ループ保持器支持体の 少なくとも2つの整合した開口 と を通過する少なくとも1つの解放ピンを さらに 備え、 前記解放ピンが前記ループ状端部と 前記少なくとも2つの整合した開口 と を通過する場合に、前記 支持フレーム及び前記封止膜 は前記折り畳み構成で保持される、請求項 21 に記載のデバイス。
- 23前記支持フレームは、 前記 折り畳み構成時の第1の周囲から 前記 拡張構成時の第2の周囲へと半径方向に拡張し、前記第2の周囲は、前記第1の周囲より大きい、請求項1から22のいずれか1項に記載のデバイス。
- 24拡張すると、前記支持フレームは前記脈管壁に対して半径方向の圧力を加えるように構成され、前記半径方向の圧力は、約2mmHgと約400mmHgの間の範囲である、請求項1から22のいずれか1項に記載のデバイス。
- 25前記封止膜は、生体分解性材料で形成される、請求項1から22のいずれか1項に記載のデバイス。
- 26前記支持フレームの少なくとも一部は、非生体分解性材料で形成される、請求項1から22のいずれか1項に記載のデバイス。
- 27前記支持フレームは、安定した状態にある場合に前記封止膜を拡張するように構成された予備整形材料で形成される、請求項1から22のいずれか1項に記載のデバイス。
- 28前記支持フレームは、安定した状態にある場合に前記封止膜を拡張するように構成された予備整形材料を含み、前記予備整形材料は、(a)形状記憶金属又は(b)形状記憶ポリマーのうち少なくとも1つを含む、請求項1から22のいずれか1項に記載のデバイス。
- 29前記脈管内で前記支持フレームを拡張すると、前記 支持フレーム は、 前記脈管の内周の大半に沿って拡張するように構成され、それにより、 前記封止膜 が 前記穿刺部位に対し て押 し付け られ る 、 請求項1から22のいずれか一項に記載のデバイス。
- 30脈管穿刺を閉じるシステムであって、 脈管内に配置可能な 拡張式支持フレームと、前記拡張式支持フレームによって少なくとも部分的に支持された封止膜と、を有する脈管構造閉鎖デバイスであって、 前記支持フレーム及び前記封止膜は、 全体的に前記脈管の長さに整合され前記脈管の長さに沿って延在する縦軸に沿って 折り畳み構成へと 巻き、 拡張構成へと 解くことができるように構成されるとともに、 前記デバイスは、前記支持フレーム及び前記封止膜を前記折り畳み構成で解放可能に維持するために、前記支持フレーム及び前記封止膜を解放可能に囲む柔軟なループ状部材を有する封じ込め機構をさらに備え、前記支持フレームは、 脈管壁に存在する穿刺部位に対して前記封止膜を腔内から位置決めするように構成される、脈管構造閉鎖デバイスと、 前記支持フレーム及び前記封止膜が 前記折り畳み構成 にあるときに 前記脈管構造閉鎖デバイスを受け、前記穿刺部位を通して前記脈管内への前記脈管構造閉鎖デバイスの配置を容易にするように動作可能であるシースと、 前記シースを通して前記脈管構造閉鎖デバイスを前進させるように動作可能であるプッシュロッドと、を備える、システム。
- 31前記シースに挿入する前に前記折り畳み構成の前記脈管構造閉鎖デバイスを受けるように動作可能であり、前記脈管構造閉鎖デバイスを前記シース内又は前記脈管内に配置するために少なくとも部分的に前記シースに挿入するように動作可能である装填チューブをさらに備える、請求項30に記載のシステム。
- 32前 記封 じ込め機構 は、前記支持フレーム及び前記封止膜が前記折り畳み構成にあるときに前記支持フレーム及び前記封止膜に沿って延在するループ保持器支持体をさらに備え、 前記ループ状部材は、前記支持フレーム及び前記封止膜を解放可能に囲む糸であり、 前記糸は、前記ループ保持器支持体に固定された固定端を有する 、請求項30又は31に記載のシステム。
- 33前記シース上に位置決め可能な少なくとも1つの外部スリーブをさらに備え、前記少なくとも1つの外部スリーブは、前記シースの外径より大きい外径を備える、請求項30又は31に記載のシステム。
- 34前記シースは、前記シースの側壁を通過して前記シースの遠位位置に位置特定された少なくとも1つの穴を備え、前記少なくとも1つの穴によって、血液はそれを通って流れることができる、請求項30又は31に記載のシステム。
- 35脈管構造閉鎖デバイスであって、 脈管内で配置可能な拡張式支持フレームと、 少なくとも部分的に前記拡張式支持フレームによって支持される封止膜と、 前記封止膜の少なくとも一部にわたって延在しかつ前記支持フレームの対向する側部に取り付けられる横材支持体と、 前記支持フレーム、前記封止膜及び前記横材支持体のうち少なくとも1つに固定され るプ ルストリングと、 前記支持フレーム及び前記封止膜を折り畳み構成で解放可能に維持するために、前記支持フレーム及び前記封止膜を解放可能に囲む柔軟なループ状部材と、 を備え、 前記脈管内に前記支持フレームを配置すると、前記デバイスは、前 記プ ルストリングを除いて全体が前記脈管内に位置決めされ、 前記脈管内で 前記ループ状部材を解放しかつ 前記支持フレームを拡張すると、前記 支持フレーム は、脈管壁に存在する穿刺部位に対して前記封止膜を腔内から位置決めするように構成される、脈管構造閉鎖デバイス。
- 36前記デバイスは、全体的に前記脈管の長さに整合され前記脈管の長さに沿って延在する縦軸に沿って 折り畳み構成へと 巻き、 拡張構成へと 解くことができるように構成される、請求項35に記載のデバイス。
Independent claims36
165 paragraphs, as filed
(Cross-reference to related applications) This application claims priority to US Provisional Patent Application No. 61 / 251,054 filed October 13, 2009 and US Provisional Patent Application No. 61 / 285,503 filed December 10, 2009, both of which are referenced. Is incorporated herein by all means.
The present disclosure relates generally to implantable medical devices and related methods, and in particular to vascular devices and methods that close holes in the vascular wall.
During certain intravascular surgical procedures, an intravascular catheter is inserted through an incision in the patient's skin and underlying tissue to access arteries or veins. After the surgical procedure is complete and the catheter is removed from the vessel, the puncture that provides access through the patient's vessel wall must be closed. This is extremely difficult because of the high blood pressure in the arteries, as well as the many layers of tissue that must be penetrated to reach and close the vessels.
Physicians are currently using several methods to close vascular punctures, including application of local pressure, sutures, collagen plugs, adhesives, gels and / or foams. To apply local pressure, the physician applies pressure to the vessel to facilitate spontaneous coagulation of the vessel puncture. However, this method can take 30 minutes or more and requires the patient to remain in motion restraint during compression and then kept in the hospital for observation. The amount of time required for compression may be even longer depending on the level of anticoagulants (eg, heparin, glycoprotein IIb / IIa antagonists, etc.) administered during endovascular procedures in some circumstances. In addition, local compression may increase the likelihood that the blood clot at the puncture site will come off. Closing procedures that add sutures, collagen plugs, adhesives, gels and / or foams have the variability and uncertainty associated with transplantation procedures, many of which are complex and require highly specialized transplantation techniques. .. Some of these closure methods sometimes cause unwanted deformation of the vasculature. In addition, in relatively new intravascular procedures such as abdominal or thoracic aortic aneurysm repair, percutaneous valve replacement and repair, or cardiac resection, which usually use a large diameter delivery system in the range of 8Fr to 25Fr, these Conventional closure methods are suboptimal.
<p num="0005"> Therefore, there is a need for improved vascular closure devices and methods to deploy and use them to perform treatment. Therefore, it is advantageous to provide a vascular structure closing device that more quickly and effectively closes the vascular wall puncture.</p>
<p num="0006"> Vascular closure devices and systems and methods of their use are provided. According to one aspect, a vascular structure closure device is provided. In one embodiment, the vascular structure closure device comprises an expandable support frame that can be deployed within the vessel and a sealing membrane that is at least partially supported by the expandable support frame. When the support frame is extended, the vascular structure closure device is configured to secure the sealing membrane from within the cavity to the puncture site present on the vascular wall.</p><p num="0007"> According to another aspect, a method of closing the vascular puncture is provided. In one embodiment, the method comprises deploying a vascular structure closing device, including a support frame and a sealing membrane, through a sheath through the puncture site and into the vessel, where the support frame is compressed during deployment. This involves positioning and expanding the support frame within the vessel to provide a sealing membrane and at least partially seal the puncture site.</p><p num="0008"> According to yet another aspect, a system for closing the vascular puncture is provided. In one embodiment, the system comprises an expandable support frame and a vascular structure closure device that includes a sealing membrane that is at least partially supported by the expandable support frame. The vascular structure closure device extends from the folding configuration to secure the sealing membrane from within the cavity to the puncture site present in the vessel. The system also receives a foldable vascular closure device and advances the vascular closure device through the sheath, with a sheath that can operate to facilitate deployment of the vascular closure device into the vessel through the puncture site. It can include a push rod that can be moved to make it work.</p>
<figref num="1">It is a figure of the transplanted vascular structure closure device (VCD) by one embodiment.</figref><figref num="2">It is a figure of VCD by one Embodiment.</figref><figref num="3">It is a diagram of VCD and corresponding containment mechanism according to some typical embodiments, including FIGS. 3A-3D.</figref><figref num="4">It is a figure of VCD by some typical embodiments, including FIGS. 4A-4J.</figref><figref num="5">It is a diagram of an additional VCD according to some typical embodiments, including FIGS. 5A-5G.</figref><figref num="6">It is a flow chart which shows the method of sending and fixing a VCD by an exemplary embodiment.</figref><figref num="7">FIG. 7A to FIG. 7D are cross-sectional views showing a delivery system according to one embodiment and a step of sending and fixing a VCD into a vessel.</figref><figref num="8">FIG. 5 is a cross-sectional view showing the temporary positioning of the VCD in the vessel during delivery according to one embodiment.</figref><figref num="9">9A to 9I are cross-sectional views showing a delivery system according to another embodiment and a step of advancing the VCD through it.</figref><figref num="10">FIG. 10A to FIG. 10P are cross-sectional views showing additional delivery systems and corresponding containment mechanisms according to other representative embodiments.</figref><figref num="11">11A to 11C are included, and is a cross-sectional view showing that the VCD is fixed in the vessel according to one embodiment.</figref>
An improved vascular closure device and system that facilitates hemostasis and closure of vascular puncture is provided along with a method of delivering a vascular closure device (VCD) to a patient in need of it. VCDs according to various embodiments include at least one encapsulant membrane and at least one support frame that is attached to, integrated with, or otherwise supports the encapsulant membrane. The support frame is used to expand the sealing membrane from a folded configuration to an expanded configuration when deployed in the vessel. The support frame can be configured to expand enough to press the encapsulant membrane against the vascular puncture. Although the force applied by the support frame can be varied, it is effective in keeping the VCD at least partially in the desired position within the vessel, which at least partially provides the sealing membrane for vascular puncture. Press. Positioning and applying pressure to the vascular puncture with a sealing membrane prevents and / or reduces blood leakage and promotes hemostasis and healing. In some cases, the VCD encapsulant can significantly reduce blood leakage from the vascular puncture, while complete hemostasis by thrombi formed on or around the encapsulant against the puncture. Is achieved. The ability to form a thrombus can be enhanced by providing a thrombus promoter on the sealing membrane and / or anchor tab or pull wire. The VCD can be left in a fixed position within the vessel for essentially any period of time, which may be indefinite in certain embodiments.
According to various embodiments, some of the VCDs are biodegradable, bioabsorbable and / or bioerosive (unless otherwise stated, collectively referred to herein as "biodegradable"). And therefore, after a period of time, some decompose, absorb, or erode. For example, at least the sealing membrane, and in some embodiments the support frame or part thereof and / or the anchor tab or pull wire, will absorb and minimize the components remaining in the vessel in the future, but this is subsequently Simplifies access to or near vascular puncture to reduce the likelihood of long-term complications. The shapes, configurations, and compositions of the various components of a VCD, and the systems and methods that deliver them, can be implemented in several ways, typical examples of which are described below.
The VCDs described herein can be used to close vascular punctures or penetrations in humans or other animals (eg mammals). Such animals can be referred to herein as patients. As used herein, the term "trachea" refers to other vascular lumens that carry arteries, veins, blood or lymph, or other body lumens, which are the gastrointestinal system (eg, urethra, stomach, small intestine, etc.). The body lumen of the colon (or colon), the airway system (eg trachea, bronchus, or bronchus), the urinary system (eg bladder, ureter, or urethra), or the cerebrospinal system (eg submucosal lumen or brain and / or spinal cord) Peripheral and / or medial ventricular system), but not limited to these. VCDs can be of various vascular anatomical structures and sizes in adult and pediatric patients, and can be sized for effective use in puncture at various vascular sites in patients. VCDs can be configured to be used in combination with various surgical procedures to close punctures in other body lumens. For example, in one other embodiment, the VCD can be configured to close a luminal puncture or to be used to close a lumbar puncture during a spontaneously opened transluminal endoscopic surgery. ..
Vascular structure closure device With reference to the figure, FIG. 1 shows a VCD100 implanted in a vessel 10 according to one embodiment. According to this embodiment, the VCD 100 includes a sealing film 105 and a peripheral support frame 110 that provides shape and support to the sealing film 105 along at least a portion of the periphery of the sealing film 105. As shown in FIG. 1, the VCD100 is implanted intracavitarily into the patient's vascular 10 and is positioned and anchored therein at the vascular puncture site 15 (present specification) that resides through the wall of the vascular 10. Indiscriminately, the target area at or near the "access hole", "access site", "vascular puncture", "puncture hole", "puncture site" or other similar variant thereof) is at least temporary. Seal in. In one embodiment, the VCD100 is in place due to the tendency of the perimeter support frame 110 to have a predetermined shape and / or a naturally stable shape (eg, shape memory material) until hemostasis occurs at the puncture site 15. Be retained. In other embodiments, as described in more detail herein, all or part of the VCD100 is biodegradable, whereby these components are degraded, absorbed, or eroded after a period of time. Therefore, the VCD100 that remains in the vessel is only a part, if any.
The sealing membrane 105 of this embodiment is therefore generally VCD100 wound and unwound along the longitudinal axis extending along the length of the vessel 10 as a whole when transplanted. Can be formed in any shape that can be formed. For example, a simple form is similar to a sheet that can be rolled or unwound, or a tube that is entirely slit along the vertical axis (referred to as "gull wing" in US Provisional Patent Application No. 61 / 251,054). It is the composition of. However, as described below, any other shape that can be folded and then expanded in the vessel to facilitate fixation of the VCD100 can be provided.
According to the embodiment shown in FIG. 1, the VCD 100 further includes a cross member support 115 that extends at least partially between the opposing sides of the peripheral support frame 110. Due to its stiffness and / or at least partial stiffness and / or tension between the peripheral support frames 110, the cross member support 115 is located at the center of the sealing film 105, as described in more detail with respect to FIG. Provide structural and shape surface support to it at or near it. Such additional support is advantageous when positioned relative to the puncture site 15 to avoid loosening of the membrane at the puncture site 15. Additional support is also advantageous during delivery, providing longitudinal strength so that the sides of the sealing membrane 105 can be wrapped around it to fit within the delivery sheath or other delivery system. Helps maintain the VCD100 in a rolled or folded configuration.
The anchor tab 120 is also fixed to the VCD 100 according to one embodiment. The anchor tab 120 can be attached to and / or extend from the sealing membrane 105, the cross member support 115 and / or the support frame 110. While placing the VCD100, the anchor tab 120 can be pulled proximally (away from the puncture site 15 and out of it), thereby pulling the VCD100 against the internal vascular wall, thus this. Can be oriented to or near the target area of the puncture site 15. Orienting the anchor tab 120 and / or the cross member support 115 with respect to the surface of the sealing membrane 105 further facilitates centering of the VCD 100 within the vessel 10 during implantation. This is because the VCD 100 moves within the vessel 10 (usually downstream) until the anchor tab 120 hits the edge of the vessel puncture 15. Therefore, the position of the cross member support 115 is adjusted along the width of the sealing membrane 105, and / or the position of the anchor tab 120 is adjusted along the length of the cross member support 115 within the vessel 10. It can correspond to the movement of VCD100 expected in.
According to one embodiment, the anchor tab 120 is the epidermis of the patient at or near the vascular access site (eg, at or near the first incision made to access the vascular). It can be attached to the dermis, subcutaneous layer, fat layer, or muscle tissue (eg, sutured, glued, hooked, held by elastic holding means, etc.). According to various embodiments, the VCD100 may additionally or optionally include a pullstring, which also facilitates the positioning of the VDC100 to or near the target by pulling distally. .. The pullstring can be attached to a VCD 100 such as a sealing membrane 105, a cross member support 115 and / or a support frame 110, or attached to an anchor tab 120 and extended from there.
According to one embodiment, the anchor tab 120 is flexible and can be resized. In one embodiment, the anchor tab 120 has a relatively thin cross section, such as a thread, or a thick cross section, such as a diameter similar to or slightly smaller than the puncture site 15 (eg, about 1 mm to about 9.0 mm in diameter). Has. The anchor tab 120 is advantageous because it can further assist in promoting hemostasis by at least partially filling the puncture site 15 and the access channel through the patient's tissue. In one embodiment, the anchor tab 120 and pullstring are integrated and long enough to come together from the proximal end of the delivery sheath or other delivery system (eg, about 10 cm to about 100 cm). The extra length can be removed after fixing the anchor tab 120 to or near the puncture site in the patient's epidermis, dermis, subcutaneous layer, adipose tissue, or muscle tissue. In other embodiments, the anchor tab 120 and pullstring are attached to the VCD100 separately or have different diameters, widths, and lengths, which are different members otherwise contained therein, and / or from different materials. Will be built. For example, the anchor tab 120 can be made shorter than the pullstring (eg, from about 10 mm to about 100 mm) and / or thicker than the pullstring. In one embodiment, the anchor tab 120 may also include connecting means such as eyes, hooks, toggles, etc. at the proximal end, to which a separate pullstring can be permanently or detachably attached.
FIG. 1 is provided to delineate one direction of the VCD100 within the vessel 10, as described herein as a VCD containing a radially expandable support frame as described with respect to FIGS. 5A-5G. It should be understood that any VCD according to the various embodiments described in the above can be similarly positioned from within the cavity and the membrane can be immobilized or otherwise retained against the vessel at or near the puncture site. These embodiments will be described in more detail with reference to the following figures.
FIG. 2 shows an embodiment of a VCD100 that is implanted intravascularly and is similar to the VCD shown in FIG. According to this embodiment, the VCD 100 supports the sealing film 105 and the sealing film 105, or at least in the vicinity of the periphery thereof, at least partially, and is integrated with or attached to the sealing film 105. Includes perimeter support frame 110. In this embodiment, the VCD 100 further includes a cross member support 115 extending between opposing sides of the perimeter support frame 110. Here, the VCD 100 has a circular or elliptical encapsulation film 105 and a circular or elliptical perimeter support frame 110 that substantially follows the shape of the encapsulation film 105. However, as described herein, the shapes of the sealing membrane and the peripheral support frame can be changed as desired according to other embodiments.
For the embodiment of FIG. 2, the perimeter support frame 110 is formed in a pre-shaped configuration, thus the perimeter support frame 110, in its natural stable state, the curvature inside the vessel into which it is implanted.<u style="single">radius</u>Greater curvature<u style="single">radius</u>(Ie, it is flatter and has a larger radius). For example, if the vessel into which the VCD100 is implanted (such as a typical femoral artery vessel) has a diameter in the range of about 4.5 mm to about 9 mm, the perimeter support frame 110 will have a greater curvature.<u style="single">radius</u>Can be pre-shaped with, resulting in a diameter between about 7 mm and 20 mm. curvature<u style="single">radius</u>It should be understood that the VCD100 can be modified depending on the anatomy of the vessel into which it is implanted and the amount of desired force exerted by the perimeter support frame 110. Usually the curvature of the vessel<u style="single">radius</u>Curvature of VCD100 relative to<u style="single">radius</u>The greater the force applied by the support frame 110. At least a portion of the perimeter support frame 110 is formed from a material with elastic properties that allows the perimeter support frame 110 to be rolled up or otherwise folded during delivery and then expanded to a natural stable state upon transplantation. Will be done.
Therefore, the curvature is greater than the internal vascular wall<u style="single">radius</u>By having the natural stability of the perimeter support frame 110, it expands during implantation to exert a force on the inner wall of the vessel. This force, combined with the pressure generated by the blood pressure exerted on the membrane 105 and the surrounding support frame 110, holds the VCD 100 in place at or near the puncture site. However, the amount of force applied to the vascular wall must be limited to avoid damage to the vascular wall. For example, in an expanded configuration, the VCD100 (and any other VCD embodiment described herein) applies a pressure in the range of about 0.3 mmHg to about 400 mmHg to the inner wall of the vessel in various embodiments. In one embodiment, a pressure between about 2 mmHg and about 50 mmHg can be applied to the inner wall of the vessel. A shape memory metal or alloy, such as a nickel-titanium alloy (eg, nitinol), a shape memory polymer, or any of them, to obtain a preformed perimeter support frame 110 with the desired shape and curvature described herein. The combination and / or its temperature treatment can be used to make all or part of the perimeter support frame.
The cross-sectional thickness of the member with the perimeter support frame 110 can contribute to the amount of force applied to the VCD 100 in a natural stable (extended) configuration. For example, according to various embodiments, the thickness can range between about 0.01 mm and about 2.0 mm, in some embodiments between about 0.04 mm and about 0.2 mm, in other embodiments. The thickness can be in the range between 0.2 mm and about 0.7 mm. For example, in one embodiment, the members of the peripheral support frame 110 have a width greater than the thickness (dimensions perpendicular to the top and bottom of the surface of the encapsulant 105) (dimensions along the surface of the encapsulant 105). For example, widths in the range between about 0.05 mm and about 1.5 mm, or between about 0.2 mm and about 0.7 mm in one embodiment, and about 0.01 mm and about 0.3 mm in another embodiment. Thickness in the range between, or between about 0.04 mm and about 0.1 mm. It is understood that these dimensions are exemplary and not limiting. The width and thickness of the perimeter support frame 110 can be varied as desired and may be determined by the intended transplantation.
The VCD100 with the perimeter support frame 110 also performs interference minimization if the VCD100 (or at least the perimeter support frame 110) remains in the vessel during subsequent vascular access. The peripheral support frame 110 is at a distance from the current puncture site. This is because it is oriented only around the sealing film 105. Further, the space occupied by the peripheral support frame 110 can be minimized by having the support frame only around the sealing membrane 105 (and optionally the cross member support 115). In many situations, the number of vessels that provide adequate access to vascular structure intervention procedures is limited. Access is particularly limited for patients with vessels suffering from stenosis or calcification. Therefore, in some cases, the amount of additional vascular obstruction is reduced by minimizing the components of the VCD100, such as the perimeter support frame 110, which may remain in the vascular or otherwise block subsequent access. It may be desirable to have it.
According to some embodiments, the sealing membrane 105 is biodegradable. Therefore, in the future, at least the sealing membrane 105 will decompose and will not itself interfere with vascular access. According to another embodiment, the sealing membrane 105, whether biodegradable or not, is made of a material that is thin enough or weak enough that it does not substantially interfere with reaccess to the vessels. Will be done. For example, in some embodiments, the sealing membrane 105 is partially or completely modified cellulose, collagen, fibrin, fibrinogen, elastin, tissue, biomembrane (eg, heart membrane), or other binding protein or natural substance. From biodegradable substances such as, but not limited to, aliphatic polyesters (eg poly-L-lactide (PLLA), poly-D-lactide (PDLA)), polyglycolide (PGA), poly (glycol-co). -Lactic acid) (PLGA), polydioxanone (PDS), polycaprolactone (PCL), poly (glycolide-co-trimethylene carbonate) (PGA-TMC), polyglyconate, polylactic acid-polyethylene oxide copolymer, poly (hydroxybutyrate) ), Polyan anhydride, polyphosphate ester, poly (amino acid), poly (alpha-hydroxyic acid), or any other similar copolymer, but not limited to, from polymers or copolymers, from magnesium or magnesium alloys. , Or aluminum or an aluminum alloy, and any composites and combinations thereof, and combinations of other biocompatible substances that are absorbed by the organism after a period of time. In other embodiments, the encapsulant may not be partially or completely bioabsorbable and may not be bioabsorbable, such as foamed polytetrafluoroethylene (ePTFE), polyethylene, polypropylene, polyester, polyurethane, silicone, dacron, urethane. , Polyallyl ether ether ketone (PEEK), stainless steel, titanium, nickel-titanium, cobalt, nickel-chromium, gold, platinum, and / or any compound, alloy, or combination of above or other suitable substances, etc. However, this Manufactured from any other biocompatible material, not limited to these. It should be understood that in some embodiments, the sealing membrane can be made from a combination of one or more biodegradable and non-absorbable materials.
Further, according to some embodiments, the sealing film 105 can be formed as a continuous material, but in other embodiments, the sealing film 105 can be formed of a woven or net configuration. The woven or net configuration facilitates the formation of a barrier against blood leakage by sealing as a thrombus or other body material or cell attached to the woven or net sealing membrane 105. Similarly, the sealing membrane 105 can include holes, perforations, or partial perforations, at least in or near the puncture site, in or near an area designed to be positioned. In some embodiments, holes can only be provided in a portion of the sealing film 105, but in other embodiments, more than 60% of the sealing film 105 can include holes or perforations. The holes or perforations can be formed in any suitable size, eg, in one embodiment they have a diameter in the range of about 0.05 mm to about 2 mm, in other embodiments the holes or perforations have other diameters. Can be done. The holes or perforations serve to promote cell proliferation on the sealing membrane 105 and integration of the sealing membrane 105 with the vessels. In addition, the perforated encapsulation membrane 105 also reduces the total amount of foreign matter (eg, encapsulant membrane 105) transplanted into the patient and thus promotes membrane degradation. According to some embodiments, the material of the sealing membrane 105 is selected to exhibit one or more of the following properties: That is, it avoids inflammatory or toxic reactions when transplanted, has an acceptable storage life, controls the rate of degradation if biodegradable, metabolizes if biodegradable, and / or is easily sterilized. To.
In some embodiments, the perimeter support frame 110 can, but is not limited to, made from the biodegradable material, at least in part. According to one embodiment, the perimeter support frame 110 is an aliphatic polyester (eg, poly-L-lactide (PLLA), poly-D-lactide (PDLA)), polyglycolide (PGA), poly (glycol-co-lactic acid). ) (PLGA), polydioxanone (PDS), polycaprolactone (PCL), poly (glycolide-co-trimethylene carbonate) (PGA-TMC), polygluconate, polylactic acid-polyester oxide copolymer, poly (hydroxybutyrate), From materials such as, but not limited to, polyanhydrides, polyphosphates, poly (amino acids), poly (alpha-hydroxyic acids), or any other similar copolymer, or from magnesium or magnesium alloys, or aluminum or It can be made from an aluminum alloy and any combination or combination thereof, or a combination of other biocompatible substances that will be absorbed by the organism after a period of time. However, in other embodiments, the perimeter support frame 110 is made of nickel-titanium alloy (Nitinol), stainless steel, titanium, cobalt-based alloys, chromium alloys, gold, platinum, tantalum, biocompatible polymers such as shape memory polymers. Or any combination thereof, but not limited to, made from non-absorbable material, at least in part. Therefore, in the case of an embodiment in which the peripheral support frame 110 is made of a non-absorbent material, it is desirable to minimize the size and space occupied by the frame so as to be achieved by the direction surrounding the sealing film 105. Sometimes. Moreover, as mentioned above, many of the substances or combinations thereof exhibit elastic, hyperelastic and / or shape memory characteristics, which change from a flexed or other altered state to a stable natural state during implantation. It is advantageous because the VCD100 can be automatically expanded to form the desired shape so that the fixation of the VCD100 can be improved in the vessel.
The cross member support 115 extending between the corresponding sides of the perimeter support frame 110 serves at least two functions. First, the cross member support 115 supports the sealing membrane 105 at or near its center to avoid loosening that would come in contact with the vascular puncture site and improve the seal created between them. To do. Second, the cross member support 115 can include mounting means 205 for locking the anchor tabs and / or pullstrings to the VCD 100 as described with respect to FIG. Mounting means 205 can include, but is not limited to, openings, hooks, eyes, posts, tabs, adhesives, heat welding, laser welding, mechanical mounting and the like. For example, in one embodiment, the anchor tab and / or pullstring is detachably attached to the attachment means 205 prior to transplantation (eg, during manufacture or delivery). In other embodiments, the anchor tabs and / or pullstrings are more permanent to the sealing membrane 105 and / or the cross member support 115, such as when the anchor tabs are formed from excess sealing membrane material. Can be attached to. Additional details regarding the construction of anchor tabs and / or pullstrings are described below. For example, FIG. 3A shows a VCD100 folded for delivery.
In one embodiment, the cross member support 115 is made of a material that has additional strength and / or rigidity with respect to the rest of the perimeter support frame 110, as described with respect to the straight edge portion of FIG. 4A. Adding additional stiffness to the cross member support 115 improves the stiffness along the vertical axis of the VCD100 and its center, which is the desired shape when in the folded configuration, as described with respect to FIG. 3A. Make maintenance even easier. The rigidity of the cross member support 115 can be improved in several ways. It increases the cross-sectional contour of the cross-section support 115 with respect to the rest of the perimeter support frame 110, forms the cross-section support 115 from a stiffer frame material, and is a stiffer frame material. It includes, but is not limited to, reinforcing the support 115, or any combination thereof.
According to one embodiment, the cross member support 115 is made from a biodegradable polymer, a biodegradable metal or alloy, any other biodegradable material or any combination thereof. The biodegradable cross member support 115 improves subsequent access to the vessel at or near the implantation site at any time after degradation. Since the cross member support 115 is located in or near the puncture site in this embodiment, it is formed from a biodegradable material to avoid obstruction of access to the puncture site. In one exemplary embodiment, the cross member support 115 is configured as a wire extending between the peripheral support frames 110 at or near the same position as shown in FIG. 2, but separate from it. It can be biodegradable or non-biodegradable. In other embodiments, the VCD100 can include a cross member support 115 made from a non-absorbable material, at least in part. In yet another embodiment, the VCD 100 may not include the cross member support 115 and / or the anchor tab 120 or pullstring as described above.
In one embodiment, the VCD100, of which some or all of the components are made from biodegradable materials, is manufactured in a manner that allows predictable degradation rates. For example, in one embodiment, the biodegradable component is made from a material having a degradation time of at least 1 day and may reach at least 720 days. For example, in one embodiment, the decomposition time may be between about 20 days and about 120 days. These decomposition rates are for illustrative purposes only and are not limiting. In other embodiments, the degradation time may be longer or shorter than these ranges, as desired, which may be determined by the site of implantation and / or the procedure performed. Further in some embodiments, the various components of the VCD100 may decompose at different rates, eg, the VCD100 having a sealing film 105 that decomposes faster than the perimeter support frame 110 and / or the cross member support 115. is there.
In addition, the materials that make up the components of the VCD100 must be stable over a wide range of temperatures to avoid decomposition or defects during manufacturing, sterilization and storage. An exemplary temperature range in which the components of the VCD100 must be stable may range from about -20 ° C to about 65 ° C, or in some embodiments from about -10 ° C to about 45 ° C. .. According to some embodiments, the components of the VCD100 can be stable at temperatures above and below this range. Illustrative materials showing the desired quality for producing the components of biodegradable VCD100 include, but are not limited to, Resomer® products manufactured by Boheringer Ingelheim GmbH in Ingelheim am Rhein, Germany. , It is based on lactic acid and glycolic acid.
In other embodiments, the VCD 100, including the sealing membrane 105 and the perimeter support frame 110, is an ellipse, asymmetry, oval, rectangle, rhombus, triangle, pentagon, hexagon, or any other polygon. However, it can be configured in various shapes not limited to these. In an embodiment having a sealing film 105 configured differently from that shown in FIG. 2, one or more portions of the perimeter support frame 110 are additional to the rest of the perimeter support frame 110. It can be formed from a material with strength and / or rigidity, which allows the VCD100 to be encapsulated in the desired fold shape during delivery and / or at the edges or edges of the sealing membrane 105 during delivery and / or after implantation. Illustrated by a portion 220 along one end of a peripheral support frame that can serve to prevent at least a portion of the portion from spreading in a morning glory shape. Other typical VCD shapes will be described with reference to FIGS. 4A-5G.
In the embodiment shown in FIG. 2, the sealing film 105 completely covers the peripheral support frame 110. However, in other embodiments, the sealing membrane 105 extends from the perimeter support frame 110 at or near the center of the VCD100, thereby covering the puncture site within the vessel after implantation. The perimeter support frame 110 can extend beyond the encapsulation film 105 along one or more edges of the VCD 100, while the brace 105 may cover only part of the perimeter support frame 110. .. The sealing membrane 105 is coupled to the peripheral support frame 110 at one or more points along the frame and / or cross member support 115 by any suitable manufacturing method as described in more detail herein. can do.
To provide the desired hemostasis, the dimensions of the sealing membrane 105 are at least as large as or larger than the puncture site, as shown in FIG. 1 according to one embodiment. The sealing membrane can be larger than the puncture site. However, in other embodiments, the size of the sealing membrane 105 is smaller than the size of the puncture site. For example, the sealing membrane 105 may be about 10% or 50% smaller than the fiber site, yet the holes in the puncture site tend to shrink after the delivery sheath or other delivery system has been removed from the puncture site. So this can be effective. According to various embodiments, the thickness of the sealing film 105 is between about 5 microns and about 500 microns, between about 10 microns and about 200 microns, or between about 30 microns and about 150 microns. The thickness of the sealing film 105 can be determined, at least in part, by a manufacturing method as described herein. In addition, the thickness of the sealing film 105 (and optionally the porosity of the sealing film 105) can affect the rate of decomposition and can therefore be adjusted to control it.
The sealing membrane 105 can be formed in any number of configurations including, but not limited to, woven membranes, non-woven membranes, nets, films, gels, single membranes, multilayer films, or any combination thereof. .. The sealing membrane 105 includes, but is not limited to, extruding, solution deposition, coating, molding, electrospinning, weaving, or any other method suitable for producing polymer sheets, fabrics or membranes. Can be built according to a number of techniques.
According to one embodiment, the sealing film 105 is produced by weaving, air spinning, or electrospinning, which uses an electric charge to extract the fibers from the liquid form. Weaving, air spinning, and electrospinning can control the density, surface area topography, and flexibility of the sealing film 105. As a result, the control of the decomposition rate of the sealing film 105 is improved, and as a result, the effective surface area is increased, and as a result, the decomposition rate is increased. Controlling the flexibility of the membrane controls the ability of the sealing membrane 105 to wrap or fold into a folding configuration during delivery, while also avoiding significant wrinkles and creases that can occur in extruded membranes without it. .. In addition, the reduced density sealing membrane 105 as achieved by weaving or electrospinning increases the compressibility of the sealing membrane 105, which is caused by the inner wall topography of the blood vessel (eg, calcification). Improves the ability to adjust (such as surface roughness) and improves sealing ability.
The sealing membrane 105 can be a single material or a composite material. The single or composite material may be porous, non-porous, or a combination thereof.
According to various embodiments, the sealing film 105 can have substantially uniform properties throughout, or the sealing film 105 can exhibit diverse properties, eg, multiple layers of different materials. And / or includes layers with different densities or porosities. For example, according to one embodiment in which the sealing film 105 is formed from a plurality of layers, the sealing film 105 is at least a first porous material forming the first layer, and therefore less porous. It is constructed from a second layer formed from a smooth material. The first layer is made of the same material as the second layer, but can be made in different ways to create different porosities, or the first and second layers are formed from different materials. be able to. In one example, in a VCD100 with a sealing membrane 105 that is more porous towards the lumen of the vessel than the surface facing outward towards the inner wall of the vessel, the surface inside the vessel. The decomposition rate of the sealing film 105 can be increased on the inner surface. However, in another embodiment, the less porous layer can be directed outward towards the vascular wall, making the surface in contact with blood flowing through the vascular smoother. Weaving and electrospinning, for example, can be used to produce various combinations of density, porosity, and surface area properties that may differ from the typical examples described herein.
Encapsulating Membrane 105 includes, but is not limited to, any number of suitable techniques including, but not limited to, adhesion, solvent adhesion, thermal welding, laser welding, ultrasonic welding, mechanical attachment, layered integration, or any combination thereof. It can be used to integrate with or otherwise combine with the perimeter support frame 110 at one or more points along the perimeter support frame 110 and / or the cross member support 115. The technique selected for coupling the sealing film 105 to the peripheral support frame 110 can, to some extent, be determined by the manufacturing technique used to fabricate the sealing film 105 and / or the peripheral support frame 110.
According to one embodiment, the peripheral support frame 110 can be sandwiched between two membrane layers forming the sealing film 105, and the peripheral support frame 110 can be fixed at a predetermined position between them. For example, in one technique, a first membrane layer is formed on the mandrel, which has a curvature equal to or slightly greater than the vessel intended for implantation of the VCD100.<u style="single">radius</u>(Thus, it is flatter than that). After forming the first membrane layer of the mandrel, the perimeter support frame 110 is placed on the first membrane layer. In one embodiment, at this stage, the perimeter support frame 110 is treated to be naturally stable around the mandrel, as if the perimeter support frame 110 were made from shape memory metal, alloy, or polymer. To. However, in other embodiments using shape memory metals, alloys, or polymers, the perimeter support frame 110 is treated at another manufacturing stage (eg, before or after) to a natural stable state. Or the perimeter support frame 110 may not be made from any shape memory metal, alloy, or polymer.
According to one embodiment, the support frame 110 is formed by cutting the frame from a sheet of the desired size, cutting from a tube of the desired size, or crimping, brazing, welding, etc. from a wire (flat or round cross section). By forming, it is manufactured from a shape memory alloy such as a nickel-titanium alloy. Nickel-titanium alloys can be cut by laser, chemical etching, electrolytic corrosion, or any combination thereof. After cutting and / or otherwise forming the support frame 110 to its desired dimensions, the support frame 110 is subjected to the desired natural stable shape, such as by heat treatment, as is known in the art of shape memory materials. For example, it is pre-shaped to its superelastic state). Preformation can be performed on the mandrel or separately. According to some embodiments, the surface of the support frame 110 is further treated. For example, removing oxides, smoothing, electropolishing, passivating to improve corrosion resistance, and / or increasing surface roughness to improve adhesion to sealing film 105, but limited to these. Not done. The example of forming the support frame 110 is exemplary and is not limited.
After applying the perimeter support frame 110 to the mandrel on the first membrane layer, a second membrane layer can be formed on the perimeter support frame 110 and the sealing film 105. Therefore, the sealing film 115 and the peripheral support frame 110 become an integral component by fusing the two film layers with the peripheral support frame 110 sandwiched between them or by attaching them by another method. Similar techniques can be used in embodiments that include the cross member support 115 or any other support frame structure. Other techniques suitable for bonding the sealing membrane to the support frame can be performed, such as techniques similar to those used in the design and manufacture of covered stents or stent grafts.
In one embodiment, the encapsulating membrane 105 and / or the surrounding support frame 110 is coated, impregnated, covered, and / or by means of releasing chemical components into the surrounding environment, such as in the vascular site at or near the puncture site, after implantation. Can be included. Examples of such chemical components include hemostatic agents, drugs, biological agents, viruses, cells, or any other substance that can affect or control biological processes, but these Not limited to. For example, one or more chemical components are used to promote healing of blood vessels and / or puncture sites, suppressing, reducing, or reducing cell proliferation, as in the case used in drug-eluting stents. Alleviate, suppress, reduce, or reduce blood clotting (eg by releasing heparin, etc.), enhance blood clotting (eg, by releasing thrombin, etc.), and / or use antibiotics or other drugs. Release can reduce the risk of infection. The chemical composition can be applied to the perimeter support frame 110, sealing film 105 and / or anchor tab 120 or pullstring by coating the surface at least partially. In other embodiments, the chemical component is physically or chemically bound to at least one of the materials forming the perimeter support frame 110 and / or the sealing film 105, or mixed into the sealing film 105 during manufacturing. can do. According to one embodiment, one or more chemical components are released after absorption, decomposition, or erosion of one or more components of VCD100.
According to various embodiments, the total length of the VCD 100 from one edge of the sealing film 105 to the opposite edge along the vertical axis is between about 4 mm and about 50 mm, and in one embodiment about 5 mm. It can be in the range of about 25 mm. According to various embodiments, the diameter of the folded VCD100 as shown and described in FIG. 3A is at least less than about 9 mm to fit a 27 Fr inducer sheath and about 7 mm to fit a 21 Fr inducer sheath. Less than, or even less than about 6 mm to fit an 18 Fr inducer sheath. In yet other embodiments, the diameter can be less than about 4 mm, which fits a 12 Fr inducer sheath, or even less than about 3 mm, which fits a 9 Fr inducer sheath. In yet another embodiment, the VCD100, when in the folded state, fits into and can be deployed with any inducer sheath between 4Fr and 8Fr. The above dimensions are exemplary and not limited. In other embodiments, the VCD100 in a folded or extended configuration may be larger or smaller than the typical examples described herein.
The materials, manufacturing techniques, and features of the VCD100 and the individual components also apply to any other VCD embodiment described herein.
FIG. 3A shows an embodiment of the VCD100 similar to that described in FIG. 2 in a folded configuration for delivery. The VCD100 can be sent using a sending system as described with respect to FIGS. 6-10P, and is first inserted and sent in a folded configuration as shown in FIG. 3A. Here, the VCD100 rolls the device along the vertical axis into a folded or rolled configuration. The cross member support 115 can further improve the rigidity and stability of the VCD 100 in the vertical direction when it is wound. In the absence of the stiffness provided by the perimeter support frame 110 and / or the cross member support 115, the edges are opened in a morning glory shape by a containment mechanism as described below that is positioned in or near the center of the VCD100. , And / or the sealing film 105 may be wrinkled. However, as described herein, in other embodiments the VCD100 does not include a rigid cross member support 115 and optionally instead a cross member support of a non-rigid member such as a biodegradable or non-degradable wire. Can include 115. Therefore, the opening or wrinkles of the morning glory shape can be reduced by winding the VCD100 in a folded state.
Along with the VCD100, a containment mechanism 305 implemented as one or more strings, wires, ribbons, strips, or cords surrounding the VCD100 to hold the VCD100 in an openly folded configuration is also illustrated. When the containment mechanism 305 is released after being properly positioned in the vessel, the VCD100 expands into an expanded configuration. As shown in the embodiment of FIG. 3A, the containment mechanism 305 is such that the containment mechanism 305 is selectively released from the periphery of the VCD100 by using a tie, lanyard, or other releasable fixing means. It is configured as a thread or other loop-like member that surrounds and compresses. The containment mechanism 305 also has at least one end extending from the VCD100 (and optionally within a delivery system as described herein) so that all operators can operate and release the containment mechanism 305. including. In another embodiment, the containment mechanism is one or more removable pins that can be released by the operator, one or more releasable wire loops, one or more releasable straps, releasable. Includes a wire, or another similar releasable mechanism that holds the VCD100. In yet another embodiment, a thin holding tube with a ripcord is mounted on the compressed VCD100 so that when the ripcord is pulled, the holding tube is torn or otherwise separated and compressed VCD100. release. The containment mechanism 305 can also be used to position the VCD100 in its final position across the vascular puncture.
FIG. 3B shows another embodiment of the VCD100 containment mechanism. In this embodiment, the containment mechanism comprises looped wires 315 formed to be alternating loop rows 317, 319. In the alternating rows of loops 317, 319, the first loop 317 is positioned on one side of the VCD100 when wound, and the second loop 319 adjacent to the first loop 317 is below the opposite side of the VCD100. It is passed and oriented to be positioned on it. A cradle can be created around the VCD100 to form any number of adjacent loops that hold it in a folded configuration. FIG. 3C shows looped wires 315 and their alternating loop rows 317, 319 in the absence of VCD100 for further clarity. The looped wire 315 is illustrated with an arrow indicating the path such that the loops 317, 319 traverse along the length of the VCD positioned between them. In one embodiment, each end of the looped wire 315 is passed from the delivery system over the VCD100 folded on the same side of the VCD100, and thus when released, the looped wire 315 does not suppress the expansion of the VCD100. It can be recovered by a sending system or other means.
With reference to FIG. 3B, the containment mechanism further includes a pulling means 320 attached at some point along the release wire 325 between the first side 325a and the second side 325b of the release wire 325. The pulling means 320 may be a wire, string, thread, rod, or any other member that can be secured to the release wire 325. The release wire 325 is passed between the respective vertices of the alternating loop rows 317 and 319 and secures the loop wire 315 around the folded VCD100. Therefore, when tension is applied to both sides 325a, 325b of the release wire 325, alternating loop rows 317, 319 are pinned against the folded VCD, maintaining it in a tightly folded configuration during delivery. When either side or both sides 325a, 325b of the release wire 325 is released, the tension applied to the alternating loop rows 317, 319 is reduced and the VCD100 begins expansion. The pulling means 320 collects the release wire 325 when pulled and completely releases the alternating loop rows 317, 319 of the looped wire 315. In one embodiment, the looped wire 315 is recoverable after the VCD100 is released.
FIG. 3D shows another embodiment of the VCD100 containment mechanism. According to this embodiment, the containment mechanism comprises a loop cage support 330 configured to extend from the distal end to the delivery device, a fixed end 337 fixed to the loop cage support 330, and a loop. Includes a loop 335 having an end 339 and optionally passing through a hole 341 of the loop cage support 330 and having a loop or other retaining means formed thereby. The containment mechanism also includes a cage pin 340 configured to operate selectively during delivery of the VCD100, which releases the looped end 339 from the cage pin and thus causes the loop 335 from around the VCD100. It acts to free you. As shown, when in a fixed configuration, the loop 335 is positioned around the VCD100 and maintains it in a folded (eg, rolled) configuration. The fixed end 337 of the loop 335 is secured to the loop cage support 330 by any suitable means, and the looped end 339 of the loop 335 is releasably threaded over the cage pin 340. The cage pin 340 is looped by any suitable means, including, but not limited to, extending through, tightening, passing through, etc., through one or more passages (shown in FIG. 3D). It is operably secured to the cage support 330 and can extend proximally through the flow path of the selected delivery device.
The containment means releases the VCD100 from its folded position by pulling the loop cage pin 340 proximally during operation. Any suitable actuating mechanism can be included in the selected delivery device to allow the loop cage pin 340 to be pulled. Pulling the loop cage pin 340 proximally frees the looped end 339 of the loop 335, freeing the VCD100 and allowing it to expand into a stable expansion configuration. The loop 335 pulls the loop 335 by removing the loop cage support 330 and / or the delivery device in use, as its fixed end 337 remains fixed to the loop cage support 330. It can be removed from the vessel.
According to one embodiment, the loop cage support 330 is from a flexible film having a thickness of, for example, between about 0.05 mm and about 5 mm, or between about 0.1 mm and about 0.5 mm in other embodiments. It is formed. The width of the loop cage support 330 may be, for example, between about 1 mm and about 5 mm in one embodiment, or between about 2 mm and about 4 mm in another embodiment. The loop cage support 330 may be a polymer (eg, polytetrafluoroethylene or other fluoropolymer, polyethylene, polyurethane, polyamide, polyimide, PEEK, or any other suitable polymer), or a metal (eg, nitinol, stainless steel, etc.). It can be made from any flexible material, such as, but not limited to, a cobalt alloy, or any other suitable metal), or any combination thereof. However, other suitable loop cage support 330 configurations and dimensions can be provided. It is made of a variety of suitable materials, such as, for example, more rigid members and / or any other biocompatible material described herein.
It can have a cross-sectional diameter in the range between 5 mm. As described herein, in one embodiment, the loop cage pin 340 extends through the delivery device and is connected to an actuating mechanism for actuation by the operator. This includes, but is not limited to, sliders, pushbuttons, wheels, opposing handles, or any other suitable means of pulling the loop cage pin 340 proximally. In other embodiments, the loop cage pin 340 can have a shorter length, such as between about 2 mm and about 50 mm, or between about 4 mm and about 15 mm in other embodiments, strings or wires. It is connected to the operating mechanism by an intermediate member such as. According to various embodiments, the loop cage pin 340 is a polymer (eg, polytetrafluoroethylene or other fluoropolymer, polyethylene, polyurethane, polyamide, polyimide, PEEK, or any other suitable polymer), or It is formed from a metal (eg, nitinol, stainless steel, a cobalt alloy, or any other suitable metal), or any combination thereof. Although not shown, the VCD100 can further include anchor tabs 120 and / or pullstrings as shown in FIG. 3A to allow the VCD100 to be positioned after being released from loop 335. The containment mechanisms described with respect to FIGS. 3A-3D are provided for exemplary purposes only. Any other suitable means of holding the VCD in an openly folded configuration can be provided. For example, with respect to FIG. 3B, instead of alternating loops, a looped wire 315 can be formed around the folded VCD as a spiral along its length and completely released by pulling one end. .. As another example, instead of the looped wire 315, a releasable mesh or tubular member can enclose at least part of the VCD, thus opening the mesh or tubular member or otherwise splitting it. , You can free the VCD from there. An additional containment mechanism, such as the sending device described with respect to FIGS. 6-10P.
4A-4J show the additional configuration of a VCD, each with a differently shaped sealing film and / or support frame. The shape and / or configuration of the VCDs of these embodiments may differ from those described with respect to FIGS. 1-2, at least in part, but each may be formed in the same or similar manner and in the same manner or similar. Can be folded into a rolled configuration for delivery in the manner of.
FIG. 4A shows the VCD 402, which according to one embodiment comprises at least one axis, ie, a sealing film 405 that is asymmetric with respect to the vertical axis. In the embodiment shown in FIG. 4A, the sealing film 405 is shaped on one side with a bowed edge 414 and on the other side with a substantially straight edge 412. The perimeter support frame 410 generally follows the same or similar shape as the outer edge of the sealing film 405, which is formed in a bow shape on one side and a substantially straight shape on the other side.
One objective achieved by the bowed rim 414 and the contralateral straight rim 412 is to prevent the rim of the sealing membrane 405 from opening in a morning glory shape if in a folded configuration during delivery or after implantation. Is. The bow rim 414 reduces the surface area of the sealing membrane 405 on at least one side, minimizing the additional drag generated by the fluid flowing over it during implantation. Further, the perimeter support frame 410 along the straight edge 412 may be stiffer and therefore more rigid than the support frame along the bow 414. In the embodiment shown in FIG. 4A, the perimeter support frame 410 has a larger contour 416 (eg, thicker, wider, or both) along the straight edge 412, which improves strength and stiffness. The strength and stiffness of the perimeter support frame 410 can be improved in any number of ways along the straight edge 412, which is the frame along the straight edge 412 relative to the rest of the perimeter support frame 410. The perimeter support frame 410 along the straight edge 412 is made of a more rigid frame material, which increases the cross-sectional contour of the straight edge 412, and the perimeter support frame 410 along the straight edge 412 is reinforced with a more rigid frame material. , Or any combination thereof, but not limited to these.
Further, providing a high rigidity toward the peripheral support frame 410 along the straight edge 412 also works to reduce the spread in the morning glory shape in the folded configuration as shown in FIG. 3A. This is because the bow-shaped edge 414 is wound downward and contained in the straight edge 412. Therefore, the perimeter support frame 410 along the stiffened straight edge 412 prevents the edges of the other sealing film 405 from opening in a morning glory shape when wrapped inward. The portion of the perimeter support frame 410 along the straight edge 412 is selected to have higher stiffness and strength. This is because the straight shape still allows the peripheral support frame 410 to be wound around the relatively less rigid and more flexible portion. Otherwise, forming the bow-shaped portion of the perimeter support frame 410 with higher stiffness would prevent the ability of the VCD402 to effectively wind at least half of the bow-shaped portion into a folded configuration, as the bow-shaped portion would be stiffer. Because. Further, when the peripheral support frame 410 along the straight edge 412 is strengthened, the larger the area, the higher the rigidity, and the support extends to the rest of the VCD 402 wound inward.
FIG. 4B shows another embodiment of the VCD422 with an asymmetrical shape, which is slightly different from the asymmetrical shape of the VCD100 shown in FIG. According to this embodiment, the VCD 422 has a sealing film 425 and a perimeter support frame 430, both of which are formed to have a substantially straight edge 424 and a contralateral arched edge 426. Similar to the VCD100 described with respect to FIG. 1, the asymmetrical shape and straight edge 424 facilitate the winding and folding of the VCD422. This is especially true if the perimeter support frame 430 is stiffened along at least part of the straight edge 424. In addition, at least one other portion of the perimeter support frame 430 may include a more rigid area to increase the stiffness and support of the perimeter support frame 430. In this embodiment, the increased strength area 428 is oriented at or near the apex of the arcuate edge 426 and faces the straight edge 424. Only a portion of the perimeter support frame 430 along the bow rim 426 includes an increased strength area 428, yet the perimeter support frame 430 can be wound along the vertical axis.
FIG. 4C shows a VCD 442 with an oval sealing film 445. According to this embodiment, the VCD 442 also has a peripheral support frame 450 that follows the oval shape of the sealing film 445 at or near its outer edge as a whole, but extends from itself to fold the VCD 442. Also includes at least two openings or eyes 444 that facilitate containment in. For example, the VCD 442 shown in FIG. 4C includes four eyes 444a, 444b, 444c, 444d extending from opposite portions of the sealing film 445 and / or the peripheral support frame 450. When folded and wound along the vertical axis, the opposing pairs of eyes 444a, 444b and 444c, 444d receive a containment mechanism through the eyes and hold the VCD442 freely in a folded configuration. To be aligned. For example, according to one embodiment, when the VCD442 is wound, the first release pin can be releasably inserted through the eyes 444a, 444b and the second release pin can be releasable through the eyes 444c, 444d. Can be inserted into, which serves to hold the VCD442 in a wound configuration. When each release pin is removed during delivery, the VCD442 can be extended into an extended configuration with the force of a peripheral support frame 450 that expands into a natural stable shape.
In other embodiments, instead of the release pin, one or more wires, cords, or string members, such as the containment mechanism 305 described with respect to FIG. 3A, are releasably inserted through the opposite pair of eyes 444. Provide any other member that can. Further, the VCD 442 containing one or more pairs of openings or eyes 444 is formed in any other shape, such as any of the VCDs described herein, or any other suitable shape as desired. can do. Similarly, one or more pairs of eyes 444 can be incorporated into any of the other VCDs described herein, if desired. In another embodiment, the eye 444 is formed through a portion of the sealing film 445, instead of or in addition to being formed by a portion of the perimeter support frame 450.
Further, the VCD 442 of this embodiment includes two cross member supports 455, 457 similar to the cross member support 115 shown in FIG. 2, separated from the opposite side of the peripheral support frame 450 and positioned between them. .. The two stiffer cross member supports 455, 457 provide additional longitudinal support throughout the sealing film 445 when in a rolled and expanded configuration.
Further, according to this embodiment, the first cross member support 455 is oriented at or near the latitude center of the sealing film 445, and the second cross member support 457 is removed from the center of the latitude center. Oriented. Off-center orientation of the second cross member support 457 provides additional support and stiffness to the sealing film 445, and the support frame 450 and / or sealing when in a rolled or folded configuration. Membrane 445 is prevented from opening in a morning glory shape or undergoing other unwanted deformations. Any of the VCD embodiments described herein may optionally include a plurality of cross member supports, either of which may be centered or decentered. Similarly, the mounting means 205 can be oriented off-center along the vertical axis so that the VCD 100 can be more effectively centered along the vertical axis.
FIG. 4D shows VCD462 incorporating different stiffening and supporting means. Here, the VCD 462 includes a perimeter support frame 470 and at least one support wire 475 through a plurality of eyes 467 formed on opposite sides along the perimeter of the VCD 462. The eye 467 can be formed through the perimeter support frame 470 and / or the sealing film 465, both of which are formed and configured in the same or similar manner as described with respect to other embodiments herein. To. The support wire 475 provides additional support throughout the sealing film 465 between the perimeter support frames 470. In the illustrated embodiment, the support wire 475 is threaded through the eye 467 in an anterior-posterior configuration in a manner very similar to lacing the two opposite sides of the VCD462. The support wire 475 can be formed from any suitable biocompatible material, metal, alloy, polymer, or any other suitable material as described above with respect to FIG. The support wire 475 may be completely biodegradable, partially biodegradable, or not degradable, absorbable, or erosive, depending on various embodiments. The support wire 475 is separated from the sealing membrane 465 below the sealing membrane 465 inward toward the inside of the vessel or above the sealing membrane 465 facing the vessel wall. Alternatively, it can be taut and / or attached to the sealing film 465. Otherwise, the support wire 475 can be further integrated with the sealing membrane 465 and the peripheral support frame 470 so as to be sandwiched between the two membrane layers, similar to the fabrication technique described with respect to FIG. Support wires 475 and eye 467 can be configured for use in any VCD embodiment described herein.
FIG. 4E shows a similar VCD482 containing multiple support wires 492. According to this embodiment, each support wire 492 is passed separately through a pair of opposing eyes 467 or otherwise secured laterally to the perimeter support frame 490. Separation of the plurality of support wires 492 and substantially lateral positioning improves the ability of the VCD 482 to wrap into a folding configuration along the vertical axis, while still a stretched sealing film between the peripheral support frames 490. Additional support for the 485 is provided.
4F-4H show another embodiment of VCD494 comprising a circular or oval sealing film 498 coupled to a circular or oval perimeter support frame 496. FIG. 4F shows a VCD494 with a sealing film 498 assembled and attached to a peripheral support frame 496. 4G and 4H show the sealing film 498 and the peripheral support frame 496 separately, respectively. According to this embodiment, the sealing film 498 is coupled to the perimeter support frame 496 at one or more locations along its perimeter.
As described herein, it is advantageous because the sealing membrane matches the internal shape of the vessel and covers the vascular puncture site to facilitate hemostasis. According to various methods, the conformance of the sealing membrane to the vessel shape is relative to the perimeter support frame where the surface shape of the membrane can be made variable by the natural elasticity and / or deformability of the sealing membrane material. By any extra encapsulant material and / or by multiple attachment points where the encapsulant is intermittently attached to the support frame to allow the membrane to act on itself, as provided by this embodiment. Can assist.
As shown in FIG. 4G, the sealing membrane 498 can be cut or formed with at least two tabs 495 extending from the perimeter of the membrane. Six tabs 495 are provided in the illustrated embodiment, but any number of tabs can be provided in other embodiments. Tab 495 is configured to enclose or otherwise attach to individual parts of the support frame 496. For example, each tab 495 is configured to loop around (or at least a portion of) the support frame 496, such as by a loop member or hook member. According to one embodiment, each tab 495 is integral with the sealing membrane 498 and is not attached to the sealing membrane 498 separately. However, in other embodiments, the sealing film 498 can be formed first and then attached to it separately from each tab 495.
In one embodiment, the membrane 498 is positioned on the vessel-facing surface of the support frame 496 and, upon implantation, is sealed so that the sealing membrane 498 is positioned between the vascular inner wall and the support frame 496. Membrane 498 is attached to support frame 496. In one embodiment, the tab 495 is bent around the top of the support frame 496 and attached to the bottom surface of the sealing membrane 498 (eg, a surface that does not face the vascular wall after implantation). Fixation of the tab 495 to the surface of the sealing film 498 can be accomplished using adhesive, solvent, heat, ultrasonic welding, or any other means of attaching the polymer surface, but is limited thereto. Not done. In various embodiments, the sealing film 498 can be coupled to the support frame 496 by tabs 495 at any number of locations, eg, at any number of locations, such as three or more locations. For example, in various embodiments, 2 to 12 tabs 495 are used, or 2 to 6 tabs 495 are used.
According to one embodiment, all or some of the tabs 495 and the binding means allow a small amount of relative movement between the sealing membrane 498 and the support frame 496. This movement can serve to reduce the strain of the sealing membrane 498, while at or near vascular puncture the membrane 498 matches the shape of the vascular wall and promotes hemostasis. Can be done. In addition, in situations where re-access to the vessel at the same puncture site is desirable, if the mounting tab 495 slides while puncturing the membrane 498, the support frame 496 should continue to support the sealing membrane 498. It can minimize the portion of the sealing membrane 498 that enters the vessel and, in some cases, block blood flow during subsequent procedures. According to various embodiments, the range of relative motion between the sealing film 498 and the support frame 496 can vary from about 0.1 mm to about 5 mm.
According to one embodiment, the sealing film 498 is also coupled to the support frame 496 near the vertical axis (eg, near the connecting means 497 of the support material 493 described below). In one embodiment, the encapsulant membrane 498 is attached to the support frame 496 only on or near the vertical axis, whereby the encapsulant membrane 498 is subjected to a radial force exerted by the support frame 496 on the vessel wall. In response to the support frame 496, it can be exercised in other states. In the embodiment in which the sealing film 498 is only connected to the support frame 496 on or near the vertical axis, the sealing film 498 has a shape and a shape having the same or larger dimensions as the support frame 496. Can be sized. For example, the sealing membrane may be about 6 mm larger, or even larger in some embodiments. In another embodiment, the sealing film 498 is attached to the support frame 496 on or near the vertical axis and at one or more other locations along the support frame 496.
According to one embodiment, as shown, the perimeter support frame 496 does not include an integral cross member support such as the cross member support 115 described herein with respect to other embodiments. However, in one embodiment as shown in FIGS. 4F-4H, the perimeter support frame 496 includes connecting means 497 that connects the support member 493 with a portion of the perimeter support frame 496. Therefore, the support material 493 can be permanently or detachably attached to the support frame 496 by the connecting means 497. According to various embodiments, the connecting means 497 can include, but is not limited to, eyes, hooks, tabs, pressure or friction fitting slots, and the like. According to various embodiments, the support frame 493 is flexible, such as, but not limited to, polymers (biodegradable or non-biodegradable) polymers, metals, alloys, or combinations thereof, as described herein. Alternatively, it may be a wire or string formed from a rigid material. However, in other embodiments, the cross member support such as the cross member support 115 described with respect to FIGS. 1 and 2 may optionally include a support frame 496.
Also, as shown in FIG. 4F, the VCD494 can further include anchor tabs 120 and / or pullstrings, which, depending on the configuration of the VCD494, support frame 496, support member 493, and / or cross member support. Can be connected to. As described herein, anchor tabs 120 and / or pullstrings can be constructed from biodegradable or non-biodegradable materials.
It is understood that the features of the encapsulating membrane coupled to the support frame described with respect to the embodiments of FIGS. 4F-4H also apply to any of the other VCD embodiments described herein.
4I-4J show another embodiment of VCD481 including a sealing film 483, a support frame 489, and a cross member support 487. In this embodiment, the support frame 489 is composed of one member oriented approximately perpendicular to the vertical axis, so upon expansion, the support frame is radially or around the vessel in which it is positioned. Extend along. The support frame 489 can be formed from any biodegradable or non-biodegradable material, such as those described with respect to FIG. In one embodiment, the support frame 489 is preformed to the desired shape and curvature using a shape memory metal or alloy such as a nickel titanium alloy (eg nitinol), a shape memory polymer, or any combination thereof. .. For example, according to one embodiment, the support frame 489 is the curvature of the vessel into which the VCD481 is implanted.<u style="single">radius</u>Slightly larger curvature<u style="single">radius</u>Pre-shaped to extend to have.
The sealing film 483 of this embodiment is formed in a quadrilateral geometry (eg, quadrangle, rectangle, diamond, etc.) with two opposing corners oriented towards the individual ends of the support frame 489 and the other two. The two opposing corners are oriented towards the individual ends of the cross member support 487. The quadrilateral geometry reduces the sealing film 483 from spreading or deforming in a morning glory along its edges. The sealing membrane 483 can be constructed of any biodegradable or non-biodegradable material or a combination thereof, as described with respect to FIG.
According to one embodiment, the cross member support 487 differs from the other cross member supports described herein by including a guide flow path 484 that passes through itself. The guide channel 484 is sized and configured to allow one or more guide wires to pass through it, which facilitates delivery and placement of the VCD481 using conventional guide wire technology and / or VCD. Used to maintain access to the guide wire after deployment. As shown in FIGS. 4I-4J, according to one embodiment, the guide flow path 484 is curved, which has an entrance point 491 passing through one end and a cross member at any intermediate location 488. Exit support 487. FIG. 4J shows a cross member support 487 without a self-integrated sealing film 483 or support frame 489. When integrated with or otherwise attached to the sealing film 483, the cross member support 487 can be oriented so that the intermediate outlet does not face the sealing film 483. However, in another embodiment, a hole is formed through the encapsulant membrane, which allows the guide wire to exit the guide flow path 484 and pass through the encapsulant membrane 483. In some embodiments, the anchor tab or pullstring may also pass through this same outlet point through the sealing film 483 to further seal the exit point 488 formed on the sealing film 483. it can. In the embodiment including the curved guide flow path 484, the curvature can be gently formed so as to facilitate the passage of the guide wire. In a further embodiment, at least the inlet 491 of the guide channel 484, and optionally the outlet 488, is formed in a conical or wider shape to facilitate insertion of the guide wire.
Guide wires can be used to facilitate advancement and positioning of the VCD within the vessel or other lumen. According to some embodiments, the guide wire can be removed after delivery and before release of the containment means. In another embodiment, the VCD is in place and the guide wire can be removed after observing its performance. Thus, the guide wire facilitates subsequent intravascular access that can be performed in the event of VCD malfunction, failure, or other reason requiring removal of the transmitted VCD. After removing the first VCD, a replacement VCD can be delivered on the guide wire. In addition, the guide wire further facilitates the introduction of additional means of preventing and / or reducing bleeding from the unsealed puncture so that it is useful during placement or positioning of the VCD prior to sealing the puncture. To.
Understand that any of the VCD embodiments described or illustrated herein can be delivered using one or more guide wires in the same or similar manner as described with respect to FIGS. 4I-4J. I want to be. In embodiments where the support structure does not include a guide flow path, such as the guide flow path described with respect to FIGS. 4I-4J, the guide wire can pass through the internal space defined by the VCD in a folded configuration, thus the VCD. Effectively wound on the guide wire, the guide flow path is oriented along or parallel to its vertical axis. In other embodiments, the VCD can include an additional flow path or opening, which, in a folded or wound configuration, passes through the guide wire and is along or parallel to the vertical axis of the VCD. The guide wire can be oriented. In yet another embodiment, the guide wire is positioned and / or coupled to one or more other components of the VCD delivery means, such as those described with respect to FIG. 3D and illustrated loop cage supports. be able to.
According to various embodiments, the cross member support 487 has a length of about 3 mm to about 50 mm, and in one embodiment a length of about 4 mm to about 20 mm. The thickness or width of the cross member support 487 can range between about 0.5 mm and about 3 mm, and in one embodiment between about 1 mm and about 2 mm. In other embodiments, the cross-section support 487 can have a substantially circular cross-section, or optionally any other cross-section contour, rather than a square or rectangular cross-section as shown in FIG. 4F. Further, the guide flow path 484 of the cross member support 487 can have an inner diameter sufficiently large to accommodate guide wires in the range of about 0.1 mm to about 1.1 mm in diameter. The guide flow path 484 can be formed in different sizes to accommodate guide wires with other dimensions as desired, which is determined by the procedure to be performed and / or the patient's anatomy. There is. According to various embodiments, the cross member support 487 can be constructed of any biodegradable or non-biodegradable material, or a combination thereof, as described with respect to FIG.
Thus, the VCD481 of this embodiment has a size minimized relative to other embodiments described herein, such as only a single member forming the cross member support 487 and / or the support frame 489. It provides an advantageous configuration by including a limited number of non-biodegradable or non-absorbable components. By reducing the number and size of supporting components, the VCD495 is rolled or otherwise compressed into a folding configuration that can eventually be made smaller than the other embodiments described herein. It can also be delivered through a smaller puncture and / or a smaller delivery system can be used.
It is understood that any of the features described with respect to the exemplary embodiments of the additional VCDs of FIGS. 4A-4J can be incorporated into any other VCD embodiment described and / or illustrated herein. Further according to various embodiments, any or all components of the perimeter support frame can be made from at least partially biodegradable material as exemplified with respect to FIG. Most, if not all, can eventually be degraded after transplantation. However, in other embodiments, the perimeter support frame and / or other components of the VCD can be constructed from non-biodegradable materials as described with respect to FIG. 2, resulting in at least the components of the VCD. Some remain in the vessel after transplantation. Moreover, the general shapes, orientations, and / or compositions of VCDs and components described herein are exemplary, but not limited.
5A-5G show other embodiments of VCD, each having a different means for retaining the VCD in the vessel. FIG. 5A shows a VCD502 with a radially expandable support frame 510 in an anteroposterior configuration (eg, accordion-like) integrated with or otherwise attached to the encapsulant membrane 505. In one embodiment, a support frame 510 having a tubular shape is formed, and the sealing membrane 505 is also formed in a tubular shape of similar dimensions, and thus when expanded, the support frame 510 vascularizes the sealing membrane 505. Extends in all directions in the radial direction within. In the folded configuration, the support frame 510 has a first perimeter that is smaller than the inner circumference of the vessel wall 12 so that it can be delivered through a delivery system with a small flow path diameter. The support frame 510 then extends into an extended configuration with a second perimeter that is greater than the first perimeter, which is equal to or slightly larger than the inner circumference of the vascular wall 12. Thus, as the VCD502 expands within the vessel 10, the support frame 510 exerts a small radial pressure inside the vessel wall as a result of similar perimeters or larger circumferences.
The sealing membrane 505 can be constructed at least partially from a biodegradable material or from a non-absorbable material such as any of the above materials described by way of illustration with respect to FIG. Also, at least a portion of the support frame 510 is preliminarily made to the desired shape and curvature using shape memory metals or alloys such as nickel titanium alloys (eg nitinol), shape memory polymers, or any combination thereof. Can be shaped.
In one embodiment, the sealing membrane 505 is one or one below the sealing membrane 505 facing inward toward the inside of the vessel 10 or above the sealing membrane 505 facing the vessel wall 12. It is connected to the support frame 510 at a plurality of attachment points 512. In the embodiment shown in FIG. 5A, the attachment points 512 are separated and dispersed along the entire sealing membrane 505 and support frame 510. However, in other embodiments, the attachment points 512 may be less than this, such as at or near the center of the sealing film 505, along the edges of the sealing film 505, or a combination thereof. Can be focused on. The attachment point 512 between the encapsulation film 505 and the support frame 510 can be achieved by any suitable means, which is sutures, adhesives, heat seals, twisting of the support frame 510 and encapsulation film 505, It includes, but is not limited to, mechanical attachment, or any other similar method. In another embodiment, the support frame 510 can be further integrated with the sealing film 505 manufactured in the same manner as the manufacturing technique described with respect to FIG. 2, such as by sandwiching it between two membrane layers.
According to this embodiment, the VCD502 also optionally has an anchor tab 120 that passes through the puncture site 15 and anchors to the patient's tissue to facilitate fixation of the VCD502 in place, as described with respect to FIG. Include in selection.
FIG. 5B shows yet another embodiment of the VCD 522 having a support frame 530 formed substantially in a coil or spiral, whereby a plurality of continuous coils extend longitudinally through the vessel 10. As with other embodiments described herein, the support frame 530 is at least partially constructed from a biodegradable material or is non-absorbent, as in any of the above materials exemplified with reference to FIG. It can be constructed from materials. Also, at least a portion of the support frame 530 uses shape memory metals or alloys such as nickel-titanium alloys (eg nitinol), shape memory polymers, or any combination thereof, to shape and curvature of the brains. Can be pre-shaped.
FIG. 5C shows another embodiment of the VCD 542 with a support frame 510 that extends radially back and forth as described with respect to FIG. 5A. In this embodiment, the sealing film 545 covers only a part of the support frame 510. The encapsulation membrane 545 is sized to fit the support frame 510 and is attached or otherwise integrated to position the encapsulation membrane 545 at or near the puncture site within the vessel. The puncture site can be covered at least partially to facilitate hemostasis. While the support frame 510 represents a single element formed in an anterior-posterior configuration, the support frame 510 of other embodiments is a "Chinese finger trap" as used in many woven auto-expansion stent devices. Like the structure, it can be composed of a plurality of woven elements having a front-back structure. FIG. 5F shows an exemplary embodiment in which the support frame is constructed in a woven manner.
FIG. 5D is constructed in a manner similar to that described with respect to FIG. 5A or FIG. 5C, but with another VCD552 containing a support frame 510, a sealing membrane 545, and / or a protrusion 555 extending from the anchor tab 120. An embodiment is shown. The protrusion 555 can extend approximately from the center or from any other location along the VCD552. By positioning the protrusion 555 in the vicinity of the fiber site, the protrusion 555 locks the VCD552 in place and extends within the puncture to facilitate at least partial sealing of the puncture site. According to one embodiment, the protrusion 555 also locally elutes or otherwise releases one or more chemical components to control biological processes, as described with respect to FIG. To do. According to various embodiments, the protrusion 555 can be formed in a conical shape, a conical trapezium, a triangular pyramid, a triangular pyramid trapezium, or other cross-sectional geometry. In one embodiment, the protrusion 555 can be integrated with the support frame 510 or otherwise configured.
According to one embodiment, the protrusion 555 is formed from a plurality of wire elements such as braided or twisted wires that provide structural support and at least partial rigidity to the protrusion 555. The wire element can be formed from any biocompatible material as described with respect to FIG. In one embodiment, the wire elements of the protrusion 555 are separated from each other sufficiently close to each other to facilitate hemostasis without the need for an additional sealing membrane, whereby the wire elements serve to seal the puncture site. do. In one embodiment, the spacing and / or configuration of the wire elements forming the protrusion 555 produces a different density or shape than the rest of the support frame 510, whereby the protrusion 555 is additional to the support frame 510. Can perform a function or a different function. For example, in one embodiment, the protrusion 555, and optionally the wire element forming the portion of the support frame 510, puncture the vessel to improve its ability to promote hemostasis without placing a sealing membrane on top. It is further separated in the vicinity of the site.
However, in another embodiment, the protrusion 555 is at least partially covered with the sealing film 545. The sealing film 545 may cover a part or all of the support frame 510 in addition to the protrusions 55, or may cover only the protrusions 555. In another embodiment, instead of or in addition to forming the protrusion 555 from the underlying structure, the protrusion 555 can be formed from extra membrane material, which is with the material forming the sealing membrane 545. It may be the same or different.
FIG. 5E shows another embodiment of the VCD. The VCD according to this embodiment is an articulated VCD 562 having an articulated support frame including a first radial support frame 570 portion and a second radial support frame 575 portion. Each radial support frame 570, 575 is constructed in a manner similar to the support frame 510 described with respect to FIGS. 5A, 5C and 5D. However, in this embodiment, the radial support frames 570, 575 are narrower (eg, shorter along the longitudinal access) and have a vertical axis because they can be positioned on opposite sides of the puncture site after implantation. Separated along. In one embodiment, the two radial support frames 570, 575 are connected by at least one junction 580 and / or sealing film 565 extending between them. As further described below with respect to FIGS. 10J-10M, the articulated VCD562 with two support frames 570, 575 allows for additional loading and delivery techniques.
According to one embodiment, the sealing film 565 covers at least a portion of the support frames 570, 575 and / or at least a portion of the joint 580. The encapsulant membrane 565, the two radial support frames 570, 575, and / or the junction 580 shall be made from any biodegradable or non-absorbable material or any combination thereof , as described with respect to FIG. Can be done. Also, the two radial support frames 570, 575 and junction 580 may have the desired shape and alloy using shape memory metals or alloys such as nickel titanium alloys (eg nitinol), shape memory polymers, or any combination thereof. Can be preshaped to curvature. For example, according to one embodiment, the radial support frames 570, 575 are spared to extend radially to and around the inner diameter and circumference of the vessel into which the articular VCD562 is implanted, respectively. Shaped, while the joint 580 is pre-shaped to extend longitudinally from the pleated or bent position during delivery and to be separated to position the radial support frames 570 and 575, respectively. Will be done.
According to various embodiments, the overall dimensions of the articular VCD562 may be the same as or similar to those described with respect to FIG. The (vertical) width of each radial support frame 570, 575 may range from about 2 mm to about 12 mm. The radial support frames 570, 575 may have substantially the same or similar widths, or may have different widths. Similar to that described with respect to FIG. 2, the articular VCD562 can be folded into a folding configuration that can be delivered, for example, through a delivery device having a sheath size in the range of 4 Fr sheath size to 27 Fr sheath size. it can.
FIG. 5F shows another embodiment of VCD. According to this embodiment, the VCD582 is formed from a support frame 585 composed of braided or twisted wire elements, substantially in the form of tubes. VCD582 within vascular 10 in the same or similar manner that can be provided by various known stent devices such as self-expandable metal stents or other expandable or woven stents by braided or twisted wire elements. Can be easily expanded and folded. Therefore, the support frame 585 extends from the first perimeter in the folded configuration to the second perimeter in the expanded configuration, which is larger than the first perimeter, and the second perimeter is intended to be ported to the VCD582. Similar to or larger than the inner circumference of the vessel 10. The individual wire elements of the support frame 585 can be made from any biodegradable or non-absorbable material, such as those mentioned with respect to FIG. 2, or any combination thereof. In addition, some or all of the support frame 585 is preformed to the desired shape and curvature using shape memory metals or alloys such as nickel titanium alloys (eg nitinol), shape memory polymers, or any combination thereof. can do.
In one embodiment of the VCD582, the spacing between the braided or twisted wire elements of the support frame 585 is small enough to achieve hemostasis without the sealing membrane. That is, the wire element performs the sealing function. According to some embodiments, in different areas of the frame, the spacing between the braided or twisted wire elements of the support frame 585 may be different and / or the wire elements may have different densities or shapes. For example, in one embodiment, the elements of the support frame 585 are located in the area of VCD582 intended to be positioned near the puncture site 15 of the vessel 10 so that hemostasis is achieved without the sealing membrane. The density increases in or near.
According to various embodiments, the braided or twisted wire elements described with respect to FIG. 5F can be included in other VCD embodiments to provide an easily expandable and foldable support frame. In addition, other features described for other embodiments, such as sealing membranes, can be incorporated into the VCD 582 of FIG. 5F.
FIG. 5G shows another embodiment of VCD. Here, the VCD 592 includes an encapsulating membrane 505 and an extended support frame 595 that are positioned on an expandable balloon 597 that is used to extend the support frame 595 and secure the VCD 592 within the vessel 10. In one embodiment, the support frame 595 includes a strap or other member that secures the sealing membrane 505 to the balloon. As with other embodiments, the sealing film 505 of this embodiment can cover all or part of the support frame 595 and the balloon 597. During delivery, the balloon 597 remains contracted. After inserting the VCD592 into the vessel 10 and positioning the sealing membrane 505 at or near the puncture site 15, inflate the balloon 597. When the balloon 597 is inflated, the support frame 595 and the sealing membrane 505 expand within the vessel 10 to cover the puncture site 15 at least partially, thereby assisting hemostasis. The balloon 597 can then be contracted for extraction through a small hole in the sealing membrane 505 (eg, less than about 2 mm, even less than about 1 mm) and then through the puncture site 15. The balloon can be expanded by any conventional means, such as delivering a liquid into the balloon, in order to expand the highly compliant body within the blood vessel.
Embodiments of the VCD 592, including an expandable balloon 597 that expands the support frame 595, allow the use of non-auto-expandable materials to form the support frame 595. For example, the support frame 595 of this embodiment includes polylactide (eg PLLA, PDLA), PGA, PLGA, PDS, PCL, PGA-TMC, polygluconate, PLA, polylactic acid-polyethylene oxide copolymer, poly (hydroxybutyrate). , Polyanhydrides, polyphosphates, poly (amino acids), poly (alpha-hydroxyic acids), or any other similar copolymers, including, but not limited to, bioabsorbable polymers or copolymers, magnesium or magnesium alloys, Alternatively, it can be formed from aluminum or an aluminum alloy, and any composites and combinations thereof. Other combinations that can include biodegradable materials can also be used to form part or all of the support frame 595.
The above VCD embodiments described with respect to FIGS. 1 to 5G are exemplary and not limited. None of the various VCD embodiments described herein and the materials, manufacturing techniques, and features of the individual components shall be in any of the other VCD embodiments described unless the opposite is specified. Is also true.
Sending method and corresponding sending system In various embodiments, the VCD and delivery system are used by physicians, surgeons, interventional cardiologists, emergency medical technicians, other medical professionals, and the like. In describing how to use VCDs and deployment systems, these people can be referred to herein as "operators."
FIG. 6 is a process flow diagram illustrating an embodiment of Method 600 in which an intravascular procedure is performed, a VCD is delivered and transplanted, and a vascular puncture is closed. This method will be described with reference to FIGS. 7A to 7D showing a plurality of steps of the method 600. Method 600 begins at block 605 and inserts the sheath 700 into the lumen of the vessel 10 through the puncture site 15 formed in the vessel wall 12. In one embodiment, the sheath 700 is optionally inserted assisted by a small puncture needle, a Serdinga needle, a dilator, an inducer, and / or another similar device. In one embodiment, the sheath 700 used to perform the intravascular procedure is the same as the sheath used to deliver and position the VCD. In another embodiment, different sheaths are used to deliver the VCD. Specific embodiments of the sending system will be described with reference to FIGS. 9A-10P.
Following block 605 is block 610, which performs intravascular procedures via access to vessel 10 provided by sheath 700. In one embodiment, this action is performed prior to sending the VCD100. Representative examples of appropriate intravascular procedures in this step include percutaneous valve replacement or repair, cardiac resection, intravascular graft transplantation, coronary or peripheral stenting, diagnostic catheter placement, or carotid stenting. Basically, any procedure that requires access to the internal cavity through the puncture site can be performed.
After performing the intravascular procedure, the same sheath can be used to deliver the VCD, or a different sheath can be used.
If different sheaths are used, perform blocks 615 and 620. Remove the first sheath at block 615, leaving a guide wire in the puncture. At block 620, the VCD delivery sheath is inserted into the puncture site in the same or similar manner as described for block 605, or otherwise by appropriate technique. To position the sheath 700 in the vessel (eg, a sheath different from that positioned in block 605) at block 620, the sheath 700 is recovered proximally until the distal end is near the puncture site 15. In one embodiment, the sheath 700 is provided by visually assisting with marks or shades on the sheath 700 and / or by using one or more side holes 715 formed in the wall of the sheath 700. Pull proximally to the desired position. If included, removing the side hole 715 from the blood flow in the vessel 10 would stop the flow of blood through the side hole 715, which the sheath 700 would in vessel 10 as shown in FIG. 7C. On the other hand, it indicates that it is in the desired position. Therefore, the side hole 715 is formed at a predetermined distance from the distal end of the sheath 700 so that the sheath 700 and VCD100 can be properly positioned within the vessel 10. In various embodiments, the position of the side hole 715 with respect to the distal end of the sheath varies according to the intended use and implantation site for the VCD100.
According to some embodiments, guide wires can be optionally used to facilitate delivery and positioning of the VCD 100 within the vessel 10. The guide wire can be delivered through the sheath 700 after the sheath has been properly positioned as described for block 620. The guide wire can also be used to facilitate subsequent access within the vessel 10 that can be performed in case of VCD100 malfunction, failure, or other reason requiring removal of the VCD100. After removing all of the first VCD, the replacement VCD100 can be sent out on the guide wire. In addition, the guide wire further prevents and / or reduces bleeding from the unsealed puncture 15 so that it can be useful during replacement or repositioning of the VCD100 prior to sealing the puncture 15. Facilitate the introduction of means. When used, the guide wire can be removed after positioning the VCD100 (eg after block 640 below).
In yet another embodiment, the guide wire can be inserted after the folded VCD100 has advanced into the vessel (eg, after block 635 below). The guide wire can be delivered through the same delivery sheath 700 (eg, parallel to the VCD100), or in some embodiments, the delivery system can include an additional passage or lumen into which the guide wire is provided. The guide wire can be positioned parallel to the passing and folded VCD100.
Work continues to block 625, where a loading tube 705 containing the VCD 100 compressed according to one embodiment is inserted into the sheath 700, as shown in FIG. 7A. Although the VCD is given a reference number of VCD100, it should be understood that any of the VCD embodiments described herein can be delivered using similar techniques. The loading tube 705 already contains the folded VCD100 and has a diameter sized to fit within the sheath 700, further facilitating the insertion of the VCD100 into the sheath 700. In embodiments where the sheath 700 comprises a hemostatic valve that suppresses bleeding and prevents air embolism, the loading tube 705 is inserted beyond the hemostatic valve. The loading tube 705 can be preloaded prior to the procedure or can be loaded by the surgeon during the procedure. In another embodiment, the VCD is loaded directly into the sheath 700 without using the loading tube 705.
After block 625 is block 630, pushing VCD100 through the loading tube 705 and sheath 700 until it exits the lumen of vessel 10. In one embodiment, a push rod (referred to herein as a "propulsion device" or "propulsion device" without distinction) is used to exit the sheath 700 and enter the vessel 10 as shown in FIG. 7B. Is pushed into the sheath 700. In one embodiment, the push rod 710 includes marks, shades, or other means within the sheath 700 that indicate the depth of the push rod 710 penetrating it. In one embodiment, the push rod 710 includes a stop mechanism that prevents the push rod 710, and thus the VCD 100, from being further inserted through the sheath 700. Upon exiting the sheath 700, anchor tabs 120 and / or pullstrings attached to the VCD100 as described with respect to FIGS. 1-2 extend from the VCD100 and exit proximally from the sheath 700 to position and position the VCD100. Facilitate release. In another embodiment, instead of a push rod, an actuator handle that works with the loading tube 705 is used to advance the VCD100 through the sheath 700 as described with respect to FIGS. 9C-9F.
Block 635 follows block 630 and the sheath 700, push rod 710, and VCD 100 are collected proximally until the distal end is near the puncture site 15, as shown in FIG. 4C. In addition, the anchor tab 120 and / or pullstring is used to pull the VCD100 into position near the puncture site 15. In another embodiment, a push rod 710 is used to facilitate positioning of the VCD100. In yet another embodiment, additional features can facilitate the positioning of the VCD100 in the desired intracavitary location. Examples of these features include curved tips, springs and urging means, some of which are described further herein. In addition, the techniques described for blocks 615 and 620 allow the sheath 700 to be further positioned. However, in other embodiments, the sheath 700 is completely removed from the vessel 10 at block 635 and optionally from the patient's body.
Following block 635 is block 640, which, in one embodiment, releases the containment mechanism that holds the VCD100 in a foldable configuration, which allows the support frame to fully expand and pulse, as shown in Figure 7D. The sealing membrane can be positioned with respect to the tube puncture site 15. An exemplary containment mechanism and its operation will be described in more detail with respect to FIGS. 3A-3C and 10A-10P. As part of the release of the containment mechanism, the anchor tab 120 and / or the pullstring can be further manipulated to facilitate positioning of the VCD 100 at or near the puncture site 15. For example, depending on the location of the anchor tab 120 and / or pullstring attachment point to the VCD100, pull the anchor tab 120 and / or pullstring proximally at or near the puncture site 15 as desired. VCD100 is almost centered or aligned in other states. In some embodiments, an optional containment mechanism is included in a safety tab (not shown), as described further, for example with respect to FIG. 9F, to prevent unintentional release of the VCD100.
Block 645 follows block 640, anchoring tab 120 to the patient's tissue, further anchoring VCD100 into the vessel and preventing intracavitary movement of VCD. In certain embodiments, sutures, biocompatible adhesives, bandages, tapes, or integral hooks are used to secure the anchor tab to or near the vascular access site to the patient's tissue. In another embodiment, the anchor tab 120 is secured by closing the vascular access site with sutures or taping and capturing the anchor tab 120 there.
In another embodiment, as shown in FIGS. 11A-11C, the VCD100 includes a recoil member 1150 that applies tensile force to the anchor tab 120 instead of or in addition to anchoring the anchor tab 120 to the patient's tissue. Is urged against the puncture site 15 in the vessel or otherwise fixed. The recoil member 1150 can be configured in any number of ways to provide an elastic member that recoils from a compression configuration to an expansion configuration, which can be a spring, elastic tube, elastic ring, arm, foam or It includes, but is not limited to, other elastic members and the like. For example, the recoil member 1150 can be formed from an elastic polymer, including but not limited to silicone or latex, from an elastic metal, or any combination thereof.
The anchor tab 120 is threaded through the recoil member 1150 or otherwise adjustablely coupled to it. When positioning the VCD100 within the vessel 10, the recoil member 1150 is positioned relative to the patient's skin surface 1152. The anchor tab 120, which extends from the VCD 100 through the patient's skin tissue 1154, is then secured in a relatively taut position with respect to the recoil member 1150. In one embodiment, the anchor tab 120 is secured in a taut state by the locking means 1156, which selectively locks the recoil member 1150 to the anchor tab 120 (or the pullstring extending from it). The locking means 1156 can operate to selectively secure overhand knots, clamps, tab and tooth assemblies, and / or recoil members 1150 in one or more positions along the anchor tab 120. It can be configured as other means, but is not limited to these.
FIG. 11B shows a partial view of the anchor tab 120 and the recoil member 1150, which is applied to the patient's skin 1152 but is in a loosened state. FIG. 11C shows a partial view of the anchor tab 120 that pulls the recoil member 1150 against the patient's skin and compresses the recoil member 1150 at least partially. The compression of the recoil member 1150 keeps the anchor tab 120 in tension and pulls the VCD100 proximally to the vascular wall, as shown in FIG. 11A. The recoil member 1150 described with respect to FIGS. 11A-11C can be used in any of the various embodiments described herein. Other means of fixing the VCD 100 in place, such as fixing the anchor tab 120 to the patient's skin, are also envisioned.
Method 600 can be terminated after block 645, delivering and immobilizing the VCD 100 intravascularly to or near the puncture site 15 to facilitate hemostasis at the puncture site. As discussed herein, after transplantation of VCD100, some or all of VCD100 may eventually be degraded and / or absorbed to reduce the content that remains in the vessel. This feature of VCD may be advantageous, for example, when the patient requires another intravascular procedure, for example to simplify subsequent access at or near the same vascular site.
In some cases, it may be desirable to remove the VCD from the vessel during or after transplantation, such as due to device failure, surgical complications, or any other reason. In one embodiment, the VCD with the perimeter support frame as described with respect to FIGS. 2-4J pulls the anchor tab and / or pullstring proximally while holding the delivery sheath in place, even after expansion. It can be recovered by. This proximal force pulls the VCD back against the distal end of the sheath. The extended support frame can optionally be formed from at least slightly flexible material so that it can be bent in any direction, thereby folding the VCD and recovering it through a sheath or other delivery system. .. The VCD, which is still in a folded configuration, is more easily recovered by simply pulling it proximally, either through the distal end of the sheath or directly through the puncture. It should be understood that additional guide wires or other guide devices can be passed through the delivery system to facilitate VCD recovery.
VCDs can be recovered using other methods and devices. For example, a hoof loop can be used to capture and grab the VCD and optionally fold the VCD prior to recovery. In another example, an elongated member, such as a wire or rod with a hook at the distal end, can be inserted into the vessel through, for example, a sheath and through the same puncture site where the VCD was delivered. The elongated member and its hooks secure at least part of the VCD (eg, part of the support frame, crosspiece support, anchor tabs, etc.), pull the VCD proximally and bend it to provide a sheath. It can be collected through.
After recovering the VCD, the same sheath can be used to retransmit the same or different VCD, or a new sheath can be inserted. The new sheath can be inserted on the guide wire inserted before removing the previous sheath, or on the anchor tab and / or pullstring extending through the puncture from the VCD before removal. .. In one embodiment in which an anchor tab and / or pullstring is used to deliver a subsequent sheath, by passing a needle or other low contour sleeve over the anchor tab and / or pullstring to deliver a new sheath. , Provide additional support. Other means of removing the expanded or folded VCD may be used. The above procedure is exemplary and not limited.
FIG. 8 shows an embodiment in which different techniques are performed during the deployment of the VCD100. After inserting the sheath 700 and before performing the intended intravascular procedure, or during the preparatory phase of the intravascular procedure, the compressed VCD100 is deployed into the vessel 10 to provide a compartment exposed to injury during the procedure. Preliminarily positioned within an alternative vessel 11 located proximal or distal to the puncture site 15, such as within a crossing vessel. For example, the compressed VCD100 can be positioned within the contralateral iliac artery. This is because the most vulnerable vessels are the compartment between the access point of the femoral or iliac artery and the aorta. However, in other embodiments, the VCD100 can be pre-positioned to any other vascular location. In another example, the VCD100 uses a known capture method with the anchor tab 120 and / or pullstring extending proximally from the VCD100 through the sheath 700 to the contralateral iliac artery (or). A separate lumen inserted into the other vessel) can be positioned directly into the contralateral iliac artery (or other vessel) through a smaller sheath. Preliminary positions of compressed VCD100 can be selected to avoid interference with ongoing intravascular procedures.
After pre-positioning to the proximal or distal vessel, the VCD100 is ready for rapid deployment, such as in a manner similar to that described with respect to FIG. Rapid deployment may be desirable during intravascular procedures such as incision or perforation of the vessel in the event of complications that can be fatal if not sealed. The VCD100 can be moved from the preliminary position of the vasculature and positioned at or near the puncture site 15 for rapid sealing.
According to another similar embodiment, the VCD100 is preliminarily delivered into the same vessel (eg, vessel 10 as shown in FIG. 8) and distanced distally or proximally from the puncture site 15. Can be left. When delivered to a preliminary location, the VCD100 can be extended to extended configurations as described herein. If the puncture site 15 needs to be sealed, pull the anchor tab 120 and / or pullstring proximally (eg through the delivery sheath 700), partially pass the VCD to the puncture site 15 and onto it. It can be positioned and the site 15 sealed. Preliminary placement of the VCD100 can be achieved with or without a containment mechanism.
9A-9I show an embodiment of an exemplary delivery system that delivers and positions a VCD into a patient's vessel or other body lumen. For example, a sending system can be used to perform some or all of the work of method 600 described with respect to FIG. Further, the sending system can be used to deliver any of the exemplary VCD embodiments described herein, but is not limited to the particular VCD embodiments described by way of illustration. In addition, the relative dimensions and shapes of the components illustrated in FIGS. 9A-9I (and any other figures herein) best represent the individual features and their spatial relationships and orientations relative to other features. Provided to show complete. Relative dimensions and shapes are not limited and other dimensions and shapes can be provided. As an example, the sheath 905 shown in FIG. 9A may be longer and / or narrower than those shown in some embodiments with respect to the overall size of the sheath.
In the embodiment shown in FIG. 9A, the delivery system includes an introducer sheath 905 that provides access to the inside of the vessel. The sheath 905 forms an internal flow path 910 between the proximal end 907 and the distal end 909 of the sheath 905. At or near the proximal end 907 is a port 915 that communicates fluid or gas with the internal flow path 910. A side hole 920 is formed in or near the distal end 909 of the sheath 905 to communicate fluid (gas or liquid) with the internal flow path 910 and thus with port 915. In one embodiment, one or more hemostatic valves 903 may be provided at or near the proximal end 907 of the sheath 905, which may be used to selectively access the internal flow path 910 of the sheath 905. it can. In one embodiment, the distal end 909 of the sheath 905 is formed at an angle to the length of the sheath 905. This can facilitate the achievement of the desired position of the VCD within the vessel. This can also help prevent its retreat by keeping the VCD at an angle during its delivery. In various embodiments, this angle may range between about 30 ° and about 90 ° with respect to the length of the sheath 905. However, in other embodiments, the distal end 909 does not have the angle as described above and is formed in another suitable geometry. For example, it can be conical, curved, diagonal, or right angle.
In one embodiment, the dilator 925 is also included in the delivery system to facilitate insertion of the sheath 905 into the vessel. 9A-1 and 9A-2 show the dilator 925 separately from the sheath 905, and FIG. 9B shows the dilator 925 inserted through the flow path 910 of the sheath 905 and exiting its distal end 909. When inserted into the sheath 905, the dilator 925 substantially seals the proximal end 907 of the sheath 905, which can optionally be facilitated by a hemostatic valve 903 integrated with it.
In one embodiment, the distal end 926 of the dilator 925 is formed in a substantially conical shape, which reaches the maximum outer diameter at or near location 923 along the dilator 925. The diameter of the dilator at this location 923 is approximately the same as, slightly smaller than, or larger than the inner diameter of the introducer sheath flow path 910, providing a tight fit of the dilator 925 within the flow path 910 or sheath 905. A tight fit achieves sealing of the distal end 909 of the sheath 905 when the dilator 925 extends through it, as shown in FIG. 9B and described with respect to it.
In one embodiment, the dilator 925 has an outer diameter that gradually diminishes in the proximal direction, starting at location 924, which is proximal to location 923 along the dilator 925. For example, in one embodiment, the reduced diameter of the dilator is reduced by at least about 0.05 mm from the maximum outer diameter of area 923, eg, from about 0.05 mm to about 2.5 mm, or from about 0.1 mm to about 1 mm. The location of 924 where the stepwise diminishing outer diameter of the dilator 925 occurs is that when the dilator 925 is inserted into the sheath 905 by a predetermined amount, the area 924 is between the side hole 920 and the distal end of the sheath 905. Is determined to be oriented to. Thus, as mentioned above, blood can flow proximally into the flow path 910 towards the exit port 915 through the side hole 920, while still sealing at the distal end 909 of the sheath 905. Achieve a stop. In some embodiments, the distance between areas 923 and 924 corresponds to an area on one side of the sheath 905 that is larger than the other, such as when the distal end 909 of the sheath 905 is tilted. May need to be done. The distal end 926 of the dilator 925 can be formed into any other suitable shape if desired.
In one embodiment, there is fluid communication between the side hole 920 and the port 915 even after inserting the dilator 925 through the sheath 905. With such fluid communication, it is possible to detect when the side hole 920 was inserted into or removed from the vessel. This is because, as mentioned with respect to FIG. 6, when exposed to bloodstream, blood (or other fluid) flows into the side hole 920 and exits port 915 through flow path 910. Therefore, the side holes 920 and port 915 facilitate the detection of the insertion depth of the sending system. In one embodiment, fluid communication between the side hole 920 and the port 915 is provided by the difference between the outer diameter of the dilator 925 and the inner diameter of the sheath flow path 910. However, in other embodiments, the groove or flow path formed along the dilator 925 has an outer diameter that is not significantly different from the inner diameter of the sheath flow path 910 and therefore, when properly positioned, the groove or flow path. Is aligned with both side holes 920 and port 915. In another embodiment, a groove or other flow path is formed in the inner surface of the inner flow path 910 of the sheath 905 rather than in the dilator 925. In yet another embodiment, the sheath 905 and / or the expander 925 includes a passage that is integrally formed to provide fluid communication between the side hole 920 and the port 915.
In one embodiment, the dilator 925 further comprises at least one lumen 930 extending along its length through which a guide wire or other instrument can pass. For example, the lumen 930 can have an outer diameter or contoured guide wire or other inner diameter, such as in the range of about 0.1 mm to about 1 mm, 0.9 mm in one embodiment. One or more lumens 930 formed through the dilator can be sized to accommodate larger or smaller instruments than those provided as usual, which is the procedure to be performed and / or the patient. May be determined by the anatomy of the. The above dimensions are exemplary and not limited.
Thus, FIG. 9B shows an dilator 925 inserted into the internal flow path 910 of the sheath 905 and represents an embodiment of an arrangement configuration used to deliver the sheath 905 into the patient's vascular tube. In one embodiment, the sheath 905 shown in FIGS. 9A-9I is a different sheath than that used to perform intravascular procedures, whereby the sheath 905 that delivers the VCD contains specific features in VCD delivery. be able to. However, in other embodiments, the sheath used to deliver the VCD is the same sheath used to perform subsequent intravascular procedures.
The sheath 905 and dilator 925 are inserted into the vessel and the dilator 925 is removed after achieving the desired positioning based on blood flow through the side holes 920 and port 915. In other embodiments, one or more markers may be included on the sheath 905 instead of or in addition to the side holes 920 and port 915 to determine the insertion depth of the delivery system. With the dilator 925 removed, the sheath 905 is ready to load the VCD for delivery.
In one embodiment, one or more additional external sleeves 927 are included in the delivery system, as shown in FIG. 9I. The outer sleeve 927 is sized to have an inner diameter equal to or slightly larger than the outer diameter of the sheath 905 to provide a tight fit of the outer sleeve 927 on the sheath 905. Each outer sleeve 927 can have a different wall thickness, resulting in a different outer diameter for each outer sleeve 927. In one embodiment, each outer sleeve 927 also includes means for achieving proper alignment between the sleeve side hole 929 and the sleeve side hole 929 and the sheath 905 side hole 920. The side holes 920 and port 915 of the sheath 905 can continue to be used through the holes 929 on the side of the sleeve. In one embodiment, the distal edge of each outer sleeve 927 is formed with a tapered end 928 that tapers towards the distal end 909 of the sheath 905. The tapered end 928 minimizes trauma to the vessel during use.
Therefore, different sized outer sleeves 927 allow the same sheath 905 to be used for different puncture sizes through the vessel. Each outer sleeve 927 is sized to have a different puncture size, effectively changing the outer diameter of the delivery system indiscriminately. In one embodiment, the VCD is sized to fit a puncture in the range of about 12 Fr to about 21 Fr. However, a 12 Fr compatible sheath 905 can lead to unwanted blood leaks when intended for use after procedures using a 21 Fr sheath and similar sized puncture sites. Therefore, with the additional outer sleeve 927 included, the VCD delivery sheath 905 should be sized to have the desired minimum outer diameter (eg, 12 Fr in one embodiment, but even smaller in other embodiments). On the other hand, the outer sleeve 927 allows the overall outer diameter of the delivery system to be adjusted for use in procedures that produce larger punctures. For example, for the above scenarios, an outer sleeve 927 that increases the overall diameter of the 12Fr size sheath 905 can be added to the 21Fr size puncture site, thereby unwanted leakage after delivery of the delivery system including the outer sleeve 927. To prevent.
In certain embodiments, the outer sleeve 927 is made of a flexible material and / or is relatively soft compared to the material of the sheath 905. In yet another embodiment, different outer sleeves 927 can be formed from materials with different stiffness, which may vary according to the size of the sleeve. For example, in an exemplary embodiment, an adapter that works with a 21 Fr sleeve 927 may be significantly stiffer than an adapter that works with a 14 Fr sleeve 927. Therefore, an assembly containing an outer sleeve 927 that fits a 21 Fr adapter can increase stiffness, which may also be required when inserting a larger sheath into the vessel. In other embodiments, the stiffness or stiffness of the outer sleeve 927 varies along its length.
In various embodiments, the outer sleeve 927 is supplied with the VCD, delivery system, VCD and delivery system kit, either as a separate set of outer sleeves 927 or in individual sterile packages. In one embodiment, each different outer sleeve 927 and / or its package includes markings or other identifiers (eg, color, shape, label, etc.) so that the various sleeve sizes can be easily identified.
According to yet another embodiment as shown in FIGS. 9H-9I, the sheath 905 further comprises one or more holes or passages, which allows blood to flow through the distal end of the sheath 905. .. In some situations, the distal end 909 of the sheath 905 may have, for example, the inner diameter of the vessel after insertion being similar to, or slightly smaller than, the diameter of the sheath 905, or such a diameter. Can be sized to occupy a significant area within the vessel, such as. Such size constraints may derive from the original vessel diameter, which is similar to the outer diameter of the sheath, or the vessel is the physical pressure the sheath exerts on the access point of the vessel, vascular spasm. , Reduced blood flow, and / or thrombi formed by reduced blood flow may result in smaller diameters. In these cases, insertion of the sheath 905 reduces, partially blocks, or completely impedes blood flow through the vasculature at or near the sheath 905 and / or distal to the sheath 905. May be blocked. For example, blocking blood flow from the proximal vasculature 18 of the sheath 905 (as shown in FIG. 9I) can cause a decrease in vascular diameter of the distal vasculature 17 of the sheath. Decreased blood flow can cause any of several clinical side effects, including, but not limited to, ischemia of distal organs or tissues, thrombus formation, or vascular collapse on the distal side of sheath 905. There is. In addition, the reduced diameter may increase the difficulty of positioning the VCD within the vessel.
To minimize this and other possible complications, one or more holes or other passages are formed at or near the distal end 909 of the sheath 905. According to the embodiment shown in FIG. 9H, the distal end 909 of the sheath 905 extends through one side of the wall of the sheath 905, a hole 921 in the first row, and approximately the opposite side of the wall of the sheath 905. Includes a second row of holes 922 extending through. In one embodiment, the holes 921 in the first row correspond to the holes 922 in the second row, but in other embodiments, the number of holes 921, 922 in the first and second rows and / Or the alignment of the holes may change. For example, the number and orientation of holes can be selected to provide the desired blood flow, which can increase the rate of blood flow through the sheath as the number of holes in the vessel increases. However, in other embodiments, there only needs to be one hole selected from the holes 921 in the first row or the holes 922 in the second row. For example, there may be one hole 921 (eg, one on the distal side 17 of the sheath 905 if it is in the vessel), which allows blood to pass through the distal end 909 of the sheath of the sheath 905. It can flow out of one hole 921. Further, in another embodiment, for example, the side holes 920 shown in FIGS. 9A-9I can serve as one or more holes through which blood can flow through the sheath 905. With reference to FIG. 9I, a sheath 905 is illustrated that includes a hole 921 in the first row and a hole 922 in the second row and is inserted into the vessel 10 through the access site 15. In this example, blood flows within the vessel 10 from the proximal side 18 of the sheath 905 to the distal side 17 of the sheath 905. To prevent obstruction or diminished blood flow, blood flows into the sheath 905 through holes 922 in the second row and exits through holes 921 in the first row.
In one embodiment, internal members such as tubes, rods, or dilators are used to selectively seal one or more of the holes 921 in the first row and / or the holes 922 in the second row. Thus, some holes 921, 922 can be selectively kept open and the other holes 921, 922 can be kept closed. When the sheath 905 is positioned within the vessel 10, it may be desirable to selectively seal the holes 921, 922 if some of the holes 921, 922 are inside the vessel and some are outside the vessel. This allows the holes on the outside of the vessel to be sealed to prevent blood loss.
In one embodiment, the method of delivering the VCD is such that the sheath 905 is positioned within the vessel 10 to have acceptable blood flow levels and / or the inner diameter of the vessel 10 is acceptable prior to delivery of the VCD. It can include the step of inspecting for the correct size. For example, the examination is performed by introducing a contrast medium through the sheath 905 and visualizing the passage of the contrast medium to the distal side 17 of the vessel (by known means of visualizing flow and / or material in the vessel). Can be executed. In addition, to further reduce vascular restriction and / or occlusion, vasodilators that treat vasospasm or vasodilation can be delivered at any stage of the delivery procedure, which is nitroglycerin, papaverine. However, it is not limited to these.
FIG. 9C-1 shows an embodiment including a VCD loading tube 935 containing a VCD100, and FIG. 9C-2 shows an embodiment including an actuator handle 940 containing a loading tube 935 that facilitates delivery and release of the VCD100. Shown. The loading tube 935 forms a flow path into which the VCD 100 is loaded. In one embodiment, the loading tube 935 includes a proximal rim 937 (or other member) extending radially at or near its proximal end, which is the sheath 905, as described with respect to FIG. 9D. It acts to suppress the loading tube 935 during insertion into. However, the rim may not be needed if the loading tube forms a sufficient tight fit within the sheath 905 (eg at the hemostatic valve 903) so that the loading tube 935 stays in place during delivery, for example. ..
The VCD100 may be any VCD described herein. In this embodiment, the VCD100 includes a containment mechanism having at least an anchor tab 120 and / or a pullstring, and a release wire, both of which pass through the actuator handle 940 and are operably integrated with it. As shown, the VCD100 is loaded into the loading tube 935, such as in a rolled configuration or other folding configuration. The VCD100 can be preloaded during manufacturing and / or packaging prior to delivery, or can be loaded into the loading tube 935 by the operator as part of the delivery procedure. Upon loading, the anchor tab 120 and / or pullstring extends proximally from the loading tube 935. The containment mechanism may be any suitable containment mechanism described herein. The release wire 945 may be one or more wires or other members that can be operated to selectively release the containment mechanism and allow expansion of the VCD100, which is determined by the design and operation of the containment mechanism. be able to.
Insert the loading tube 935 into the actuator handle 940 so that the loading tube 935 extends at least partially from the distal end 955 of the actuator handle 940, as shown in FIG. 9C-2. The loading tube 935 can be preloaded into the actuator handle 940 before the operator initiates the delivery procedure (eg, it can be inserted during the manufacture, assembly, or packaging of the VCD system). Alternatively, the surgeon can insert the loading tube into the actuator handle as part of the delivery procedure.
FIG. 9D shows the actuator handle 940 and loading tube 935 in use with the sheath 905 described with respect to FIGS. 9A-9B, which is the dilator after the sheath 905 has been inserted and placed in the vessel and when used. Executed after removing 925. The distal end 955 of the actuator handle 940 can optionally include a first elongated slot 943 defined along a portion of its length from the proximal end of the actuator handle 940 to at least some midpoint. The first elongated slot allows the actuating mechanism 950, described in more detail with respect to FIGS. 9E-9F, to slide distally towards the vessel during the delivery procedure to advance the push rod 947. The elongated slot 943 controls the movement of the push rod 947 to be substantially linear and serves to prevent the VCD100 from rotating during delivery. In addition, the actuator handle 940 can optionally include a second slot 949 extending from its distal end 955. The second slot 949 is shaped to receive the exit port 915 of the delivery sheath 905 if included. Further, as shown in FIG. 9D, the aligned alignment of the second slot 949 with the outlet port 915 allows the surgeon to accurately orient the movement of the VCD 100 from the loading tube 935 into the sheath 905. However, other embodiments use other means including, but not limited to, alignment pins, slots and / or markings to ensure accurate orientation between the inducer sheath 905 and the loading tube 935. be able to.
If the hemostatic valve 903 is provided on the sheath 905, inserting the loading tube 935 distally into the sheath 905 forces the hemostatic valve to open, providing selective access within the flow path 910 of the sheath 905. Referring to FIG. 9D, the loading tube 935 is advanced into the proximal end 907 of the sheath 905. In one embodiment, the loading tube 935 seals within the proximal end 907 and stays in place due to its shape and / or tight fit.
The actuator handle 940 includes a push rod 947 that is slidably enclosed within the body of the actuator handle 940 and operably attached to the actuating mechanism 950. The push rod 947 is used to advance the VCD100 distally out of the loading tube 935 and into the internal flow path 910 of the sheath 905. The surgeon advances the push rod 947 by grasping the safety grip 960 and sliding it distally through the first elongated slot 943.
The push rod 947 then continues to advance distally through the actuator handle 940 and sheath 905, pushing it through sheath 905 until VCD100 exits distal end 909, as shown in FIG. 9E. The VCD100 remains in the folded configuration until the containment mechanism and release wire 945 are released. At this stage, the surgeon can locate the implant using any suitable imaging technique, including, but not limited to, a polarizing device or ultrasound. Anchor tabs 120 and / or pullstrings attached to the VCD100, extending proximally through the delivery mechanism, can also be used to position the VCD100.
FIG. 9F shows an embodiment of the operation of the transmission mechanism while releasing the VCD100. First, the safety grip 960 of the actuating mechanism 950 is removed, which prevents unintended actuation of the containment release mechanism (eg, the loop cage pin mentioned with respect to FIG. 3D) when in place. The surgeon then proceeds to remove the sheath 905 and actuator handle 940 proximally from the vessel, which in turn pulls the anchor tab 120 and / or pullstring to position the VCD100 near the puncture site. The sheath 905 is pulled proximally to position the VCD100 with respect to the vessel wall, increasing resistance to the spring in the actuating mechanism. This is because the release wire 945 is attached to the actuating mechanism 950. Increased spring compression as the sheath 905 and actuator handle 940 are pulled proximally indicates that the VCD100 is well positioned against the vascular wall and is ready to expand. In one embodiment, pulling the sheath 905 and actuator handle 940 in the proximal direction, combined with the resistance of the VCD100 to be pulled against the vessel, creates a sufficiently large tension, resulting in the position of the actuating mechanism. It changes and thus the containment mechanism (eg loop holding pin) is released. For example, with respect to the containment mechanism described with respect to FIG. 3D, when tension increases, the loop holding pin 340 moves proximally until the looped end 339 is released from the cage pin 340, causing the loop 335 to move from around the VCD100. release. The spring can be operably included in the actuating mechanism 950 to increase the force required to actuate the provided mechanism and prevent pre-release of the implant. In another embodiment, the release wire 945 (or release of another containment mechanism) is provided by the surgeon or by any other suitable means, such as various exemplary containment mechanism embodiments described herein. Release manually or selectively.
Therefore, when the containment mechanism is released, the VCD100 expands and is positioned with respect to the vascular wall at or near the puncture site, which extends to a pre-shaped configuration or to a natural stable state. This is partly due to the supporting frame. After dilation, the surgeon can terminate the procedure by anchoring the anchor tab 120 and / or pullstring to the patient's tissue.
The transmission system described with respect to FIGS. 9A-9I can be appropriately configured to transmit any VCD embodiment described herein. The combination of features is described for the purpose of illustration only and is not limited.
10A-10P show the features of additional sending systems that can be configured in the sending system described herein. FIG. 10A includes an embodiment of the push rod 1005 as described with respect to FIGS. 6 and 7A-7C, including a tip 1007 curved to the distal end. The curved tip 1007, according to one embodiment, curves or tilts in the direction facing the vascular puncture site 15, which separates from the vascular puncture site 15 against the opposite side of the vascular 10 It punctures the folded VCD100 and works to avoid retreat by the VCD100. However, in other embodiments, the curved tip 1007 can have a different configuration, such as the oppositely inclined tip shown in FIG. 10A, or a substantially straight tip. In yet another embodiment, the sheath and / or actuator handle as described with respect to FIGS. 9A-9I includes a similarly formed and curved tip.
10B-10D show another embodiment of the push rod. In this embodiment, the push rod 1010 includes at least one urging member 1012 extending from its distal end. The urging member 1012 urges one end of the VCD100 away from the push rod 1010 and thus from the puncture site 15. FIG. 10B shows the angle formed between the VCD 100 and the push rod 1010 caused by the urging member 1012. The angle formed and the distance generated are such that at least one end of the VCD100 is separated from the puncture site 15 and the distal end of the push rod 1010 and sheath while the VCD100 is positioned within the vessel 10. Must be large enough. Otherwise, the VCD100 may retreat from the puncture site 15 and not be properly positioned within the vessel 10. The urging member 1012 shown in FIG. 10B is fixed to or near the distal end of the push rod 1010 and is formed as a vent strip that exerts a force on the VCD 100 but is not attached to it. 10C-10D show other possible shapes of the urging member 1012, which include the "S" shaped urging member 1012 and the "C" shaped urging member 1012, respectively. Any other suitable urging member capable of urging the VCD 100 away from the puncture site 15 can be provided. Typical examples of other bias members include springs, elastic arms and the like.
10E-10G show an additional embodiment of a delivery system that includes a push rod or a delivery sheath with a protective member extending radially from itself. The protective member can act to prevent the VCD from retreating during delivery and entering the vascular puncture. The protective member can be in the form of an annular ring. For example, FIG. 10E shows an embodiment in which the sheath 1020 comprises a protective member 1022 configured as a flexible annular ring extending radially from the vicinity of the distal end of the sheath 1020. In one embodiment, the protective member 1022 is selectively constrained by a collar, holding tab, or the like so that the protective member 1022 remains bent or otherwise unexpanded until it enters the vessel 10. Can be done. Since the protective member 1022 can have a diameter similar to or larger than the diameter of the vascular puncture site 15, the surgeon feels resistance during extraction of sheath 1020, thus resistance is described with respect to FIG. 7D. As such, accurate positioning of the sheath 1020 can be assisted, for example to align side holes or other sheath features. When positioned relative to the wall of the vessel 10, the protective member 1022 also serves to temporarily seal at least a portion of the vessel puncture site 15. With the protective member 1022 in contact with the vascular puncture site 15, the VCD100 can be retracted to the desired position. This is because no part of the VCD100 extends into the puncture and does not interfere with accurate positioning when its distal or proximal end attempts to approach the puncture site 15. In addition, the at least partial encapsulation provided by protective member 1022 reduces or limits significant bleeding from the vessel 10 while positioning the VCD100.
According to another embodiment, the protective member is integrated with the push rod device at or near its distal end in the same or similar manner as described with respect to FIG. 10E, or as follows. Alternatively, it can be configured by other methods. 10F-10G show a sheath 1025 that is contained within itself and has a push rod 1030 that includes a protective member 1032. The protective member 1032 of this embodiment is constructed of an elastic material such as an elastic polymer, which, when released from the sheath 1025, expands the protective member 1032 into an extended configuration (eg, a ring as shown in the figure in one embodiment). Then, it can extend radially from the push rod 1030. FIG. 10F shows an embodiment in which the protective member 1032 is folded into the sheath 1025 and bent around the push rod 1030 towards its proximal end. FIG. 10G shows another embodiment of the protective member 1032 loaded within the sheath 1025, where the protective member 1032 is bent towards the distal end of the push rod 1030.
The protective member described herein can be formed from one or a combination of flexible or elastic polymers as described with respect to FIG.
In one embodiment, the protective member is formed from a thin membrane and one or more expandable or elastic members can be coupled to it and act to expand radially when the protective member is released into the vessel. Is. For example, each elastic member can be configured as an elastic or superelastic wire, ribbon, or net, which is a nickel-titanium alloy, stainless steel, superelastic polymer, or any other suitable as described with respect to FIG. It can be formed from materials such as, but not limited to, elastic or expandable materials, or any combination thereof.
10H-10I show another embodiment of the protective member. In this embodiment, the delivery system includes a sheath 1025, a push rod 1040, and an inflatable protective member 1042 integrated with the push rod 1040. The inflatable protective member 1042 can be formed in a ring shape extending radially from the push rod 1040, or in any other one or more shapes. After exiting the sheath 1025 as shown in FIG. 10I, the inflatable protective member 1042 inflates by forcing a salt solution or other suitable fluid through the filling flow path 1044, which extends the push rod 1040. It passes in the direction, communicates fluidly with the internal space of the inflatable protective member 1042, and enters it. After positioning and fixing the VCD in the vessel, the inflatable protective member 1042 shrinks and is removed with the push rod 1040.
10H-10I show an inflatable protective member 1042 having a ring or annular shape. In other embodiments, the inflatable protective member 1042 is formed to have a different shape. Examples of such other shapes include quadrilaterals, rectangles, triangles, or other polygons. In other cases, the protective member may be in the form of a plurality of protruding arms or the like. Further, in embodiments configured such that the sheath 1025 and / or the push rod 1040 is inserted into the vessel at an angle, an inflatable protective member 1042 is attached to the push rod 1040 at an angle that compensates for the tilted insertion. be able to. Similar orientation adjustments can be performed for any of the other protective member embodiments described herein to accommodate various insertion angles or alternative uses.
FIG. 10J shows an embodiment of a delivery system that delivers an articulated VCD, such as the articulated VCD562 described with respect to FIG. 5E. In this embodiment, the articulated VCD562, including two radial support frames 570, 575 connected by at least one joint 580, is in a compressed form a push rod 1055 that is at least partially bent along the joint 580. Alternatively, it is delivered through the delivery sheath 1050 by the actuator handle. The VCD562 of this embodiment further includes a containment mechanism having members 1057, 1059 that hold the respective radial support frames 570, 575 in a foldable configuration so as to be releasable. In one embodiment, the containment mechanism members 1057, 1059 are selectively releaseable containment loops extending from the individual releaseable members 1056, 1058, respectively. As the articular VCD562 exits the sheath 1050, the joint 580 straightens and extends two radial support frames 570, 575 within the vessel. After positioning with the anchor tab 120 and / or pull wire or the like, as shown in FIG. 5E, the members 1057, 1059 are released from the periphery of the radial support frames 570, 575, and the radial support frames 570, 575 are expanded. The articulated VCD562 is released and becomes an expanded configuration.
10K-10M show another embodiment of deploying an articulated VCD562 (or any other VCD embodiment described herein) that includes additional means of maneuvering the articulated VCD562 into place. Is shown. In this embodiment, the articulated VCD562 is one or more rings 1060 or other flow path demarcation coupled to a sealing membrane 565 extending to one or both of the radial support frames 570, 575 and / or between them. Including members. In one embodiment, each ring 1060 is positioned proximally along the vertical axis of the articular VCD562. The articular VCD101 can receive appropriate guidance by means of one or more rings 1060. One embodiment of such a guiding means is two guide wires 1062 capable of guiding each of the two radial support frames 570, 575 to an appropriate position in the vessel, as shown in FIGS. 10K-10M. , 1064. In embodiments that use guide wires 1062, 1064, or any other guide means that passes through one or more rings 1060, the junction 580 can be optionally removed. This is because the two radial support frames 570, 575 can be separated and positioned within the vessel using guide wires 1062, 1064. However, in another embodiment, the junction 580 is used in addition to the guiding means to facilitate deployment and further support the sealing membrane 565.
At the time of use, according to one embodiment, after the end of the intravascular procedure, two guide wires 1062, 1064 are inserted through the sheath 1050, one of which is far from the access site of the vessel 10. It extends in the direction of the position and the other extends in the proximal direction. Next, as shown in FIG. 10L, the compressed articulated VCD562 is loaded into the sheath 1050 with the guide wires 1062 and 1064 passed through the ring 1060. FIG. 10M depicts an articular VCD562 extending longitudinally in the vessel on either side of the puncture site after being released from the sheath 1050. Finally, the guide wires 1062, 1064 are removed to release the containment mechanism (any suitable containment mechanism described herein) from the two radial support frames 570, 575. This allows the articular VCD562 to expand sufficiently within the vessel 10 and the sealing membrane 565 to be pressed against the puncture site to facilitate hemostasis.
10N-10P show examples of other embodiments of the delivery system that release the containment mechanism, thereby allowing the VCD to expand radially within the vessel. The delivery system can be used with any VCD embodiment described herein and with any containment mechanism that includes one or more releasable members. Referring to FIG. 10N, a VCD such as the VCD100 described with respect to FIG. 2 is held in a compression configuration by a containment mechanism including a wire loop 1070 (or any other looped member) and the wire loop is broken. Release loop 1070 to allow VCD100 to expand intravascularly. The wire loop 1070 has a first end 1072, which is passed through the distal end of the delivery sheath 1075 and enters the distal end of the needle-cut tube 1080. The second end 1074 of the wire loop 1070 is threaded through a side hole 1076 formed within the sheath 1075, which may be the same as or different from the side hole described with respect to FIG. 9A. .. After passing through the side hole 1076, the second end 1074 of the wire loop 1070 is passed into the distal end of the cutting tube 1080. The cutting tube 1080, which has an outer diameter slightly smaller than the inner diameter of the sheath 1075, is sharp and can operate to cut the second end 1074 of the wire loop 1070 when passed by the side hole 1076. It has at least one blade at its distal end.
FIG. 10O shows another embodiment of a delivery system that is capable of operating to cut the second end 1074 of the wire loop 1070. In this embodiment, the sheath 1085 has its distal end closed, but has one hole 1087, which is sized to allow the folded VCD100 and wire loop 1070 ends 1072, 1074 to pass through itself. However, it provides a cutting surface 1089 that has a diameter smaller than the outer diameter of the cutting tube 1080 and receives the sharp edge of the cutting tube 1080. The sheath 1085 is manufactured with only one hole 1087, or has a hole 1087 formed through itself and is subsequently fitted with a separate flat stopper that can be fixed to the distal end of the sheath 1085. Can be sealed.
During operation, the first end 1072 is passed through the flow path of the cutting tube 1080 and the second end 1074 is passed outside the cutting tube 1080 between its outer surface and the inner surface of the sheath 1085. Shear force cuts the second end 1074 by pressing the sharp blade of the cutting tube 1080 against the cutting surface 1089 at the end of the sheath 1085. Cutting the second end 1074 of the wire loop 1070 in any of these embodiments releases the containment mechanism and allows the VCD100 to expand from its compressed state.
FIG. 10P shows yet another embodiment of a delivery system that can operate to release the containment mechanism of the VCD100. In this embodiment, the VCD100 is held folded by a wire loop 1090 (or other strip, string, or other member, etc.). One end of the wire loop 1090 is secured to the push rod 1095 or actuator handle (eg, fastened, glued, internally formed, or otherwise attached). The opposite end of the wire loop 1090 includes a ring, hole, or loop 1092 and is passed through a flow path 1094 formed on the side wall of the push rod 1095. The wire loop 1090 is stretched or otherwise held in a taut configuration to keep the VCD100 in a folded configuration. The release rod 1097, immovably fixed to the sheath 1099 (eg, inserted into the inner wall of the sheath 1099 or otherwise attached), is first positioned through a ring, hole, or loop 1092 and then positioned. Hold the wire loop 1090 in a taut configuration.
In use, pulling the release rod 1097 out of the ring, hole, or loop 1092 at the second end of the wire loop 1090, while retracting the sheath 1099 and leaving the push rod 1095 in the puncture, hangs on the wire loop 1090. The tension is released. After extracting the release rod 1097 and releasing the wire loop 1090, the push rod 1095 is also retracted from the vascular puncture. Since the wire loop 1090 is fixed to the push rod 1095 and is no longer held in place by the release rod 1097, the wire loop 1090 releases the VCD100, allowing the VCD100 to expand. In one embodiment, the anchor tab 120 and / or pullstring remains connected to the VCD100, which can be used to facilitate positioning of the VCD100 within the vessel and to be fixed to the patient if desired.
The VCDs and associated delivery systems described herein are advantageous because they provide a means of at least temporarily closing or otherwise sealing the puncture of the patient's vascular or other body lumen. .. Faster and more effective sealing is advantageous because it eliminates the time and expense of manually applying pressure to the puncture, otherwise required by conventional methods. The various support frames and sealing membranes disclosed effectively hold the closure device in the vessel, while requiring less additional surgical intervention by the surgeon during delivery. In addition, the embodiments described herein are capable of folding the VCD into significantly smaller contours during delivery, thus avoiding unnecessary enlargement of vascular puncture. Similarly, since exemplary VCDs can be deployed through various sheath configurations, some embodiments are more than those currently available, as in the case of sheaths used during cardiac catheterization procedures. It is even more advantageous to use with access to small sheaths.
Modifications and modifications of the devices, systems, and methods described herein, such as variations in dimensions, size and / or shape, are apparent to those skilled in the art from the above detailed description, as described above and many other advantages. Is understood to be. Such modifications and modifications shall fall within the scope of the claims.
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Every citation, both ways
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| WO2008094706A2 | Cites | World Intellectual Property Organization (WIPO) |
| JP2002513308A | Cites | Japan |
| JP2001046509A | Cites | Japan |
| JP11347130A | Cites | Japan |
| US05383897A | Cites | United States of America |
| US06395015B1 | Cites | United States of America |
| JP2001346799A | Cites | Japan |
| JP2008502378A | Cites | Japan |
19 members in 11 offices
Priority claims14
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| CA2774279A1 | Canada | A1 | |
| WO2011046932A2 | World Intellectual Property Organization (WIPO) | A2 | |
| WO2011046932A3 | World Intellectual Property Organization (WIPO) | A3 | |
| AU2010306984A1 | Australia | A1 | |
| CN102573660A | China | A | |
| EP2488109A2 | European Patent Office (EPO) | A2 | |
| JP2013507229A | Japan | A | |
| NZ598720A | New Zealand | A | |
| RU2012117529A | Russian Federation | A | |
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Numbers
- Publication
- 5992829
- Publication, DOCDB
- 5992829
- Publication, EPODOC
- JP5992829B
- Application
- 2012534284
- Application, DOCDB
- 2012534284
- Application, EPODOC
- JP20120534284
Titles2
- Japanese
- 脈管構造閉鎖デバイス及び方法
- English
- Vascular closure devices and methods
Classification
- CPC, 11
- A61B17/0057
- A61B17/0625
- A61B2017/00004
- A61B2017/00592
- A61B2017/00597
- A61B2017/0061
- A61B2017/00615
- A61B2017/00623
- A61B2017/00628
- A61B2017/00659
- A61B2017/00867
- IPC, 2
- A61B17 12
- A61M29 02
