US20010049552A1 - Bifurcated stent with improved side branch aperture and method of making same - Google Patents

Abstract

A bifurcated stent for insertion into a bifurcated vessel such as a blood vessel. In one embodiment, a first sheet is formed into a first leg, a second sheet is formed into a second leg, a third sheet is formed into a stem, and the two legs are attached to the stem. In a second embodiment, a first sheet is formed into a member having a first leg and half of a stem, a second sheet is formed into a second member having a second leg and half of a stem, and the two stem halves are combined to form the bifurcated stent. In a third embodiment, the stent comprises two sections that are serially inserted and assembled within the vessel at the site of the bifurcation to be treated.

Description

FIELD OF THE INVENTION
• The present invention relates to stents, and more particularly to bifurcated stents and methods of making bifurcated stents for insertion within a branching vessel.[0001]
BACKGROUND OF THE INVENTION
• Stents are well known in the art. They are typically formed of a cylindrical metal mesh which can expand when pressure is internally applied. Alternatively, they can be formed of wire wrapped into a cylindrical shape or sheets of material formed into a cylindrical shape.[0002]
• Stents are devices which are usually implanted within bodily conduits including the vascular system to reinforce collapsing, partially occluded, weakened, or abnormally dilated sections of the blood vessel. Stents also have been successfully implanted in other areas, e.g., the urinary tract or the bile duct to reinforce such bodily conduits.[0003]
• U.S. Pat. No. 4,994,071 (MacGregor) discloses an expandable, bifurcating stent having a main cylindrical lattice formed from interconnected flexible wire. Two additional cylindrical lattices, having smaller diameters than the main lattice, are similarly constructed. The main lattice includes a flexible wire interconnecting the main lattice to one of the additional lattices. A second flexible wire interconnects the main lattice to the other additional lattice. The flexible wires form backbones that extend axially along the length of the main lattice and along each of the additional lattices. One disadvantage of this bifurcating stent is the complex nature of the interconnection of the flexible wires forming the backbones with the loop structure of each lattice.[0004]
SUMMARY OF THE INVETNION
• The present invention solves these and other disadvantages of the prior art by providing bifurcated stents and methods of fabricating and deploying bifurcated stents having a stem portion and two leg portions.[0005]
• In a first embodiment of the invention, a bifurcated stent is made by providing three sheets patterned to a desired pattern, wherein two sheets are substantially the same size and the third sheet is wider than either of the first two sheets. Each of the sheets is formed into tubes by turning up the longitudinal edges and forming a joint by welding. The larger sheet forms a tube that acts as the stem portion of the bifurcated stent and the other sheets form tubes which act as the leg portions of the bifurcated stent. The two leg portions are then joined to the stem portion to form the bifurcated stent.[0006]
• In a second embodiment of the invention, the bifurcated stent is formed by preparing two stent sheets. For each sheet, the longitudinal edges of a portion of the sheet are turned up and secured to each other to form one of the two leg portions of the bifurcated stent. The remaining free edges of each of the two sheets are then joined to form the stem portion of the stent.[0007]
• In a third embodiment, the bifurcated stent comprises first and second tubular portions. The first portion has a proximal end which forms the stem portion and a distal end which forms one of the leg portions of the bifurcated stent. A branch aperture is disposed between the proximal end and the distal end of the first portion. The second portion is introduced into the longitudinal bore of the stem portion of the first portion and is advanced through the branch aperture so that it protrudes beyond the branch aperture to form a second leg. When the second portion is expanded, the proximal end of the second portion engages the material defining the branch aperture so as to secure the second leg in the desired position.[0008]
• It is an object of this invention to provide a method of making a bifurcated stent, comprising the steps of: a) preparing a first sheet having a first edge, a second edge, a third edge, and a fourth edge; b) preparing a second sheet having a first edge, a second edge, a third edge, and a fourth edge; c) preparing a third sheet having a first edge, a second edge, a third edge, and a fourth edge; d) attaching the second edge to the third edge of the first sheet to form a tubular first leg portion having a proximal end and a distal end; e) attaching the second edge to the third edge of the second sheet to form a tubular second leg portion having a proximal end and a distal end; f) attaching the second edge to the third edge of the third sheet to form a tubular stem portion having a proximal end and a distal end; and g) attaching the proximal end of the first leg portion and the proximal end of the second leg portion to the distal end of the stem portion.[0009]
• It is another object of this invention to provide a method of making a bifurcated stent, comprising the steps of a) preparing a first sheet having a proximal end and a distal end; b) deforming the distal end of the first sheet to form a first leg and deforming the proximal end of the first sheet to form a first stem half; c) preparing a second sheet having a proximal end and a distal end; d) deforming the distal end of the second sheet to form a second leg and deforming the proximal end Of the second sheet to form a second stem half; and e) joining the first stem half to the second stem half to form a stem.[0010]
• It is yet another object of this invention to provide a method of making a bifurcated stent comprising the steps of a) preparing a first expandable tubular member having a proximal end and a distal end and a longitudinal bore therethrough, the first tubular member provided with a branch aperture disposed between said proximal end and the distal end, the branch aperture communicating with said longitudinal bore and the aperture sized and adapted to receive and secure a second expandable tubular member; b) delivering the first expandable tubular member to a bifurcated vessel having a first lumen and a second lumen so that the first expandable member is disposed within the first lumen and the branch aperture communicates with the second lumen; c) expanding the first expandable member in an amount sufficient to secure the first expandable member in the first lumen; d) preparing a second expandable tubular member having a proximal end and a distal end and having longitudinal bore therethrough; e) widening the branch aperture; f) delivering the second expandable tubular member into the branch aperture so that the distal end of the second expandable tubular member is disposed within the second lumen and the proximal end of the second expandable tubular member is disposed within the longitudinal bore of uhe first longitudinal member; and g) expanding the second expandable tubular member in an amount sufficient to secure the second expandable tubular member within the second lumen and within said branch aperture.[0011]
• It is still another object of this invention to provide a method of making a bifurcated stent comprising the steps of:[0012]
• a) preparing a sheet having a proximal end, a distal end, a longitudinal axis, and a circumferential axis, the sheet provided with:[0013]
• a first side having a proximal portion having a proximal end and a distal end and a distal portion having a proximal end and a distal end;[0014]
• a second side having a proximal end and a distal end, the second side disposed between the proximal end of the sheet and the distal end of the sheet;[0015]
• a third side having a proximal end and a distal end, the third side disposed between the distal end of the second side and the distal end of the sheet;[0016]
• a fourth side disposed between the proximal end of the proximal portion of the first side and the proximal end of the second side;[0017]
• a fifth side disposed between the distal end of the distal portion of the first side and the distal end of the third side, the fifth side having a length that is shorter than the length of the fourth side; and[0018]
• a sixth side disposed between the second side and the third side;[0019]
• b) attaching the second side to the proximal portion of the first side and attaching the third side to the distal portion of the first side to form a first expandable tubular member having a longitudinal bore defining a longitudinal axis, the fourth side defining a proximal stent aperture communicating with the longitudinal bore, the fifth side defining a distal stent aperture communicating with the longitudinal bore, and the sixth side and the proximal end of the third side and the proximal end of the distal portion of the first side defining a side branch aperture communicating with the longitudinal bore and sized and adapted to receive and secure a second expandable tubular member;[0020]
• c) delivering the first expandable tubular member to a bifurcated vessel having a first lumen and a second lumen so that the first expandable tubular member is disposed within the first lumen and the branch aperture communicates with the second lumen;[0021]
• d) expanding the first expandable tubular member in an amount sufficient to secure the first expandable tubular member in the first lumen;[0022]
• e) preparing a second expandable tubular member having a proximal end and a distal end and having longitudinal bore therethrough;[0023]
• f) delivering the second expandable tubular member into the branch aperture of the first tubular member so that the distal end of the second expandable tubular member is disposed within the second lumen and the proximal end of the second expandable tubular member is disposed within the longitudinal bore of the first tubular member; and[0024]
• g) expanding the second expandable tubular member in an amount sufficient to secure the second expandable tubular member within the second lumen and within the branch aperture.[0025]
• It is yet another object of this invention to provide a bifurcated stent comprising:[0026]
• a) a first tubular member having a proximal end and a distal end and a longitudinal bore therethrough defining a longitudinal axis, the first tubular member comprised of a sheet having a proximal end, a distal end, a longitudinal axis, and a circumferential axis, the sheet provided with:[0027]
• a first side having a proximal portion having a proximal end and a distal end and a distal portion having a proximal end and a distal end;[0028]
• a second side having a proximal end and a distal end, the second side disposed between the proximal end of the sheet and the distal end of the sheet;[0029]
• a third side having a proximal end and a distal end, the third side disposed between the distal end of the second side and the distal end of the sheet;[0030]
• a fourth side disposed between the proximal end of the proximal portion of the first side and the proximal end of the second side;[0031]
• a fifth side disposed between the distal end of the distal portion of the first side and the distal end of the third side, the fifth side having a length that is shorter than the length of the fourth side; and[0032]
• a sixth side disposed between the second side and the third side;[0033]
• b) means for attaching the second side to the proximal portion of the first side and the third side to the distal portion of the first side so that the fourth side defines a proximal stent aperture communicating with the longitudinal bore, the fifth side defines a distal stent aperture communicating with the longitudinal bore, and the sixth side and the proximal end of the third side and the proximal end of the distal portion of the first side define a side branch aperture communicating with the longitudinal bore and sized and adapted to receive and secure a second tubular member; and[0034]
• c) a second tubular member having a proximal end and a distal end and having longitudinal bore therethrough, the second tubular member disposed within the branch aperture so that the proximal end of the second tubular member is disposed within the longitudinal bore of the first tubular member.[0035]
• It is a further object of this invention to provide a method of making a bifurcated stent comprising the steps of:[0036]
• a) cutting a proximal member from a first expandable tube having a first cross-sectional diameter, the proximal member having a proximal end and a distal end and a longitudinal bore therethrough;[0037]
• b) cutting a distal member from a second expandable tube having a second cross-sectional diameter smaller than the first diameter of the first tube, the distal member having a proximal end and a distal end and a longitudinal bore therethrough;[0038]
• c) attaching a portion of the distal end of the proximal member to a portion of the proximal end of the distal member so that the longitudinal bore of the proximal member is in fluid communication with the longitudinal bore of the distal member to form a first expandable tubular member having a proximal end and a distal end and a longitudinal bore therethrough, the unattached portion of the distal end of the proximal member and the unattached portion of the proximal end of the distal member defining a side branch aperture communicating with the longitudinal bore of the first tubular member and sized and adapted to receive and secure a second expandable tubular member;[0039]
• c) delivering the first expandable tubular member to a bifurcated vessel having a first lumen and a second lumen so that the first expandable tubular member is disposed within the first lumen and the branch aperture communicates with the second lumen;[0040]
• d) expanding the first expandable tubular member in an amount sufficient to secure the first expandable tubular member in the first lumen;[0041]
• e) preparing a second expandable tubular member having a proximal end and a distal end and having longitudinal bore therethrough;[0042]
• f) delivering the second expandable tubular member into the branch aperture of the first tubular member so that the distal end of the second expandable tubular member is disposed within the second lumen and the proximal end of the second expandable tubular member is disposed within the longitudinal bore of the first tubular member; and[0043]
• g) expanding the second expandable tubular member in an amount sufficient to secure the second tubular member within the second lumen and within the branch aperture.[0044]
• It is yet a further object of this invention to provide a bifurcated stent comprising:[0045]
• a) a first tubular member having a proximal end and a distal end and a longitudinal bore therethrough, the first tubular member comprised of a proximal member and a distal member, the proximal member having a first cross-sectional diameter, a proximal end and a distal end and a longitudinal bore therethrough, and the distal member having a second crosssectional diameter smaller than the first diameter, a proximal end and a distal end and a longitudinal bore therethrough;[0046]
• b) means for attaching a portion of the distal end of the proximal member to a portion of the proximal end of the distal member so that the longitudinal bore of the proximal member is in fluid communication with the longitudinal bore of the distal member to form the first tubular member, the unattached portion of the distal end of the proximal member and the unattached portion of the proximal end of the distal member defining a side branch aperture communicating with the longitudinal bore of the first tubular member and sized and adapted to receive and secure a second expandable tubular member; and[0047]
• c) a second tubular member having a proximal end and a distal end and having longitudinal bore therethrough, the second tubular member disposed and secured within the branch aperture so that the proximal end of the second tubular member is disposed within the longitudinal bore of the first tubular member.[0048]
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 shows a bifurcated stent manufactured in accordance with the present invention;[0049]
• FIG. 2 shows sheets used to form the legs and stem of the stent shown in FIG. 1;[0050]
• FIG. 3 shows the sheets shown in FIG. 2 after they have been rolled into a tubular shape;[0051]
• FIG. 4 is a perspective view of the tubes shown in FIG. 3 prior to assembly;[0052]
• FIG. 5 is an end view of the tubes shown in FIGS. 3 and 4 after they have been assembled to form a stent;[0053]
• FIG. 6 is a top view of the assembled apparatus shown in FIG. 5;[0054]
• FIG. 7 shows sheets used to form another embodiment of a bifurcated stent manufactured in accordance with the invention;[0055]
• FIG. 7B shows sheets used to form another embodiment of a bifurcated stent manufactured in accordance with the invention;[0056]
• FIG. 8 shows the sheets of FIG. 7 with demarcation points;[0057]
• FIG. 9 shows the sheets of FIG. 8 after they have been rolled into a tubular shape;[0058]
• FIG. 9B shows the sheets of FIG. 7B after they have been rolled into a tubular shape;[0059]
• FIG. 10 shows the tubes of FIG. 9 just prior to assembly;[0060]
• FIG. 10B shows the tubes of FIG. 9B just prior to assembly;[0061]
• FIG. 11 is a side view of the tubes shown in FIGS. 9 and 10 after assembly;[0062]
• FIG. 11B is a side view of the tubes shown in FIGS. 9B and 10B after assembly;[0063]
• FIG. 12 is an end view of the assembled apparatus shown in FIG. 11;[0064]
• FIG. 12B is an end view of the assembled apparatus shown in FIG. 11B;[0065]
• FIG. 12C shows an alternative embodiment of a pattern that may be used in place of the patterns shown in FIGS. 7 and 7B;[0066]
• FIG. 13 shows a stem and first leg portion and a second leg portion used to form another embodiment of a bifurcated stent manufactured in accordance with this invention;[0067]
• FIG. 14 shows guide wires disposed in the trunk lumen and branch lumen to be treated;[0068]
• FIG. 15 shows the stem and first leg portion shown in FIG. 13 disposed on catheters and guide wires prior to introduction into the lumen to be treated;[0069]
• FIG. 16 shows the stem and first leg portion shown in FIG. 13 after it has been delivered to the bifurcation to be treated and prior to its expansion;[0070]
• FIG. 17 shows the second leg portion shown in FIG. 16 after it has been expanded;[0071]
• FIG. 18 shows expansion of the branch aperture;[0072]
• FIG. 19 shows the unexpanded second leg portion disposed in the branch aperture;[0073]
• FIG. 20 shows the expansion of the second leg portion shown in FIG. 19; and[0074]
• FIG. 21 shows the assembled bifurcated stent disposed in the bifurcated lumen to be treated;[0075]
• FIG. 22 shows a sheet used to form a first expandable tubular member;[0076]
• FIG. 23 shows the sheet of FIG. 22 after it has been formed into a first expandable tubular member;[0077]
• FIG. 24 shows the first expandable tubular member of FIG. 23 with catheters inserted into the longitudinal bore and the side branch aperture;[0078]
• FIG. 25 shows the first expandable tubular member of FIG. 24 after expansion with an unexpanded second tubular member being introduced into the side branch aperture;[0079]
• FIG. 26 shows the first expandable tubular member of FIG. 24 after expansion with an unexpanded second tubular member disposed in the side branch aperture;[0080]
• FIG. 27 shows the second tubular member of FIG. 26 after it has been expanded;[0081]
• FIG. 28 shows a side view of a proximal member and a distal member used to make an alternative embodiment of the invention;[0082]
• FIG. 29 shows the proximal and distal members of FIG. 28 after they have been connected to form a first expandable tubular member;[0083]
• FIG. 30 is an end view of FIG. 29;[0084]
• FIG. 30A is an end view of FIG. 29 showing an alternative embodiment in which a portion of the proximal member and a portion of the distal member have been deformed prior to being attached; and[0085]
• FIG. 31 shows the first expandable tubular member of FIG. 29 with a second expandable tubular member disposed within the side branch aperture.[0086]
DETAILED DESCRIPTION
• In the embodiment illustrated in FIG. 1, the[0087]bifurcation stent5 comprises afirst leg10, asecond leg15, and astem20. FIG. 2 shows afirst sheet25 which is used to formfirst leg10, asecond sheet30 which is used to formsecond leg15, and athird sheet35 which is used to formsteci20. Thefirst sheet25 andsecond sheet30 are substantially flat and are sized to a predetermined length and width. For many applications, thefirst sheet25 andsecond sheet30 will have substantially the same dimensions so as to producelegs10 and15 that are substantially the same size, however, thelegs10 and15, and thesheets25 and30 used to produce them, may be of varying sizes as specific applications dictate. The stents of this invention may be sized so that when assembled they are their final size, however, in a preferred embodiment the stents are expandable and sized and adapted to assume their final dimensions upon expansion. Thestent sheets70 and75 may be patterned or etched with perforations forming a variety of patterns as specific applications dictate to achieve the expandable features required as previously discussed. Thethird sheet35 is sized so that when it is rolled into a tube its internal cross-section can be made to accommodate the cross-sectional external diameters offirst leg10 andsecond leg15.First sheet25 has afirst edge26, asecond edge27, athird edge28, and afourth edge29.Second sheet30 has afirst edge31, asecond edge32, athird edge33, and afourth edge34.Third sheet35 has afirst edge36, asecond edge37, athird edge38, and afourth edge39. After the sheet metal has been cut to formsheets25,30, and35, it is deformed and rolled so as to cause two opposite edges to meet and create a cylinder. In the example shown in FIGS.2 and3,edge27 is joined to edge29 via weld run14 to formfirst leg10.Edge32 is joined to edge34 via weld run19 to formsecond leg15.Edge37 is joined to edge39 via weld run29 to formstem20. The edges may be joined in a wide variety of ways well known to those skilled in the art as suitable for this purpose, e.g., screwing, crimping, soldering, however, in a preferred embodiment welding is utilized. In an especially preferred embodiment, spot welding is utilized. As shown in FIG. 3,first leg10 has a proximal end11, adistal end12, and defines alongitudinal bore13.Second leg15 has aproximal end16, adistal end17, and defines alongitudinal bore18. Thestem20 has aproximal end26, adistal end27, and defines alongitudinal bore28. FIG. 4 shows thefirst leg10,second leg15, and stem20 just prior to assembly. To form thebifurcated stent5, the proximal end11 offirst leg10 and theproximal end16 ofsecond leg15 are joined to thedistal end27 of thestem portion20 so that thelongitudinal bores13,18, and28 are in communication with each other. FIG. 5 is an end view and FIG. 6 is a side view of the assembled apparatus.
• FIG. 11 shows a second embodiment of a bifurcation stent manufactured in accordance with this invention. The[0088]stent50 is provided with afirst leg55 and asecond leg60 attached to astem portion65. Thebifurcation stent50 is formed from afirst sheet70 and asecond sheet75 as shown in FIG. 7. Thestent sheets70 and75 may be patterned or etched with perforations forming a variety of patterns as specific applications dictate to achieve the expandable features required as previously discussed. Thesheets70 and75 are substantially flat and have a predetermined length and width.First sheet70 has afirst edge71, asecond edge72, athird edge73 and afourth edge74. Thesecond sheet75 has afirst edge76, asecond edge77, athird edge78, and afourth edge79. To form the legs of the stent a portion ofedge72 is rolled towards a portion ofedge74 and a portion ofedge77 is rolled towards a portion ofedge79. Demarcation points80,81,82, and83 are selected onsheets70 and75 as shown in FIG. 8. These demarcation points80,81,82, and83 are selected to meet the requirement of specific applications and may be adjusted depending upon the length required forlegs55 and60 and the length required forstem65. Demarcation points80 and81 that are equidistant fromedges73 and71 and demarcation points82 and83 that are equidistant fromedges76 and78 will result in a stent in which thelegs55 and60 have a length that is substantially equal to stemportion65. If the demarcation points are selected to be closer toedges73 and78 than toedges71 and76 the stem will have a length that is greater than the length of each of the legs. If the demarcation points are selected to be closer toedges71 and76 than toedges73 and78, each of thelegs60 and65 will have a length that is greater than the length of thestem65. In a preferred embodiment, however, the demarcation points80,81,82, and83, are selected so thatproximal edges72″,74″,77″, and79″ are about ⅓ the length ofedges72,74,77, and79. As shown in FIG. 8,demarcation point80 dividesedge72 at approximately its midpoint into adistal edge72′ and aproximal edge72″.Demarcation point81 dividesedge74 at approximately its midpoint into adistal edge74′ and aproximal edge74′.Demarcation point82 dividesedge77 at approximately its midpoint into adistal edge77′ and aproximal edge77″ anddemarcation point83 dividesedge79 at approximately its midpoint into adistal edge79′ and aproximal edge79″.
• To form the stent, edge[0089]72′ is connected to edge74′ via weld run90 to formfirst member95 having afirst leg portion55 and afirst stem half65′ as shown in FIG. 9.Edge77′ is connected to edge79′ via weld run91 to formsecond member100 having asecond leg portion60 and asecond stem half65″. As previously discussed, the edges may be connected in a variety of ways well known to those skilled in the art. FIG. 10 shows thefirst member95 and thesecond member100 shown in FIG. 9 in alignment just prior to assembly. To produce thebifurcated stent50 shown in FIGS. 11 and 12,edge72″ is connected to edge79″ viaweld run92 andedge74″ is connected to edge77″ via weld run93 so thatfirst stem half65′ andsecond stem half65″form stem65. FIG. 12 is a cross-sectional end view of the stent shown in FIG. 11.
• In the embodiment shown in FIG. 7,[0090]sheets70 and75 are squares or rectangles. Thesheets70 and75 are not limited to this configuration, however, as shown in FIG. 7B. FIG. 11B shows a bifurcation stent manufactured using thesheets270 and275 shown in FIG. 7B. Thestent250 is provided with afirst leg255 and asecond leg260 attached to astem portion265. Thebifurcation stent250 is formed from afirst sheet270 and a second sheet275 as shown in FIG. 7B. Thestent sheets270 and275 may be sized and etched as previously discussed. As shown in FIG. 7B,first sheet270 has afirst edge271, asecond edge272, athird edge273, a fourth edge274, a fifth edge275, and asixth edge276, aseventh edge146, and aneighth edge147. The second sheet275 has afirst edge277, asecond edge278, athird edge279, afourth edge280, a fifth edge281, asixth edge282, aseventh edge148, and aneighth edge149. As shown in FIG. 9B, edge274 is connected to edge276 via weld run290 to formfirst member295 having afirst leg portion255 and afirst stem half265′.Edge280 is connected to edge282 via weld run291 to formsecond member300 having asecond leg portion260 and asecond stem half265″. As previously discussed, the edges may be connected in a variety of ways well known to those skilled in the art. FIG. 10B shows thefirst member295 and thesecond member300 shown in FIG. 9B in alignment just prior to assembly. To produce thebifurcated stent250 shown in FIGS. 11B and 12B,edge272 is connected to edge149 viaweld run292 andedge278 is connected to edge147 via weld run293 so thatfirst stem half265′ andsecond stem half265″form stem265. FIG. 12B is a cross-sectional end view of the stent shown in FIG. 11B. FIG. 12C shows an alternative pattern that may be used in place of the patterns shown in FIGS. 7 and 7B.
• A third embodiment of this invention comprises two portions which are deployed serially in two steps and assembled within the patient to form a bifurcated stent. FIG. 13 shows stem and[0091]first leg portion110 provided with alongitudinal bore131 and having aproximal end115 defining astem portion125 and adistal end120 defining afirst leg portion130.Second leg portion140 is provided with alongitudinal bore132 and has aproximal end145 and adistal end150. Stem andfirst leg portion110 andsecond leg portion140 may be sized and patterned or etched as previously discussed. Abranch aperture135 is disposed between theproximal end115 and thedistal end120 of stem andfirst leg portion110. Thebranch aperture135 is sized to receivesecond leg portion140 and is adapted to engage and secure thesecond leg portion140 when it has been expanded within thebranch aperture135.Second leg portion140 is sized and adapted to engage and be secured intobranch aperture135 upon expansion. FIGS.14 to21 show how the bifurcated stent is assembled within a bifurcated lumen. As shown in FIGS.14 to21, the area to be treated is a bifurcated lumen having a first ortrunk lumen190 and a second orbranch lumen195. As shown in FIG. 14, afirst guide wire155 is introduced into thetrunk lumen190 and asecond guide wire156 is introduced into thebranch lumen195. As shown in FIG. 15, a balloon expandable stem andfirst leg portion110 is disposed on the tip of afirst balloon catheter170 so that theballoon175 is disposed withinlongitudinal bore131. Asecond balloon catheter171 is then introduced intolongitudinal bore131 of stem andfirst leg portion110 and is advanced so that theballoon176 is disposed withinaperture135.First catheter170 is mounted onfirst guide wire155 andsecond catheter171 is mounted onsecond guide wire156. As shown in FIG. 16, the unexpanded stem andfirst leg portion110 is guided to the area to be treated so thatfirst leg portion130 is disposed withintrunk lumen190 andbranch aperture135 communicates withbranch lumen195.Guide wire156 facilitates the orientation of thebranch aperture135 with thebranch lumen195. The size of the conventional catheters and balloons is not to scale and details well known to those skilled in the art have been omitted for clarity.Balloon175 is inflated which causes the stem andfirst leg portion110 to expand, as shown in FIG. 17, to secure it in the desired position. After expansion, the external wall of stem andfirst leg portion110 would contact the interior walls oftrunk lumen190, however, a gap has been intentionally left for clarity. Theballoon175 onfirst catheter170 is left inflated and theballoon176 onsecond catheter171 is then inflated to enlarge thebranch aperture135 as shown in FIG. 18. As thebranch aperture135 is enlarged a portion of the stent defining thebranch aperture135 is pushed outward to form abranch securing lip180.
• Balloons[0092]175 and176 are deflated,second catheter171 is withdrawn, andsecond guide wire156 is left in place in thebranch lumen195.Second leg portion140 is then applied tosecond catheter171 so thatballoon176 is disposed inlongitudinal bore132 andsecond catheter171 is then applied tosecond guide wire156.Second leg portion140 is then guided to, and introduced into, thelongitudinal bore131 of the stem andfirst leg portion110 and is advanced and passed throughbranch aperture135 so that thedistal end150 of thesecond leg portion140 protrudes into thebranch lumen195 and theproximal end145 communicates withlongitudinal bore131, as shown in FIG. 19. Theballoon176 onsecond catheter171 is partially inflated and theballoon175 onfirst catheter170 is then partially inflated to a pressure substantially equal to the pressure inballoon176. Both balloons175 and176 are then simultaneously inflated to substantially equal pressures. As shown in FIG. 20, inflation of theballoon176 onsecond catheter171 causessecond leg member140 to expand so that its external walls engage and are secured to thearea surrounding aperture135. Inflation of theballoon175 on thefirst catheter170 prevents stem andfirst leg portion110 from collapsing whenballoon176 is inflated. After expansion, the external walls ofsecond leg140 would contact the inner wall oflumen195, however, a gap has been intentionally left for clarity. Theballoons175 and176 are deflated,catheters170 and171 and guidewires155 and156 are withdrawn, and the assembled bifurcated stent160 is left in place as shown in FIG. 21.
• FIGS.[0093]22 to31 show an especially preferred method of making a bifurcated stent in accordance with the invention. FIG. 22 shows asheet300 used to form a firstexpandable tubular member301. Thesheet300 has alongitudinal axis302, acircumferential axis303, aproximal end304, adistal end305, afirst side306, asecond side307, athird side308, a fourth side309, a fifth side310, and a sixth side311. Thesheet300 may be provided with a variety of patterns, however, in a preferred embodiment thesheet300 is provided with a plurality ofexpandable cells312 adapted to be substantially flexible prior to expansion of the firsttubular member301 and substantially rigid after expansion of the firsttubular member301. In an especially preferred embodiment theflexible cells312 of thesheet300 are substantially uniform as shown in FIG. 22.
• The[0094]first side306 of thesheet300 has aproximal portion313 having aproximal end314 and adistal end315. Thefirst side306 also has adistal portion316 having aproximal end317 and adistal end318.
• The[0095]second side307 of thesheet300 has aproximal end319 and adistal end320 and is disposed between theproximal end304 of thesheet300 and thedistal end305 of thesheet300.
• The[0096]third side308 of thesheet300 has aproximal end321 and adistal end322 and is disposed between thedistal end320 of thesecond side307 and thedistal end305 of thesheet300.
• The fourth side[0097]309 of thesheet300 is disposed between theproximal end314 of theproximal portion313 of thefirst side306 and theproximal end319 of thesecond side307.
• The fifth side[0098]310 of thesheet300 is disposed between thedistal end318 of thedistal portion316 of thefirst side306 and thedistal end322 of thethird side308 and is provided with a length L1 that is shorter than the length L2 of the fourth side309. In a preferred embodiment, the length L1 of the fifth side310 and the length L2 of the fourth side309 are in a ratio of about 5:7, i.e., the fifth side310 has a length L1 that is about 70% of the length L2 of the fourth side309. In an especially preferred embodiment thesheet300 is etched with a plurality of substantiallyuniform cells312 as previously discussed and the number of cells disposed along thecircumferential axis303 of the fifth side310 and the number of cells disposed along thecircumferential axis303 of the fourth side309 are in a ratio of about 5:7.
• A sixth side[0099]311 is disposed between thesecond side307 and thethird side308. In an especially preferred embodiment, thefirst side306,second side307, andthird side308 are substantially parallel to each other and the fourth side309, fifth side310, and sixth side311 are substantially parallel to each other and thefirst side306,second side307, andthird side308 are substantially perpendicular to the fourth side309, fifth side310, and sixth side311.
• To make the first[0100]expandable tubular member301, thesecond side307 of thesheet300 is attached via attaching means to theproximal portion313 of thefirst side306 of thesheet300 and thethird side308 of thesheet300 is attached via attaching means to thedistal portion316 of thefirst side306 of thesheet300 to form a firstexpandable tubular member301 having alongitudinal bore323 defining alongitudinal axis324 as shown in FIG. 23. The attaching step may be carried out utilizing a variety of attaching means well known to those skilled in the art as suitable for this purpose, however, in a preferred embodiment the attaching step is carried out utilizing screwing, crimping, soldering, welding, or spot welding. In the embodiment shown in FIG. 23spot welding325 has been utilized. After the sides have been attached as discussed above, the fourth side309 defines a vproximal tubular member aperture orstent aperture326 communicating with thelongitudinal bore323, and the fifth side310 defines a distal tubular member aperture orstent aperture327 communicating with thelongitudinal bore323 as shown in FIGS. 23 and 26. The sixth side311 and theproximal end321 of thethird side308 and theproximal end317 of thedistal portion316 of thefirst side306 define a side branch aperture328 (as shown in FIGS.23-26) sized and adapted to receive and secure a second expandable tubular member329 (shown in FIGS.26-27). Thebranch aperture328 has a diameter D1 that is larger than the diameter D2 of the unexpanded stent, i.e., thebranch aperture328 is larger than the proximal anddistal apertures326 and327 of the firsttubular member301 both before and after thetubular member301 is expanded.
• The first[0101]expandable tubular member301 is then delivered to a bifurcated vessel having a first lumen and a second lumen so that the first expandable tubular member is disposed within the first lumen and the branch aperture communicates with the second lumen. In a preferred embodiment, delivery is via a balloon catheter as previously discussed. After it has been positioned, the first expandable tubular member is expanded in an amount sufficient to secure the first expandable tubular member in the first lumen.
• A second[0102]expandable tubular member329 is then prepared having aproximal end330 and adistal end331 and havinglongitudinal bore332 therethrough. The second expandable tubular member329 (shown in FIGS. 25, 26, and27) may be patterned in the same way as thesheet300 as previously discussed. In a preferred embodiment thecells312 of thesheet300 used to make the firstexpandable tubular member301 and thecells312′ of the secondexpandable tubular member329 are substantially uniform.
• The second[0103]expandable tubular member329 is delivered into thelongitudinal bore323 of the firsttubular member301, as shown in FIG. 25, and is advanced into and beyond thebranch aperture328, as shown in FIG. 26, so that thedistal end331 of the secondexpandable tubular member329 is disposed within the second lumen and theproximal end330 of the secondexpandable tubular member329 is disposed within thelongitudinal bore323 of the firsttubular member301. The secondexpandable tubular member329 is then expanded in an amount sufficient to secure the secondexpandable tubular member329 within the second lumen and within thebranch aperture328 of the firsttubular member301 as shown in FIG. 27.
• Among the advantages that this embodiment provides is that this stent provides a large branch aperture that facilitates the introduction of the second tubular member into the side branch or second lumen. In addition, this stent is especially suitable for the performance of serial bifurcation stenting and also for stenting around a side branch before it is occluded.[0104]
• FIGS.[0105]28 to31 shown an alternative embodiment and alternative method of making the first tubular member shown in FIGS.23-27. In this embodiment the first tubular member400 (shown in FIG. 29) is comprised of aproximal member401 having aproximal end402 and adistal end403 and adistal member404 having aproximal end405 and adistal end406 as shown in FIG. 28. Theproximal member401 has alongitudinal bore415 and is cut from afirst tube407 having first cross-sectional diameter D1. Thedistal member404 has alongitudinal bore416 and is cut from asecond tube408 having a second cross-sectional diameter D2. D2 is smaller than D1. Thetubes401 and404 may be etched or patterned as previously discussed before theproximal member401 anddistal member404 are cut from thetubes407 and408. Alternatively, the proximal anddistal members401 and404 may be etched or patterned after the proximal anddistal members401 and404 have been cut from thetubes407 and408. To make the firsttubular member400, a portion of thedistal end403 of theproximal member401 is attached via attaching means417 to a portion of theproximal end405 of thedistal member404 to form a firsttubular member400 having aproximal end409 and adistal end410 and a longitudinal bore therethrough411 as shown in FIG. 29. Themembers401 and404 may be attached utilizing a variety of attachingmeans417 as previously discussed, however, in a preferred embodiment the attaching means utilized is welding. In an especially preferred embodiment spot welding is utilized. Because D2 is less than Dl the unattached portion of thedistal end403 of theproximal portion401 and the unattached portion of theproximal end405 of thedistal portion404 define abranch aperture412 as shown in FIG. 29 and FIG. 30 (which is an end view of FIG. 29). In some applications it may be desirable to have a greater portion of thedistal end403 of theproximal member401 and theproximal end405 of thedistal member404 contact each other before they are attached in order to increase the strength of the firsttubular member400. This may be accomplished by, e.g., by distorting, aligning, and contacting a greater surface area of thedistal end403 of theproximal member401 and a greater surface area of theproximal end405 of thedistal member404 prior to attaching thedistal end403 to theproximal end405. FIG. 30A is an end view of this embodiment and shows that a greater surface area of thedistal end403 and theproximal end405 are attached when compared to the embodiment shown in FIG. 30. FIG. 30A also shows that in this embodiment thebranch aperture412′ is larger than thebranch aperture412 shown in FIG. 30. A secondtubular member413 may then be introduced into thebranch aperture412 and412′ and as previously discussed is expanded and secured so that a portion of the secondtubular member413 communicates withlongitudinal bore411 to form a bifurcated stent414 (shown in FIG. 31).

Claims (56)

What is claimed is:

1. A method of making a bifurcated stent comprising the steps of:

a) preparing a sheet having a proximal end, a distal end, a longitudinal axis, and a circumferential axis, the sheet provided with:

a first side having a proximal portion having a proximal end and a distal end and a distal portion having a proximal end and a distal end;

a second side having a proximal end and a distal end, the second side disposed between the proximal end of the sheet and the distal end of the sheet;

a third side having a proximal end and a distal end, the third side disposed between the distal end of the second side and the distal end of the sheet;

a fourth side disposed between the proximal end of the proximal portion of the first side and the proximal end of the second side;

a fifth side disposed between the distal end of the distal portion of the first side and the distal end of the third side, the fifth side having a length that is shorter than the length of the fourth side; and

a sixth side disposed between the second side and the third side;

b) attaching the second side to the proximal portion of the first side and attaching the third side to the distal portion of the first side to form a first expandable tubular member having a longitudinal bore defining a longitudinal axis, the fourtn side defining a proximal stent aperture communicating with the longitudinal bore, the fifth side defining a distal stent aperture communicating with the longitudinal bore, and the sixth side and the proximal end of the third side and the proximal end of the distal portion of the first side defining a side branch aperture communicating with the longitudinal bore and sized and adapted to receive and secure a second expandable tubular member;

c) delivering the first expandable tubular member to a bifurcated vessel having a first lumen and a second lumen so that the first expandable tubular member is disposed within the first lumen and the branch aperture communicates with the second lumen;

d) expanding the first expandable tubular member in an amount sufficient to secure the first expandable tubular member in the first lumen;

e) preparing a second expandable tubular member having a proximal end and a distal end and having longitudinal bore therethrough;

f) delivering the second expandable tubular member into the branch aperture of the first tubular member so that the distal end of the second expandable tubular member is disposed within the second lumen and the proximal end of the second expandable tubular member is disposed within the longitudinal bore of the first tubular member; and

g) expanding the second expandable tubular member in an amount sufficient to secure the second expandable tubular member within the second lumen and within the branch aperture.

2. The method of

claim 1

, wherein the attaching step is carried out utilizing screwing.

3. The method of

claim 1

, wherein the attaching step is carried out utilizing crimping.

4. The method of

claim 1

, wherein the attaching step is carried out utilizing soldering.

5. The method of

claim 1

, wherein the attaching step is carried out utilizing welding.

6. The method of

claim 1

, wherein the welding step is carried out utilizing spot welding.

7. The method of

claim 1

, wherein the fifth side has a length that is about 70% of the length of the fourth side.

8. The method of

claim 1

, further compri sing the steps of providing the first and second tubular members with a plurality of cells adapted to be substantially flexible prior to expansion and substantially rigid after expansion.

9. The method of

claim 1

, further comprising the step of providing the sheet and the second tubular member with an etched pattern defining a plurality of cells.

10. The method of

claim 9

, wherein the cells are adapted to be substantially flexible prior to the expansion of the first and second tubular members and are adapted to be substantially rigid after the expansion of the first and second tubular members.

11. The method of

claim 10

, wherein the cells of the sheet are substantially uniform.

12. The method of

claim 10

, wherein the cells of the second tubular member are substantially uniform.

13. The method of

claim 10

, wherein the cells of the sheet and the cells of the second tubular member are substantially uniform.

14. The method of

claim 11

, wherein the number of cells disposed along the circumferential axis of the fifth side of the sheet and the number of cells disposed along the circumferential axis of the fourth side of the sheet are in a ratio of about 5:7.

15. The method of

claim 1

, wherein the branch aperture is larger than the proximal and distal apertures of the first tubular member.

16. The method of

claim 1

, wherein the first, second, and third sides are substantially parallel to each other and the fourth, fifth, and sixth sides are substantially parallel to each other.

17. The method of

claim 16

, wherein the first, second, and third sides are substantially perpendicular to the fourth, fifth, and sixth sides.

18. A bifurcated stent comprising:

a) a first tubular member having a proximal end and a distal end and a longitudinal bore therethrough defining a longitudinal axis, the first tubular member comprised of a sheet having a proximal end, a distal end, a longitudinal axis, and a circumferential axis, the sheet provided with:

a first side having a proximal portion having a proximal end and a distal end and a distal portion having a proximal end and a distal end;

a second side having a proximal end and a distal end, the second side disposed between the proximal end of the sheet and the distal end of the sheet;

a third side having a proximal end and a distal end, the third side disposed between the distal end of the second side and the distal end of the sheet;

a fourth side disposed between the proximal end of the proximal portion of the first side and the proximal end of the second side;

a fifth side disposed between the distal end of the distal portion of the first side and the distal end of the third side, the fifth side having a length that is shorter than the length of the fourth side; and

a sixth side disposed between the second side and the third side;

b) means for attaching the second side to the proximal portion of the first side and the third side to the distal portion of the first side so that the fourth side defines a proximal stent aperture communicating with the longitudinal bore, the fifth side defines a distal stent aperture communicating with the longitudinal bore, and the sixth side and the proximal end of the third side and the proximal end of the distal portion of the first side define a side branch aperture communicating with the longitudinal bore and sized and adapted to receive and secure a second tubular member; and

c) a second tubular member having a proximal end and a distal end and having longitudinal bore therethrough, the second tubular member disposed within the branch aperture so that the proximal end of the second tubular member is disposed within the longitudinal bore of the first tubular member.

19. The stent of

claim 18

, wherein the attaching means is a screw.

20. The stent of

claim 18

, wherein the attaching means is a crimp.

21. The stent of

claim 18

, wherein the attaching means is solder.

22. The stent of

claim 18

, wherein the attaching means is a weld.

23. The stent of

claim 18

, wherein the attaching means is a snot weld.

24. The stent of

claim 18

, wherein the fifth side has a length that is about 70% of the length of the fourth side.

25. The stent of

claim 18

, wherein the first and second tubular members are provided with a plurality of cells adapted to be substantially flexible prior to expansion and substantially rigid after expansion.

26. The stent of

claim 18

, wherein the sheet and the second tubular member comprise an etched pattern defining a plurality of cells.

27. The stent of

claim 26

, wherein the cells are adapted to be substantially flexible prior to the expansion of the first and second tubular members and are adapted to be substantially rigid after the expansion of the first and second tubular members.

28. The stent of

claim 27

, wherein the cells of the sheet are substantially uniform.

29. The stent of

claim 27

, wherein the cells of the second tubular member are substantially uniform.

30. The stent of

claim 27

, wherein the cells of the sheet and the cells of the second tubular member are substantially uniform.

31. The stent of

claim 28

, wherein the number of cells disposed along the circumferential axis of the fifth side of the sheet and the number of cells disposed along the circumferential axis of the fourth side of the sheet are in a ratio of about 5:7.

32. The stent of

claim 18

, wherein the branch aperture larger than the proximal and distal apertures of the first tubular member.

33. The stent of

claim 18

, wherein the first, second, and third sides are substantially parallel to each other and the fourth, fifth, and sixth sides are substantially parallel to each other.

34. The stent of

claim 33

, wherein the first, second, and third sides are substantially perpendicular to the fourth, fifth, and sixth sides.

35. A kit for forming a bifurcated stent comprising:

a) a first expandable tubular member having a proximal end and a distal end and a longitudinal bore therethrough defining a longitudinal axis, the first expandable tubular member comprised of a sheet having a proximal end, a distal end, a longitudinal axis, and a circumferential axis, the sheet provided with:

a first side having a proximal portion having a proximal end and a distal end and a distal portion having a proximal end and a distal end;

a second side having a proximal end and a distal end, the second side disposed between the proximal end of the sheet and the distal end of the sheet;

a third side having a proximal end and a distal end, the third side disposed between the distal end of the second side and the distal end of the sheet;

a fourth side disposed between the proximal end of the proximal portion of the first side and the proximal end of the second side;

a fifth side disposed between the distal end of the distal portion of the first side and the distal end of the third side, the fifth side having a length that is shorter than the length of the fourth side; and

a sixth side disposed between the second side and the third side;

b) means for attaching the second side to the proximal portion of the first side and for attaching the third side to the distal portion of the first side so that the fourth side defines a proximal stent aperture communicating with the longitudinal bore, the fifth side defines a distal stent aperture communicating with the longitudinal bore, and the sixth side and the proximal end of the third side and the proximal end of the distal portion of the first side define a side branch aperture communicating with the longitudinal bore and sized and adapted to receive and secure a second expandable tubular member;

c) a second expandable tubular member having a proximal end and a distal end and having longitudinal bore therethrough, the second expandable tubular member sized and adapted to be disposed and secured within the branch aperture so that the proximal end of the second tubular member is disposed within the longitudinal bore of the first tubular member;

c) a first guide wire;

d) a second guide wire;

e) a first balloon catheter; and

f) a second balloon catheter.

36. A method of making a bifurcated stent comprising the steps of:

a) cutting a proximal member from a first expandable tube having a first cross-sectional diameter, the proximrjl member having a proximal end and a distal end and a longitudinal bore therethrough;

b) cutting a distal member from a second expandable tube having a second cross-sectional diameter smaller than the first diameter of the first tube, the distal member having a proximal end and a distal end and a longitudinal bore therethrough;

c) attaching a portion of the distal end of the proximal member to a portion of the proximal end of the distal member so that the longitudinal bore of the proximal member is in fluid communication with the longitudinal bore of the distal member to form a first expandable tubular member having a proximal end and a distal end and a longitudinal bore therethrough, the unattached portion of the distal end of the proximal member and the unattached portion of the proximal end of the distal member defining a side branch aperture communicating with the longitudinal bore of the first tubular member and sized and adapted to receive and secure a second expandable tubular member;

c) delivering the first expandable tubular member to a bifurcated vessel having a first lumen and a second lumen so that the first expandable tubular member is disposed within the first lumen and the branch aperture communicates with the second lumen;

d) expanding the first expandable tubular member in an amount sufficient to secure the first expandable tubular member in the first lumen;

e) preparing a second expandable tubular member having a proximal end and a distal end and having longitudinal bore therethrough;

f) delivering the second expandable tubular member into the branch aperture of the first tubular member so that the distal end of the second expandable tubular member is disposed within the second lumen and the proximal end of the second expandable tubular member is disposed within the longitudinal bore of the first tubular member; and

g) expanding the second expandable tubular member in an amount sufficient to secure the second tubular member within the second lumen and within the branch aperture.

37. The method of

claim 36

, wherein the attaching step is carried out utilizing screwing.

38. The method of

claim 36

, wherein the attaching step is carried out utilizing crimping.

39. The method of

claim 36

, wherein the attaching step is carried out utilizing soldering.

40. The method of

claim 36

, wherein the attaching step is carried out utilizing welding.

41. The method of

claim 40

, wherein the welding step is carried out utilizing spot welding.

42. The method of

claim 36

, further comprising the step of providing the first and second tubular members with a plurality of cells adapted to be substantially flexible prior to expansion and substantially rigid after expansion.

43. The method of

claim 36

, further comprising the step of providing the first tubular member proximal member, the first tubular member distal member and the second tubular member with an etched pattern defining a plurality of cells.

44. The method of

claim 43

, wherein the cells are adapted to be substantially flexible prior to the expansion of the first and second tubular members and are adapted to be substantially rigid after the expansion of the first and second tubular members.

45. The method of

claim 44

, wherein the cells of the first tubular member and the cells of the second tubular member are substantially uniform.

46. A bifurcated stent comprising:

a) a first tubular member having a proximal end and a distal end and a longitudinal bore therethrough, the first tubular member comprised of a proximal member and a distal member, the proximal member having a first cross-sectional diameter, a proximal end and a distal end and a longitudinal bore therethrough, and the distal member having a second crosssectional diameter smaller than the first diameter, a proximal end and a distal end and a longitudinal bore therethrough;

b) means for attaching a portion of the distal end of the proximal member to a portion of the proximal end of the distal member so that the longitudinal bore of the proximal member is in fluid communication with the longitudinal bore of the distal member to form the first tubular member, the unattached portion of the distal end of the proximal member and the unattached portion of the proximal end of the distal member defining a side branch aperture communicating with the longitudinal bore of the first tubular member and sized and adapted to receive and secure a second expandable tubular member; and

c) a second tubular member having a proximal end and a distal end and having longitudinal bore therethrough, the second tubular member disposed and secured within the branch aperture so that the proximal end of the second tubular member is disposed within the longitudinal bore of the first tubular member.

47. The stent of

claim 46

, wherein the attaching means is a screw.

48. The stent of

claim 46

, wherein the attaching means is a crimp.

49. The stent of

claim 46

, wherein the attaching means is solder.

50. The stent of

claim 46

, wherein the attaching means is a weld.

51. The stent of

claim 50

, wherein the weld is a spot weld.

52. The stent of

claim 46

, wherein the first and second tubular members are comprised of a plurality of cells adapted to be substantiaIly flexible prior to expansion and substantially rigid after expansion.

53. The stent of

claim 46

, wherein the first tubular member proximal member, the first tubular member distal member, and the second tubular member comprise an etched pattern defining a plurality of cells.

54. The stent of

claim 53

, whereIn the plurality of cells are adapted to be substantially flexible prior to the expansion of the first and second tubular members and are adapted to be substantially rigid after the expansion of the first and second tubular members.

55. The stent of

claim 54

, wherein the cells of first tubular member and the cells of the second tubular member are substantially uniform.

56. A kit for forming a bifurcated stent comprising:

a) a first expandable tubular member having a proximal end and a distal end and a longitudinal bore therethrough, the first expandable tubular member comprised of an expandable proximal member and an expandable distal member, the expandable proximal member having a first cross-sectional diameter, a proximal end and a distal end and a longitudinal bore therethrough and the expandable distal member having a second cross-sectional diameter smaller than the first diameter, a proximal end and a distal end and a longitudinal bore therethrough;

b) means for attaching a portion of the distal end of the expandable proximal member to a portion of the proximal end of the expandable distal member so that the longitudinal bore of the expandable proximal member is in fluid communication with the longitudinal bore of the expandable distal member to form the first expandable tubular member, the unattached portion of the distal end of the expandable proximal member and the unattached portion of the proximal end of the expandable distal member defining a side branch aperture communicating with the longitudinal bore of the first expandable tubular member and sized and adapted to receive and secure a second expandable tubular member;

c) a second expandable tubular member having a proximal end and a distal end and having longitudinal bore therethrough, the second expandable tubular member sized and adapted to be disposed and secured within the branch aperture so that the proximal end of the second expandable tubular member is disposed within the longitudinal bore of the first tubular member; c) a first guide wire; d) a second guide wire; e) a first balloon catheter; and f) a second balloon catheter.

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