US20050085849A1 - Systems, methods and devices for removing obstructions from a blood vessel - Google Patents

Abstract

Devices and methods for removing an obstruction from a blood vessel are described. The devices are deployed in a collapsed condition and are then expanded within the body. The devices are then manipulated to engage and remove the obstruction.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• The present application is a continuation of application Ser. No. 10/839,977, filed on May 5, 2004 which is a continuation-in-part of application Ser. No. 10/460,751, filed on Jun. 11, 2003, which is a continuation-in-part of application Ser. No. 10/055,714, filed Jan. 22, 2002 which is a continuation-in-part of application Ser. No. 09/891,141, filed Jun. 25, 2001, which is a continuation in part of application Ser. No. 09/756,476, filed Jan. 8, 2001, which is a continuation-in-part of application Ser. No. 09/605,143, filed Jun. 29, 2000, the full disclosures of which are incorporated herein by reference for all purposes.
BACKGROUND OF THE INVENTION
• Field of the Invention
• The present invention is directed to methods and devices for removing obstructions from blood vessels. The device may be used to retrieve and remove clots and other biological obstructions. The device may also be used to retrieve embolic coils and the like which have been misplaced or have migrated to an undesirable location.
• One such obstruction removal device is disclosed in U.S. Pat. No. 5,895,398 which is hereby incorporated by reference. The device has an expandable engaging member which is introduced into the blood vessel to engage the obstruction for removal.
• The present invention is also directed to devices, systems and methods which use an expandable capture element when removing obstructions from a blood vessel. One such system for removing obstructions in a blood vessel is described in U.S. Pat. No. 5,102,415 to Guenther et al. The system described in U.S. Pat. No. 5,102,415 has a balloon catheter and a catheter having an expandable tip which receives the obstruction. The balloon catheter is passed through the obstruction while the balloon is deflated. The balloon is then inflated and the tip of the catheter is expanded. The balloon is then moved proximally so that the obstruction is pulled into the expanded tip of the catheter. A problem with the system of U.S. Pat. No. 5,102,415 is that the interaction between the balloon catheter and the leading edge of the catheter may tend to shear off portions of the obstruction. This can cause obvious problems when working in sensitive vascular areas.
• The present invention is directed to additional devices and methods for removing obstructions in a blood vessel.
SUMMARY OF THE INVENTION
• In accordance with the present invention, device and methods for removing obstructions are provided. In a first aspect of the invention, an obstruction removal device is provided which has an obstruction engaging element extending from an insertion element. The engaging element is movable from a collapsed position to an expanded position. The engaging element forms coils having varying diameter wherein the coils at a distal portion are larger than coils at an intermediate portion. The distal portion forms a relatively closed structure which prevents the obstruction, or any part thereof, from migrating downstream. The distal portion is expanded distal to the obstruction while the proximal portion engages and holds the obstruction.
• In another aspect of the present invention, another obstruction removal device is provided which has at least one closed loop and preferably two closed loops. The closed loop provides an advantage when advanced through a catheter or sheath in that the closed loop produces opposing radial forces on the catheter or sheath through which the loop is advanced. In this manner, the obstruction removal device can be advanced more easily through the catheter or sheath to prevent binding or kinking of the device during advancement. In a preferred embodiment, the obstruction removal device has two loops of varying diameter with the distal loop having a larger diameter. Each of the loops lie in a plane with the planes of the two loops preferably being perpendicular to one another.
• Any of the obstruction removal devices described herein may also be used with a source of power coupled to the obstruction removal device for use as described below. The source of power may simply produce a positive or negative charge or may be an RF energy source. The source of power may be used to help the obstruction removal device penetrate and engage the obstruction and may also be used to adhere the obstruction to the obstruction removal device as will be described. In a preferred embodiment, a negative charge is provided when advancing the obstruction removal device into the obstruction and a positive charge, or RF energy, is supplied to adhere the device to the obstruction.
• The devices of the present invention may be manufactured in any suitable manner. In another aspect of the present invention, the obstruction removal device has a core element surrounded by a sheath. A strand, preferably about four strands, are positioned between the core element and the tube. The strand and the tube prevent any part of the obstruction removal device from breaking free should the core element fail. The strand and tube will hold the obstruction removal device together even if the core element breaks. The sheath is preferably flexible so that the sheath can undergo much larger deflections than the core element.
• The obstruction removal devices of the present invention may also be advanced through a guide catheter having a flow restricting element which is preferably a balloon but may be any other suitable structure. The flow restricting element is expanded to reduce blood flow through the obstructed vessel to minimize the likelihood that the obstruction will migrate downstream.
• In another aspect of the invention, a system is provided which has an expandable capture element and an obstruction engaging device which together work to remove an obstruction from a blood vessel. The capture element is advanced through the patient in a collapsed position and is expanded when at the desired location. The obstruction engaging device preferably has one or more filaments which provide a relatively flexible interaction between the engaging device and the capture element. This provides advantages over the use of a balloon catheter as described in greater detail below. The obstruction engaging device preferably has 1-4 filaments and more preferably 1-2 filaments. Of course, the obstruction engaging device may have more filaments without departing from various aspects of the invention and, in fact, the device may form a filter which further helps to prevent portions of the obstruction from being carried downstream.
• The capture element is preferably naturally biased toward the expanded position although the capture element may also be manually actuated as described below. The capture element has a support structure with a flexible cover attached thereto. The support structure preferably has a closed loop which opens the distal end of the cover. The loop is preferably integrally formed and has a number of integrally formed hinges which deflect when the loop is expanded and collapsed. The hinges are preferably V-shaped although other shapes may be used. A plurality of struts extend proximally from the loop.
• The capture element may also be expanded by the user so that the user may select the appropriate time for expansion of the capture element. In this manner, the user may advance the capture element to a suitable location for expansion. The user may also collapse the capture element before withdrawing the capture element into a catheter. The capture element has an actuator for opening and closing the capture element. The actuator may have a control arm and a stable arm although any suitable actuator may be used. The control arm is manipulated to expand and contract a loop at the distal end of the capture element. Alternatively, the actuator may be a tube which cinches the loop closed. In a specific embodiment, the capture element may also evert when moving to the expanded position.
• The device of the present invention may be used in various different locations and for various different purposes. In one embodiment, the device may be used in connection with a guide catheter. When used with the guide catheter, the device may be expanded to slow or even stop blood flow when performing other procedures downstream of the guide catheter such as removing a clot or placing a stent.
• Alternatively, the device may be passed through a conventional guide catheter so that the device may be introduced further into the vasculature. In this system, the capture element passes through the guide catheter. The obstruction engaging device is then used to engage the obstruction and move the obstruction into the capture element.
• In still another aspect of the invention, the capture element inverts when the obstruction is moved into the capture element. The obstruction is preferably engaged with an engaging element having a filament which ensnares the obstruction. The obstruction engaging element may be independent from the capture element or may be connected to the engaging element. The capture element inverts upon application of a compressive force to the inverting portion or upon any other suitable actuation force. The capture element preferably inverts when the compressive force is applied by either the obstruction or the engaging element.
• In still another aspect of the present invention, a device and method for removing an obstruction from a blood vessel is provided. A strand extends along the elongate obstruction removing element and extends between the coils of the element. The element may be manipulated to entangle the main element with the strand and to entangle the device with the obstruction. The strand will become entangled with the element at locations dependent upon permitted expansion of the element within the blood vessel.
• In yet another aspect, an intravascular device and method for removing material from a vascular site are provided. A filament is wrapped around the main element in a delivery condition. The filament and main element are then rotated relative to one another to cause the two to essentially unravel.
• These and other advantages of the invention will become apparent from the following description, drawings and claims.
BRIEF DESCRIPTION OF THE DRAWING FIGURES
• FIG. 1 shows a system for removing an obstruction.
• FIG. 2 shows the obstruction removal device in a collapsed condition.
• FIG. 3 shows the obstruction removal device with a distal portion of the obstruction removal device expanded.
• FIG. 4 shows the obstruction removal device with a proximal portion expanded to engage an obstruction.
• FIG. 5 shows the capture element collapsed around the obstruction prior to withdrawal.
• FIG. 6 shows the capture element contained within the catheter in an inverted position when collapsed.
• FIG. 7 shows another device for capturing an obstruction.
• FIG. 8 shows the capture device ofFIG. 7 advanced at least partially into engagement with the obstruction.
• FIG. 9 shows an obstruction engaging element advanced through the capture element.
• FIG. 10 shows the element engaging the obstruction.
• FIG. 11 shows the obstruction partially contained within the capture element.
• FIG. 12 shows the obstruction completely contained within an inverted portion of the capture element.
• FIG. 13 shows still another device for capturing an obstruction.
• FIG. 14 shows the element engaging the obstruction.
• FIG. 15 shows the inverting portion beginning to invert to capture the obstruction.
• FIG. 16 shows the obstruction partially contained within the capture element.
• FIG. 17 shows the obstruction completely contained within the capture element.
• FIG. 18 shows the inverting portion contained within another catheter such as the guide catheter for removal from the patient.
• FIG. 19 shows the distal end of the device ofFIGS. 13-18 with the engaging element expanded.
• FIG. 20 shows the distal end of the device ofFIGS. 13-18 with the engaging element collapsed.
• FIG. 21 shows another device for removing an obstruction.
• FIG. 22 shows the device ofFIG. 21 expanded within a blood vessel.
• FIG. 23 shows another device for removing an obstruction in a collapsed position.
• FIG. 24 shows one possible configuration for the expanded device ofFIG. 23.
• FIG. 25 shows another possible configuration for the expanded device ofFIG. 23.
• FIG. 26 shows a device having more strands and loops along the proximal section than along the distal section.
• FIG. 27 shows the device having an interlocking strand extending between two strand loops.
• FIG. 28 shows the strand loops interlocking closer to the distal and proximal ends in the upper and lower parts, respectively.
• FIG. 29 shows the strands positioned within the expanded shape of the main element.
• FIG. 30 shows the device positioned proximate to an obstruction.
• FIG. 31 shows the device advanced into and through the obstruction.
• FIG. 32 shows expansion of part of the main element distal to the obstruction.
• FIG. 33 shows expansion of part of the main element within the obstruction.
• FIG. 34 illustrates that rotation of the main element causes the strand to become entangled with the main element and enhances engagement between the device and the obstruction.
• FIG. 35 shows still another device for removing an obstruction collapsed within the delivery catheter.
• FIG. 36 shows the device in an expanded shape.
• FIG. 37 shows the device ofFIG. 35 with the filaments removed for clarity.
• FIG. 38 shows the device ofFIG. 36 with the filaments removed for clarity.
• FIG. 39 shows still another device for removing an obstruction with a catheter having an interlocking structure.
• FIG. 40 shows the interlocking structure entangled with an obstruction engaging element.
• FIG. 41 shows the interlocking structure and element embedded within the obstruction.
• FIG. 42 shows the interlocking structure and element being withdrawn.
• FIG. 43 shows a catheter having a flexible tube to contain the obstruction.
• FIG. 44 shows the obstruction contained within the catheter ofFIG. 43.
• FIG. 45 shows another catheter having a flexible tube which cooperates with the element to dislodge and capture the obstruction.
• FIG. 46 shows the catheter and element entangled.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS
• Referring now toFIGS. 1-4, asystem2 for removing an obstruction is shown. Aguide catheter4 is advanced to a location proximal to an obstruction. When accessing the cerebral vasculature, for example, theguide catheter4 is often positioned in the carotid or vertebral artery. Of course, theguide catheter4 may not be necessary or may be positioned in any other suitable location depending upon the location of the obstruction. Theguide catheter4 preferably has aflow restricting element6 which restricts or even stops blood flow through the vessel as described below. Theflow restricting element6 is preferably aballoon5 coupled to a source ofinflation fluid7 which is used to inflate theballoon5.
• Anobstruction removing device8 is advanced through theguide catheter4 to the obstruction. Amicrocatheter10 may also be positioned within theguide catheter4 to deliver theobstruction removing device8 further into the vasculature. The obstruction removing device may be advanced by itself through themicrocatheter10 or may be contained within asheath12 which is advanced through themicrocatheter10. Asource power14 may also be coupled to theobstruction removal device8 for use in the manner explained below. Thepower source14 may simply produce a positive or negative charge or may be an RF or other suitable power source.
• Theobstruction removing device8 has an engagingelement16 extending from aninsertion element18. The engagingelement16 is movable from a collapsed position (FIG. 2) to an expanded position (FIGS. 3 and 4). When the engagingelement16 is contained within thesheath12 ormicrocatheter10, the engagingelement16 is in a relatively straight configuration. The engagingelement16 has adistal portion20, which forms a relatively closed structure, which can catch or trap the obstruction, or any part thereof, to prevent migration of the obstruction or part thereof. The engagingelement16 has aproximal portion22 which is formed with smaller coils than thedistal portion20. Theproximal portion22 engages the obstruction as described below.
• The engaging element16 (FIGS. 2-4) preferably has a number ofmarkers23,25,27 (FIG. 1) which provide an indication as to how much of the engagingelement16 extends from thesheath12 ormicrocatheter10. For example,markers23,25,27 may indicate when the engagingelement16 is about to be exposed or is ½, ¾ or fully exposed. In this manner, the user may quickly advance the engagingelement engaging element16 through thesheath12 ormicrocatheter10 without inadvertently exposing and advancing the engagingelement16 out of thesheath12 or microcatheter. Themarkers23,25,27 can also be used to provide a controlled diameter of the engagingelement16 since the diameter of the engagingelement16 is known for the various positions corresponding to themarkers23,25,27. Themarkers23,25,27 may also be used to size the vessel in which the engagingelement16 is positioned by observing when the engagingelement16 engages the vessel walls and determining the size of the engagingelement16 using themarkers23,25,27.
• Theinsertion element18 is preferably made of a superelastic material or stainless steel having a diameter of 0.004 to 0.038 inch and preferably about 0.010 inch. Although theinsertion element18 is preferably a solid, elongate element, theinsertion element18 may take any other suitable structure such as a hollow tube. The engagingelement16 is preferably made of a superelastic material, such as nitinol, and has a diameter of 0.005-0.018 inch, more preferably 0.005-0.010 inch and most preferably about 0.008 inch. The engagingelement16 has a rounded,atraumatic tip24 to prevent damage to the vessel and facilitate advancement through the vessel,microcatheter10 and/orsheath12. Aradiopaque wire26, such asplatinum ribbon28 having a width of 0.004 inch and a thickness of 0.002 inch, is preferably wrapped around the engagingelement16 to improve radiopacity.
• Thedevice8 is preferably self-expanding but may also be expanded with an actuator29. The actuator29 is preferably a thin filament which is tensioned to move thedevice8 to the expanded position. An advantage of the invention is that the filament29 extends through the same lumen as thedevice8 thereby minimizing the overall size of the device. It is understood that throughout discussion of the devices and methods herein that any of the devices may be expanded using the actuator29 rather than being self-expanding without departing from the scope of various aspects of the invention.
• Thedevice8 may also include acover9 which extends between adjacent coils. Thecover9 may be a number of individual strands11 which extend between the coils or may be an elastic membrane which covers the coils. The strands11 are preferably elastic to stretch when thedevice8 is expanded.
• Use of theobstruction removing device8 is now described. Theguide catheter4 is introduced into the patient and delivered proximal to the target vessel such as to the carotid or vertebral artery. Themicrocatheter10 is then advanced through theguide catheter4 further into the vasculature to a position proximal to, within or distal to the obstruction. Theobstruction removal device8 is then advanced through themicrocatheter10 either by itself or pre-loaded within thesheath12. Theobstruction removal device8 is then advanced to the obstruction. Before advancing theobstruction removal device8 further, theflow restricting element6 on theguide catheter4 is expanded to reduce and even stop flow through the vessel. Stopping flow in the vessel may help prevent the obstruction, or any parts thereof, from migrating downstream. Reducing flow through the vessel may also reduce the likelihood that the obstruction is disrupted by a combination of flow and theobstruction removal device8.
• Theobstruction removal device8 is then placed into the obstruction and preferably through the obstruction. The engagingelement16 is then advanced out of themicrocatheter10 orsheath12 to permit thedistal portion20 of the engagingelement16 to expand at a location beyond the obstruction. In this manner, the relatively closeddistal portion20 prevents the obstruction, or any part thereof, from migrating downstream. Theproximal portion22 is then advanced out of thesheath12 ormicrocatheter10 so that the smaller coils of theproximal portion22 engage the obstruction as shown inFIG. 4.
• Thepower source14 may be also be used with any of the obstruction removal devices in the following manner, however, the methods and devices of the present invention may, of course, be practiced without thepower source14. As mentioned above, thepower source14 may simply produce a charge at the engagingelement16 or may be a source of RF energy. In one particular method of the present invention, thepower source14 produces a negative charge while advancing the engagingelement16 through the obstruction. The negative charge may aid in passing the engagingelement16 through the obstruction and may help to dissolve part of the obstruction. The power supply is then changed to produce a positive charge to adhere the obstruction to the engagingelement16. Alternatively, thepower source14 may be an RF energy source, which delivers RF to the engagingelement16 which also adheres the obstruction to the engagingelement16 and may help provide a controlled penetration into the obstruction. The obstruction is then removed by moving the obstruction into theguide catheter4, which is then withdrawn to remove the obstruction. Use of thepower source14 is particularly useful when the obstruction is a biologic structure such as a clot.
• Referring toFIG. 6, acapture element150 is shown. Thecapture element150 has acover114 and anactuator138 which includes astable arm142, acontrol arm140, and aloop136 although other actuating structures may be used. Thecapture element150 is contained within the catheter107 or theguide catheter4 during introduction and is then everted out of the catheter107 orcatheter4 when deployed. After the obstruction is contained within thecapture element150, thecapture element150 is withdrawn into thecatheter4. Although it is preferred to withdraw thecapture element150 into thecatheter4, thecapture element150 may be collapsed and then inverted back into thecatheter134 thereby trapping the obstruction in thecatheter134 itself.
• Thecapture element150 is opened and closed by manipulating thearms140,142 to open and close theloop136. The obstruction is captured with theelement150 by itself or together with an obstruction engaging element as described herein.
• Referring toFIGS. 7-12, anothercapture element200 is shown for capturing an obstruction. Thecapture element200 has an invertingportion202 that inverts to entrap the obstruction. Thecapture element200 is then withdrawn into the guide catheter4 (FIG. 1) for removal of the obstruction from the patient.
• Referring toFIG. 10, the engagingelement204 is shown engaging the obstruction. Theelement204 may be any suitable element such as the obstruction engaging elements and removal devices described herein. Theelement204 passes through alumen205 in thecapture element200. Theengaging element204 may be advanced through thecapture element200 by itself or may be contained within themicrocatheter10 or sheath12 (FIGS. 1 and 2) which is advanced through thecapture element200.
• Thecapture element200 has adistal portion207 which is flexible and which may be partially contained, engaged or otherwise in contact with the obstruction as shown inFIG. 8. Thedistal portion207 may also invert but preferably does not invert. Thedistal portion207 necks-down at adistal end209 to a size smaller than the guidewire GW so that thecapture element200 is advanced together with the guidewire. Of course, thecapture element200 may also be advanced by itself after introduction of the guidewire and may be contained within or advanced over another catheter without departing from the invention.
• Theelement204 engages the obstruction in any suitable manner. The invertingportion202 is then inverted by applying a compressive force to the invertingportion202. The compressive force is applied by moving thecapture element200 relative to theengaging element204 which causes theelement200 and/or obstruction to compress the inverting portion. Continued relative movement moves the obstruction into theinverted capture element200 as shown inFIGS. 11 and 12 to capture the obstruction. Thecapture element200 is then moved into the guide catheter4 (FIG. 1) for removal from the patient. Thecapture element200 may be made of any suitable materials. For example, thedistal portion207 may be made of any suitable polymeric material such as those described herein and the invertingportion202 may be made of a braided or woven material or fabric made of fibers or filaments of nitinol, stainless steel, polymer or other material.
• Referring toFIGS. 13-20, anothercapture element210 for removing an obstruction is shown wherein the same or similar reference numbers refer to the same or similar structure. Thecapture element210 also has an invertingportion212 connected to anend213 of adelivery element214 which may be a hollow tube, sheath or catheter. The distal end of thecapture element210 has acollar214 attached to aproximal end216 of anengaging element218. Adistal end220 of theobstruction engaging element218 is attached to aninner element222 such as a wire, mandrel or guidewire. Thecollar214 slides over theinner element222 so that when theinner element222 anddelivery element214 are movable relative to one another. Relative movement between theinner element222 anddelivery element214 moves theobstruction engaging element218 between the expanded and collapsed positions (FIGS. 19 and 20) and also can collapse thecapture element210. Theengaging element218 is similar to the other elements and devices described herein in that the element has afilament224 which is tensioned to collapse thefilament224. Thefilament224 forms coils226 around theinner element222.
• Thecapture element210 andobstruction engaging element218 are advanced through the patient in either thesheath12 or microcatheter10 (FIGS. 1 and 2). Thecapture element210 andobstruction engaging element218 are then positioned distal to the obstruction and the obstruction is engaged with theelement218. Thecapture element210 andengaging element218 are then moved relative to one another to invert thecapture element210 as described above.
• Referring toFIGS. 21-29, still anotherdevice902 for removing an obstruction is shown. Thedevice902 has amain element904 that may be anysuitable element904 such as those described herein. Theelement904 is held in a substantially straight, collapsed position within thedelivery catheter905 as described above. Similar to the embodiment ofFIGS. 2 and 3, theelement904 has one ormore strands906 which extend along theelement904. Of course, thestrands906 may extend freely alongside themain element904 or may be wound helically, interwoven or interlocked with theelement904 without departing from the scope of the invention. Thestrands906 are tied, knotted, looped, soldered, or otherwise attached to themain element904 at the ends of the expandable portion of themain element904. Of course, thestrands906 may be looped around or attached to themain element904 at other parts of themain element904. For example, thestrand906 may be attached or coupled to themain element904 several centimeters proximal to the expandable portion of themain element904 without departing from the scope of the invention.
• Themain element904 may be anysuitable element904 which is naturally biased toward the expanded position such as any of the elements described herein.FIGS. 22, 24 and25 show three different embodiments of themain element904 for purposes of illustration. Themain element904 may formhelical coils907 having varying diameter as shown inFIG. 22 or may havecoils907 with the same diameter as shown inFIG. 25 or may even havecoils907 which extend transverse to the longitudinal axis as shown inFIG. 24. Of course, any suitable shape may be used for themain element904. Any of the devices described herein may have a main element which extends transverse or perpendicular to the longitudinal axis as shown inFIG. 24 and as further shown below in connection withFIG. 36. Thus, the embodiment ofFIG. 29, for example, may have the coils extending transverse to the longitudinal axis.
• Thestrand906 may be any suitable filament, wire, fiber, monofilament and may be made of any suitable material such as nylon, polypropylene, polyester, polyurethane, silicone, latex, a liquid crystal polymer (LCP) such as Vectran or even nitinol or stainless steel. Thestrand906 is flexible and may or may not have a predetermined shape with thestrand906 being deformed and deflected by theelement904 as theelement904 expands. Theelement904 includes twostrands906 which interlock or have interlockingloops908 at about the midpoint of the expandable portion of theelement904. Stated another way, thestrands906 form twoloops908 which interlock at the midpoint as shown inFIG. 21. Thestrands906 andloops908 are shown in an exaggerated state in the collapsed position ofFIG. 21 for clarity. Of course, one advantage of the invention is that thestrands906 are relatively small and flexible and do not take up much space in the lumen of the delivery catheter as compared to conventional structures using wires and the like. This feature cannot be appreciated, of course, in the exaggerated depiction ofFIG. 21.
• Referring toFIG. 26, thestrands906 may also formmore loops908 on one side than on the other. An interlockingloop910 extending around themain element904 may also be provided to interlock pairs ofloops908 as shown inFIG. 27. Thestrands906 orloops908 may also intersect nearer to the proximal or distal ends as shown in the upper and lower parts ofFIG. 28. Referring toFIG. 29, thestrands906 may also be positioned generally inside theelement904 when theelement904 is expanded. The device may be loaded by pulling the ends of theelement904 when in the position ofFIG. 25 to collapse themain element904 around thestrands906. The device is then restrained in thedelivery catheter905 and delivered to the obstruction.
• Referring again toFIGS. 22-25, themain element904 may have afilament912, such as platinum coil, wound around the expandable portion of themain element904. The filament may help to improve radiopacity and may also be sized and configured so that thestrand906 can be held between adjacent windings of thefilament912 to enhance interlocking engagement between thestrand906 andelement904. Alternatively, thefilament912 may only be provided at the ends of the expandable portion of themain element904 as shown inFIG. 22 where thestrands906 are coupled to themain element904.
• Use of thedevices902 ofFIGS. 21-29 is now described with further reference toFIGS. 30-34. Thedelivery catheter905 is passed through the obstruction so that the distal tip is beyond the obstruction as shown inFIG. 31. Themain element904 is then expanded so that one or more coils are distal to the obstruction as shown inFIG. 32. Thedelivery catheter905 is then withdrawn further to expose more of the expandable portion of themain element904 as shown inFIG. 33. Although it is preferred to position one or more coils distal to the obstruction, all or part of the expandable portion of themain element904 may be expanded within, distal or even proximal to the obstruction without departing from the scope of the invention.
• The device900 may emerge from thedelivery catheter905 with thestrands906 being relatively free of themain element904 between the proximal and distal attachments to the main element. Of course, thestrands906 may be interwoven, looped around or even somewhat entangled with themain element904 so long as the user may manipulate the device to further entangle thestrand906 andelement904. Rotation of the device causes thestrands906 to become entangled with themain element904 in a manner dictated by the geometric restrictions of the vessel and obstruction. The device itself may also become more entangled with the obstruction during rotation of themain element904. An advantage of using the helical or coiled structures described herein is that rotation of themain element904 not only causes the device to engage the obstruction but also causes thestrand906 to become entangled with themain element904.
• Another aspect of the present invention is that the amount of entanglement between thestrand906 andelement904 may be controlled. For example, the user may first attempt to remove the obstruction with little or no rotational manipulation of theelement904. The user can then pull on themain element904 and determine whether the device can remove or dislodge the obstruction or whether the main element is disengaging or slipping relative to the obstruction. Disengagement can occur due to excessive elongation or distortion of themain element904 or may be simply due to poor engagement between the device and obstruction. The user may then rotate or otherwise manipulate the device to cause further entanglement between thestrand906 andelement904 and between the device itself and the obstruction. Increasing the entanglement between thestrand906 andmain element904 may help to reinforce the main element which can reduce stretching and distortion of themain element904 when themain element904 is tensioned. Thestrands906 also increase the overall surface area of the device and generally reduce the size of interstitial spaces in themain element904. Another aspect of the present invention is that thestrand906 andelement904 may engage one another at locations dependent upon the permitted expansion of themain element904 within the vessel. As such, the present invention provides advantages over conventional mesh-like structures having a predetermined geometry since these structures may not perform adequately under a variety of different size restrictions in an obstruction.
• Although thestrand906 andelement904 may not be substantially entangled when the element is initially expanded, themain element904 andstrand906 may also be designed to become entangled with one another during expansion of themain element904. For example, theelement904 may naturally begin to twist in a helical manner to formcoils908 when expanding due to the shape of theelement904. The twisting motion causes thestrand906 to engage, contact and and/or otherwise entangle itself with theelement904 and obstruction. Thestrand906 will engage theelement904 at a number of locations dependent upon the manner in which the element expands within the vessel as described above. Although theelement904 generally follows a helical path when expanding, theelement904 may expand in any other manner which tends to entangle thestrand906 andelement904. For example, theelement904 may rotate one way and then another or may be longitudinally displaced or reciprocated. Thus, it can be appreciated that the element may expand in a number of different ways to cause thestrand906 to become entangled with the element. Of course, the element may also be rotated or otherwise manipulated to enhance entanglement between thestrand906 and element even after expansion of the main element to provide the advantages described above.
• After the obstruction has been engaged by the device, the main element is pulled to dislodge the obstruction for removal as describe above. Once the element has dislodged the obstruction, the obstruction may be moved into aguide catheter909 or sheath for removal from the patient. Theguide catheter909 may have a balloon to occlude blood flow during withdrawal of the obstruction.
• Referring now toFIGS. 35-38, still anotherdevice300 for removing an obstruction from a vascular location is shown. Thedevice300 includes amain element302 having a self-expandingportion304 which forms a number ofcoils306. Of course, theelement302 may take other shapes when expanded such as those described herein and incorporated by reference. Thecoils306 may be oriented at an angle of about 90 degrees with respect to a longitudinal axis of theelement302 or may be oriented in any other manner such as parallel to the longitudinal axis. Thecoils306 may have substantially the same diameter or the diameter of thecoils306 may vary in any suitable manner. Thedevice300 has one ormore filaments308 extending alongside thecoils306 similar to other devices described herein such as the devices ofFIGS. 1-4 and21-34.FIGS. 37 and 38 show only theelement302 andcatheter309 for clarity whileFIGS. 35 and 36 show both theelement302 andfilaments308.
• Thefilaments308 are coupled to themain element302 at proximal anddistal locations310,312. Thefilaments308 may be coupled to theelement302 at non-expanding portions just proximal and distal to the self-expandingportion304 or thefilaments308 may be coupled to the expandingportion304 of theelement302 such as thecoils306. Thefilaments308 are preferably free to slide at the proximal location and are looped around themain element302 to permit sliding. Thefilaments308 are fixed at the distal location by securing thefilaments308 between windings of a radiopaque wire wrapped around themain element302 at the distal end (seeradiopaque wire26 ofFIG. 2). Other devices described herein, such as the devices ofFIGS. 21-34, may have filaments which are slidable on the main element. For example, thewire912 may be slidable on the main element so that all of thefilaments906 are coupled together and slidable on themain element904. Alternatively, of course, the filaments may be independently slidable on the main element by simply looping the filaments around the main element as described above.
• Use of the device ofFIGS. 35 and 36 is now briefly described and all methods of using the devices described in connection withFIGS. 1-4 and21-34 are incorporated here. The guidewire (seeFIG. 1) is initially advanced through the obstruction and thecatheter309 is then advanced into or through the obstruction over the guidewire. The self-expandingportion304 is then permitted to expand by either advancing the element or retracting thecatheter309. The expandingportion304 of themain element302 may be deployed distal to the obstruction or may be partially or entirely deployed within the obstruction. As theelement302 andfilaments308 are deployed, theelement302 andfilaments308 interact with one another and with the obstruction as theelement302 expands. The manner in which thefilaments308 deploy and contact themain element302 and obstruction is dependent upon various factors including the geometry of the vessel and obstruction and the manner in which theelement302 expands as explained above. Thefilaments308 may prevent excessive elongation of themain element302 and may improve the ability of theelement302 to capture the obstruction.
• Referring now toFIGS. 39-42, still anothersystem400 is shown for removing obstructions from a vascular location. The system includes anobstruction engaging element402 which works together with acatheter404 to remove the obstruction. Theelement402 is preferably advanced through alumen406 in thecatheter404 as described below. Theelement402 has an expandingportion405 which expands to formcoils407 as described herein. Theelement402 may be anysuitable element402 which is configured to engage the obstruction such as those described herein.
• Thecatheter404 has an interlockingstructure410 at the distal end which cooperates with theelement402 to dislodge and remove the obstruction or may be used by itself to engage, dislodge and remove the obstruction. The interlockingstructure410 is preferably a loose, flexible structure formed byflexible filaments408 such as suture or wire. Thefilaments408 are attached to the distal end of thecatheter404 and may formloops412 or may be woven or interlocked in any manner. Thecatheter404 has eightloops412 attached to the distal end of thecatheter404 with theloops412 having two different sizes. Aradiopaque material414, such as platinum, may be attached to thefilaments408 at discrete locations to improve radiopacity and to improve the ability of the interlockingstructure410 to become entangled with theelement402 and obstruction. Thematerial414 may be formed in any suitable manner such as beads of platinum or small coils or tubes attached to thefilaments408.
• The relatively flexible nature of thefilaments408 does not substantially increase the stiffness of thecatheter404 so that thecatheter404 can still be advanced through small and tortuous vessels. As thecatheter404 is advanced through the patient's vasculature, thefilaments408 are free to move and displace and will naturally lie against the body of thecatheter404. Thecatheter404 may be delivered through another catheter, such as a guide catheter, which is advanced to a location near the obstruction with thecatheter404 being advanced by itself over the guidewire to the obstruction (seeFIG. 1). Thecatheter404 may even be used by itself to remove an obstruction or may be used with another catheter which encapsulates the obstruction such as the device ofFIGS. 43 and 44 described below.
• Another method of the present invention is now described with reference to the system ofFIGS. 39-42. The guidewire (seeFIG. 1) is advanced through the obstruction and the catheter is then advanced through the obstruction over the guidewire. Thecatheter404 is then withdrawn a small distance so that the interlockingstructure410 is deployed distal to the obstruction. The guidewire is then withdrawn and replaced by theelement402. Theelement402 is then permitted to expand by advancing theelement402 or withdrawing thecatheter404 to expose theelement402. Exposure of theelement402 may cause theelement402 andinterlocking structure410 to naturally become entangled or interlocked. Theelement402 may also be twisted or rotated to enhance interaction between the interlockingstructure410 andelement402. Thecatheter404 andelement402 are then moved proximally to engage and dislodge the obstruction. Although theentire interlocking structure410 and expandingportion405 of theelement402 are shown distal to the obstruction, part of either structure may, of course, be deployed within the obstruction. For example, with reference toFIGS. 40 and 41, thecatheter404 may be advanced into or through the obstruction and then withdrawn into the obstruction so that the loose,flexible filaments408 are naturally left within the obstruction. Theelement402 is then deployed within the obstruction and theelement402 is manipulated to entangle the element andfilaments408. Of course, some part of the element, such as a few windings of thecoil407, may be deployed distal to the obstruction before withdrawing thecatheter404. After theelement402 andinterlocking structure410 have become entangled, theelement402 is manipulated to dislodge and remove the obstruction.
• Referring toFIGS. 43 and 44, still anothersystem500 for removing an obstruction is shown. Thesystem500 includes anobstruction engaging element502 which may be any suitable element such as those described herein. Thesystem500 also includes acatheter504 which receives and contains the obstruction during removal from the patient. Thecatheter504 has acontainment chamber506 which is defined by aflexible tube508. Thetube508 may be everted from the position ofFIG. 42 to the position ofFIG. 43. Thetube508 is made of expanded PTFE but may be made of any other suitable material.
• In use, theobstruction engaging element502 engages the obstruction and thecatheter504 is advanced adjacent to the obstruction as shown inFIG. 43. Thecatheter504 andelement502 are then moved proximally together so that thecontainment chamber506 everts and covers the obstruction. Thecatheter504 andelement502 are then withdrawn from the patient together to remove the obstruction. Theflexible containment chamber506 protects and encases the obstruction to reduce the likelihood of losing pieces of the obstruction as the obstruction is removed.
• Referring toFIGS. 45 and 46, still anotherdevice600 for removing an obstruction is shown. Thedevice600 includes acatheter602 having atube604 mounted to the distal end. Thetube604 hasopenings606 therein such aslongitudinal slots608. Thedevice600 is similar to other devices described herein in that thetube604 cooperates with anelement610 to dislodge and remove an obstruction. Theelement610 is manipulated so that theelement610 extends through one or more of theopenings606 to entangle theelement610 andtube604. Thetube604 may be deployed distal to the obstruction by advancing thecatheter602 through the obstruction and then withdrawing thecatheter602 to deploy thetube604. Theelement610 is then advanced out of the distal end of thecatheter602 and manipulated to entangle thetube604 andelement610 together. For example, theelement610 may be twisted and/or pulled proximally. Of course, theelement610 may naturally twist or displace to pass through theopenings606 when advanced from thecatheter602.
• While the above is a description of the preferred embodiments of the invention, various alternatives, substitutions and modifications may be made without departing from the scope thereof, which is defined by the following claims. Thus, the preferred embodiments should not be taken as limiting the scope of the invention. For example, although all of the obstruction removal devices described herein are self-expanding structures, the obstruction removal devices may also have actuating mechanisms for moving the engaging element between the expanded and collapsed positions. Furthermore, the present invention is directed to a number of separate inventions and each of these inventions may be claimed independently of one another. Each feature, aspect and advantage of the invention may be claimed independent of one another without departing from the scope of the invention. As a further example, any engaging device, even a balloon, may be used with some of the inventive aspects of the capture element and any capture element may be used with inventive aspects of the engaging device. Finally, the devices of the present invention may also be used in connection with simply controlling blood flow through an area and not necessarily with removal of an obstruction.

Claims (33)

1. A method of removing an obstruction from a blood vessel, comprising the steps of:

providing an obstruction removal device having an obstruction engaging portion, the obstruction engaging portion being movable from a collapsed shape to an expanded shape, the obstruction engaging portion being naturally biased toward the expanded shape, the obstruction removal device also having at least one flexible filament which is coupled to the obstruction removal device at a proximal location and a distal location, the flexible filament being slidably coupled to the obstruction removal device at the proximal location;

advancing the obstruction removal device through a patient's vascular system to the obstruction;

introducing the obstruction engaging portion into the obstruction;

permitting the obstruction engaging portion of the obstruction removal device to expand; and

removing the obstruction with the obstruction removal device.

2. The method ofclaim 1, wherein:

the providing step is carried out with the obstruction removal device being a single filament extending to a free end.

3. The method ofclaim 2, wherein:

the providing step is carried out with the obstruction engaging portion forming a helical coil.

4. The method ofclaim 2, wherein:

the providing step is carried out with the obstruction engaging portion forming a number of coils.

5. The method ofclaim 1, wherein:

the providing step is carried out with the flexible filament being connected to a non-expanding portion of the obstruction removal device.

6. The method ofclaim 1, wherein:

the providing step is carried out with a plurality of filaments slidably coupled to the obstruction removal device.

7. The method ofclaim 1, wherein:

the advancing step is carried out by advancing a distal end of the obstruction removal device through the obstruction with the obstruction removal device in the collapsed position; and

the permitting step is carried out with part of the obstruction removal device expanding distal to the obstruction and part of the obstruction removal device expanding within the obstruction.

8. A device for removing an obstruction from a vascular location, comprising:

an elongate wire having an obstruction engaging portion which is movable between a collapsed position and an expanded position, the obstruction engaging portion being naturally biased toward the expanded position; and

a filament coupled to the wire at a proximal location and a distal location, the filament being slidably coupled to the elongate wire at the proximal location.

9. The device ofclaim 8, wherein:

a plurality of filaments are coupled to the elongate wire, wherein each of the plurality of filaments is coupled to elongate wire at proximal and distal locations, the filaments being independently slidable on the elongate wire.

10. The device ofclaim 8, wherein:

the obstruction engaging portion of the wire forms a coiled section near the distal end when in the expanded position;

the filament being coupled to the wire proximal to the coiled section at the proximal location.

11. The device ofclaim 8, wherein:

the filament is coupled to the wire distal to the coiled section at the distal location.

12. The device ofclaim 8, wherein:

one wire is provided along the obstruction engaging portion, the wire extending to a free end.

13-28. (canceled)

29. A method of removing an obstruction from a blood vessel, comprising the steps of:

providing an obstruction engaging element and a catheter having an interlocking structure, the obstruction engaging element being movable from a position within the catheter to a position outside the catheter;

advancing the catheter into an obstruction;

withdrawing the catheter after the advancing step so that the interlocking structure remains within the obstruction; and

moving the element so that the element becomes entangled with the obstruction and the interlocking structure.

30. The method ofclaim 29, wherein:

the providing step is carried out with the interlocking structure being a loose, flexible structure;

the withdrawing step being carried out with the loose, flexible interlocking structure being held by the obstruction so that the loose, flexible structure remains within the obstruction.

31. The method ofclaim 30, wherein:

the advancing step is carried out with the interlocking structure being a loose, flexible structure which lies loosely against an outer wall of the catheter.

32. The method ofclaim 30, wherein:

the providing step is carried out with the flexible structure including at least one filament.

33. The method ofclaim 30, wherein:

the providing step is carried out with the filament forming at least one closed loop.

34. The method ofclaim 33, wherein:

the providing step is carried out with the interlocking structure including at least four closed loops.

35. The method ofclaim 33, wherein:

the providing step is carried out with a plurality of closed loops having different sizes.

36. The method ofclaim 32, wherein:

the providing step is carried out with the filament having at least one radiopaque material attached thereto.

37. The method ofclaim 36, wherein:

the providing step is carried out with the radiopaque material being formed as discrete beads, tubes or coils on the filament.

38. The method ofclaim 29, wherein:

the moving step is carried out by moving the element proximally into engagement with the obstruction after the withdrawing step.

39. The method ofclaim 29, wherein:

the providing step is carried out with the obstruction engaging element being naturally biased to an expanded position.

40. The method ofclaim 39, wherein:

the providing step is carried out with the obstruction engaging element extending through a lumen in the catheter.

41. The method ofclaim 40, wherein:

the moving step is carried out by permitting the obstruction engaging element to expand.

42. The method ofclaim 40, wherein:

the moving step is carried out by rotating the obstruction engaging element so that the element becomes entangled with the interlocking structure.

43. The method ofclaim 29, further comprising the step of:

exposing part of the obstruction engaging element before completing the withdrawing step.

44. The method ofclaim 43, wherein:

the exposing step is carried out before beginning the withdrawing step.

45. The method ofclaim 29, wherein:

the providing step is carried out with the interlocking structure being a tube of material.

46. The method ofclaim 45, wherein:

the providing step is carried out with the tube having a plurality of slots therein.

47. The method ofclaim 46, wherein:

the moving step is carried out with the element extending into the slots in the tube.

48-80 (canceled)

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