US20110106235A1 - Method and apparatus for deployment of an endoluminal device - Google Patents

Abstract

An introducer deploys an endoluminal device in a distal location from a proximal location. The introducer comprises a retrograde portion, an anterograde portion axially moveable relative to the retrograde portion, a shaft having a distal tip and an anterograde sheath attached to the distal tip, and anchoring means in at least one of the retrograde portion or the anterograde portion for anchoring the device during deployment from its proximal end to its distal end. An inner sheath may be mounted concentrically over the shaft with the endoluminal device mounted concentrically over the inner sheath. The anchoring device may comprise an inflatable balloon mounted radially inside the retrograde portion, a tether, or an extended portion of the endoluminal device confined by a notch in the interface of two sheaths in the retrograde portion of the introducer, or may comprise a holder in the anterograde portion.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of U.S. patent application Ser. No. 11/363,015, filed Feb. 27, 2006, which is a divisional of U.S. application Ser. No. 10/081,641, filed Feb. 22, 2002, the entire contents of which are incorporated herein by reference.
TECHNICAL FIELD
• This invention relates generally to endoluminal devices and, more specifically, to methods and apparatus for deploying endoluminal devices in body lumens.
BACKGROUND OF THE INVENTION
• A stent is an elongated device used to support an intraluminal wall. In the case of a stenosis, a stent provides an unobstructed conduit through a body lumen in the area of the stenosis. Such a stent may also have a prosthetic graft layer of fabric or covering lining the inside and/or outside thereof. Such a covered stent is commonly referred to in the art as an intraluminal prosthesis, an endoluminal or endovascular graft (EVG), or a stent-graft. A stent-graft may be used, for example, to treat a vascular aneurysm by removing the pressure on a weakened part of an artery so as to reduce the risk of rupture. Other devices, such as filters, particularly vena cava filters, may have similar structures to stents and may be placed in a body lumen by similar methods. As used herein, the term “endoluminal device” refers to covered and uncovered stents, filters, and any other device that may be placed in a lumen. The term “stent” as used herein is a shorthand reference referring to a covered or uncovered stent.
• Typically, an endoluminal device, such as a stent-graft deployed in a blood vessel at the site of a stenosis or aneurysm, is implanted endoluminally, i.e. by so-called “minimally invasive techniques” in which the device, restrained in a radially compressed configuration by a sheath or catheter, is delivered by a delivery system or “introducer” to the site where it is required. The introducer may enter the body from an access location outside the body, such as through the patient's skin, or by a “cut down” technique in which the entry blood vessel is exposed by minor surgical means. The term “proximal” as used herein refers to portions of the stent or delivery system relatively closer to this access location, whereas the term “distal” is used to refer to portions farther from the access location.
• When the introducer has been threaded into the body lumen to the stent deployment location, the introducer is manipulated to cause the stent to be ejected from the surrounding sheath or catheter in which it is restrained (or alternatively the surrounding sheath or catheter is retracted from the stent), whereupon the stent expands to a predetermined diameter at the deployment location, and the introducer is withdrawn. Stent expansion may be effected by spring elasticity, balloon expansion, or by the self-expansion of a thermally or stress-induced return of a memory material to a pre-conditioned expanded configuration.
• Referring now to a typical prior art introducer as seen inFIGS. 1A and 1B, there is shown a standardpre-loaded delivery system10 comprising anouter sheath12, a compressedendoluminal device14 loaded therein, and aconventional stabilizer16 loaded adjacent to theproximal end17 of the endoluminal device. A standard deployment technique comprises maneuvering the introducer to a desired deployment location and retractingouter sheath12 so that the endoluminal device is deployed beginning at its distal end and ending at its proximal end.Stabilizer16 stabilizes or prevent retraction ofendoluminal device14 whensheath12 is retracted, thus effecting deployment of the device into a desired location by forcing relative movement between the sheath and the device.
• Delivery system10 also may comprise acatheter tip20 at its distal end attached to aninternal shaft23 that runs through the delivery system throughinner lumen22 instabilizer16, as shown inFIG. 1A. Astabilizer handle26 is typically located at the proximal end ofstabilizer16, outside the body lumen.Internal shaft23 may guide the delivery system through the body lumen over a guidewire (not shown) to the area to be repaired, or may be adapted for inflating a balloon (if applicable), and/or for flushing the system.
• It is often important during endoluminal device delivery to ensure accurate placement of the device termini, particularly in intravascular deployment of multipart stents. Improper stent placement can prevent successful medical treatment. There is a particular need in the art to anchor the proximal end of a self-expanding stent while deploying the distal end, and also to provide accurate deployment of self-expanding stents in a way that prevents recoil of the endoluminal device upon release, which may adversely affect the accuracy of the device placement. Balloons are commonly used to anchor endoluminal devices during deployment, but the pressure of a balloon against a vessel wall may damage tissue, particularly if the vessel wall is already diseased. Thus, it is further desirable to anchor the proximal end of an endoluminal device while deploying the distal end without applying unnecessary force against the vessel wall.
• In a procedure to repair an abdominal aortic aneurysm (AAA), use of a modular self-expanding stent involves accurate placement of a terminus of a first stent component in the abdominal aorta just below the renal arteries. A second stent component is then deployed in the first stent component and permitted to extend to a terminus in one of the iliac arteries. It is difficult, however, to ensure accurate placement of the iliac terminus of the second stent component. If the terminus is not placed far enough into the iliac, then the stent may be ineffective. If the terminus extends too far, it may interfere with blood flow in arteries branching from the iliac, such as the internal iliac artery. This problem also occurs in the deployment of multipart stents in other branched arteries. Thus, it is desirable to provide a way to ensure accurate deployment of all the termini of a multipart stent.
SUMMARY OF THE INVENTION
• In accordance with this invention, there is provided an introducer having a retrograde portion and an anterograde portion for deployment of an endoluminal device in a distal location from a proximal location. The introducer comprises, in a most basic embodiment, a shaft having a distal tip; an inner sheath mounted concentrically over the shaft with the endoluminal device mounted concentrically over the inner sheath; and an anterograde sheath attached proximally to the distal tip, mounted over the endoluminal device in the anterograde portion of the introducer, and axially moveable relative to the inner sheath by moving the shaft. The introducer may further comprise anchoring means in at least one of the retrograde portion or the anterograde portion for anchoring the endoluminal device during deployment of the device from its proximal end to its distal end.
• In one embodiment, the anchoring means comprises an inflatable balloon in the retrograde portion. A proximally retractable retrograde sheath may be mounted concentrically over the shaft and inner sheath and may extend axially over the proximal end of the endoluminal device and the balloon. A medial sheath may be mounted concentrically between the inner sheath and the retrograde sheath in the retrograde portion of the introducer proximal the balloon.
• In another embodiment, the anchoring means comprises a holder in the anterograde portion. The holder may be concentrically mounted to the inner sheath and adapted to prevent distal movement of the endoluminal device during advancement of the anterograde shaft. The anterograde sheath may extend over an entire length of the endoluminal device.
• In another embodiment, the introducer comprises the proximally retractable retrograde sheath and the medial sheath, wherein the anchoring means comprises an extended portion of a proximal end of the endoluminal device and a notch in one or both of the medial sheath and the retrograde sheath for releasably confining the extended portion between the retrograde sheath and the medial sheath with the retrograde sheath in a first position and for releasing the extended portion with the retrograde sheath in a second, retracted position relative to the medial sheath.
• In yet another embodiment, the anchoring means comprises a tether attached to a proximal end of the endoluminal device. In an embodiment comprising the proximally retractable retrograde sheath and the medial sheath, the tether may be attached to one of the medial sheath, the retrograde sheath, or the inner sheath. In another embodiment, the tether may extend proximally from the device a sufficient distance to terminate outside a body lumen through which the introducer is adapted to be introduced. In such an embodiment, the medial sheath may comprise a lateral channel through which the tether extends.
• Still another embodiment of the present invention comprises an introducer having a retrograde portion and an anterograde portion and comprising an inflatable balloon mounted radially inside the retrograde portion for anchoring the endoluminal device during deployment of the device from its proximal end to its distal end. The anterograde portion comprises a distal tip and an anterograde sheath attached proximally to the distal tip. A shaft attached to the distal tip and extending concentrically through a central lumen defined by the anterograde portion and retrograde portion is adapted for moving the anterograde portion relative to the retrograde portion. The endoluminal device is mounted concentrically over the shaft in the central lumen and has a distal end contained by the anterograde portion and a proximal end contained by the retrograde portion. The introducer may further comprise an inner sheath mounted concentrically over the shaft underneath the endoluminal device, the inner sheath defining a lumen connected to an inner region of the inflatable balloon for communication of a fluid to the balloon for inflation of the balloon. The retrograde portion comprises a proximally retractable retrograde sheath mounted concentrically over the shaft and inner sheath and extending distally over the balloon and a retrograde portion of the endoluminal device.
• The invention also comprises a method for deployment of an endoluminal device in a distal location in a body lumen from a proximal location. The method comprises the steps of inserting an introducer of the present invention into a body lumen, aligning the introducer in a deployment location, extending the shaft to distally advance the anterograde sheath to deploy at least the anterograde portion of the endoluminal device, and then removing the introducer from the body lumen. Where the introducer comprises anchoring means in the anterograde portion, the method comprises aligning the proximal end of the device with the deployment location, and confining the endoluminal device between the anchoring means and the advancing anterograde sheath during advancement of the anterograde sheath. Where the anchoring means are in the retrograde portion, the method comprises anchoring the proximal end during advancement of the anterograde sheath and releasing the proximal end prior to or concurrently with removal of the introducer from the lumen.
• Where the anchoring means comprises an inflatable balloon, the method comprises inflating the balloon prior to deployment of the anterograde portion of the endoluminal device and deflating the balloon after deployment of the anterograde portion. Where a retrograde sheath is present, the retrograde sheath may be retracted prior to inflating the balloon, such that the balloon is inflated to anchor the proximal end of the endoluminal device against the body lumen. In the alternative, the balloon may be inflated to anchor the proximal end of the endoluminal device against the retrograde sheath, in which case the retrograde sheath is not retracted until after deflating the balloon after the anterograde portion of the endoluminal device has been deployed.
• Where the anchoring means comprises a tether, the method comprises separating the tether from the endoluminal device prior to or during removal of the introducer from the body. Where the anchoring means comprises an extended portion of the endoluminal device releasably confined in a notch between the retrograde sheath and the medial sheath or between the retrograde sheath and the inner sheath, the method comprises retracting the retrograde sheath sufficient to release the extended portion from the notch after deployment of the anterograde portion of the endoluminal device.
• For the embodiment wherein the retrograde portion comprises an inflatable balloon mounted inside the retrograde portion, an exemplary method comprises aligning the introducer in a deployment location, retracting at least part of the retrograde portion and deploying the proximal end of the endoluminal device. The balloon is then inflated to compress the endoluminal device against the lumen wall while the shaft is extended to distally advance the anterograde sheath to deploy a remaining portion of the endoluminal device.
• It is to be understood that both the foregoing general description and the following detailed description are exemplary, but not restrictive, of the invention.
BRIEF DESCRIPTION OF THE DRAWINGS
• The invention is best understood from the following detailed description when read in connection with the accompanying drawing, in which:
• FIG. 1A shows a longitudinal section of a standard introducer of the prior art;
• FIG. 1B shows a detailed longitudinal section of the encircled portion ofFIG. 1A;
• FIG. 2 shows a longitudinal section of an exemplary introducer of the present invention;
• FIG. 3 shows a flowchart depicting an exemplary method of the invention;
• FIG. 4A shows a longitudinal section of a portion of an exemplary introducer of the present invention having an extended cell and notch anchoring arrangement and a medial sheath;
• FIG. 4B shows a longitudinal section of a portion of another exemplary introducer of the present invention having an extended cell and notch anchoring arrangement with no medial sheath;
• FIG. 5A shows a longitudinal section of a portion of an exemplary introducer of the present invention having a tether attached to the retrograde sheath for anchoring the proximal end of the endoluminal device;
• FIG. 5B shows a cross section of a portion of another embodiment of an exemplary introducer of the present invention having a channel in the medial sheath for the tether;
• FIG. 5C shows a longitudinal section of a portion of another exemplary introducer embodiment of the present invention having a tether attached to the inner sheath for anchoring the proximal end of the endoluminal device;
• FIG. 6 shows a longitudinal section of another exemplary introducer of the present invention having a holder at the distal end of the endoluminal device; and
• FIG. 7 shows a portion of a longitudinal section of another exemplary introducer of the present invention in which the balloon is contained within the retrograde portion.
DETAILED DESCRIPTION OF THE INVENTION
• The invention will next be illustrated with reference to the figures wherein the same numbers indicate similar elements in all figures. Such figures are intended to be illustrative rather than limiting and are included herewith to facilitate the explanation of the apparatus of the present invention.
• Referring now toFIG. 2 there is shown an exemplary introducer embodiment of the present invention.Introducer100 comprises aretrograde portion102 and ananterograde portion104.Shaft106 may be solid or tubular, and is surrounded by three concentrically positioned sheaths:inner sheath108,medial sheath110, andretrograde sheath112.Medial sheath110 preferably has a fixed position and operates as a radial spacer, separating retrograde sheathdistal extension114 from inner sheathdistal extension116. Thedistal extension114 ofretrograde sheath112 anddistal extension116 ofinner sheath108 comprise the respective portions of those sheaths located distally of thedistal end111 ofmedial sheath110.
• Other types of spacers may also be used. For example, radial protrusions on inner sheath or retrograde sheath may provide such spacing. Furthermore, inner sheath may have a stepped outside diameter or retrograde sheath may have a stepped inside diameter, such as created by medial sheath being fused to either inner sheath or retrograde sheath, or by any other method that creates an equivalent structure.
• Radial space118 betweenretrograde sheath112 andinner sheath108 may be sufficiently large to allow room for a radial-force-exerting device, such asballoon120.Inner sheath108 preferably has a fixed position and may include a lumen for communicating pressurized fluid to balloon120. Although shown inFIG. 2 withballoon120 andproximal end131 ofdevice130 as part ofretrograde portion102 covered byretrograde sheath112, in an alternative embodiment shown inFIG. 7,balloon120 andproximal end131 ofdevice130 may be part ofanterograde portion104 and covered byanterograde sheath126.
• Anterograde portion104 ofintroducer100 includes adistal extension122 ofshaft106 anddistal extension116 ofinner sheath108.Distal extension122 ofshaft106 terminates with an attachment toradial spacer125 connected todistal tip124.Distal tip124 is coupled toanterograde sheath126, which extends proximally fromdistal tip124, and is positioned concentrically about shaftdistal extension122 and inner sheathdistal extension116.Radial spacer125 creates anarea128 into which anendoluminal device130, such as a stent graft, can be loaded.
• Retrograde sheath112 andanterograde sheath126 may have alateral space132 therebetween, the sheaths may abut one another (not shown) without anyspace132, or the sheaths may laterally overlap one another as depicted by dashedlines140 inFIG. 2. Dashedlines140 show a proximal extension ofanterograde sheath126 that overlapsretrograde sheath112. In an alternative embodiment, a similar distal extension (not shown) ofretrograde sheath112 may laterally overlapanterograde sheath126.
• An exemplary method for usingintroducer100 is depicted in the flowchart shown inFIG. 3. The method may be performed, for example, in an operating room or an angiographic suite, preferably under fluoroscopic guidance as is known in the art. First, the introducer is inserted into a body lumen, as indicated instep210,distal tip124 first, from a proximal access site, such as a femoral artery or iliac artery, for vascular deployment. Typically, the introducer is threaded into the lumen over a guidewire (not shown) as is well known in the art. The access site may be surgically exposed and punctured with, for example, an 18-gauge needle as is known in the art.
• Next, instep220, theproximal end131 ofendoluminal device130 is aligned in an appropriate deployment position. Fluoroscopic guidance and/or a guide wire may be used to guideproximal end131 into the desired position. For example, whereendoluminal device130 is an AAA stent graft,proximal end131 ofdevice130 is positioned in the iliac (not shown), preferably just above a branch of the internal iliac artery (not shown).
• Then, instep230,retrograde sheath112 is retracted at least far enough to exposeproximal end131 ofdevice130 andballoon120. In an alternative embodiment wherein theproximal end131 andballoon120 are located underanterograde sheath126, theanterograde sheath126 is initially advanced far enough to expose the proximal end and balloon.Balloon120 is inflated instep240, such as by pressurizingballoon120 with fluid communicated via a lumen ininner sheath108, to exert radial force that compresses theretrograde portion133 ofdevice130 against the lumen wall (not shown). Although the various lumens are shown concentrically, other configurations, including side-by-side lumen can be used. Such other configurations are described in an application titled “APPARATUS AND METHOD FOR DEPLOYMENT OF AN ENDOLUMINAL DEVICE,” by Johnson et al., Ratner & Prestia docket number BSI-498US, filed the same day as this application and assigned to the common assignee of this application, incorporated herein by reference. Instep250,shaft106 is extended distally to deploy theanterograde portion135 ofdevice130. Prior to extending the shaft, the guidewire andretrograde sheath112 may typically be locked together to prevent movement of the retrograde sheath or the guidewire during extension of the shaft. As used herein, the “retrograde portion” ofdevice130 refers to any portion initially covered by the retrograde sheath (as shown inFIG. 2) or any portion underlied byballoon120 and any portion proximal thereof (as shown inFIG. 7), and the “anterograde portion” refers to the remainder of the device distal of the retrograde portion.Balloon120 is then deflated instep260 andintroducer100 is removed from the lumen in accordance withstep270. If desired, prior to removal from the lumen,balloon120 may be used formodeling device130 to better conform to the contours of the lumen wall, as is known in the art. Thus,introducer100 and the method depicted inFIG. 3 provides means for accurately placing the proximal end of an endoluminal device.
• In an alternative method, step240 of inflatingballoon120 may be carried out prior to step230 of retractingretrograde sheath112, so that the balloon exerts radial force compressingretrograde portion133 ofdevice130 into the retrograde sheath. Then, afterstep250 of extendingshaft106 to deployanterograde portion135 ofdevice130,balloon120 is deflated instep260 andretrograde sheath106 is retracted instep230 to complete deployment of the retrograde portion of the device. Finally, the introducer is removed instep270. Thus, in a first method, the steps are performed in numerical order as shown inFIG. 3, and in a second method, the steps are performed in the step order210-220-240-250-260-230-270. The second method has the advantage that the balloon does not press against the lumen wall, but instead presses against the retrograde sheath, thus avoiding exertion of stress on the lumen wall. This second method is particularly desirable in the case of diseased lumen walls, which could be damaged due to the force of the balloon. This method, however, may sacrifice a few millimeters of accuracy due to recoil of thedevice130. Consequently, the second method may be more desirable for applications in which the small sacrifice in accuracy is medically acceptable.
• As an alternative to balloon120, other means for holdingproximal end131 ofdevice130 may be employed. For example, as shown inFIG. 4A, anotch150 may be located inmedial sheath110a. A proximally extendedportion131aofdevice130a, such as an extended cell or a loop, is fixed withinnotch150. In the method shown inFIG. 3, theretrograde sheath112 is only retracted instep230 until theproximal end131 ofstent130 deploys, except for proximally extendedportion131a. A radiopaque deployment marker (not shown) may be used to mark theend131 so that the retrograde sheath is not retracted too far.Steps240 and260 are omitted from the method steps, as proximally extendedportion131aremains compressed innotch150 betweenmedial sheath110aandretrograde sheath112 to hold theproximal end131 ofdevice130 in place until the distal portion of the stent has been deployed. Then, prior to removing deployment device instep270,retrograde sheath112 is retracted the remaining distance necessary to release proximally extendedportion131afromnotch150.
• In yet another alternate embodiment, shown inFIG. 5A, atether152 may be used for anchoring.Distal end153 oftether152 is attached toproximal end131 ofdevice130 andproximal end154 of the tether may be attached to the distal end of either retrograde sheath112 (as shown inFIG. 5A) or medial sheath110 (not shown), or to an intermediate portion of inner sheath108 (shown inFIG. 5C). Tether152 may be attached todevice130 andsheath112 or110 in any way known in the art, such as by gluing, suturing, stapling, welding, heat shrinking, and the like. The tether may comprise any type of material known in the art, including metal or non-metal filaments. Preferably, the tether is attached to the device in such a way that it is readily detachable from the device when desired. Suitable mechanism for detachably connecting a wire to an implantable device are described in U.S. Pat. No. 5,354,295 and U.S. Pat. No. 5,122,136 to Guglielmi et al., as well as in U.S. patent application Ser. No. 09/852,524, filed on May 10, 2001, by Chris Elliott on behalf of the assignee of this invention, all of which are incorporated herein by reference.
• Although shown inFIG. 5A attached to the distal end ofretrograde sheath112,tether152 may be employed in any way known in the art, including extending proximally all the way back to the access location outside the body lumen. For example, as shown in the cross-sectional illustration ofFIG. 5B,medial sheath110amay have a lateral channel running its entire length into whichtether152 may extend. Thus,tether152 may connect to a power supply or a handle for exerting tensional or torsional force, as described in the '524 application.
• For tethered embodiments, the method is carried out as shown inFIG. 3 up to step230, at which point theretrograde sheath112 is retracted untilproximal end131 of thedevice130 deploys, withtether152 holdingproximal end131 in place. The guidewire is then typically locked withretrograde sheath112 to prevent further movement of theretrograde sheath112, andanterograde sheath126 is advanced by advancingshaft106 to deploy the anterograde portion ofdevice130. Then, the remainder ofretrograde sheath112 is retracted as part ofstep270 to releasedevice130 fromtether152. Ifproximal end154 oftether152 is attached tomedial sheath110 instead ofretrograde sheath112, the medial sheath may be retracted, or if the medial sheath is not retractable, the entire introducer may be retracted to releasedevice130 fromtether152 instep270.
• Anotherintroducer embodiment600 is shown inFIG. 6. In this embodiment, all of the components are essentially the same as inembodiment100, except that instead of a combination ofballoon120 andretrograde sheath112 at the proximal end, there is aholder602 near the distal end ofinner sheath extension116. Anterograde sheath126 (and thusanterograde portion104 of introducer600) extends to theproximal end131 ofdevice130.Holder602 may comprise any material known in the art and may have any geometry known in the art sufficient to holddevice130 in place while anterograde sheath is advanced. A number of geometries and materials useful for holding a stent in place from inside the stent are described in U.S. application Ser. No. 09/574,418 by Sullivan et al., filed on May 19, 2000, assigned to the assignee of this invention, and incorporated herein by reference. For example,holder602 may be a sleeve of a relatively higher friction material thansheath126 such thatdevice130 is frictionally retained whilesheath126 advances. In another embodiment,holder602 may comprise one or more radial protrusions that exerts an axial restraining force against individual members ofdevice130. Other structures or combinations of multiple structures may also be used as holders.
• Aholder602 at or near the distal end ofdevice130 as shown inFIG. 6 may be beneficial for combination with a balloon at or near the proximal end of the device as shown inFIG. 7. Such aholder602 may minimize potential distal advancement ofproximal end131 ofdevice130 during the initial advancement ofsheath126 to exposeballoon120, as may otherwise potentially occur as a result of frictional contact between the anterograde sheath and the device. In the embodiment shown inFIG. 7,balloon120 may also be provided with a greater frictional engagement force thansheath126 so thatdevice130 tends to stay with the balloon rather than move with the sheath. Such a greater frictional engagement force may be the result of a higher coefficient of friction, for example.
• Thus, the method of usingintroducer600, referring back toFIG. 3, involvessteps210,220,250, and270, without any of the steps relating to the balloon or the retrograde shaft. In fact, the embodiment shown inFIG. 6 may comprise a minimal set ofcomponents comprising shaft106,inner sheath108,holder602 mounted directly to theinner sheath108, and tip124 attached toanterograde sheath126. The remaining components shown inFIG. 6 are optional.
• Holder602 is not limited to restraining only the distal end ofdevice130. For example,holder602 may extend the length ofdevice130, an embodiment that may be particularly useful with devices having a relatively low column strength. A hybrid ofintroducers100 and600 may also be provided comprising both aholder602 and aballoon120 or other anchoring means atproximal end131 ofdevice130, withanterograde sheath126 extending over the proximal end of the device. In such a configuration comprising a balloon, the deployment method follows the method steps in the order shown inFIG. 3, except that instep230 instead of retractingretrograde sheath112, the method comprises advancing anterograde sheath a sufficient distance to uncoverballoon120, and then inflating the balloon atstep240 and continuing on with the remainder of the method steps. Asballoon120, once inflated, is capable of anchoringdevice130,holder602 may be located closer toproximal end131 of the device so that it engages the device only during the initial advancement ofanterograde sheath126 prior to inflation of the balloon.
• Tethered or extended-portion-and-notch embodiments may also be provided withanterograde sheath126 extending to the proximal end ofendoluminal device130. In an extended-portion-and-notch embodiment shown inFIG. 4B, there may be no medial sheath, such thatretrograde sheath112adirectly contactsinner sheath108a, and thenotch150 may be ininner sheath108a,retrograde sheath112a, or may comprisenotch portions150aand150bin each, respectively, as shown inFIG. 4B. The medial sheath may optionally be present, such as to preserve a constant radial profile throughout the introducer, in which case the notch or a portion of the notch may be located in one or both of the retrograde sheath and the medial sheath. The method of using such an embodiment comprises inserting the device instep210, aligning the proximal end instep220, extending the shaft to deploy thedevice250, and then retracting the retrograde sheath in step230 a sufficient distance to release the extended portion from the notch.
• In a tethered embodiment withanterograde sheath126 extending to the proximal end ofendoluminal device130, as shown inFIG. 5C there may be no medial sheath or retrograde sheath, andtether152 may just be attached to an intermediate portion ofinner sheath108 as shown inFIG. 5C, or may extend freely (not shown) through the lumen back through the access location and outside the lumen to some means for manipulating the tether, such as the means shown and described in '524 application. As shown inFIG. 5C,tether152 is wrapped aboutinner sheath108 in a manner than fixes it axially and may be further anchored in place with an adhesive.Notch155 in tether provides a predetermined weak spot so that the retraction of the introducer is sufficient to break the tether at the notch. It is important that the amount of force required to breaktether152 at a preferred location, such asnotch155, is less than the amount of force that will break the tether in other locations or remove the affixation of the tether to inner sheath, more than the amount of force necessary to holdproximal end131 ofendoluminal device130 in place during deployment of its distal end (so that it does not break prematurely), and less than the amount of force that will axially movedevice130 once deployed in the lumen (so that breaking the tether does not take the deployed device out of its proper alignment). The tether may also be affixed in a slipknot that requires an amount of force to undo the knot that does not break the tether, pull the deployed device out of alignment, or undo prematurely.
• One concern of the reverse deployment method and introducers described herein is that if the anterograde portion is too long, it may enter the heart during deployment of an AAA stent graft. Other, non-AAA applications may have similar concerns with surrounding organs or other body structure. Thus, the dimensions of the introducer may be optimized to prevent damage caused by the anterograde portion being too long. One way of shortening the anterograde portion for a particular application is to lengthen the retrograde portion. Thus, although shown inFIGS. 2 and 6 with anterograde portion extending over the majority of the length ofdevice130, in other embodiments the anterograde portion and retrograde portions may extend over equal lengths of the device, or portion of the device over which the retrograde portion extends may be longer than the portion over which the anterograde portion extends. Such embodiments, for example an introducer wherein the retrograde and anterograde portions extend over equal lengths of the device, may be useful where the location of the proximal end of the device is less important than aligning the middle of the device with a certain region of a lumen.
• Although illustrated and described herein with reference to certain specific embodiments, the present invention is nevertheless not intended to be limited to the details shown. Rather, various modifications may be made in the details within the scope and range of equivalents of the claims and without departing from the spirit of the invention.

Claims (20)

1. A method for deployment of an endoluminal device in a distal location in a body lumen from a proximal location, the method comprising the steps of:

inserting an introducer into the body lumen, the introducer comprising a retrograde portion; an anterograde portion; a shaft having a distal tip; an inner sheath mounted concentrically over the shaft with the endoluminal device mounted concentrically over the inner sheath; and an anterograde sheath proximally attached to the shaft distal tip, mounted over the endoluminal device in the anterograde portion of the introducer, and axially moveable relative to the inner sheath;

aligning the introducer in a deployment location;

extending the shaft to distally advance the anterograde sheath to deploy at least a proximal portion of the endoluminal device; and

removing the introducer from the body lumen.

2. The method ofclaim 1, wherein the introducer further comprises anchoring means in the anterograde portion for anchoring the endoluminal device during deployment of the device from a proximal end to a distal end of the device, the method comprising aligning the proximal end of the device with the deployment location and confining the endoluminal device between the anchoring means and the advancing anterograde sheath.

3. The method ofclaim 1, wherein the introducer further comprises anchoring means in the retrograde portion for anchoring the endoluminal device during deployment of the device from a proximal end to a distal end of the device, the method comprising aligning the proximal end of the device with the deployment location, anchoring the proximal end, and releasing proximal end prior to or concurrently with removing the introducer from the body lumen.

4. The method ofclaim 3, wherein the anchoring means comprises an inflatable balloon, and the method further comprises inflating the balloon prior to extending the shaft to distally advance the anterograde sheath and deflating the balloon after extending the shaft to distally advance the anterograde sheath.

5. The method ofclaim 4, further comprising a proximally retractable retrograde sheath mounted concentrically over the shaft and inner sheath and extending axially over the proximal end of the endoluminal device and the balloon, the method further comprising retracting the retrograde sheath prior to inflating the balloon, and inflating the balloon to anchor the proximal end of the endoluminal device against the body lumen.

6. The method ofclaim 4, further comprising a proximally retractable retrograde sheath mounted concentrically over the shaft and inner sheath and extending axially over the proximal end of the endoluminal device and the balloon, the method further comprising inflating the balloon to anchor the proximal end of the endoluminal device against the retrograde sheath and then retracting the retrograde sheath after deflating the balloon.

7. The method ofclaim 3, wherein the anchoring means comprises a tether releasably attached to the proximal end of the endoluminal device, the method comprising separating the tether from the endoluminal device prior to removing the introducer from the body lumen.

8. The method ofclaim 7, wherein the introducer further comprises a proximally retractable retrograde sheath mounted concentrically over the shaft and inner sheath; a medial sheath mounted concentrically between the inner sheath and the retrograde sheath in the retrograde portion of the introducer and terminating proximally of the proximal end of the endoluminal device; and the anchoring means comprises a tether releasably attached to the proximal end of the endoluminal device and non-releasably attached to a distal end of the retrograde sheath, the method comprising retracting the retrograde sheath to separate the tether from the endoluminal device prior to removing the introducer from the body lumen.

9. The method ofclaim 8, wherein a portion of the retrograde sheath extends over a portion of the endoluminal device, the method comprising retracting the portion of the retrograde sheath extending over the endoluminal device prior to extending the shaft to distally advance the anterograde sheath.

10. The method ofclaim 7, wherein the introducer further comprises a proximally retractable retrograde sheath mounted concentrically over the shaft and inner sheath and the anchoring means comprises a tether releasably attached to the proximal end of the endoluminal device and non-releasably attached the inner sheath, the method comprising separating the tether from the endoluminal device while removing the introducer from the body lumen.

11. The method ofclaim 3, wherein the introducer further comprises a proximally retractable retrograde sheath mounted concentrically over the shaft and inner sheath; a medial sheath mounted concentrically between the inner sheath and the retrograde sheath in the retrograde portion of the introducer and terminating proximally of the proximal end of the endoluminal device; and the anchoring means comprises a proximally extended portion of the endoluminal device and a notch in one or both of the medial sheath and the retrograde sheath, the method further comprising releasably confining the extended portion between the retrograde sheath and the medial sheath until after extending the shaft to distally advance the anterograde sheath, and then retracting the retrograde sheath relative to the medial sheath a distance sufficient to release the extended portion from the notch.

12. The method ofclaim 11, wherein the retrograde sheath extends over a retrograde portion of the endoluminal device, the method comprising retracting the portion of the retrograde sheath extending over the endoluminal device prior to extending the shaft to distally advance the anterograde sheath.

13. The method ofclaim 3, wherein the introducer further comprises a proximally retractable retrograde sheath mounted concentrically over the shaft and inner sheath and the anchoring means comprises a proximally extended portion of the endoluminal device and a notch in one or both of the inner sheath and the retrograde sheath, the method further comprising releasably confining the extended portion between the retrograde sheath and the inner sheath until after extending the shaft to distally advance the anterograde sheath, and then retracting the retrograde sheath relative to the inner sheath sufficient to release the extended portion from the notch.

14. A method for deployment of an endoluminal device in a distal location in a body lumen from a proximal location, the method comprising the steps of:

inserting an introducer into the body lumen having a lumen wall, the introducer comprising a retrograde portion, an anterograde portion comprising a distal tip and an anterograde sheath attached proximally to the distal tip, a shaft attached to the distal tip and extending concentrically through a central lumen defined by the anterograde portion and retrograde portion, an endoluminal device mounted concentrically over the shaft in the central lumen and having a distal end contained by the anterograde portion and a proximal end contained by the retrograde portion, an inflatable balloon mounted inside the retrograde portion for anchoring the endoluminal device during deployment of the device, and a proximally retractable retrograde sheath extending distally over the balloon and the proximal end of the endoluminal device;

aligning the proximal end of the endoluminal device in a deployment location;

inflating the balloon to anchor the proximal end of the endoluminal device; and

extending the shaft to distally advance the anterograde sheath to deploy a portion of the endoluminal device.

15. The method ofclaim 14, further comprising a proximally retractable retrograde sheath mounted concentrically over the shaft and inner sheath and extending axially over the proximal end of the endoluminal device and the balloon, the method further comprising retracting the retrograde sheath prior to inflating the balloon, and inflating the balloon to anchor the proximal end of the endoluminal device against the body lumen.

16. The method ofclaim 14, further comprising a proximally retractable retrograde sheath mounted concentrically over the shaft and inner sheath and extending axially over the proximal end of the endoluminal device and the balloon, the method further comprising inflating the balloon to anchor the proximal end of the endoluminal device against the retrograde sheath and then retracting the retrograde sheath after deflating the balloon.

17. A method for deployment of an endoluminal device in a distal location in a body lumen from a proximal location, the method comprising the steps of:

inserting an introducer into the body lumen, the introducer comprising a retrograde portion; an anterograde portion; a shaft having a distal tip; an inner sheath mounted concentrically over the shaft with the endoluminal device mounted concentrically over the inner sheath; and an anterograde sheath proximally attached to the shaft distal tip, mounted over the endoluminal device in the anterograde portion of the introducer, and axially moveable relative to the inner sheath; and a tether releasably attached to the proximal end of the endoluminal device for anchoring the endoluminal device during deployment of the device;

aligning the proximal end of the device with the deployment location;

anchoring the proximal end of the endoluminal device with the tether;

extending the shaft to distally advance the anterograde sheath to deploy at least a proximal portion of the endoluminal device; and

removing the introducer from the body lumen.

18. The method ofclaim 17, wherein the introducer further comprises a proximally retractable retrograde sheath mounted concentrically over the shaft and inner sheath; a medial sheath mounted concentrically between the inner sheath and the retrograde sheath in the retrograde portion of the introducer and terminating proximally of the proximal end of the endoluminal device; and the tether releasably attached to the proximal end of the endoluminal device and non-releasably attached to a distal end of the retrograde sheath, the method comprising retracting the retrograde sheath to separate the tether from the endoluminal device prior to removing the introducer from the body lumen.

19. The method ofclaim 18, wherein a portion of the retrograde sheath extends over a portion of the endoluminal device, the method comprising retracting the portion of the retrograde sheath extending over the endoluminal device prior to extending the shaft to distally advance the anterograde sheath.

20. The method ofclaim 17, wherein the introducer further comprises a proximally retractable retrograde sheath mounted concentrically over the shaft and inner sheath and the tether releasably attached to the proximal end of the endoluminal device and non-releasably attached the inner sheath, the method comprising separating the tether from the endoluminal device while removing the introducer from the body lumen.

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